Josephine Van De Maat (Netherlands)

Radboudumc Internal Medicine
Josephine van de Maat is a medical doctor from The Netherlands. Last year, she defended her PhD research, titled “Childhood Pneumonia. Clinical decision support in the emergency department”. She performed epidemiological research in pediatric infectious diseases in the Sophia Children’s Hospital, Rotterdam. The main aim of her research is to improve decision-making on diagnostics and treatment of fever and respiratory infections in children. Currently, she is working as a postdoctoral researcher in infectious diseases and global health in the Radboudumc, Nijmegen. In this position, she is part of an international consortium working in Tanzania and Uganda, giving her the opportunity to extend her research to the setting of low-and-middle-income countries.

Presenter of 1 Presentation

 Conference Calendar

PRIMARY CARE CASE MANAGEMENT OF FEBRILE CHILDREN: INSIGHTS FROM THE EPOCT ROUTINE CARE COHORT IN DAR ES SALAAM, TANZANIA (ID 927)

Session Name
2510 - PARALLEL SYMPOSIUM 12 (JOINT SESSION WITH MSF): PEDIATRIC INFECTIOUS DISEASES CHALLENGES IN HUMANITARIAN SETTINGS (ID 102)
Lecture Time
10:52 - 10:59
Room
Hall 04
Presenter

Abstract

Background

More granular data on the quality of care for febrile children in low-resource settings are needed. This study aims to provide insight in the primary healthcare (PHC) case management of febrile children under-five in Dar es Salaam, and to identify areas for improving quality of care.

Methods

We used data of the routine care arm of the ePOCT trial, including children aged 2-59 months who presented with an acute febrile illness to two health centers in Dar es Salaam (2014-2016). For all children research staff performed malaria rapid diagnostic testing and collected presenting complaint, anthropometrics, vital signs, as well as tests performed and routine clinician diagnosis and treatment. We used descriptive statistics to analyze the frequencies of diagnoses, adherence to diagnostics and prescribed treatments.

Results

We included 547 children (47% male, median age 14 months). Most diagnoses were viral: upper respiratory tract infection (60%) and/or gastro-enteritis (18%). Vital signs and anthropometric measurements taken by research staff and urinary testing failed to influence treatment decisions. In total, 518/547 (95%) children received antibiotics, while 119/547 (22%) had an indication for antibiotics based on local guidelines. Antibiotic dosing was frequently out of range. Non-recommended treatments were common (29%), most often cough syrup and vitamins.

Conclusions

Our study points to challenges in using diagnostic test results, concerns regarding quality of antibiotic prescriptions, and frequent use of non-evidence-based complementary medicines in PHC in Tanzania. Larger studies on diagnostic and treatments processes in PHC in Tanzania are needed to inform effective solutions to support PHC workers in case management of children.

Clinical Trial Registration

NCT02225769

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