Department of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033, USA.
Department of Public Health Sciences, Penn State College of Medicine, 500 University Drive, Hershey, PA, 17033, USA.
BMC Infect Dis. 2023 Jun 12;23(1):391. doi: 10.1186/s12879-023-08350-5.
Evidence on the relative importance of various factors associated with febrile illness in children and their heterogeneity across countries can inform the prevention, identification, and management of communicable diseases in resource-limited countries. The objective of the study is to assess the relative significance of factors associated with childhood febrile illness in 27 sub-Saharan African countries.
This cross-sectional study of 298,327 children aged 0 to 59 months assessed the strengths of associations of 18 factors with childhood fevers, using Demographic and Health Surveys (2010-2018) from 27 sub-Saharan African countries. A total of 7 child level factors (i.e., respiratory illness, diarrhea, breastfeeding initiation; vitamin A supplements; child's age; full vaccination; sex), 5 maternal factors (maternal education; maternal unemployment; antenatal care; maternal age, and maternal marriage status) and 6 household factors (household wealth; water source; indoor pollution, stool disposal; family planning needs and rural residence) were assessed. Febrile illness was defined as the presence of fever in 2 weeks preceding the survey.
Among the 298,327 children aged 0 to 59 months included in the analysis, the weighted prevalence of fever was 22.65% (95% CI, 22.31%-22.91%). In the pooled sample, respiratory illness was the strongest factor associated with fever in children (adjusted odds ratio [aOR], 5.46; 95% CI, 5.26-5.67; P < .0001), followed by diarrhea (aOR, 2.96; 95% CI, 2.85-3.08; P < .0001), poorest households (aOR, 1.33; 95% CI,1.23-1.44; P < .0001), lack of maternal education (aOR, 1.25; 95% CI, 1.10-1.41; P < .0001), and delayed breastfeeding (aOR, 1.18; 95% CI, 1.14-1.22; P < .0001. Febrile illnesses were more prevalent in children older than >6 months compared to those 6 months and younger. Unsafe water, unsafe stool disposal, and indoor pollution were not associated with child fever in the pooled analysis but had a large country-level heterogeneity.
Major causes of fevers in sub-Saharan Africa could be attributed to respiratory infections and possibly viral infections, which should not be treated by antimalarial drugs or antibiotics. Point-of-care diagnostics are needed to identify the pathogenic causes of respiratory infections to guide the clinical management of fevers in limited-resource countries.
了解与儿童发热相关的各种因素的相对重要性及其在各国之间的异质性，可为资源有限国家的传染病的预防、识别和管理提供信息。本研究的目的是评估 27 个撒哈拉以南非洲国家儿童发热相关因素的相对重要性。
本横断面研究纳入了 298327 名 0 至 59 月龄儿童，使用来自 27 个撒哈拉以南非洲国家的 2010-2018 年期间的人口与健康调查数据评估了 18 个因素与儿童发热的关联强度。共有 7 个儿童层面的因素（即呼吸道疾病、腹泻、母乳喂养起始；维生素 A 补充剂；儿童年龄；完全接种疫苗；性别）、5 个产妇层面的因素（产妇教育；产妇失业；产前护理；产妇年龄和产妇婚姻状况）和 6 个家庭层面的因素（家庭财富；水源；室内污染，粪便处理；计划生育需求和农村居住）。发热定义为调查前 2 周内存在发热。
在纳入分析的 298327 名 0 至 59 月龄儿童中，发热的加权患病率为 22.65%（95%CI，22.31%-22.91%）。在汇总样本中，呼吸道疾病是与儿童发热相关性最强的因素（调整后的优势比[aOR]，5.46；95%CI，5.26-5.67；P<0.0001），其次是腹泻（aOR，2.96；95%CI，2.85-3.08；P<0.0001）、最贫困家庭（aOR，1.33；95%CI，1.23-1.44；P<0.0001）、产妇缺乏教育（aOR，1.25；95%CI，1.10-1.41；P<0.0001）和母乳喂养延迟（aOR，1.18；95%CI，1.14-1.22；P<0.0001）。与 6 个月及以下儿童相比，大于 6 个月的儿童发热更为常见。在汇总分析中，不安全用水、不安全粪便处理和室内污染与儿童发热无关，但存在较大的国家间异质性。
撒哈拉以南非洲地区发热的主要原因可能归因于呼吸道感染和可能的病毒感染，这些感染不应使用抗疟药物或抗生素治疗。迫切需要床边诊断来确定呼吸道感染的病因，以指导资源有限国家发热的临床管理。
