Improving the clinical management and facility-based surveillance of febrile illness in rural Guinea: a multidisciplinary approach

Febrile illness constitutes a frequent and major diagnostic challenge in tropical areas due to the non-specific clinical presentation and lack of appropriate diagnostic tools particularly in sub-Saharan African (SSA). The declining incidence of clinical malaria is associated with a proportional increase of undetermined etiologies of fever, which are usually treated with antibiotics by first-line clinicians, as a default option.

It is likely that an important proportion of febrile illness cases in West Africa are due to viral pathogens, especially those fevers presenting with respiratory symptoms or with no focus of infection. In addition, a country like Guinea is regularly affected by epidemic-prone pathogens causing viral hemorrhagic fever (Ebola, Lassa, yellow fever, …) and arboviral outbreaks (dengue, chikungunya, …) to name a few. However, the lack of diagnostic capacity, especially in rural areas, makes both the appropriate case management of fever and the early recognition of outbreaks extremely difficult, resulting in massive overuse of (unnecessary) antibiotics on the one hand, and major delay in outbreak response on the other hand.

In this regard, the present doctoral research aims to address several knowledge gaps on febrile illness in Guinea. First, in a retrospective study I surveyed the syndromic patterns and clinical management of in- and outpatients presenting with fever at two study facilities in the rural district of Forécariah, Guinea. Second, within an already completed international multicentric prospective cohort study (Fever cohort 1, within the “Febrile Illness in Sub-Saharan Africa”, FISSA, study), I am currently documenting the severity of febrile illness and the frequency and the risk factors of adverse outcome at the primary health center of Maferinyah. Finally, in a second multicentric prospective cohort study of febrile patients (Fever cohort 2), part of the larger MuSIFe (Multidisciplinary Surveillance and Investigation of Febrile Illness in Guinea) project which is about to start, I will (i) determine the biomarkers profile and viral etiologies of febrile illness among in- and outpatients attending the two study facilities of Forécariah, (ii) assess the field accuracy of the clinical case definitions currently used by the Guinean National Agency of Health Security (ANSS) for the surveillance of epidemic-prone infections and contribute to optimize and update them based on the generated evidence; and (iii) document the improvement of clinical management with novel diagnostic tools (laboratory biomarkers and smartphone-based decision aid for the primary care; panoramas for the secondary care) in febrile in- and outpatients at the two study facilities of Forécariah.

We believe this PhD research will contribute to reduce the diagnostic uncertainties about febrile illness and to contain the widespread inappropriate antibiotics prescription as a default option in rural Guinea. It will also provide an invaluable source of baseline clinical information and well-documented biobanked samples that will allow, beyond this PhD, secondary research on viral and bacterial etiologies of fever with more advanced metagenomic methods