ArticleBMJ (Clinical research ed.)2010
WHO guidelines for antimicrobial treatment in children admitted to hospital in an area of intense Plasmodium falciparum transmission: prospective study.
Article in BMJ (Clinical research ed.), 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 109 papers, 8 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
109 citing papers in PubMed, 8 syntheses or guidelines pooled it, 172 citations in OpenAlex.
- Pooled it
- A Systematic Review and Meta-analysis of the Prevalence of Community-Onset Bloodstream Infections among Hospitalized Patients in Africa and Asia.Antimicrobial agents and chemotherapy · 2019Pooled it
- Using hospital-based studies of community-onset bloodstream infections to make inferences about typhoid fever incidence.Tropical medicine & international health : TM & IH · 2019Pooled it
- Bacterial pathogens and resistance causing community acquired paediatric bloodstream infections in low- and middle-income countries: a systematic review and meta-analysis.Antimicrobial resistance and infection control · 2019Pooled it
- A Systematic Review of the Incidence, Risk Factors and Case Fatality Rates of Invasive Nontyphoidal Salmonella (iNTS) Disease in Africa (1966 to 2014).PLoS neglected tropical diseases · 2017Pooled it
- Global burden of invasive nontyphoidal Salmonella disease, 2010(1).Emerging infectious diseases · 2015Pooled it
- Etiology of Severe Febrile Illness in Low- and Middle-Income Countries: A Systematic Review.PloS one · 2015Pooled it
- Invasive bacterial co-infection in African children with Plasmodium falciparum malaria: a systematic review.BMC medicine · 2014Pooled it
- Azithromycin in severe malaria bacterial co-infection in African children (TABS-PKPD): a phase II randomised controlled trial.BMC medicine · 2024Trial
- Pre-referral Rectal Artesunate Treatment by Community-Based Treatment Providers in Ghana, Guinea-Bissau, Tanzania, and Uganda (Study 18): A Cluster-Randomized Trial.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2016Trial
- Compliance With Referral Advice After Treatment With Prereferral Rectal Artesunate: A Study in 3 Sub-Saharan African Countries.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2016Trial
- Predicting the clinical outcome of severe falciparum malaria in african children: findings from a large randomized trial.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2012Trial
- Severe malaria-bacterial sepsis co-infection among critically ill children admitted to pediatric emergency departments in Kinshasa.World journal of clinical pediatrics · 2026Article
- Non-typhoidal Salmonella co-infect and complicate Plasmodium falciparum malaria in children under-five: A prospective cohort study on clinical presentation and outcome in Kisantu district hospital, DR Congo.PLoS neglected tropical diseases · 2026Observational
- Malaria: a review on its current epidemiological status and management strategies.Malaria journal · 2026Review
- Misclassification of malaria as pneumonia in children in sub-Saharan Africa.International journal of epidemiology · 2025Article
- Developing a clinical prediction model to modify empirical antibiotics for non-typhoidal Salmonella bloodstream infection in children under-five in the Democratic Republic of Congo.BMC infectious diseases · 2025Observational
- A Systemic Review on Fitness and Survival ofIndian journal of microbiology · 2024Review
- Leptospirosis Cases among Outpatients with Non-Malaria Fever Attending Primary Care Clinics during the Rainy Season in Bobo Dioulasso, Burkina Faso.The American journal of tropical medicine and hygiene · 2024Article
- Myco-synthesis of multi-twinned silver nanoparticles as potential antibacterial and antimalarial agents.RSC advances · 2024Article
49 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
15 authors at 6 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo assess the performance of WHO's "Guidelines for care at the first-referral level in developing countries" in an area of intense malaria transmission and identify bacterial infections in children with and without malaria.
designProspective study.
settingDistrict hospital in Muheza, northeast Tanzania.
participantsChildren aged 2 months to 13 years admitted to hospital for febrile illness.
main outcome measuresSensitivity and specificity of WHO guidelines in diagnosing invasive bacterial disease; susceptibility of isolated organisms to recommended antimicrobials.
resultsOver one year, 3639 children were enrolled and 184 (5.1%) died; 2195 (60.3%) were blood slide positive for Plasmodium falciparum, 341 (9.4%) had invasive bacterial disease, and 142 (3.9%) were seropositive for HIV. The prevalence of invasive bacterial disease was lower in slide positive children (100/2195, 4.6%) than in slide negative children (241/1444, 16.7%). Non-typhi Salmonella was the most frequently isolated organism (52/100 (52%) of organisms in slide positive children and 108/241 (45%) in slide negative children). Mortality among children with invasive bacterial disease was significantly higher (58/341, 17%) than in children without invasive bacterial disease (126/3298, 3.8%) (P<0.001), and this was true regardless of the presence of P falciparum parasitaemia. The sensitivity and specificity of WHO criteria in identifying invasive bacterial disease in slide positive children were 60.0% (95% confidence interval 58.0% to 62.1%) and 53.5% (51.4% to 55.6%), compared with 70.5% (68.2% to 72.9%) and 48.1% (45.6% to 50.7%) in slide negative children. In children with WHO criteria for invasive bacterial disease, only 99/211(47%) of isolated organisms were susceptible to the first recommended antimicrobial agent.
conclusionsIn an area exposed to high transmission of malaria, current WHO guidelines failed to identify almost a third of children with invasive bacterial disease, and more than half of the organisms isolated were not susceptible to currently recommended antimicrobials. Improved diagnosis and treatment of invasive bacterial disease are needed to reduce childhood mortality.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.