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      Management of acute fever in children: Consensus recommendations for community and primary healthcare providers in sub-Saharan Africa

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          Abstract

          Fever is one of the most common reasons for unwell children presenting to pharmacists and primary healthcare practitioners. Currently there are no guidelines for assessment and management of fever specifically for community and primary healthcare workers in the sub-Saharan Africa region. This multidisciplinary consensus guide was developed to assist pharmacists and primary healthcare workers in sub-Saharan Africa to risk stratify and manage children who present with fever, decide when to refer, and how to advise parents and caregivers.

          Fever is defined as body temperature ≥ 37.5 °C and is a normal physiological response to illness that facilitates and accelerates recovery. Although it is often associated with self-limiting illness, it causes significant concern to both parents and attending healthcare workers. Clinical signs may be used by pharmacy staff and primary healthcare workers to determine level of distress and to distinguish between a child with fever who is at high risk of serious illness and who requires specific treatment, hospitalisation or specialist care, and those at low risk who could be managed conservatively at home. In children with warning signs, serious causes of fever that may need to be excluded include infections (including malaria), non-infective inflammatory conditions and malignancy. Simple febrile convulsions are not in themselves harmful, and are not necessarily indicative of serious infection. In the absence of illness requiring specific treatment, relief from distress is the primary indication for prescribing pharmacotherapy, and antipyretics should not be administered with the sole intention of reducing body temperature. Care must be taken not to overdose medications and clear instructions should be given to parents/caregivers on managing the child at home and when to seek further medical care.

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          Most cited references105

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          Systematic review of COVID‐19 in children shows milder cases and a better prognosis than adults

          Abstract Aim The coronavirus disease 2019 (COVID‐19) pandemic has affected hundreds of thousands of people. Data on symptoms and prognosis in children are rare. Methods A systematic literature review was carried out to identify papers on COVID‐19, which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), using the MEDLINE and Embase databases between January 1 and March 18, 2020. Results The search identified 45 relevant scientific papers and letters. The review showed that children have so far accounted for 1%‐5% of diagnosed COVID‐19 cases, they often have milder disease than adults and deaths have been extremely rare. Diagnostic findings have been similar to adults, with fever and respiratory symptoms being prevalent, but fewer children seem to have developed severe pneumonia. Elevated inflammatory markers were less common in children, and lymphocytopenia seemed rare. Newborn infants have developed symptomatic COVID‐19, but evidence of vertical intrauterine transmission was scarce. Suggested treatment included providing oxygen, inhalations, nutritional support and maintaining fluids and electrolyte balances. Conclusions The coronavirus disease 2019 has occurred in children, but they seemed to have a milder disease course and better prognosis than adults. Deaths were extremely rare.
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            Characteristics and Outcomes of Children With Coronavirus Disease 2019 (COVID-19) Infection Admitted to US and Canadian Pediatric Intensive Care Units

            The recent and ongoing coronavirus disease 2019 (COVID-19) pandemic has taken an unprecedented toll on adults critically ill with COVID-19 infection. While there is evidence that the burden of COVID-19 infection in hospitalized children is lesser than in their adult counterparts, to date, there are only limited reports describing COVID-19 in pediatric intensive care units (PICUs).
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              Fever and the thermal regulation of immunity: the immune system feels the heat.

              Fever is a cardinal response to infection that has been conserved in warm-blooded and cold-blooded vertebrates for more than 600 million years of evolution. The fever response is executed by integrated physiological and neuronal circuitry and confers a survival benefit during infection. In this Review, we discuss our current understanding of how the inflammatory cues delivered by the thermal element of fever stimulate innate and adaptive immune responses. We further highlight the unexpected multiplicity of roles of the pyrogenic cytokine interleukin-6 (IL-6), both during fever induction and during the mobilization of lymphocytes to the lymphoid organs that are the staging ground for immune defence. We also discuss the emerging evidence suggesting that the adrenergic signalling pathways associated with thermogenesis shape immune cell function.
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                Author and article information

                Contributors
                Journal
                Afr J Emerg Med
                Afr J Emerg Med
                African Journal of Emergency Medicine
                African Federation for Emergency Medicine
                2211-419X
                2211-4203
                10 April 2021
                June 2021
                10 April 2021
                : 11
                : 2
                : 283-296
                Affiliations
                [a ]Department Paediatrics and Child Health, University of Pretoria, South Africa
                [b ]Houghton House Group, Johannesburg, South Africa
                [c ]Department of Paediatrics & Child Health, University of KwaZulu Natal, Durban, South Africa
                [d ]Division of Emergency Medicine, University of the Witwatersrand, Johannesburg, South Africa
                [e ]Health Aid Chemist, Nairobi, Kenya
                [f ]Levy Mwanawasa Medical University, School of Health Sciences, Lusaka, Zambia
                [g ]Care Group of Pharmacies, South Africa
                [h ]South African Pharmacy Council, Johannesburg, South Africa
                [i ]Sister Lilian Centre (Pty), Pretoria, South Africa
                [j ]Steve Biko Academic Hospital, Department of Paediatrics and Child Health, University of Pretoria, South Africa
                Author notes
                [* ]Corresponding author at: Houghton House, 432 York Ave, Randburg, Gauteng, South Africa. dawebb@ 123456mweb.co.za
                Article
                S2211-419X(20)30133-6
                10.1016/j.afjem.2020.11.004
                8063696
                33912381
                048b5a27-633a-4ee8-a1b6-80096a55fe62
                © 2018 Published by Elsevier Ltd. CC BY 4.0.

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                : 26 July 2020
                : 8 November 2020
                : 15 November 2020
                Categories
                Review Article

                childhood,fever,febrile,primary healthcare,sub-saharan africa

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