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Fever management practices among sickle cell disease programs in low and middle-income countries

key information

source: American Society of Pediatric Hematology/Oncology

year: 2016

authors: Catherine Taylor, Alexandra Coria, Venée N. Tubman

summary/abstract:

Under-5 mortality for children with sickle cell disease (SCD) in low and middle-income countries (LMIC) is high, with the majority of deaths likely related to infectious complications. In the United States, dramatic decreases in childhood mortality for SCD over the past 40 years have been aided by interventions to reduce mortality associated with infections. In LMIC, these interventions (i.e. penicillin prophylaxis, rapid investigation and treatment of febrile illness, and vaccination) may not be consistently available.

Design/Method: A survey of English and French-speaking providers at SCD programs in LMIC. The survey was available online and offline, distributed via email distribution lists, at applicable meetings, and by referral.

Results: Providers from 13 LMIC returned 27 interpretable surveys, including 23 from malaria-endemic areas. Newborn screening is associated with 34% (n=10/27) of programs. Pneumococcal conjugate vaccine is available at 66% (n=14/25) of programs. Penicillin prophylaxis is prescribed to some or all patients by 65% (n=17/26) of respondents. Malaria prophylaxis is prescribed by 83% (n=19/23) in malarial-endemic areas. Forty-eight percent of programs (n=14/27) have written fever management protocols. To patients with SCD presenting with fever, 21% (n=5/24) of respondents ‘always’ give antibiotics, although 54% (n=13/24) give antibiotics ‘almost always’. First line antibiotics are given orally by 27% (n=7/26); 77% (n=20/26) would consider oral antibiotics in some circumstances. The preferred first line antibiotic is ceftriaxone for 9/19 giving IV/IM antibiotics and amoxicillin-clavulanate for 4/7 giving oral antibiotics. At programs in malaria-endemic areas, 79% (n=18/23) ‘always’ or ‘almost always’ give antimalarials to febrile patients. Forty-six percent (n=12/26) of respondents report that a majority of febrile patients receive antibiotics prior to presentation. In malaria-endemic areas, 74% (n=17/23) report that a majority receive antimalarials prior to presentation.

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