Impact of a diagnostic tool package and clinical algorithm on antibiotic use in acute fever case management in rural Mozambique
1
Department of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
2
Medicus Mundi Italia, Brescia, Italy
3
Research Nucleo, Provincial Health Directorate, Inhambane, Mozambique
4
District health services, Ministry of Health, Inhambane, Mozambique
5
Unit of Biostatistics and Biomathematics & Unit of Bioinformatics, University of Brescia, Brescia, Italy
6
Simple Structures at the Departmental Centre for Tropical Diseases, Spedali Civili Hospital, Brescia, Italy
Popul. Med. 2026;8(Supplement Supplement 1):A230
ABSTRACT
INTRODUCTION:
Antimicrobial resistance (AMR) represents a critical threat to public health in resource-limited countries (RLC) like Mozambique, where limited diagnostic capacity for acute febrile illnesses often leads to inappropriate empirical antibiotic prescribing, accelerating the development of AMR1,2,3. Adapted from a similar protocol used in a multicenter trial in RLC4, this study assessed the impact of an intervention composed by new diagnostic tools and clinical algorithms on antibiotic use and clinical outcomes in acute fever cases.
METHODS:
A prospective, comparative, controlled non-randomized, experimental study was conducted in four similar outpatient peripheral health centers (HC) in Inhambane Province. Non critical patients older than five years, presenting with non-malarial fever lasting less than seven days, were recruited. An intervention package composed by clinical algorithm plus point-of-care rapid tests for Dengue and Zika, firstly, and C-reactive protein, to subsequently drive antibiotic prescription) was implemented in two HC, compared to routine practice implemented in others two HC. All patients were invited for a reassessment after seven days to define the clinical outcome.
RESULTS:
The research involved 839 patients (49.7% adults, 64.6% female, median age 14 years IC 9-79). Clinical outcomes at 7 days were favorable in 82.4% of reassessed patients (74%), with no difference between study arms and no impact of antibiotic therapy on symptom resolution. The intervention significantly reduced antibiotic prescribing in adults (37.1% vs 65.9% in control group, p<0.005) without compromising clinical outcomes. A very low incidence of Dengue and Zika virus cases (0.4% and 0.6%, respectively) were detected.
CONCLUSIONS:
This research suggests that implementing rapid diagnostic tests and clinical algorithms in RLC can safely optimize antibiotic use in febrile adults, contributing to AMR containment. The findings underscore the importance of targeted diagnostic interventions and ongoing healthcare worker training in rural areas to promote antimicrobial stewardship.
Antimicrobial resistance (AMR) represents a critical threat to public health in resource-limited countries (RLC) like Mozambique, where limited diagnostic capacity for acute febrile illnesses often leads to inappropriate empirical antibiotic prescribing, accelerating the development of AMR1,2,3. Adapted from a similar protocol used in a multicenter trial in RLC4, this study assessed the impact of an intervention composed by new diagnostic tools and clinical algorithms on antibiotic use and clinical outcomes in acute fever cases.
METHODS:
A prospective, comparative, controlled non-randomized, experimental study was conducted in four similar outpatient peripheral health centers (HC) in Inhambane Province. Non critical patients older than five years, presenting with non-malarial fever lasting less than seven days, were recruited. An intervention package composed by clinical algorithm plus point-of-care rapid tests for Dengue and Zika, firstly, and C-reactive protein, to subsequently drive antibiotic prescription) was implemented in two HC, compared to routine practice implemented in others two HC. All patients were invited for a reassessment after seven days to define the clinical outcome.
RESULTS:
The research involved 839 patients (49.7% adults, 64.6% female, median age 14 years IC 9-79). Clinical outcomes at 7 days were favorable in 82.4% of reassessed patients (74%), with no difference between study arms and no impact of antibiotic therapy on symptom resolution. The intervention significantly reduced antibiotic prescribing in adults (37.1% vs 65.9% in control group, p<0.005) without compromising clinical outcomes. A very low incidence of Dengue and Zika virus cases (0.4% and 0.6%, respectively) were detected.
CONCLUSIONS:
This research suggests that implementing rapid diagnostic tests and clinical algorithms in RLC can safely optimize antibiotic use in febrile adults, contributing to AMR containment. The findings underscore the importance of targeted diagnostic interventions and ongoing healthcare worker training in rural areas to promote antimicrobial stewardship.
| eISSN: | 2654-1459 |
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