Improving clinical care of Febrile Illnesses in Nepal

Febrile illness is one of the most common reasons for seeking medical care and is a cause of significant morbidity and mortality in Nepal. There is limited data on the spectrum of illnesses presenting with febrile syndrome in the health care facilities. The scarcity of skilled personnel and adequate laboratory facilities makes the differential diagnosis of fevers even more complex. The difficulty in establishing the cause of febrile illnesses has resulted in omission or delays in treatment, irrational prescriptions with poly-therapy, increasing cost and the potential for development of drug resistance. This research project seeks to document the spectrum of etiology of febrile illness presenting to the health care facilities in Nepal. Also the health seeking behavior of the community to fever will be documented to get a better understanding including the perceptions of the faith healers and local pharmacies. Information of the etiology, clinical presentation and basic laboratory parameters in combination with the point of care RDT currently available for febrile illness will be utilized to develop an algorithm for the management of febrile illness cases. For this study, fever cases of ≥ 1 week presenting to BPKIHS, Dharan and from peripheral level of hospitals will be recruited and the etiology will be established. Qualitative studies on the health seeking behavior and perceptions of fever will be conducted in the community and will also include faith healers and local pharmacies. The study will also attempt to estimate the cost-of-illness in febrile patients presenting to a tertiary care and also primary level health facilities in Nepal from a societal perspective. An algorithm for clinical care of febrile syndrome will be developed taking the information of the etiology, clinical and laboratory parameters. This study will be carried out as a nested study within the frame work of NIDIAG project at B.P. Koirala Institute of Health Science (BPKIHS) Dharan, involving the peripheral level hospitals in the region.

Keywords:B680-public-health