Acute Febrile Illness: The Role of Respiratory Syncytial Virus and Malaria in an Urban Peadiatric Population in Ghana
Date
2011-10
Authors
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Journal ISSN
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Publisher
University of 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.
Description
Thesis (PhD) - University of Ghana, 2011