London School of Hygiene & Tropical Medicine

What are the main causes of fever in sub-Saharan Africa and Asia, and how should they be treated? Are pathogens developing resistance to drugs used to treat fever patients in that part of the world? These questions are the focus of a global study led by the London School of Hygiene & Tropical Medicine.

The four-year FIEBRE (Febrile Illness Evaluation in a Broad Range of Endemicities) project is funded by the UKAid from the Department for International Development. It will be conducted with the Liverpool School of Tropical Medicine, Barcelona Institute for Global Health (ISGlobal, Spain) the Universities of Oxford, and Otago, as well as partner institutions within five study countries - Laos, Malawi, Mozambique, Myanmar and Zimbabwe.

By identifying the treatable and preventable causes of febrile illness in the region, and how patients with fever are cared for, the researchers aim to design new evidence-based guidelines for the management of fever. This will ensure patients receive drugs that give them the best chance of recovery, as well as help stop the spread of antimicrobial resistance - a major global health problem.

Fever is one of the most common symptoms that leads people living in sub-Saharan Africa and Asia to seek healthcare or be admitted to hospital. However, very few studies have examined the reasons why people develop it. Until recently, most febrile illness in this part of the world was attributed to malaria, but wider access to improved diagnostics has revealed that most patients with a fever do not have malaria.

FIEBRE is a multi-disciplinary project that brings together laboratory science, clinical epidemiology, social science, and data management and archiving. It will investigate the leading causes of fever in children and adults attending primary care health services and those admitted to district hospitals in the five study countries.

Another arm of the study will involve interviews and focus group discussions with local adults and families, prescribers, and workers who generate and implement clinical guidelines. The aim is to reveal how fever is treated at health facilities at a local level, including the use of antimicrobial drugs.

David Mabey, Professor of Communicable Diseases at the London School of Hygiene & Tropical Medicine and Principal Investigator of the FIEBRE project, said: “The world has made great strides in tackling malaria. Surprisingly, there has been limited research on other potential causes of febrile illness, such as infections by bacteria, viruses, and fungi, and the World Health Organization does not provide specific guidance on the management of non-malarial fevers.

“We want to identify the treatable and preventable causes of fever in children and adults in Africa and Asia, and to identify those most at risk of different infections. Our goal is to develop guidelines that can be a blueprint for the effective management of patients with fever in different settings.”

The researchers believe that that these new treatment protocols will have the potential to safely reduce prescription of antimicrobial drugs and improve patient care.

Prof Mabey said: “Antimicrobial resistance is one of the greatest health challenges of our time. Tackling it means solving a wide-range of issues, including the culture of prescribing drugs ‘just in case’ which exists in many countries around the world. By studying outpatients we can ensure appropriate antimicrobial drugs are being prescribed, while our inpatient study hopes to reduce deaths by ensuring that patients receive the most appropriate available treatment.”

FIEBRE will also see the development of the first bank of biomedical samples collected from a large group of fever patients from diverse settings in sub-Saharan Africa and Asia. This unique archive will give researchers the tools to evaluate new diagnostic tests that differentiate between bacterial and viral infections. These could have a major global impact on antimicrobial resistance by limiting the unnecessary use of antimicrobials.