ZONIFICACION DEL FUNCIONAMIENTO ESPACIAL

There was an average monthly, febrile illness of 160.25 SD±10.63 for the twelve months of cohort study, with a significant difference in monthly febrile cases (P<0.001). The ages 5 to 14 years had an average of 25.83±7.85 cases per month. Those within 15 to 29 years had average monthly cases of 48.83±6.7. Ages 30 to 44 had 41.66±4.2 while the age group≥45

years had monthly cases of 43.91±6.7.

Results of this study showed that malaria accounts for less than 50% of febrile illnesses investigated in the study location, but about 60% of participants in the study self-diagnosed and self-treated malaria a month prior to the study. The high rate of self-diagnoses is of concern, since treatment decisions that follow could be wrong, delaying recovery, increasing disease burden with a possibility of nurturing antimicrobial resistance. Among the medications used were herbs with unspecified dosages1_{. While herbs could treat certain}

diseases, they also have the propensity to delay treatment outcomes or cause severe complications from the toxicity of the herbs.

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Common non-malaria febrile illnesses in Bo, Sierra Leone include: Chikungunya which accounts for over 40% of febrile disease morbidity in Bo but exists mainly in a transient form with symptoms such as arthralgia, chills, headaches and back pains, with the latter persisting in affected patients2_{. Having an incidence or person-time rate of 573.7 per 1000 people per}

year at a 95% confidence interval, the incidence of Chikungunya is higher than that of malaria in this malaria endemic region. In a related study in Kenema which is 40km away from Bo Town, Boissen et al3 _{reported 35%(27/77) prevalence of Chikungunya in suspected Lassa}

Fever cases, indicating that ChikV is not only in Bo, but elsewhere in Sierra Leone.

Another common non-malaria febrile morbidity is viral hepatitis which was detected in this study. Per month, an average of 10.4±1.9SD Hepatitis B and 5.5±2.5SD Hepatitis C were recorded in Bo, Sierra Leone. With about 10% prevalence of hepatitis B and 5% prevalence of hepatitis C. The viral hepatitis morbidity seems grim as treatment options are limited within Sierra Leone. Available drugs are either expensive or hard to get. There is about 9% IgG seroprevalence of viral hepatitis A, but this study did not detect any current infection of HAV. It is possible that sampling at a different time could yield a high prevalence.

Furthermore, this study revealed a high seroprevalence of Salmonella typhi, about 60% having≥ 1:120 titres of typhi ‘O’ or ‘H’. However actual incidence of typhoid infection,

diagnosed by microbiological testing was lower at about 2% per year. The disparity between the Widal test and the culture and API identification methods indicate that, the antibody levels of Salmonella has increased in the Bo community. The increase may have resulted from previous infections of Salmonella typhi. Not all widal positive cases are actually having typhoid fever. This necessitates the revision of the widal titre levels accepted as positive reading, since widal tests are predominantly used in Sierra Leone to test for typhoid fever. To determine a new widal cut-off point, sensitivity and specificity of widal tests at different titre levels should be determined.

HIV, which is still dreaded, is an important part of the non-malaria febrile morbidity in Bo, Sierra Leone. The prevalence of HIV was about 9%; three-fifth of the cases were females and overall about 11% were co-infected with Hepatitis B, while 3 % were having syphilis. HIV patients assessed had a median Hb value of 10.90g/dl and 18.75% of critically low hematocrit values (≤27%PCV). The high prevalence of HIV in Bo is consistent with previous

reports from the city. Kellie(2007)[unpublished dissertation]4 _{reported a prevalence of 8%}

and other independent studies have been within the same range5,6_.

Several other infections were also detected including Human Rhinoviruses(24%) corona viruses(19%), E. coli 17%, Ascaris lumbricoides infections(19%), Citrobacter freundii (12%), Klebsiella pneumonia (12%), 11% hookworm infections, 10% Streptococcus pneumonia, 9% Enterobacter cloacae, 8% Haemophilus influenza, 8% Influenza B, 6% Schistosoma mansonia, 6% Chlamydophila pneumonia and other infections. Worthy of mention among the other infections are 16 cases of Yersinia pestis which causes bubonic plague and 66 cases of Burkholderia pseudomallei which causes melioidosis. Melioidosis is rare in Africa, but was reported in a Sierra Leonean based in Gambia in 19857_{. Thus Bo city}

is home to diversity of infections.

Syndromic definitions of febrile illnesses in this location cannot be used as a proxy of actual laboratory diagnosis because syndromes are not specific. Treatments based solely on syndromes is therefore presumptive or assumptive. To avoid assumptive treatments, point of care or point-of-need testing need to be adopted for malaria, where febrile subjects are first tested in their remote locations by themselves or by community volunteers within their communities.

Roukens and colleagues, demonstrated the possibility of malaria-self test and reported 3 %( 18/575) invalid results from self-test run by oil expatriates and compliance was higher with instructions.

In Bo, Sierra Leone, Ranasinghe and colleagues1_{reported preferences of malaria testing in}

Bo with 69% rural residents, preferred a self/family- or CHV-conducted home-based malaria test and 20% a laboratory-based test while urban residents preferred 38% and 44%, respectively. If offered a home-based test, 28% of rural residents would prefer a self/family- conducted test and 68% would prefer a CHV-assisted test1_.