Etiologies of Fever Among Adults in Dar es Salaam
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Purpose
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.
| Condition |
|---|
|
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 |
- Proportion of patients with each disease among all febrile patients, overall and stratified by HIV status [ Time Frame: 1 year ] [ Designated as safety issue: No ]Description of the distribution of causes of fever based on pre-defined case definitions for each disease.
- 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 ] [ Designated as safety issue: No ]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
- Strength of association between each febrile disease and diabetes mellitus and between acute respiratory infections and indoor air pollution [ Time Frame: 1 year ] [ Designated as safety issue: No ]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) |
| Groups/Cohorts |
|---|
|
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.
|
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
| Sampling Method: | Probability Sample |
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 LocationsPlease refer to this study by its ClinicalTrials.gov identifier: NCT01947075
| Tanzania | |
| Mwananyamala Hospital | |
| Dar es Salaam, Tanzania | |
| Principal Investigator: | Valerie D'Acremont, MD PhD | Swiss Tropical & Public Health Institute |
More Information
No publications provided
| Responsible Party: | Valérie D'Acremont, Investigator, Swiss Tropical & Public Health Institute |
| ClinicalTrials.gov Identifier: | NCT01947075 History of Changes |
| Other Study ID Numbers: | Fever Study, Adult Fever Study |
| Study First Received: | September 13, 2013 |
| Last Updated: | August 20, 2014 |
| Health Authority: | Tanzania: Ethical Committee |
Keywords provided by Swiss Tropical & Public Health Institute:
|
Fever Tanzania Pneumonia |
HIV Diabetes Indoor Air Pollution |
ClinicalTrials.gov processed this record on March 03, 2015