Clinical trial NCT01947075: Etiologies of Fever Among Adults in Dar es Salaam
Official title: Etiologies of Acute Febrile Illness Among Adults Attending an Outpatient Department in Dar es Salaam
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Acute Febrile Illnesses
Keywords: Fever
Tanzania
Pneumonia
HIV
Diabetes
Indoor Air Pollution
Lead sponsor: Swiss Tropical & Public Health Institute
Sponsor class: OTHER
Collaborators: name: Ifakara Health Institute
First posted: 2013-09-20
Enrollment: 538
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: PROBABILITY_SAMPLE
Study population: Every consecutive adult with temperature ≥38°C attending the outpatient department of Mwananyamala Hospital will be screened for inclusion. Additional inclusion criteria are fever of ≤1 week duration and first consultation for the present problem. Exclusion criteria are refusal of HIV screening, main complaint is injury or trauma, antibiotic treatment during the previous week (apart from cotrimoxazole prophylaxis), delivery within the previous 6 weeks and hospitalization during the last month. Medical history will be taken (including exposure to IAP) and clinical examination will be done in a standardized way.

Brief summary: Following the decline of malaria in Sub-Saharan Africa, clinicians face febrile patients in whom an alternative diagnosis has to be made. This situation has led to an overuse of antibiotics by clinicians. It is crucial to increase knowledge on etiologies and risk factors of outpatient febrile illness in order to improve their management.

This present proposal aims to investigate the etiologies of fever among adult patients attending an outpatient department in urban Tanzania. It also aims to assess the clinical significance of nasopharyngeal (NP) respiratory viruses and bacteria documentation in this setting. Third, it aims to compare the spectrum of infections in this population with that of children included in the same setting in a previous study. The last objective is to assess diabetes mellitus (DM) as a risk factor for infection and exposure to indoor air pollution (IAP) as a risk factor for acute respiratory infections (ARI) in adults in Tanzania.

The investigators hypothesize that acute respiratory infections are the main cause of adult febrile illness in a urban low-income setting and that use of quantitative molecular assays on naso-oropharyngeal samples can improve the diagnosis of pneumonia. The investigators also think that the spectrum of infections is different between children and adults, mainly due to a high HIV prevalence in adults. The investigators also hypothesize that experiencing IAP and/ or DM is a risk factor for infections in adults.


Eligibility criteria: Inclusion Criteria:

* Temperature \>=38°C
* History of fever for less than 8 days
* First consultation for the present problem

Exclusion Criteria:

* Refusal of HIV screening
* Main complaint is injury or trauma
* Antibiotic treatment in the last 7 days
* Within 6 weeks after delivery
* Hospitalization during the last month

Primary outcomes:
measure: Proportion of patients with each disease among all febrile patients, overall and stratified by HIV status
timeFrame: 1 year
Secondary outcomes:
measure: Proportion of febrile patients with acute respiratory infection infected with a certain respiratory pathogen, compared to the proportion of healthy controls infected with the same pathogen.
timeFrame: 1 year
Other outcomes:
measure: Strength of association between each febrile disease and diabetes mellitus and between acute respiratory infections and indoor air pollution
timeFrame: 1 year
Locations:
city: Dar es Salaam
country: Tanzania
facility: Mwananyamala Hospital
Study officials:
affiliation: Swiss Tropical & Public Health Institute
name: Valerie D'Acremont, MD PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Boillat-Blanco N, Klaassen B, Mbarack Z, Samaka J, Mlaganile T, Masimba J, Franco Narvaez L, Mamin A, Genton B, Kaiser L, D'Acremont V. Dengue fever in Dar es Salaam, Tanzania: clinical features and outcome in populations of black and non-black racial category. BMC Infect Dis. 2018 Dec 12;18(1):644. doi: 10.1186/s12879-018-3549-z.
citation: Boillat-Blanco N, Mbarack Z, Samaka J, Mlaganile T, Mamin A, Genton B, Kaiser L, Calandra T, D'Acremont V. Prognostic value of quickSOFA as a predictor of 28-day mortality among febrile adult patients presenting to emergency departments in Dar es Salaam, Tanzania. PLoS One. 2018 Jun 14;13(6):e0197982. doi: 10.1371/journal.pone.0197982. eCollection 2018.