Provider Practices with Childhood Non-Malarial Fevers: A Pilot Study in Zanzibar

Malaria has dominated the illness landscape in sub-Saharan Africa for many decades and fevers in children have typically been treated as malaria without laboratory confirmation. Recently, several parts of Africa have dramatically reduced malaria by employing multiple prevention tools and improving case management. In Zanzibar, 98 out of every 100 hundred febrile patients recently seen in clinics have tested negative for malaria. Despite the reduction in malaria cases, health care providers continue to clinically diagnose most cases of fever as malaria, wasting resources and potentially limiting attention to other treatable conditions. I have recently completed a study in Zanzibar which confirmed the accuracy of new immunochromatographic rapid diagnostic tests used for malaria detection. The ability to easily rule out malaria as a cause of febrile illness will facilitate strategies for the diagnosis and management of non-malarial fevers in settings of decreased malaria transmission. An accurate appreciation of diagnostic and treatment practices is an essential prerequisite to improving management of febrile illness in Zanzibar. Therefore, I will determine the specific diagnoses and treatments assigned by health care providers to febrile patients who test negative for malaria (Aim 1) and explore health care provider practices leading to the diagnosis and treatment of febrile patients in Zanzibar (Aim 2). I hypothesize that 1) health clinic providers in Zanzibar continue to overdiagnose and manage fevers as malaria and 2) health care provider practices in rural health clinics are influenced by available diagnostic tools, level of training and history of malaria prevalence in the clinic area. The results of this pilot study will be used in an application for NIH funding.