Etiology of acute febrile illness among out-patients seeking health care at kiteto district Hospital In Manyara Region, Tanzania

Abstract

ABSTRACT Background: Febrile illness continues to be an important public health problem especially in developing countries. This study was conducted at Kiteto District Hospital in Manyara Region to determine the etiology, associated risk factors, and management of acute febrile illness. Methods: This was a hospital-based cross-sectional study conducted between January and February 2019 in Kiteto District Hospital in Northern Tanzania that involved out-patients presenting with temperature ≥38 0C. A structured questionnaire was used to collect socio-demographic characteristics and associated risk factors and patients files were used to obtain clinical information and prescribed drugs. Blood was analyzed using AFI Taqman Array Cards (TAC) for detection of causative agents of febrile illness. Odds ratio and p-values were used to measure the strength of the association and statistical significant. Results: A total of 426 febrile outpatients were enrolled. Their median age was 28 years, with an interquartile range of 20-38 years. A hundred and eighty four (43.2%) were detected with at least one pathogen and 40 (9.4%) had multiple infections. Non-malaria cases were 144, accounting for 34.5% of all febrile illnesses compared to malaria cases that accounted for less than 10% of the cases. Majority were detected with zoonotic bacteria; (61 (14.3%) Brucella spp, Coxiella burnetii, 17 (4.0%) Leptospira spp, and 51 (12.0%) dengue virus. Dengue virus and malaria were more in children aged below 14 years, whereas Brucella spp was more common among adults. The odds of being infected by any zoonotic bacteria were higher among livestock keepers [OR=1.64, 95%CI 1.02-2.65, p=0.042] and those using raw milk [OR=1.90, 95%CI 1.19-3.01, p= <0.000] and among people living in the same house with animals [OR=3.06, 95%CI 1.16-8.08, p =0.02]. The odds of developing malaria infection reported on those with mosquito breeding sites in the household compound [OR=2.30 95% CI 1.05-5.01, p =0.03]. Of 376 (38.0%) prescriptions given to febrile patients were inappropriately given antimalarial drugs despite negative results. Conclusion: Non-malarial causes of acute febrile illness are highly prevalent and yet overlooked as compared with malaria, which is much less prevalent. The large diversity of etiologial agents underlines the need to devise a cheap and easy to use a multiplex assay. Keywords: Acute febrile illness, etiology, diagnosis, management, Kiteto, Tanzania