Universal versus conditional day 3 follow-up for children with non-severe unclassified fever at the community level in Ethiopia: A cluster-randomised non-inferiority trial

by Karin K ällander, Tobias Alfvén, Tjede Funk, Ayalkibet Abebe, Abreham Hailemariam, Dawit Getachew, Max Petzold, Laura C. Steinhardt, Julie R. Gutman BackgroundWith declining malaria prevalence and improved use of malaria diagnostic tests, an increasing proportion of children seen by community health workers (CHWs) have unclassified fever. Current community management guidelines by WHO advise that children seen with non-severe unclassified fever (on day 1) should return to CHWs on day 3 for reassessment. We compared the safety of conditional follow-up reassessment only in cases where symptoms do not resolve with universal follow-up on day 3. Methods and findingsWe undertook a 2-arm cluster-randomised controlled non-inferiority trial among children aged 2 –59 months presenting with fever and without malaria, pneumonia, diarrhoea, or danger signs to 284 CHWs affiliated with 25 health centres (clusters) in Southern Nations, Nationalities, and Peoples’ Region, Ethiopia. The primary outcome was treatment failure (persistent fever, development of dang er signs, hospital admission, death, malaria, pneumonia, or diarrhoea) at 1 week (day 8) of follow-up. Non-inferiority was defined as a 4% or smaller difference in the proportion of treatment failures with conditional follow-up compared to universal follow-up. Secondary outcomes included the percent age of children brought for reassessment, antimicrobial prescription, and severe adverse events (hospitalisations and deaths) aft...
Source: PLoS Medicine - Category: Internal Medicine Authors: Source Type: research