DIFFERENT CAUSES OF ILLNESS AMONG ADULTS AND CHILDREN HAVING FEVER ATTENDING HEALTH CARE SERVICES IN MADAGASCAR

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1 MEDICAL SCHOOL OF ANTANANARIVO UNIVERSITY DIFFERENT CAUSES OF ILLNESS AMONG ADULTS AND CHILDREN HAVING FEVER ATTENDING HEALTH CARE SERVICES IN MADAGASCAR Prof Randria Mamy Infectious diseases specialist

2 Data sources University Hospital Center (CHU) data : 2 centers University Hospital Joseph Raseta Befelatanana (CHU-JRB) Infectious diseases Unit Hepato-gastroenterology Unit Pneumology Unit Pediatric Unit University Pediatric Hospital Tsaralalana (CHU-MET) 2

3 Data sources Data from 30 districts Direction of Health Monitoring and Disease Surveillance (DVSSE) 3

4 Size University Hospital Joseph Raseta Befelatanana (CHU-JRB) Acute fever CHU-JRB < 5 y > 5 y ,4% ,5% ,6% Year 4

5 Year and ages Acute fever CHU-JRB > 5 y (53,6%) < 5 y (40,1%) > 5 y (38,4%) Acute undifferentiated fever Fever with rash Fever with ARDS < 5 y (42,6%) Fever with respiratory symptoms > 5 y (32,9%) Febrile encephalopathy / Acute encephalitic syndrome Fever with multiorgan dysfunction Fever with Gastrointestinal symptoms Fever with other focus < 5 y (46,6%) Size 5

6 Year and ages 2018 Acute fever CHU-JRB 2018 > 5 y (23%) < 5 y (21,6%) Size Acute undifferentiated fever Fever with rash Fever with ARDS Fever with respiratory symptoms Febrile encephalopathy / Acute encephalitic syndrome Fever with multiorgan dysfunction Fever with Gastrointestinal symptoms Fever with other focus 6

7 University Hospital Joseph Raseta Befelatanana (CHU-JRB) Plague Epidemic Started : August 2017 World Health Organization : 1506 cases between August 1st - October 30th Measles Epidemic Started : October 2018 Minister of public health : more than cases Low vaccination rate 7

8 Size Chronic fever CHU-JRB 400 < 5 y > 5 y Year 8

9 Size Chronic fever CHU-JRB Chronic Fever of Known Origin Chronic Fever of Unknown Origin-(FOU) < 5 y > 5 y < 5 y > 5 y < 5 y > 5 y < 5 y > 5 y Year and ages 9

10 Year and ages University Hospital Joseph Raseta Befelatanana (CHU-JRB) Acute fever and chronic fever > 5 y < 5 y > 5 y < 5 y > 5 y < 5 y > 5 y < 5 y Size Chronic fever Acute fever 10

11 11

12 University Hospital Joseph Raseta Befelatanana (CHU-JRB) Infectious diseases unit in 2018 Number of hospitalisation : 648 patients Febrile diseases : 472 (72,83%) Pediatric unit in 2018 Number of hospitalisation : 2207 patients Febrile diseases : 1333 (60,39%) 12

13 University Hospital Joseph Raseta Befelatanana (CHU-JRB) Infectious diseases unit in 2018 Diagnostic n % Measles Tuberculosis (without HIV) Malaria HIV infection Bacterial pneumonia CNS bacterial infection* Typhoid fever and febrile diarrhea Urinary tract infection Other TOTAL ,69 21,40 15,47 13,35 07,20 05,08 04,45 02,33 04, *central nervous system 13

14 University Hospital Joseph Raseta Befelatanana (CHU-JRB) Pediatric unit in 2018 Diagnostic n % Measles Neonatal infection Bronchiolitis Gastroenteritis Bacterial pneumonia CNS infection* Other TOTAL ,86 17,93 17,33 11,63 09,30 06,00 10, *central nervous system 14

15 Site Capacity Description CHU-JRB LABORATORY Availability Equipment / Type Numbers performed per month Blood culture Oui MANUAL 56 CSF cultures Oui MANUAL 33 Other Microbiological cultures Oui MANUAL 160 Realtime PCR for pathogen detection Non CLINICAL Hospital level Answer Tertiary In-patients and outpatients average admissions per months IN PATIENTS : 1300 Hospital number of beds

16 Size University Pediatric Hospital Tsaralalana CHU-MET Children admited for fever Year No of Cases < 5 y No of Cases > 5 y Decrease by 40% admission capacity due the renovation of the hospital 16

17 17

18 Site Capacity Description CHU-MET LABORATORY Availability Equipment / Type Numbers performed per month Blood culture YES MANUAL 19 CSF cultures YES MANUAL 31 Other Microbiological cultures YES MANUAL 37 Realtime PCR for pathogen detection NO CLINICAL Hospital level Answer TERTIARY In-patients and outpatients average admissions per months IN PATIENTS : 195 Hospital number of beds 59 18

19 Size CHU-MET vs CHU-JRB Number of children admitted into hospital due to febrile illness at CHU-MET and CHU-JRB Year CHUMET CHUJRB 19

20 Direction of Health Monitoring and Disease Surveillance Epidemiological surveillance The main causes of fever in the 30 districts in Madagascar 1 st : fever + gastrointestinal symptoms 2 rd : fever + respiratory symptoms 20

21 Size Direction of Health Monitoring and Disease Surveillance Fever with gastrointestinal symptoms Year No of Cases < 5 y No of Cases > 5 y 21

22 Size Direction of Health Monitoring and Disease Surveillance Fever with respiratory symptoms Year No of Cases < 5 y No of Cases > 5 y 22

23 Conclusion Causes of illness among adults and children having fever In hospitals 1 st : fever + respiratory symptoms Direction of health monitoring and diseases surveillance 1 st : fever + gastrointestinal symptoms Change of the deal during the epidemics 23

24 THANK YOU FOR YOUR ATTENTION

Acute Febrile Ilness. Brazil Marilda M Siqueira National Influenza Center/MoH, WHO National MR Laboratory/MoH,WHO

Acute Febrile Ilness. Brazil Marilda M Siqueira National Influenza Center/MoH, WHO National MR Laboratory/MoH,WHO Acute Febrile Ilness Brazil - 2019 Marilda M Siqueira National Influenza Center/MoH, WHO National MR Laboratory/MoH,WHO Introduction Aetiology of fever in Brazil- range of viruses and bacteria as elsewhere.