Research Article: Factors associated with treatment type of non-malarial febrile illnesses in under-fives at Kenyatta National Hospital in Nairobi, Kenya

Date Published: June 13, 2019

Publisher: Public Library of Science

Author(s): Borna A. Nyaoke, Marianne W. Mureithi, Caryl Beynon, Mehreen Arshad.


Non-malarial febrile illnesses comprise of almost half of all fever presenting morbidities, among under-five children in sub-Saharan Africa. Studies have reported cases of prescription of antimalarial medications to these febrile under-fives who were negative for malaria. The treatment of these children with antimalarial medications increases incidences of antimalarial drug resistance as well as further morbidities and mortalities, due to failure to treat the actual underlying causes of fever.

To identify clinical and demographic factors associated with treatment type (malarial/non-malarial) of non-malarial febrile illnesses (NMFI) in children aged ≤5 at the Kenyatta National Hospital in Nairobi, Kenya.

A positivist epistemological approach, cross sectional descriptive study design was used. A structured questionnaire was used on a sample of 341 medical records of children aged ≤5 years to extract data on clinical examinations (recorded as yes or no), diagnostic test results, and demographic data on the child’s sex and age. Descriptive and inferential analysis was applied to the data.

Prescription of antimalarial drugs despite negative microscopy results was found in 44 (12.9%) of the children, with mortality reported in 48 (14.1%). Assessment of respiratory distress was 0.13 (0.03,0.58) times associated with less likelihood of prescribing an antimalarial in those with a negative microscopy. A male patient was 0.21 (0.05,0.89) times less likely to receive an intravenous antimalarial after a negative microscopy. Patients aged ˂1 with a negative microscopy result were more likely to receive an antimalarial than older children.

There is a need to eliminate incorrect treatment of NMFI with antimalarial medication, while ensuring correct diagnosis and treatment of the specific illness occurs. This requires strengthening and adherence to diagnostic and treatment guidelines of febrile illnesses in under-fives, consequently reducing morbidities and mortalities associated with inadequate management of NMFIs.

Partial Text

Malaria is a serious and sometimes life-threatening infectious disease that affects humans and other animals, caused by several species of the Plasmodium parasite and transmitted by the bite of an infected Anopheles mosquito. Malaria typically manifests as a febrile illness that can be fatal if unrecognized, especially in young children. Approximately 3.2 billion people live in malaria endemic areas, and, in 2015, there were an estimated 214 million cases and 438,000 deaths attributable to the disease. Most of these deaths occurred in sub-Saharan African countries in children under five years of age [1]

The study used records from 341 children aged five years and under with fever of 38°C and above. The study findings were categorized into the following themes:

This study supports that clinical and demographic factors such as age, gender and assessment of presence or absence of respiratory distress are predictors of prescription of antimalarial drugs in under-fives. Tackling the NMFI challenge requires a concerted effort, to eliminate incorrect treatment with antimalarial medication, while ensuring correct diagnosis and treatment of the specific illness occurs.