Study on fever in children in Africa may change global guidelines

Children in sub-Saharan Africa with uncomplicated fever may be safely managed with conditional, rather than universal, 3-day follow-up with a community health worker, according to a randomised trial by researchers at Karolinska Institutet published in PLOS Medicine. The study suggests that current WHO guidelines for these children could be reconsidered.

The WHO’s integrated community case management (iCCM) guidelines recommend that all children presenting with uncomplicated fever and no danger signs return for follow-up with a community health worker on day 3 following the initial consultation on day 1. Such fevers often resolve rapidly, however, and previous studies suggest that expectant home care for uncomplicated fever can be safely recommended.

The trial was conducted in Ethiopia and included approximately 4,000 children under age five with uncomplicated fever, who were randomised to receive either conditional follow-up if symptoms remained or the recommended universal 3-day follow up. The results suggest that conditional follow-up is non-inferior to universal follow-up.

More efficient use of resources

“Allowing community health workers to advise caregivers to bring children back only in case of continued symptoms might be a more efficient use of resources in these settings,” says first author Karin Källander, adjunct senior lecturer at Karolinska Institutet’s Department of Public Health Sciences.

Another study from Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States, published at the same time in PLOS Medicine, shows similar results for children in the Democratic Republic of the Congo (DRC). Additional trials in other sub-Saharan African settings are needed to establish generalisability. However, taken together, the current results provide evidence relevant to formulation of WHO recommendations.

The study involving researchers from Karolinska Institutet was made possible by the support of the U.S. President's Malaria Initiative under the United States Agency for International Development's Translating Research into Action (TRAction) Project.

This news article is based on a press release from PLOS Medicine.

Publication

“Universal versus conditional day 3 follow-up for children with non-severe unclassified fever at the community level in Ethiopia: A cluster-randomised non-inferiority trial”
Källander K, Alfvén T, Funk T, Abebe A, Hailemariam A, Getachew D, Petzold M, Steinhardt LC, Gutman JR
PLOS Medicine, online 17 April 2018, doi: 10.1371/journal.pmed.1002553