Diagnosis versus medical prescription of antimalarial drugs and antibiotics: Attitudes and practices of clinicians in Kinshasa, Democratic Republic of Congo, in cases of fever
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Abstract
The management of fever, which was once routinely considered as malaria, is now based on biological diagnosis, in accordance with recommendations from the World Health Organization (WHO), due to the emergence of other causes of fever. However, this diagnosis requires laboratory infrastructure that is often inadequate, especially in tropical regions. This situation complicates the clinicians’ ability to properly assess and manage febrile illnesses. This study aimed to analyze the attitudes and practices of clinicians when faced with such cases. It is a cross-sectional analytical study conducted among clinicians (nurses and doctors) using a questionnaire administered via Kobo Collect. Data were analyzed using SPSS version 21, with a statistical significance threshold set at 5%. Multivariate analysis was performed using logistic regression. A total of 151 clinicians participated in the study, including 125 nurses, 25 general practitioners, and one specialist. The median years of professional experience was 5 years (interquartile range: 4 years). The use of biological diagnosis for febrile patients in emergency settings was statistically significant (adjusted odds ratio: 7.27; 95% CI: [1.62 – 32.63]; p = 0.01). In cases of a negative thick blood smear, clinicians often prescribed antibiotics systematically, even when C-reactive protein (CRP) levels were negative (adjusted OR: 47.78; 95% CI: [6.06 – 377.00]; p < 0.001). The results reveal irrational prescribing practices, regardless of laboratory results, the prescriber's qualifications, or experience.
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