Operational Research Priorities Febrile Morbidities
Dr. Elizabeth Juma Kenya Medical Research Institute
Febrile Morbidities The p popular p mantra “Common things occur more commonly” “Everyy fever f is malaria….” “Until proved otherwise – by testing, or death – when in doubt, treat for malaria”
Febrile Morbidities The NMCP Mantra “Not all fevers are malaria – even in malaria endemic areas look for and rule out other causes of fever” “If you suspect malaria, test, iff p positive treat with an ACT, if negative, do not treat with an ACT”
Malaria and Fever Prevalence Malaria Prevalence
Fever Prevalence (CU5) ( ) • Lake – 41% • Coast – 30% • Arid Seasonal – 21% • Highland Seasonal – 24% • Low risk – 26%
Hospital admissions and Malaria 3000
0.70 0.60 0.50
2000 0.40 1500 0.30 1000
0.20
500 0
Homabay
3500
0.9
2500
0.6
2000
0.5
1500
0.4 0.3
1000
0.00
0
0.4 0.3 02 0.2
400
Paediatric Admissions
1200
600
0
0.0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
0.4 1000
0.3
500 0.1 0
0.0
0.0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Malindi
4500
0.5
4000
0.5
3500
0.4 0.4
3000
0.3
2500
0.3 2000
0.2
1500
2500
0.5 0.5
2000
0.4 0.4 0.3
1500
0.3 0.2
1000
0.2
1000
0.1
500
0.1
0
0.0
0.1
200
0.5
1500
0.1
Kilifi 0.5
800
0.6
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
0.6
1000
2000
0.2
0.2
0.10
Msambweni 1400
0.7
0.7
500
0.8
0.8
3000
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
1600
2500
Paediatric Admissions
2500
Siaya
Pae ediatric Admissions
0.80
Pae ediatric Admissions
3500
Paediatric Admissions
Pae ediatric Admissions
Busia
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
0.2 500
0.1 0.1
0
0.0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Current Practice (Facility Survey) HFs All without facilities diagnostics
HFs with HF ith diagnostics Children < 5 years Positive N=91 (%)
Negative N=99 (%)
No Test N=377 (%)
All children N=407 (%)
Total N=974 (%)
85 (94)
46 (46)
251 (67)
298 (72)
680 (70)
No AM prescribed
0
43 (43)
104 (28)
100 (25)
247 (25)
Any AM prescribed
91 (100)
56 (57)
273 (72)
307 (75)
727 (75)
Antibiotic A ibi i prescribed
70 (77)
89 (90)
281 (75)
329 (81)
769 (79)
AL
Febrile Morbidities? • Acute Respiratory Infections – Viral and Bacterial
• Infectious diarrhoea – Viral, Bacterial and Parasitic
• Malaria • Bacterial infections – E.g. typhoid and para typhoid fevers – Leptospirosis (outbreak with fatalities in 2004)
• Viral morbidities – Dengue Fever
• Parasitic diseases (Schisto and Leishmaniasis)
On going Operational Research Funded… • Facility based fever surveillance – fever attributable to malaria in all age g ggroups p • Factors influencing demand, uptake and adherence to parasitological diagnosis and interventions to address challenges • Interventions to improve quality of malaria case management
Operational Research Priorities • Non malarial febrile illness studies – age group and by region – Goal: Influence trainingg curricula,, clinical and CCM guidelines
• Evaluation of simple p point p of care tests for non malarial fevers – if available • What is the impact of HiB, Pnemococcal and Rotavirus vaccinations on aetiology of AFI in young children?
Stakeholders • Ministry of Health Departments – – – – – – –
Malaria Programme Child and Adolescent Health Community Health Services Medicine Pharmacy Diagnostic services Health Information
• Private sector Donors technical support agencies • Donors, • Research and Training Institutions