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Review
. 2021 Jun;11(2):283-296.
doi: 10.1016/j.afjem.2020.11.004. Epub 2021 Apr 10.

Management of acute fever in children: Consensus recommendations for community and primary healthcare providers in sub-Saharan Africa

Robin Green  1 , David Webb  2 , Prakash Mohan Jeena  3 , Mike Wells  4 , Nadia Butt  5 , Jimmy Mapenzi Hangoma  6 , Rajatheran Sham Moodley  7 , Jackie Maimin  8 , Margreet Wibbelink  9 , Fatima Mustafa  10
Affiliations
Review

Management of acute fever in children: Consensus recommendations for community and primary healthcare providers in sub-Saharan Africa

Robin Green et al. Afr J Emerg Med. 2021 Jun.

Abstract

Fever is one of the most common reasons for unwell children presenting to pharmacists and primary healthcare practitioners. Currently there are no guidelines for assessment and management of fever specifically for community and primary healthcare workers in the sub-Saharan Africa region. This multidisciplinary consensus guide was developed to assist pharmacists and primary healthcare workers in sub-Saharan Africa to risk stratify and manage children who present with fever, decide when to refer, and how to advise parents and caregivers. Fever is defined as body temperature ≥ 37.5 °C and is a normal physiological response to illness that facilitates and accelerates recovery. Although it is often associated with self-limiting illness, it causes significant concern to both parents and attending healthcare workers. Clinical signs may be used by pharmacy staff and primary healthcare workers to determine level of distress and to distinguish between a child with fever who is at high risk of serious illness and who requires specific treatment, hospitalisation or specialist care, and those at low risk who could be managed conservatively at home. In children with warning signs, serious causes of fever that may need to be excluded include infections (including malaria), non-infective inflammatory conditions and malignancy. Simple febrile convulsions are not in themselves harmful, and are not necessarily indicative of serious infection. In the absence of illness requiring specific treatment, relief from distress is the primary indication for prescribing pharmacotherapy, and antipyretics should not be administered with the sole intention of reducing body temperature. Care must be taken not to overdose medications and clear instructions should be given to parents/caregivers on managing the child at home and when to seek further medical care.

Keywords: Childhood; Febrile; Fever; Primary healthcare; Sub-Saharan Africa.

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Conflict of interest statement

The development of this document was supported by an unconditional grant from Reckitt Benckiser. The sponsor did not participate in the development or writing of the document. RJG has been a member of the speakers bureau for Reckitt Benckiser, GlaxoSmithKline and Adcock Ingram. DW is a medical writer and reports personal fees from Reckitt Benckiser during development of this work; personal fees from Adcock Ingram, Astra Zeneca, Cipla, Fresenius Kabi, Litha, MSD, MundiPharma, Mylan, Novartis, Novo Nordisk, Pfizer, Pharma Dynamics, Reckitt Benkiser, and Sanofi-Aventis outside the submitted work. PMJ has been a member on the speaker bureau for Reckitt Benckiser, MSD and Pfizer. RM has been a member of the speaker's panel for Pfizer Consumer, Astra Zeneca, Reckitt Benckiser, Adcock Ingram, Mylan and Aspen Pharmacare. JM has been an advisor to, and received payment for travel from, Reckitt Benckiser. MW is an editor of the African Journal of Emergency Medicine. MW was not involved in the editorial workflow for this manuscript. The African Journal of Emergency Medicine applies a double blinded process for all manuscript peer reviews. The authors declared no further conflict of interest.

Figures

Fig. 1
Fig. 1
Approach to management of a child with fever who is at risk of malaria. Hb: haemoglobin; BF: blood film; RDT: rapid diagnostic test. Adapted with permission from World Health Organisation (WHO). WHO Informal Consultation On Fever Management In Peripheral Health Care Settings. A Global Review Of Evidence And Practice. Geneva, WHO Press; Copyright (2013). p16. https://www.who.int/malaria/publications/atoz/9789241506489/en/.
See this image and copyright information in PMC

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