title: Factors associated with mortality in febrile patients in a government referral hospital in the Kenema district of Sierra Leone.
abstract: There is a paucity of data on the etiologies and outcomes of febrile illness in rural Sierra Leone, especially in the Lassa-endemic district of Kenema. We conducted a retrospective study of patients with subjective or documented fever (T ≥ 38.0°C) who were admitted to a rural tertiary care hospital in Kenema between November 1, 2011 and October 31, 2012. Of 854 patients admitted during the study period, 429 (50.2%) patients had fever on admission. The most common diagnoses were malaria (27.3%), pneumonia (5.1%), and Lassa fever (4.9%). However, 53.4% of febrile patients had no diagnosis at discharge. The in-hospital mortality rate was 18.9% and associated with documented temperature ≥ 38.0°C (adjusted odds ratio [AOR] = 2.89, P = 0.001) and lack of diagnosis at discharge (AOR = 2.04, P = 0.03). Failure to diagnose the majority of febrile adults and its association with increased mortality highlight the need for improved diagnostic capacity to improve patient outcomes.
authors.affiliation: Department of Medicine, University of Illinois at Chicago School of Medicine, Chicago, Illinois; Kenema Government Hospital, Kenema, Sierra Leone; College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; Department of Medicine, Tulane University, New Orleans, Louisiana; Department of Medicine, University of Washington, Seattle, Washington.
authors.forename: Prerana J
authors.initials: PJ
authors.lastname: Roth
authors.affiliation: Department of Medicine, University of Illinois at Chicago School of Medicine, Chicago, Illinois; Kenema Government Hospital, Kenema, Sierra Leone; College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; Department of Medicine, Tulane University, New Orleans, Louisiana; Department of Medicine, University of Washington, Seattle, Washington.
authors.forename: Donald S
authors.initials: DS
authors.lastname: Grant
authors.affiliation: Department of Medicine, University of Illinois at Chicago School of Medicine, Chicago, Illinois; Kenema Government Hospital, Kenema, Sierra Leone; College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; Department of Medicine, Tulane University, New Orleans, Louisiana; Department of Medicine, University of Washington, Seattle, Washington.
authors.forename: Amara S
authors.initials: AS
authors.lastname: Ngegbai
authors.affiliation: Department of Medicine, University of Illinois at Chicago School of Medicine, Chicago, Illinois; Kenema Government Hospital, Kenema, Sierra Leone; College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; Department of Medicine, Tulane University, New Orleans, Louisiana; Department of Medicine, University of Washington, Seattle, Washington.
authors.forename: John
authors.initials: J
authors.lastname: Schieffelin
authors.affiliation: Department of Medicine, University of Illinois at Chicago School of Medicine, Chicago, Illinois; Kenema Government Hospital, Kenema, Sierra Leone; College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; Department of Medicine, Tulane University, New Orleans, Louisiana; Department of Medicine, University of Washington, Seattle, Washington.
authors.forename: R Scott
authors.initials: RS
authors.lastname: McClelland
authors.affiliation: Department of Medicine, University of Illinois at Chicago School of Medicine, Chicago, Illinois; Kenema Government Hospital, Kenema, Sierra Leone; College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; Department of Medicine, Tulane University, New Orleans, Louisiana; Department of Medicine, University of Washington, Seattle, Washington ojarrett@uic.edu.
authors.forename: Olamide D
authors.initials: OD
authors.lastname: Jarrett
mesh_terms: D000328:Adult; D005260:Female; D005334:Fever / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D012807:Sierra Leone / Q000453:epidemiology; D062606:Tertiary Care Centers; D055815:Young Adult