The aetiology of febrile illness in low-and-middle income countries
Fever is a common reason for people to seek healthcare in low-and-middle-income countries. For decades, cases of febrile illness have often been considered to be malaria and treated as such. However, with apparent declines in malaria worldwide since 2004, along with the increased deployment of malaria rapid diagnostic tests, it is now being found that a growing proportion of patients presenting with fever do not have malaria. Furthermore, given the undifferentiated clinical presentation of many infections causing fever, in conjunction with limited microbiological and diagnostic facilities available in some low-and middle-income countries, it is becoming evident that many patients do not receive a precise diagnosis for their illness. As a result, malaria tends to be over-treated while other causes of febrile illness are not addressed, sometimes leading to patients experiencing worse case fatality ratios. It is clear that a more comprehensive understanding of febrile illness and its aetiology is required to avert illness and death, particularly in low-and-middle income-countries. The following thesis, aims to gain an insight into the epidemiology of febrile illness in low-and-middle income-countries and shed light on its various aetiological agents. A variety of methodological techniques have been used in this project. Firstly in order to investigate the diverse aetiology of febrile illness, a systematic review was conducted. Secondly, analysis of Demographic and Health Survey’s (DHS) and Malaria Atlas Project (MAP) data was done to investigate the importance of fever as a symptom and examine the contribution of malaria towards its prevalence. Finally, a retrospective review of blood culture records was conducted in Yangon General Hospital, Myanmar to gain a more local and specific insight into the characteristics of bloodstream infections, a common febrile illness.
Advisor: Crump, John A; Murdoch, David R
Degree Name: Master of Public Health
Degree Discipline: Centre for International Health, Preventive and Social Medicine
Publisher: University of Otago
Keywords: febrile; illness; non-malarial; low and middle income countries
Research Type: Thesis