A 14-day follow-up of adult non-malarial fever patients seen by mobile clinics in rural Malawi.
Adult
Delivery of Health Care
Female
Fever
/ epidemiology
Fever of Unknown Origin
/ epidemiology
Follow-Up Studies
Health Services Accessibility
Humans
Malawi
/ epidemiology
Male
Middle Aged
Mobile Health Units
/ statistics & numerical data
Outcome Assessment, Health Care
Primary Health Care
/ methods
Malawi
Non-malarial fever
antibiotic resistance
diagnostic tools
febrile illness
mobile clinics
Journal
Malawi medical journal : the journal of Medical Association of Malawi
ISSN: 1995-7270
Titre abrégé: Malawi Med J
Pays: Malawi
ID NLM: 9500170
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
entrez:
1
8
2020
pubmed:
1
8
2020
medline:
26
8
2020
Statut:
ppublish
Résumé
While health providers consistently use malaria rapid diagnostic tests to rule out malaria, they often lack tools to guide treatment for those febrile patients who test negative. Without the tools to provide an alternative diagnosis, providers may prescribe unnecessary antibiotics or miss a more serious condition, potentially contributing to antibiotic resistance and/or poor patient outcomes. This study ascertained which diagnoses and treatments might be associated with poor outcomes in adults who test negative for malaria. Adult patients for rapid diagnostic test of malaria seen in mobile health clinics in Mulanje and Phalombe districts were followed for 14 days. Participants were interviewed on sociodemographic characteristics, health-seeking behaviour, diagnosis, treatment and access to care. Mobile clinic medical charts were reviewed. Two weeks (±2 days) following clinic visit, follow-up interviews were conducted to assess whether symptoms had resolved. Initially, 115 adult patients were enrolled and 1 (0.88%) was lost to follow-up. Of the 114 adult patients remaining in the study, 55 (48%) were seen during the dry season and 59 (52%) during the wet season. Symptoms resolved in 90 (80%) patients at the 14-day follow-up visit (n=90) with the rest (n=24) reporting no change in symptoms. None of the patients in the study died or were referred for further care. Almost all patients received some type of medication during their clinic visit (98.2%). Antibiotics were given to 38.6% of patients, and virtually all patients received pain or fever relief (96.5%). However, no anti-malarials were prescribed. Mobile clinics provide important health care where access to care is limited. Although rapid tests have guided appropriate treatment, challenges remain when a patient's presenting complaint is less well defined. In rural areas of southern Malawi, simple diagnostics are needed to guide treatment decisions.
Sections du résumé
Background
While health providers consistently use malaria rapid diagnostic tests to rule out malaria, they often lack tools to guide treatment for those febrile patients who test negative. Without the tools to provide an alternative diagnosis, providers may prescribe unnecessary antibiotics or miss a more serious condition, potentially contributing to antibiotic resistance and/or poor patient outcomes.
Methods
This study ascertained which diagnoses and treatments might be associated with poor outcomes in adults who test negative for malaria. Adult patients for rapid diagnostic test of malaria seen in mobile health clinics in Mulanje and Phalombe districts were followed for 14 days. Participants were interviewed on sociodemographic characteristics, health-seeking behaviour, diagnosis, treatment and access to care. Mobile clinic medical charts were reviewed. Two weeks (±2 days) following clinic visit, follow-up interviews were conducted to assess whether symptoms had resolved.
Results
Initially, 115 adult patients were enrolled and 1 (0.88%) was lost to follow-up. Of the 114 adult patients remaining in the study, 55 (48%) were seen during the dry season and 59 (52%) during the wet season. Symptoms resolved in 90 (80%) patients at the 14-day follow-up visit (n=90) with the rest (n=24) reporting no change in symptoms. None of the patients in the study died or were referred for further care. Almost all patients received some type of medication during their clinic visit (98.2%). Antibiotics were given to 38.6% of patients, and virtually all patients received pain or fever relief (96.5%). However, no anti-malarials were prescribed.
Conclusions
Mobile clinics provide important health care where access to care is limited. Although rapid tests have guided appropriate treatment, challenges remain when a patient's presenting complaint is less well defined. In rural areas of southern Malawi, simple diagnostics are needed to guide treatment decisions.
Identifiants
pubmed: 32733657
doi: 10.4314/mmj.v32i1.7
pmc: PMC7366163
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
31-36Informations de copyright
© 2020 The College of Medicine and the Medical Association of Malawi.
Références
Lancet. 2016 Oct 8;388(10053):1603-1658
pubmed: 27733283
Malar J. 2016 Jan 11;15:23
pubmed: 26754484
Clin Microbiol Infect. 2013 May;19(5):422-31
pubmed: 23413992
Malar J. 2011 Feb 08;10:32
pubmed: 21303538
BMC Health Serv Res. 2017 Jan 5;17(1):10
pubmed: 28056949
Trop Med Int Health. 2016 Jan;21(1):149-156
pubmed: 26544671
Ann Trop Med Parasitol. 2006 Jun;100(4):283-96
pubmed: 16762109
BMJ Open. 2017 Mar 8;7(3):e012973
pubmed: 28274962
Glob Pediatr Health. 2018 Jan 16;5:2333794X17750415
pubmed: 29372177
Rev Inst Med Trop Sao Paulo. 2016 Sep 22;58:59
pubmed: 27680164