Kirby Institute, University of New South Wales, Sydney, Australia.
College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
Sci Rep. 2022 Nov 10;12(1):19166. doi: 10.1038/s41598-022-23641-8.
We assessed the diagnosis, management and outcomes of acute febrile illness in a cohort of febrile children aged under 5 years presenting at one urban and two rural health centres and one tertiary hospital between 11 August 2019 and 01 November 2019. Pneumonia was diagnosed in 104 (30.8%) of 338 children at health centres and 128 (65.0%) of 197 at the hospital (p < 0.001). Malaria was detected in 33 (24.3%) of 136 children at the urban health centre, and in 55 (55.6%) of 99 and 7 (7.4%) of 95 children at the rural health centres compared to 11 (11.6%) of 95 at the hospital. Antibacterials were prescribed to 20 (11.5%) of 174 children without guidelines-specified indications (overprescribing) at health centres and in 7 (33.3%) of 21 children at the hospital (p = 0.013). Antimalarials were overprescribed to 13 (7.0%) of 185 children with negative malaria microscopy at the hospital. The fever resolved by day 7 in 326 (99.7%) of 327 children at health centres compared to 177 (93.2%) of 190 at the hospital (p < 0.001). These results suggest that additional guidance to health workers is needed to optimise the use of antimicrobials across all levels of health facilities.
我们评估了 2019 年 8 月 11 日至 11 月 1 日期间，在一个城市和两个农村医疗中心以及一家三级医院就诊的 5 岁以下发热儿童队列的急性发热性疾病的诊断、治疗和结局。在医疗中心，104 名（30.8%）338 名儿童和医院 128 名（65.0%）197 名儿童被诊断为肺炎（p<0.001）。在城市医疗中心，33 名（24.3%）136 名儿童中检测到疟疾，在农村医疗中心，55 名（55.6%）99 名和 7 名（7.4%）95 名儿童中检测到疟疾，而在医院，95 名儿童中只有 11 名（11.6%）检测到疟疾。在医疗中心，20 名（11.5%）无指南规定适应证（过度用药）的 174 名儿童和医院 7 名（33.3%）21 名儿童开具了抗菌药物（p=0.013）。在医院，185 名疟疾显微镜检查阴性的儿童中，抗疟药物被过度开具。在医疗中心，327 名（99.7%）327 名儿童的发热在第 7 天缓解，而在医院，190 名（93.2%）190 名儿童发热缓解（p<0.001）。这些结果表明，需要向卫生工作者提供额外的指导，以优化各级医疗机构对抗微生物药物的使用。
