Acute Febrile Illness: The Role of Respiratory Syncytial Virus and Malaria in an Urban Peadiatric Population in Ghana

Abstract

Introduction: Fever describes an increase in internal body temperature to levels that are above normal (commonly oral/axillary measurement of normal human body temperature is 36.8±0.7 °C or 98.2±1.3 °F) and is the most common response of the body to any insult to the body. The most common cause of fever in our setting is malaria and therefore children get treated for malaria once they have a fever whether the cause is proven (by laboratory confirmation) to be malaria or not. Other common causes of childhood fever, such as respiratory infections are not usually considered, although this has been found to be responsible for a high proportion of childhood illness in the West African Region in places such as The Gambia. Most of these respiratory infections are caused by viral agents including respiratory syncytial virus (RSV). Very little information exists on causes of fever in Ghana and therefore this study was conducted to determine the relative importance of RSV and malaria as causes of Acute Febrile Ilness in children under 5 years presenting at an urban hospital in Accra. Methods: The study recruited children under five years with an axillary temperature≥ 37.5°C who presented to the out-patients department of the La General Hospital from February 2009 to February 2010. A questionnaire was administered to their parents/caretakers (after consenting to allow their children to be part of the study) to elicit the demographic and socioeconomic characteristics of the recruited children and a physical examination conducted all children. Nasopharyngeal aspirates and blood samples were taken for polymerase chain reaction (PCR) for RSV and microscopy for malaria parasites respectively. A case control study was also undertaken to determine the risk factors for RSV infection among acute respiratory infection cases. Cases were children with acute respiratory infection who were positive for RSV and controls were children with acute respiratory infection who were negative for RSV. Results: Malaria, defined as presence of malaria parasites on microscopy, was found in 11.2% of all acute febrile illness. RSV was seen in 15.6% and 17.5% of acute febrile illness and respiratory infections respectively. Seven children representing 1.5% of children with acute febrile illness were positive for both malaria and RSV. Overcrowding and exclusive breastfeeding were significantly positively associated with RSV infection (p-value<0.01), whilst male gender, young age of less than one year and prematurity were also positively associated with RSV infection though not statistically significant. Discussion and Conclusion: The proportion of acute febrile illness due to malaria is lower than has been recorded routinely in children less than five years in this urban hospital. RSV is significantly prevalent in these children. Co-morbid infection with RSV and malaria was low. It is therefore important health practitioners support their diagnosis of malaria with laboratory confirmation, and also look out for other causes of fever such as RSV. The practice of treating almost all cases of fever as malaria needs to be examined critically.