# Clinical spectrum and management outcomes of acute febrile illness Among children attending health facilities in northwestern Tanzania, 2020–2021

## TL;DR

This study examines how children with fevers are diagnosed and treated in Tanzania, finding high rates of unnecessary antibiotic and antimalarial use.

## Contribution

The study provides insights into clinical management and prescription patterns of acute febrile illness in low-resource settings.

## Key findings

- Acute respiratory infections and malaria were the most common initial diagnoses among children with febrile illness.
- Over 29% of children received unnecessary antibiotics, and nearly 40% received antimalarials without confirmed malaria.
- Fever resolved in 96% of children by day 28, but complications like anemia and dehydration were common among hospitalized children.

## Abstract

The diagnostic challenges of febrile illness in children in low-resource settings and the risks of empirical overtreatment. We evaluated the range of clinical presentations and management outcomes in a cohort of children with acute febrile illness, building on our previous examination of the etiology of these illnesses.

This prospective cohort study enrolled children aged 1 to ≤12 years who were cared for by attending clinicians across primary, secondary, and tertiary healthcare settings. Management decisions were based on clinical presentation and laboratory and radiographic findings available on the day of enrollment. Outcomes were measured on days 7, 14, and 28. The study also analyzed prescription patterns for antibiotics and antimalarials in relation to established guidelines.

In this cohort of 434 children with acute febrile illness, the most common initial diagnoses were acute respiratory infections (31.3%, 136/434), of which upper respiratory tract infection (URTI) was observed in 57.0% (77/136) and pneumonia in 43.0% (59/136), followed by malaria (23.7%, 103/434). Antibacterial agents were prescribed to 65.3% (284/434) of children. Antibiotic overprescription was observed in 29.6% (84/285) of study participants. Antimalarial drugs were prescribed to 38.9% (169/434) of patients, including 103 patients judged to have malaria by a positive MRDT or a positive blood smear. A total of 66 (39.0%) patients who received antimalarial drugs were negative for either MRDT or blood smear. Fever resolved in 398 children (96.0%, 386/402) by day 28 of follow-up. The most commonly documented complications among admitted children included anemia (36.0%), dehydration (9.1%), shock (8.5%), and acute kidney injury (8.5%). Overall mortality at day 28 was 1.0% (4/434).

In environments with limited diagnostic resources, children with acute febrile illness are often treated empirically. This results in significant overprescription of antibiotics and antimalarials. While short-term results are usually positive, such practices raise concerns about antimicrobial resistance and adherence to guidelines. Better access to point-of-care diagnostics can help decrease inappropriate prescriptions and improve care quality.