title: Dengue and Chikungunya fever among viral diseases in outpatient febrile children in Kilosa district hospital, Tanzania.
abstract: BACKGROUND
  Viral etiologies of fever, including dengue, Chikungunya, influenza, rota and adeno viruses, cause major disease burden in tropical and subtropical countries. The lack of diagnostic facilities in developing countries leads to failure to estimate the true burden of such illnesses, and generally the diseases are underreported. These diseases may have similar symptoms with other causes of acute febrile illnesses including malaria and hence clinical diagnosis without laboratory tests can be difficult. This study aimed to identify viral etiologies as a cause of fever in children and their co-infections with malaria.
  
  
  METHODS
  A cross sectional study was conducted for 6 months at Kilosa district hospital, Tanzania. The participants were febrile children aged 2-13 years presented at the outpatient department. Diagnostic tests such as IgM and IgG ELISA, and PCR were used.
  
  
  RESULTS
  A total of 364 patients were enrolled, of these 83(22.8%) had malaria parasites, 76 (20.9%) had presumptive acute dengue infection and among those, 29(38.2%) were confirmed cases. Dengue was more likely to occur in children ≥ 5 years than in <5 years (OR 2.28, 95% CI: 1.35-3.86). Presumptive acute Chikungunya infection was identified in 17(4.7%) of patients. We observed no presenting symptoms that distinguished patients with Chikungunya infection from those with dengue infection or malaria. Co-infections between malaria and Chikungunya, malaria and dengue fever as well as Chikungunya and dengue were detected. Most patients with Chikungunya and dengue infections were treated with antibacterials. Furthermore, our results revealed that 5(5.2%) of patients had influenza virus while 5(12.8%) had rotavirus and 2(5.1%) had adenovirus.
  
  
  CONCLUSIONS
  Our results suggest that even though viral diseases are a major public health concern, they are not given due recognition as a cause of fever in febrile patients. Emphasis on laboratory diagnostic tests for proper diagnosis and management of febrile patients is recommended.
authors.affiliation: Nelson Mandela African Institution of Science and Technology, School of Life Sciences and Bioengineering, Arusha, Tanzania; Ifakara Health Institute, Ifakara, Tanzania.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Chipwaza
authors.affiliation: National Institute for Medical Research, Amani Medical Research Centre, Muheza, Tanga, Tanzania.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Mugasa
authors.affiliation: Ifakara Health Institute, Dar es Salaam, Tanzania.
authors.forename: Majige
authors.initials: M
authors.lastname: Selemani
authors.affiliation: Jhpiego, Dar-es-Salaam, Tanzania.
authors.forename: Mbaraka
authors.initials: M
authors.lastname: Amuri
authors.affiliation: National Health Laboratory, Ministry of Health and Social Welfare, Dar-es-salaam, Tanzania.
authors.forename: Fausta
authors.initials: F
authors.lastname: Mosha
authors.affiliation: National Institute for Medical Research, Kilosa, Morogoro, Tanzania.
authors.forename: Steve D
authors.initials: SD
authors.lastname: Ngatunga
authors.affiliation: Nelson Mandela African Institution of Science and Technology, School of Life Sciences and Bioengineering, Arusha, Tanzania; Genome Science Centre and Department of Veterinary Microbiology and Parasitology, Sokoine University of Agriculture, Morogoro, Tanzania.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Gwakisa
mesh_terms: D000293:Adolescent; D065632:Chikungunya Fever / Q000453:epidemiology* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003715:Dengue / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D005334:Fever; D006801:Humans; D008297:Male; D010045:Outpatients / Q000706:statistics & numerical data; D013636:Tanzania / Q000453:epidemiology