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Febrile illness management in children under five years of age: a qualitative pilot study on primary health care workers’ practices in Zanzibar

BACKGROUND: In Zanzibar, malaria prevalence dropped substantially in the last decade and presently most febrile patients seen in primary health care facilities (PHCF) test negative for malaria. The availability of rapid diagnostic tests (RDTs) allows rural health workers to reliably rule out malaria...

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Autores principales: Baltzell, Kimberly, Elfving, Kristina, Shakely, Deler, Ali, Abdullah S, Msellem, Mwinyi, Gulati, Shilpa, Mårtensson, Andreas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3626688/
https://www.ncbi.nlm.nih.gov/pubmed/23356837
http://dx.doi.org/10.1186/1475-2875-12-37
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author Baltzell, Kimberly
Elfving, Kristina
Shakely, Deler
Ali, Abdullah S
Msellem, Mwinyi
Gulati, Shilpa
Mårtensson, Andreas
author_facet Baltzell, Kimberly
Elfving, Kristina
Shakely, Deler
Ali, Abdullah S
Msellem, Mwinyi
Gulati, Shilpa
Mårtensson, Andreas
author_sort Baltzell, Kimberly
collection PubMed
description BACKGROUND: In Zanzibar, malaria prevalence dropped substantially in the last decade and presently most febrile patients seen in primary health care facilities (PHCF) test negative for malaria. The availability of rapid diagnostic tests (RDTs) allows rural health workers to reliably rule out malaria in fever patients. However, additional diagnostic tools to identify alternative fever causes are scarce, often leaving RDT-negative patients without a clear diagnosis and management plan. This pilot study aimed to explore health workers’ practices with febrile children and identify factors influencing their diagnostic and management decisions in non-malarial fever patients. METHODS: Semi-structured key informant interviews were conducted with 12 health workers in six PHCFs in North A district, Zanzibar, April to June 2011. Interviews were coded using Atlas.ti to identify emerging themes that play a role in the diagnosis and management of febrile children. RESULTS: The following themes were identified: 1) health workers use caregivers’ history of illness and RDT results for initial diagnostic and management decisions, but suggest caregivers need more education to prevent late presentation and poor health outcomes; 2) there is uncertainty regarding viral versus bacterial illness and health workers feel additional point-of-care diagnostic tests would help with differential diagnoses; 3) stock-outs of medications and limited caregivers’ resources are barriers to delivering good care; 4) training, short courses and participation in research as well as; 5) weather also influences diagnostic decision-making. CONCLUSIONS: This pilot study found that health workers in Zanzibar use caregiver history of fever and results of malaria RDTs to guide management of febrile children. However, since most febrile children test negative for malaria, health workers believe additional training and point-of-care tests would improve their ability to diagnose and manage non-malarial fevers. Educating caregivers on signs and symptoms of febrile illness, as well as the introduction of additional tests to differentiate between viral and bacterial illness, would be important steps to get children to PHCFs earlier and decrease unnecessary antibiotic prescribing without compromising patient safety. More research is needed to expand an understanding of what would improve fever management in other resource-limited settings with decreasing malaria.
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spelling pubmed-36266882013-04-16 Febrile illness management in children under five years of age: a qualitative pilot study on primary health care workers’ practices in Zanzibar Baltzell, Kimberly Elfving, Kristina Shakely, Deler Ali, Abdullah S Msellem, Mwinyi Gulati, Shilpa Mårtensson, Andreas Malar J Research BACKGROUND: In Zanzibar, malaria prevalence dropped substantially in the last decade and presently most febrile patients seen in primary health care facilities (PHCF) test negative for malaria. The availability of rapid diagnostic tests (RDTs) allows rural health workers to reliably rule out malaria in fever patients. However, additional diagnostic tools to identify alternative fever causes are scarce, often leaving RDT-negative patients without a clear diagnosis and management plan. This pilot study aimed to explore health workers’ practices with febrile children and identify factors influencing their diagnostic and management decisions in non-malarial fever patients. METHODS: Semi-structured key informant interviews were conducted with 12 health workers in six PHCFs in North A district, Zanzibar, April to June 2011. Interviews were coded using Atlas.ti to identify emerging themes that play a role in the diagnosis and management of febrile children. RESULTS: The following themes were identified: 1) health workers use caregivers’ history of illness and RDT results for initial diagnostic and management decisions, but suggest caregivers need more education to prevent late presentation and poor health outcomes; 2) there is uncertainty regarding viral versus bacterial illness and health workers feel additional point-of-care diagnostic tests would help with differential diagnoses; 3) stock-outs of medications and limited caregivers’ resources are barriers to delivering good care; 4) training, short courses and participation in research as well as; 5) weather also influences diagnostic decision-making. CONCLUSIONS: This pilot study found that health workers in Zanzibar use caregiver history of fever and results of malaria RDTs to guide management of febrile children. However, since most febrile children test negative for malaria, health workers believe additional training and point-of-care tests would improve their ability to diagnose and manage non-malarial fevers. Educating caregivers on signs and symptoms of febrile illness, as well as the introduction of additional tests to differentiate between viral and bacterial illness, would be important steps to get children to PHCFs earlier and decrease unnecessary antibiotic prescribing without compromising patient safety. More research is needed to expand an understanding of what would improve fever management in other resource-limited settings with decreasing malaria. BioMed Central 2013-01-28 /pmc/articles/PMC3626688/ /pubmed/23356837 http://dx.doi.org/10.1186/1475-2875-12-37 Text en Copyright © 2013 Baltzell et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Baltzell, Kimberly
Elfving, Kristina
Shakely, Deler
Ali, Abdullah S
Msellem, Mwinyi
Gulati, Shilpa
Mårtensson, Andreas
Febrile illness management in children under five years of age: a qualitative pilot study on primary health care workers’ practices in Zanzibar
title Febrile illness management in children under five years of age: a qualitative pilot study on primary health care workers’ practices in Zanzibar
title_full Febrile illness management in children under five years of age: a qualitative pilot study on primary health care workers’ practices in Zanzibar
title_fullStr Febrile illness management in children under five years of age: a qualitative pilot study on primary health care workers’ practices in Zanzibar
title_full_unstemmed Febrile illness management in children under five years of age: a qualitative pilot study on primary health care workers’ practices in Zanzibar
title_short Febrile illness management in children under five years of age: a qualitative pilot study on primary health care workers’ practices in Zanzibar
title_sort febrile illness management in children under five years of age: a qualitative pilot study on primary health care workers’ practices in zanzibar
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3626688/
https://www.ncbi.nlm.nih.gov/pubmed/23356837
http://dx.doi.org/10.1186/1475-2875-12-37
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