Background:In recent years there have been reports of viral haemorrhagic fever(VHF)epidemics in sub-Saharan Africa where malaria is endemic.VHF and malaria have overlapping clinical presentations making diferential di...Background:In recent years there have been reports of viral haemorrhagic fever(VHF)epidemics in sub-Saharan Africa where malaria is endemic.VHF and malaria have overlapping clinical presentations making diferential diagno‑sis a challenge.The objective of this study was to determine the prevalence of selected zoonotic VHFs and malaria co-infections among febrile patients seeking health care in Tanzania.Methods:This facility-based cross-sectional study was carried out between June and November 2018 in Buhigwe,Kalambo,Kyela,Kilindi,Kinondoni,Kondoa,Mvomero,and Ukerewe districts in Tanzania.The study involved febrile patients seeking health care from primary healthcare facilities.Blood samples were collected and tested for infections due to malaria,Crimean-Congo haemorrhagic fever(CCHF),Ebola virus disease(EVD),Marburg virus disease(MVD),Rift Valley fever(RVF)and yellow fever(YF).Malaria infections were tested using rapid diagnostics tests while exposure to VHFs was determined by screening for immunoglobulin M antibodies using commercial enzyme-linked immuno‑sorbent assays.The Chi-square test was used to compare the proportions.Results:A total of 308 participants(mean age=35±19 years)were involved in the study.Of these,54(17.5%)had malaria infection and 15(4.8%)were positive for IgM antibodies against VHFs(RVF=8;CCHF=2;EBV=3;MBV=1;YF=1).Six(1.9%)individuals had both VHF(RVF=2;CCHF=1;EVD=2;MVD=1)and malaria infections.The highest co-infection prevalence(0.6%)was observed among individuals aged 46‒60 years(P<0.05).District was signifcantly associated with co-infection(P<0.05)with the highest prevalence recorded in Buhigwe(1.2%)followed by Kinondoni(0.9%)districts.Headache(100%)and muscle,bone,back and joint pains(83.3%)were the most signifcant complaints among those infected with both VHFs and malaria(P=0.001).Conclusions:Co-infections of VHF and malaria are prevalent in Tanzania and afect more the older than the younger population.Since the overlapping symptoms in co-infected individuals may challenge accurate diagnosis,adequate laboratory diagnosis should be emphasized in the management of febrile illnesses.展开更多
Background Primary health care settings and hospitals of low-and middle-income countries have few accessible diagnostic tools and limited laboratory and human resources capacity to identify multiple pathogens with hig...Background Primary health care settings and hospitals of low-and middle-income countries have few accessible diagnostic tools and limited laboratory and human resources capacity to identify multiple pathogens with high accu‑racy.In addition,there is a paucity of information on fever and its underlying aetiology in the adolescent and adult population in East Africa.The purpose of this study was to estimate the pooled prevalence of fever of unidentifed aetiology among adolescent and adult febrile patients seeking health care in East Africa.Methods We pursued a systematic review using readily available electronic databases(i.e.PubMed,Cumulative Index to Nursing&Allied Health Literature,Scopus,Cochrane Library and Web of Science)without language restric‑tion from inception date of the respective databases to October 31,2022.We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Identifed studies were screened for relevance.Further analyses based on pre-set eligibility criteria were carried out for fnal inclusion.Two reviewers independently screened and extracted data.Risk of study bias was assessed.Meta-analysis of the prevalence of fever of unidentifed aetiology was performed.Results We identifed 14,029 articles of which 25 were eligible for inclusion,reporting data from 8538 participants.The pooled prevalence of febrile cases with unidentifed aetiology was 64%[95%confdence interval(CI):51–77%,I 2=99.6%]among febrile adolescents and adults in East Africa.For the proportion of patients with identifed aetiol‑ogy,the studies documented bacterial pathogens(human bloodstream infections),bacterial zoonotic pathogens and arboviruses as the main non-malarial causative agents in East Africa.Conclusions Our study provides evidence that almost two-thirds of adolescent and adult febrile patients attending health care facilities in East Africa might receive inappropriate treatments due to unidentifed potential life-threat‑ening fever aetiology.Hence,we call for a comprehensive fever syndromic surveillance to broaden a consequential diferential diagnosis of syndromic fever and to considerably improve the course of patients’disease and treatment outcomes.展开更多
文摘Background:In recent years there have been reports of viral haemorrhagic fever(VHF)epidemics in sub-Saharan Africa where malaria is endemic.VHF and malaria have overlapping clinical presentations making diferential diagno‑sis a challenge.The objective of this study was to determine the prevalence of selected zoonotic VHFs and malaria co-infections among febrile patients seeking health care in Tanzania.Methods:This facility-based cross-sectional study was carried out between June and November 2018 in Buhigwe,Kalambo,Kyela,Kilindi,Kinondoni,Kondoa,Mvomero,and Ukerewe districts in Tanzania.The study involved febrile patients seeking health care from primary healthcare facilities.Blood samples were collected and tested for infections due to malaria,Crimean-Congo haemorrhagic fever(CCHF),Ebola virus disease(EVD),Marburg virus disease(MVD),Rift Valley fever(RVF)and yellow fever(YF).Malaria infections were tested using rapid diagnostics tests while exposure to VHFs was determined by screening for immunoglobulin M antibodies using commercial enzyme-linked immuno‑sorbent assays.The Chi-square test was used to compare the proportions.Results:A total of 308 participants(mean age=35±19 years)were involved in the study.Of these,54(17.5%)had malaria infection and 15(4.8%)were positive for IgM antibodies against VHFs(RVF=8;CCHF=2;EBV=3;MBV=1;YF=1).Six(1.9%)individuals had both VHF(RVF=2;CCHF=1;EVD=2;MVD=1)and malaria infections.The highest co-infection prevalence(0.6%)was observed among individuals aged 46‒60 years(P<0.05).District was signifcantly associated with co-infection(P<0.05)with the highest prevalence recorded in Buhigwe(1.2%)followed by Kinondoni(0.9%)districts.Headache(100%)and muscle,bone,back and joint pains(83.3%)were the most signifcant complaints among those infected with both VHFs and malaria(P=0.001).Conclusions:Co-infections of VHF and malaria are prevalent in Tanzania and afect more the older than the younger population.Since the overlapping symptoms in co-infected individuals may challenge accurate diagnosis,adequate laboratory diagnosis should be emphasized in the management of febrile illnesses.
文摘Background Primary health care settings and hospitals of low-and middle-income countries have few accessible diagnostic tools and limited laboratory and human resources capacity to identify multiple pathogens with high accu‑racy.In addition,there is a paucity of information on fever and its underlying aetiology in the adolescent and adult population in East Africa.The purpose of this study was to estimate the pooled prevalence of fever of unidentifed aetiology among adolescent and adult febrile patients seeking health care in East Africa.Methods We pursued a systematic review using readily available electronic databases(i.e.PubMed,Cumulative Index to Nursing&Allied Health Literature,Scopus,Cochrane Library and Web of Science)without language restric‑tion from inception date of the respective databases to October 31,2022.We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Identifed studies were screened for relevance.Further analyses based on pre-set eligibility criteria were carried out for fnal inclusion.Two reviewers independently screened and extracted data.Risk of study bias was assessed.Meta-analysis of the prevalence of fever of unidentifed aetiology was performed.Results We identifed 14,029 articles of which 25 were eligible for inclusion,reporting data from 8538 participants.The pooled prevalence of febrile cases with unidentifed aetiology was 64%[95%confdence interval(CI):51–77%,I 2=99.6%]among febrile adolescents and adults in East Africa.For the proportion of patients with identifed aetiol‑ogy,the studies documented bacterial pathogens(human bloodstream infections),bacterial zoonotic pathogens and arboviruses as the main non-malarial causative agents in East Africa.Conclusions Our study provides evidence that almost two-thirds of adolescent and adult febrile patients attending health care facilities in East Africa might receive inappropriate treatments due to unidentifed potential life-threat‑ening fever aetiology.Hence,we call for a comprehensive fever syndromic surveillance to broaden a consequential diferential diagnosis of syndromic fever and to considerably improve the course of patients’disease and treatment outcomes.
