Analysis of infectious diseases in rural tropical areas.
A study of 256 annual reports from 17 rural tropical hospitals in 4 African countries over a period of 16 years showed an absolute increase in the number of patients admitted with infectious diseases. Admissions were highest for malaria, followed by pneumonia and gastroenteritis. Admissions for immunisable diseases are decreasing in all countries. Fever remains the most important indicator of infectious diseases. Analysis of fever patients in rural tropical hospitals relies on knowledge of the epidemiology of diseases, plus expertise in physical examination. In this study, a detailed analysis of 900 fever patients indicated that 4% showed no infection, 21% of infections could be diagnosed by physical examination, 35% were diagnosed with the help of additional laboratory tests and 40% of patients were diagnosed as FUO (fever of unknown origin). 17% of FUO patients had a short, self limiting fever, but the remaining 23% were severely ill, suggesting bacterial sepsis, as was indicated by earlier studies. Undiagnosed fevers with resulting over-treatment and high resistance are costly and dangerous. These effects stress the need for better and more laboratory facilities, including possibilities for bacterial cultures. At present, patients are generally over-treated with antimalarials and antibiotics, since further diagnostic facilities are not available. Resistance is high for antimalatials ( Malaria) and for Amoxycillin, Cotrimoxazole and Gentamicin (Gram-bacteria from urine and blood).
Petit
P. L.C.
PL
Department of Medical Microbiology, University Hospital Leiden, P.O. Box 9600, 2300 RC Leiden, The Netherlands.