CITATION: Clinical management of children with fever: a cross-sectional study of quality of care in rural Zambia
Karsten Lunze, Godfrey Biemba, J Joseph Lawrence, William B MacLeod, Kojo Yeboah-Antwi, Kebby Musokotwane, Toyin Ajayi, Simon Mutembo, Chilunga Puta, Duncan Earle, Rick Steketee & Davidson H Hamer.
Bulletin of the World Health Organization 2017;95:333-342. doi:

Correspondence to Karsten Lunze (email:


Objective: To evaluate current practices and standards of evaluation and treatment of childhood febrile illness in Southern Province, Zambia.

Methods: From November to December 2013, we conducted a cross-sectional survey of facilities and health workers and we observed the health workers’ interactions with febrile children and their caregivers…

Findings: This study included 24 health facilities, 53 health workers and 161 children presenting with fever. Facilities were insufficiently staffed, stocked and equipped to adequately manage childhood fever. Children most commonly presented with upper respiratory tract infections (46%; 69), diarrhoea (31%; 27) and malaria (10%; 16). Health workers insufficiently evaluated children for danger signs, and less than half (47%; 9/19) of children with pneumonia received appropriate antibiotic treatment. Only 57% (92/161) were tested for malaria using either rapid diagnostic tests or microscopy.

Conclusion: Various health system challenges resulted in a substantial proportion of children receiving insufficient management and treatment of febrile illness. Interventions are needed including strengthening the availability of commodities and improving diagnosis and treatment of febrile illness.

Comment (Neil PW): As always, poor quality care is due to failure to address the basic SEISMIC needs of frontline health workers:
• Skills
• Equipment
• Information
• Structural support
• Medicines
• Incentives
• Communication facilities.
A SEISMIC shift is needed to address the needs of front-line healthcare providers in low-income countries. For too long their needs have been ignored.

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