Children in sub-Saharan Africa with uncomplicated fever may be safely managed with conditional, rather than universal, 3-day follow-up with a community health worker, according to a randomized trial by researchers at Karolinska Institutet published in PLOS Medicine. The study suggests that current WHO guidelines for these children could be reconsidered.

The WHO’s integrated community case management (iCCM) guidelines recommend that all children presenting with uncomplicated fever and no danger signs return for follow-up with a community health worker on day 3 following the initial consultation on day 1. Such fevers often resolve rapidly, however, and previous studies suggest that expectant home care for uncomplicated fever can be safely recommended.

The trial was conducted in Ethiopia and included approximately 4,000 children under age 5 with uncomplicated fever, who were randomized to receive either conditional follow-up if symptoms remained or the recommended universal 3-day follow-up. The results suggest that conditional follow-up is noninferior to universal follow-up.

More efficient use of resources

“Allowing community health workers to advise caregivers to bring children back only in case of continued symptoms might be a more efficient use of resources in these settings,” says first author Karin Källander, adjunct senior lecturer at Karolinska Institutet’s Department of Public Health Sciences.

Another study from Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States, published at the same time in PLOS Medicine, shows similar results for children in the Democratic Republic of the Congo (DRC). Additional trials in other sub-Saharan African settings are needed to establish generalizability. However, taken together, the current results provide evidence relevant to formulation of WHO recommendations.