Evaluation of Fever Management Practices in Rural India

Background: Precision regarding treatment of fever is reportedly low among the rural regions of India, leading to its irrational management. This study evaluates fever management practices followed by physicians at primary health centre and correlate this with standard fever management guidelines. Methods: One hundred and forty patients admitted to hospital with fever were enrolled in the study. Patient's demographic profile and presenting symptoms were precisely studied along with their vital parameters. Patients were divided into two groups (A&B), with and without treated as per standard guidelines. Duration of illness, treatment with various drugs and clinical investigation of patients with fever were analysed statistically as outcome analysis. Results: Majority of patients (47.86 %) belonged to age of 18-30 years. Symptoms related to Upper respiratory tract infection (URTI), such as cough and rhinorrhoea, were the most common symptoms (104 patients, 74.28%). Most common clinical diagnosis was viral URTI in both the groups followed by enteric fever, acute gastroenteritis etc. No statistical significance observed in duration of illness in both groups. All the patients of group A were advised laboratory investigations to confirm the diagnosis as per the standard management protocol. Most frequently ordered investigations were complete blood count and peripheral smear for malarial parasite. Average number of drugs prescribed was 2.94 and 4.03 in group A and B (p value 0.001). 8.33% and 18.75% were belonged to category of more than 5 drugs per prescription (polypharmacy) in group A and B respectively. Amoxicillin and Azithromycin were the most preferentially prescribed antibiotics. 90% and 20% of antibiotics were prescribed appropriately (P=0.01) as per guidelines in group A and B respectively. Co-prescription of famotidine, pantoprazole etc was significantly high in group B (p<0.05). Conclusion: A large number of patients were prescribed with antibiotics without accurate confirmation of bacterial infections which was contradictory to standard guidelines of fever management practice. Hence increased awareness for rational fever management is desirable among clinical practitioners in rural India.