Factors Associated with Mortality in Febrile Patients in a Government Referral Hospital in the Kenema District of Sierra Leone

Roth, Prerana; Grant, Donald S.; Ngegbai, Amara S.; Schieffelin, John S.; McClelland, R. Scott; Jarrett, Olamide D

doi:10.4269/ajtmh.14-0418

Cited by 13 publications

(17 citation statements)

References 13 publications

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“…The rates are also less than the LVD prevalence of about 6% in febrile adults in endemic areas of Nigeria [26], and certainly less than the prevalence of 10–16% of adult medical admissions reported from endemic areas of Sierra Leone almost 3 decades ago [16]. It is however, comparable to the prevalence of 4.9% in febrile patients reported recently from a referral hospital in another endemic area of Sierra Leone [58]. The low prevalence rates found in this study should not, however, diminish from the importance of LVD in febrile children; unlike the situation with enteroviruses, effective treatment for LVD is available [33], LVD is associated with significant morbidity and mortality [48,59], and carries a high risk of nosocomial spread to other patients and health care workers [60,61].…”

Section: Discussionmentioning

confidence: 89%

Prevalence of Lassa Virus Disease (LVD) in Nigerian children with fever or fever and convulsions in an endemic area

et al. 2017

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BackgroundConvulsions with fever in children are a common neurologic emergency in the tropics, and determining the contribution of endemic viral infections can be challenging. In particular, there is a dearth of data on the prevalence and clinical differentiation of Lassa virus disease (LVD) in febrile children in endemic areas of Nigeria, which has multiple lineages of the virus. The aim of this study was to determine the prevalence and presentation of LVD in febrile children with and without convulsions.Methodology/Principal findingsThis was a prospective study of consecutive febrile children aged ≥1 month– 15 years admitted to the Children’s Emergency Room of Irrua Specialist Teaching Hospital over a period of 1 year. Febrile children with convulsions (Cases) were compared with those without convulsions (Controls). LVD was defined by the presence of a positive Lassa virus RT-PCR test. Rates were compared between groups using χ2 or Fisher’s exact tests and p <0.05 taken as significant. 373 (40.9%) of 913 admissions had fever. Of these, 108/373 (29%) presented with convulsions. The overall prevalence of LVD was 13/373 (3.5%; 95% CI = 1.9%, 5.7%) in febrile admissions, 3/108 (2.8%) in Cases and 10/265 (3.8%) in Controls [(Odds Ratio (95% Confidence Interval) (OR (95% CI)) of LVD in Cases versus Controls = 0.73 (0.2, 2.7)]. Only vomiting (OR (95% CI) = 0.09 (0.01, 0.70)) and bleeding (OR (95% CI) = 39.56 (8.52, 183.7)) were significantly associated with an increased prevalence of LVD.Conclusions/SignificanceLVD is an important cause of fever, including undifferentiated fever in children in endemic areas, but it is not significantly associated with convulsions associated with fever. Its prevalence, and lack of clinical differentiation on presentation, underscores the importance of a high index of suspicion in diagnosis. Screening of febrile children with undifferentiated fever in endemic areas for LVD could be an important medical and public health control measure.

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Section: Discussionmentioning

confidence: 89%

Prevalence of Lassa Virus Disease (LVD) in Nigerian children with fever or fever and convulsions in an endemic area

et al. 2017

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“…2 Sierra Leone, in West Africa, has one of the highest rates of malaria transmission among African countries, 3 with about half of all outpatient clinic consultations and a sizeable proportion of inpatient hospitalizations due to malaria. 4,5 However, many patients with febrile illnesses have unidentified infections. For example, 27.3% of hospitalized febrile patients in Kenema, Sierra Leone, in 2011-2012 had malaria, but more than half (53.4%) of the patients did not have a known diagnosis at discharge.…”

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confidence: 99%

“…For example, 27.3% of hospitalized febrile patients in Kenema, Sierra Leone, in 2011-2012 had malaria, but more than half (53.4%) of the patients did not have a known diagnosis at discharge. 5 Little is known about the epidemiological burden from nonmalarial VBIs in Sierra Leone, but preliminary reports of circulation of other VBIs such as chikungunya virus (CHIKV) and dengue virus have been published. [6][7][8][9] As part of a larger study of the etiology of febrile illnesses in and around Bo, Sierra Leone, Mercy Hospital Research Laboratory personnel tested 1,795 blood samples from adults and children ages 6 and older who were residents of Bo city and presented to the laboratory with self-reported or clinically confirmed fever with onset within the previous 7 days.…”

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confidence: 99%

Surveillance of Vector-Borne Infections (Chikungunya, Dengue, and Malaria) in Bo, Sierra Leone, 2012–2013

Dariano

Taitt

Jacobsen

et al. 2017

The American Journal of Tropical Medicine and Hygiene

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Malaria remains a significant cause of morbidity and mortality in West Africa, but the contribution of other vector-borne infections (VBIs) to the burden of disease has been understudied. We used rapid diagnostic tests (RDTs) for three VBIs to test blood samples from 1,795 febrile residents of Bo City, Sierra Leone, over a 1-year period in 2012-2013. In total, 24% of the tests were positive for malaria, fewer than 5% were positive for markers of dengue virus infection, and 39% were positive for IgM directed against chikungunya virus (CHIKV) or a related alphavirus. In total, more than half (55%) of these febrile individuals tested positive for at least one of the three VBIs, which highlights the very high burden of vector-borne diseases in this population. The prevalence of positives on the Chikungunya IgM and dengue tests did not vary significantly with age ( > 0.36), but higher rates of malaria were observed in children < 15 years of age ( < 0.001). Positive results on the Chikungunya IgM RDTs were moderately correlated with rainfall ( = 0.599). Based on the high prevalence of positive results on the Chikungunya IgM RDTs from individuals Bo and its environs, there is a need to examine whether an ecological shift toward a greater burden from CHIKV or related alphaviruses is occurring in other parts of Sierra Leone or the West African region.

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“…Although in sierra leone in the vast majority of Chinese have used mosquito nets, installed screen door and window screens and used other anti-mosquito measures, but anopheles breeding ground is very ubiquitous with giving priority to with Gambia anopheles. More worryingly, the lack of mosquito control measures and the heavy burden of mosquito-borne disease control [24][25][26][27][28][29] aggravate a high incidence of malaria. The high temperature made it impossible for workers to wear long clothes and trousers outdoors all the time, and it is di cult to use mosquito repellents for long periods, thus outdoor workers in Sierra Leone are unable to avoid mosquito bites completely with a higher risk of malaria infection.…”

Section: Discussionmentioning

confidence: 99%

The Knowledge, Attitudes and Practices of Malaria and The Risk of Malaria Infection Among Chinese Population in Sierra Leone

Zhao

Feng

et al. 2020

Preprint

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Background: The risk of malaria importation from malaria hyperendemic regions has threatened the achievement of the malaria elimination goal of China. However, few studies have focused on malaria control interventions among Chinese population in Africa. The aims of this study were to assess the knowledge, attitudes and practices (KAP) of malaria and the risk of malaria infection among Chinese population in Sierra Leone, then to improve the knowledge of malaria among Chinese population in Sierra Leone through health education interventions. Methods: Cluster random sampling method was undertaken to select the overseas Chinese from 27 Chinese institutions as respondents in Sierra Leone. Cross-sectional surveys of malaria KAP and the risk of malaria infection were performed on respondents by trained investigators. Health education training were conducted to educate respondents knowledge of malaria after the surveys. The same questionnaires of malaria KAP as before the training were used to evaluate the effect of health education interventions. Correlation analyses of results were performed by T test, ANOVA, Chi-Square and Logistics regression model.Results: A total of 134 respondents fully completed questionnaires were analyzed before health education training with mainly engaged in (73.88%) outdoor work. Majority of participators (82.84%) were from 20 Chinese provinces. About half of participators (49.25%) had not received malaria health education before going abroad. The practices of prevention malaria were used in most respondents, 84.33% (113/134) used mosquito net every day, 90.30% (121/134) were equipped with screen doors and Windows in their dwellings, 73.88% (99/134) used mosquito repellent when going out, and 74.63% (100/134) used mosquito insecticide at home. The average awareness rate of malaria knowledge of respondents without malaria training before going abroad (41.69 %) was significantly lower than that of with malaria training (53.41%) (T =3.337, P=0.001).According to Logistics regression analysis, age (OR=2.6, 95%CI(1.0,8.8)) and male (OR=3.2, 95%CI(1.1,9.4)) were the main factors whether the awareness rate of malaria knowledge reaches 60% before the training. After health education training, the awareness rate of malaria knowledge of 134 respondents increased to 87.62 %, which was significantly higher than that of before the training (44.4%) (P < 0.05). 29.10% (39/134) of all respondents had infected malaria in the past year. 37.37% (37/99) of outdoor workers were infected with malaria, which was significantly higher than 5.71% (6/35) of indoor workers with a significant difference (χ2=12.561, P=0.000).According to Logistics regression analysis, outdoor work was the main risk factor for malaria infection (OR=6.5, 95%CI(1.3,31.7)).Conclusion The Chinese in Sierra Leone lacked malaria knowledge training with a low awareness of malaria knowledge, and had inadequate personal prevention with high risk of malaria infection. Health education training could improve their knowledge of malaria. That implies the publicity of malaria prevention and control and outdoor prevention and control measures for overseas Chinese in Sierra Leone should be strengthened.

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Factors Associated with Mortality in Febrile Patients in a Government Referral Hospital in the Kenema District of Sierra Leone

Cited by 13 publications

References 13 publications

Prevalence of Lassa Virus Disease (LVD) in Nigerian children with fever or fever and convulsions in an endemic area

Prevalence of Lassa Virus Disease (LVD) in Nigerian children with fever or fever and convulsions in an endemic area

Surveillance of Vector-Borne Infections (Chikungunya, Dengue, and Malaria) in Bo, Sierra Leone, 2012–2013

The Knowledge, Attitudes and Practices of Malaria and The Risk of Malaria Infection Among Chinese Population in Sierra Leone

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