@article{Kiemde2022,

title = {Development and evaluation of an electronic algorithm using a combination of a two-step malaria RDT and other rapid diagnostic tools for the management of febrile illness in children under 5 attending outpatient facilities in Burkina Faso},

author = {Francois Kiemde and Adelaide Compaore and Fla Koueta and Athanase M. Some and Berenger Kabore and Daniel Valia and Toussaint Rouamba and Fadima Yaya Bocoum and Seydou Sawadogo and Macaire Nana and Diane Y. Some and Nadine A. Kone and Valentin Pagbeleguem and Inoussa Sangare and Antonia W. Bere and Massa Achille Bonko and Gautier Tougri and Sylvie Yeri Youl and Henk Schallig and Halidou Tinto},

editor = {Lucinda Shen},

url = {https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-022-06717-8},

doi = {10.1186/s13063-022-06717-8},

issn = {1745-6215},

year  = {2022},

date = {2022-01-01},

journal = {Trials},

volume = {23},

issue = {1},

pages = {779},

abstract = {BACKGROUND In Sub-Saharan Africa (SSA), febrile illnesses remain a major public health problem in children. However, the persistence of hrp2 antigen and the low sensitivity of pLDH RDT negatively affect antimalarials and antibiotics prescription practices. These limitations lead to poor management of febrile diseases and antimicrobial resistance (AMR). To improve the diagnosis of these febrile diseases and subsequent prescription of antimicrobials, it is hypothesized that the implementation of an algorithm including a two-step malaria RDT PfHRP2/pLDH supported by point-of-care (PoC) tests for bacterial infections could significantly improve the management of febrile diseases and thereby tackling AMR. METHODS To assess the value of the proposed algorithm, an open-label randomized controlled trial with three arms, enrolling febrile children from 6 to 59 months is proposed. In the control arm, febrile children will be managed according to the Integrated Management of Childhood Illnesses (IMCI), which is part of the standard of care in Burkina Faso. Treatment will be done according to national guidelines. In the RDT decisional algorithm (RDT-DA) arm (intervention), the clinical examination based on IMIC will be supported by a two-step malaria RDT and bacterial infections RDTs. Prescription will be left to the discretion of the healthcare workers based on clinical examination and PoC test results. In the e-algorithm arm (intervention), artificial intelligence integrating multiple layers of clinical information such as clinical examination, signs/symptoms and medical history, and biological information such as biomarkers (CRP and WBC) and pathogen-specific PoC tests, and oximetry will be developed. The e-algorithm will serve to guide the diagnostic and management of febrile infections in children. In the 3 arms, the case report forms will be digitalized. A final follow-up visit (day 7) will be scheduled for all participants. Patients will be asked to come back to the health facilities before the scheduled visit if the symptoms persist or in case of health condition worsening. DISCUSSION If successful, this study could contribute to improve the management of febrile diseases and reduce inappropriate use of antimicrobials. TRIAL REGISTRATION The trial is registered at ClinicalTrial.gov, NCT05285657. Enrolment started on 4 March 2022 with long-term outcome being assessed completely by 2023.},

keywords = {Artificial intelligence, e-Algorithm, Fever, Prescription, Rapid diagnostic test},

pubstate = {published},

tppubtype = {article}

}

@article{nokey,

title = {Aetiologies of non-malaria febrile episodes in children under 5 years in sub-Saharan Africa.},

author = {Francois Kiemde and Ren\'{e} Spijker and Petra F. Mens and Halidou Tinto and Michael Boele and Henk D. F. H. Schallig},

year  = {2016},

date = {2016-08-01},

journal = {Tropical medicine \& international health : TM \& IH},

volume = {21},

issue = {8},

pages = {943-955},

address = {England},

abstract = {OBJECTIVES: To provide an overview of the most frequent aetiologies found in febrile episodes of children under 5 years from sub-Saharan Africa. METHODS: MEDLINE and EMBASE were searched for publications in English and French on non-malaria fever episodes in African children under 5 years of age, which were published between January 1990 and July 2015. Case reports and conference abstracts were excluded. RESULTS: In total, 3851 titles and abstracts were reviewed, and 153 were selected for full screening of which 18 were included in the present review. Bloodstream infection (BSI) was most commonly investigated (nine of 18) followed by urinary tract infection (UTI) (four of 18) and respiratory tract infection (RTI) (two of 18). Few studies investigated BSI and UTI in the same children (two of 18), or BSI and gastrointestinal infection (GII) (one of 18). As for BSI, the most frequently isolated bacteria were E. coli (four of 12), Streptococcus pneumonia (four of 12), Salmonella spp (three of 12) and Staphylococcus aureus (two of 12) with a positive identification rate of 19.7-33.3%, 5.2-27.6%, 11.7-65.4% and 23.5-42.0%, respectively. As for UTI, the main bacteria isolated were E. coli (six of six) and Klebsiella spp (six of six) with a positive rate of 20.0-72.3% and 10.0-28.5%, respectively. No bacterium was isolated in RTI group, but Human influenzae A and B were frequently found, with the highest positive identification rate in Tanzania (75.3%). Dengue virus (two of 12) was the most frequently reported viral infection with a positive identification rate of 16.7-30.8%. Finally, only rotavirus/adenovirus (69.2% positive identification rate) was found in GII and no bacterium was isolated in this group. CONCLUSIONS: The high prevalence of treatable causes of non-malaria fever episodes requires a proper diagnosis of the origin of fever followed by an appropriate treatment, thereby reducing the under-5 mortality in sub-Saharan Africa and preventing the overprescription of antibiotics and thus circumventing the rise of antibiotic resistance.},

keywords = {aetiology, \'{A}frica subsahariana, Afrique subsaharienne, Children, enfants, etiolog\'{i}a, \'{e}tiologie, Fever, fiebre, fi\`{e}vre, Malaria, ni\~{n}os, paludisme, sub-Saharan Africa},

pubstate = {Publisher},

tppubtype = {article}

}