Etiologies of Fever Among Adults in Dar es Salaam

NCT01947075 | Completed

• 2 other identifiers: Fever StudyAdult Fever Study
• Study Type: observational
• Target: 538
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Acute Febrile Illnesses

Keywords

Fever; Tanzania; Pneumonia; HIV; Diabetes; Indoor Air Pollution

Outcome Measures

Primary Outcomes (1)

• Proportion of patients with each disease among all febrile patients, overall and stratified by HIV status

  Description of the distribution of causes of fever based on pre-defined case definitions for each disease.

  1 year

Secondary Outcomes (1)

• 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.

  1 year

Other Outcomes (1)

• Strength of association between each febrile disease and diabetes mellitus and between acute respiratory infections and indoor air pollution

  1 year

Study Arms (2)

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 Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• 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.

You may qualify if:

• Temperature \>=38°C
• History of fever for less than 8 days
• First consultation for the present problem

You may not qualify if:

• 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

Sponsors & Collaborators

• Swiss Tropical & Public Health Institute: lead
• Ifakara Health Institute: collaborator

Study Sites (1)

Mwananyamala Hospital

Dar es Salaam, Tanzania

Location

Related Publications (2)

• Boillat-Blanco N, Klaassen B, Mbarack Z, Samaka J, Mlaganile T, Masimba J, Franco Narvaez L, Mamin A, Genton B, Kaiser L, D'Acremont V. Dengue fever in Dar es Salaam, Tanzania: clinical features and outcome in populations of black and non-black racial category. BMC Infect Dis. 2018 Dec 12;18(1):644. doi: 10.1186/s12879-018-3549-z.

  PMID: 30541456 DERIVED

• Boillat-Blanco N, Mbarack Z, Samaka J, Mlaganile T, Mamin A, Genton B, Kaiser L, Calandra T, D'Acremont V. Prognostic value of quickSOFA as a predictor of 28-day mortality among febrile adult patients presenting to emergency departments in Dar es Salaam, Tanzania. PLoS One. 2018 Jun 14;13(6):e0197982. doi: 10.1371/journal.pone.0197982. eCollection 2018.

  PMID: 29902174 DERIVED

Biospecimen

Retention: SAMPLES WITH DNA

Whole blood Serum Sputa Urine

MeSH Terms

Conditions

Fever; Pneumonia; Diabetes Mellitus

Condition Hierarchy (Ancestors)

Body Temperature Changes; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Respiratory Tract Infections; Infections; Lung Diseases; Respiratory Tract Diseases; Glucose Metabolism Disorders; Metabolic Diseases; Nutritional and Metabolic Diseases; Endocrine System Diseases

Study Officials

• Valerie D'Acremont, MD PhD

  Swiss Tropical & Public Health Institute

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Target Duration: 30 Days
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Investigator

Study Record Dates

• First Submitted: September 13, 2013
• First Posted: September 20, 2013
• Study Start: July 1, 2013
• Primary Completion: July 1, 2014
• Study Completion: July 1, 2014
• Last Updated: August 21, 2014

Record last verified: 2014-08

Locations

TA (1)