title: Aetiologies of non-malaria febrile episodes in children under 5 years in sub-Saharan Africa.
abstract: OBJECTIVE
  To provide an overview of the most frequent aetiologies found in febrile episodes of children under 5 years from sub-Saharan Africa.
  
  
  METHODS
  MEDLINE and EMBASE were searched for publications in English and French on non-malaria fever episodes in African children under 5 years of age, which were published between January 1990 and July 2015. Case reports and conference abstracts were excluded.
  
  
  RESULTS
  In total, 3851 titles and abstracts were reviewed, and 153 were selected for full screening of which 18 were included in the present review. Bloodstream infection (BSI) was most commonly investigated (nine of 18) followed by urinary tract infection (UTI) (four of 18) and respiratory tract infection (RTI) (two of 18). Few studies investigated BSI and UTI in the same children (two of 18), or BSI and gastrointestinal infection (GII) (one of 18). As for BSI, the most frequently isolated bacteria were E. coli (four of 12), Streptococcus pneumonia (four of 12), Salmonella spp (three of 12) and Staphylococcus aureus (two of 12) with a positive identification rate of 19.7-33.3%, 5.2-27.6%, 11.7-65.4% and 23.5-42.0%, respectively. As for UTI, the main bacteria isolated were E. coli (six of six) and Klebsiella spp (six of six) with a positive rate of 20.0-72.3% and 10.0-28.5%, respectively. No bacterium was isolated in RTI group, but Human influenzae A and B were frequently found, with the highest positive identification rate in Tanzania (75.3%). Dengue virus (two of 12) was the most frequently reported viral infection with a positive identification rate of 16.7-30.8%. Finally, only rotavirus/adenovirus (69.2% positive identification rate) was found in GII and no bacterium was isolated in this group.
  
  
  CONCLUSIONS
  The high prevalence of treatable causes of non-malaria fever episodes requires a proper diagnosis of the origin of fever followed by an appropriate treatment, thereby reducing the under-5 mortality in sub-Saharan Africa and preventing the overprescription of antibiotics and thus circumventing the rise of antibiotic resistance.
authors.affiliation: Institut de Recherche en Science de la Santé, Nanaro, Burkina Faso.|Parasitology Unit, Royal Tropical Institute, Amsterdam, The Netherlands.
authors.forename: Francois
authors.initials: F
authors.lastname: Kiemde
authors.affiliation: Medical Library, University of Amsterdam, Amsterdam, The Netherlands.|Cochrane Netherlands, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: René
authors.initials: R
authors.lastname: Spijker
authors.affiliation: Parasitology Unit, Royal Tropical Institute, Amsterdam, The Netherlands.|Centre of Tropical Medicine and Travel Medicine, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Petra F
authors.initials: PF
authors.lastname: Mens
authors.affiliation: Institut de Recherche en Science de la Santé, Nanaro, Burkina Faso.
authors.forename: Halidou
authors.initials: H
authors.lastname: Tinto
authors.affiliation: Global Child Health Group, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Michael
authors.initials: M
authors.lastname: Boele
authors.affiliation: Parasitology Unit, Royal Tropical Institute, Amsterdam, The Netherlands.
authors.forename: Henk D F H
authors.initials: HD
authors.lastname: Schallig
keywords: Afrique subsaharienne; aetiology; children; enfants; etiología; fever; fiebre; fièvre; malaria; niños; paludisme; sub-Saharan Africa; África subsahariana; étiologie