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Etiologies of Fever Among Adults in Dar es Salaam

This study has been completed.
Ifakara Health Institute
Information provided by (Responsible Party):
Valérie D'Acremont, Swiss Tropical & Public Health Institute Identifier:
First received: September 13, 2013
Last updated: August 20, 2014
Last verified: August 2014

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.

Acute Febrile Illnesses

Study Type: Observational [Patient Registry]
Study Design: Observational Model: Cohort
Time Perspective: Prospective
Target Follow-Up Duration: 30 Days
Official Title: Etiologies of Acute Febrile Illness Among Adults Attending an Outpatient Department in Dar es Salaam

Resource links provided by NLM:

Further study details as provided by Swiss Tropical & Public Health Institute:

Primary Outcome Measures:
  • Proportion of patients with each disease among all febrile patients, overall and stratified by HIV status [ Time Frame: 1 year ]
    Description of the distribution of causes of fever based on pre-defined case definitions for each disease.

Secondary Outcome Measures:
  • 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. [ Time Frame: 1 year ]
    Nasopharyngeal respiratory viruses and bacteria documentation (presence/absence as well as pathogen loads) will be compared between patients with acute respiratory infection and a control group of healthy volunteers

Other Outcome Measures:
  • Strength of association between each febrile disease and diabetes mellitus and between acute respiratory infections and indoor air pollution [ Time Frame: 1 year ]
    Screening of diabetes mellitus and screening of exposure to indoor air pollution will be performed among patients with fever. The strength of association between diabetes and each type of febrile disease and exposure to indoor air pollution and acute respiratory infections will be measured.

Biospecimen Retention:   Samples With DNA
Whole blood Serum Sputa Urine

Enrollment: 538
Study Start Date: July 2013
Study Completion Date: July 2014
Primary Completion Date: July 2014 (Final data collection date for primary outcome measure)
Adults with fever
Every adult with fever will be screened for different infectious diseases and for nasopharyngeal respiratory viruses and bacteria
Healthy volonteers
For every adult with fever included with a diagnosis of pneumonia, a healthy volunteer will be included. These healthy volunteers will be screened for nasopharyngeal respiratory viruses and bacteria.


Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
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.

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
  Contacts and Locations
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Please refer to this study by its identifier: NCT01947075

Mwananyamala Hospital
Dar es Salaam, Tanzania
Sponsors and Collaborators
Swiss Tropical & Public Health Institute
Ifakara Health Institute
Principal Investigator: Valerie D'Acremont, MD PhD Swiss Tropical & Public Health Institute
  More Information

Responsible Party: Valérie D'Acremont, Investigator, Swiss Tropical & Public Health Institute Identifier: NCT01947075     History of Changes
Other Study ID Numbers: Fever Study
Adult Fever Study ( Other Identifier: SwissTPH )
Study First Received: September 13, 2013
Last Updated: August 20, 2014

Keywords provided by Swiss Tropical & Public Health Institute:
Indoor Air Pollution

Additional relevant MeSH terms:
Body Temperature Changes
Signs and Symptoms processed this record on May 23, 2017