Community-Level Management of Unclassified Fever

Research Overview

TRAction is currently funding a research study in Ethiopia to explore the safety of a systematic versus conditional 3-day follow up visit by a community health worker (CHW) for children with uncomplicated fever. There is limited evidence on which of the two interventions is safer for the child.  Children with untreated persistent fever may be at risk of severe outcomes if caregivers do not follow conditional follow-up advice.  However, a systematic follow-up visit for all children can waste the time and resources of CHWs and it is unclear whether this follow-up visit is even necessary.  The Malaria Consortium will implement this study in the Southern Nations, Nationalities, and People's Regional State in Ethiopia to assess the non-inferiority of WHO-recommended systematic follow-up on day 3 compared to conditional follow-up for non-severe febrile illness in children age 2 to 59 months in which no cause of fever can be identified and where danger signs are absent.

Project Location

Ethiopia: Southern Nations, Nationalities, and People’s Regional State

Research Objectives and Design

The objectives of the research are to:

• Assess the safety of a systematic 3-day follow-up for children with uncomplicated fever managed at the community level, compared to a conditional visit on non-resolution of symptoms.
• Describe the clinical presentation and outcome of illness in children where symptoms do not resolve or where danger signs develop.
• Determine the proportion of children who return for scheduled visits on Day 3 or spontaneous visits before Day 7
• Measure the rate of hospitalization up to Day 7
• Determine the proportion of children who develop danger signs requiring referral (i.e. clinical deterioration)

Researchers will use a two-arm cluster-randomized, community-based non-inferiority trial to address the research objectives.

• Arm 1: Conditional follow-up visit (control)
• Arm 2: Systematic follow-up visit (intervention)

Researchers have completed sensitization, development of data collection tools, community mobilization, and training of CHWs, and are in the process of study implementation. 

Research Partners

Malaria Consortium UK

Principal Investigator: Dr. Karin Kallander

Malaria Consortium Ethiopia

Project Status