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. 2020 Mar;32(1):31-36.
doi: 10.4314/mmj.v32i1.7.

A 14-day follow-up of adult non-malarial fever patients seen by mobile clinics in rural Malawi

Kimberly A Baltzell  1   2 , Teresa Bleakly Kortz  3   1 , Alden Blair  1 , Ellen Scarr  2 , Andrew M Mguntha  4 , Gama Bandawe  5 , Ellen Schell  2   6 , Sally H Rankin  2
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A 14-day follow-up of adult non-malarial fever patients seen by mobile clinics in rural Malawi

Kimberly A Baltzell et al. Malawi Med J. 2020 Mar.

Abstract

Background: While health providers consistently use malaria rapid diagnostic tests to rule out malaria, they often lack tools to guide treatment for those febrile patients who test negative. Without the tools to provide an alternative diagnosis, providers may prescribe unnecessary antibiotics or miss a more serious condition, potentially contributing to antibiotic resistance and/or poor patient outcomes.

Methods: This study ascertained which diagnoses and treatments might be associated with poor outcomes in adults who test negative for malaria. Adult patients for rapid diagnostic test of malaria seen in mobile health clinics in Mulanje and Phalombe districts were followed for 14 days. Participants were interviewed on sociodemographic characteristics, health-seeking behaviour, diagnosis, treatment and access to care. Mobile clinic medical charts were reviewed. Two weeks (±2 days) following clinic visit, follow-up interviews were conducted to assess whether symptoms had resolved.

Results: Initially, 115 adult patients were enrolled and 1 (0.88%) was lost to follow-up. Of the 114 adult patients remaining in the study, 55 (48%) were seen during the dry season and 59 (52%) during the wet season. Symptoms resolved in 90 (80%) patients at the 14-day follow-up visit (n=90) with the rest (n=24) reporting no change in symptoms. None of the patients in the study died or were referred for further care. Almost all patients received some type of medication during their clinic visit (98.2%). Antibiotics were given to 38.6% of patients, and virtually all patients received pain or fever relief (96.5%). However, no anti-malarials were prescribed.

Conclusions: Mobile clinics provide important health care where access to care is limited. Although rapid tests have guided appropriate treatment, challenges remain when a patient's presenting complaint is less well defined. In rural areas of southern Malawi, simple diagnostics are needed to guide treatment decisions.

Keywords: Malawi; Non-malarial fever; antibiotic resistance; diagnostic tools; febrile illness; mobile clinics.

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Figures

Figure 1
Figure 1
Map of mobile clinic sites in Mulanje and Phalombe districts
Figure 2
Figure 2
Flowchart of eligible participants presenting at a mobile clinic with a non-malarial fever in the wet or dry season
Figure 3
Figure 3
Clinician diagnoses for eligible participants presenting with non-malarial fevers based on their status at follow up
Figure 4
Figure 4
Presenting complaint by outcome status at 14 day follow up with associate p-value, odds ratio (OR) and 95% confidence interval
Figure 5
Figure 5
Bar plot of factors associated with medical treatment for participants based on their outcome at follow up
See this image and copyright information in PMC

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