Health Itinerary of Young Children With Suspected Bloodstream Infection in Kisantu General Referral Hospital, DR Congo
Health Itinerary of Young Children With Suspected Bloodstream Infection in Kisantu General Referral Hospital, DR Congo
Bloodstream infections are frequent in children admitted to the hospital for severe febrile
 illness in sub-Saharan Africa.Ongoing blood culture surveillance at Kisantu Hospital showed
 non-typhoidal Salmonella (NTS) as the first cause of bloodstream infections in children.
 Bloodstream infections have a high case fatality (15 - 20%). Outcome of bloodstream
 infections is dependent on timely diagnosis and treatment. However, observations at Kisantu
 Hospital showed that many children arrive late and die early after admission.

 By interviewing caregivers of severely ill children admitted to Kisantu Hospital, the
 investigators aim to study their health itinerary, i.e. the sequence of all actions of health
 care seeking and care provision between the onset of febrile illness and the admission at the
 hospital. The investigators aim to assess the health itinerary according to the "three
 delays" model. The three delays model studies delays and practices at the level of health
 care seeking, of transport and of start of antibiotic treatment.10 Visits to referring health
 centers will provide complementary information about diagnosis, treatment and referral
 practices. In hospital follow-up will allow to assess the outcome according to the duration
 of health itinerary. The results of routine laboratory tests upon hospital admission will
 allow to stratify the health itinerary according to fever etiology.

 The results of this study will allow to understand the duration of the health itinerary, its
 possible association with case-fatality, and factors explaining for delays at every level.
 This information is expected to orient local health policy makers towards interventions
 shortening the duration of the health itinerary and in that case improve and monitor the
 referral system. In addition, the study results are expected to orient towards further
 research to understand health seeking behavior (i.e. focus-group discussions and
 community-based studies).
The study is designed as a hospital-based cohort study at the pediatric ward of Kisantu
 general referral hospital. The investigators foresee a study inclusion period of 5 months.
 The study period is currently determined as such that it includes approximately 2 months of
 the dry season and 3 months of the rainy season. Seasonality is taken into account, because
 the rain affects the condition of the road and local disease epidemiology and can thus
 influence the study results. Most data will be collected retrospectively, i.e. all data on
 the health itinerary collected from the questionnaire and referral letter and the data from
 the health records in the referring health centers. Only the data from the in-hospital
 laboratory tests and clinical outcome will be collected prospectively.

 The data from the health records at referring health centers will be consulted after
 termination of the five months study inclusion period to avoid any influence from the study
 in the patient management at health centers during the study.
Inclusion Criteria:

 -  Be a child between 28 days and 5 years old

 -  Be admitted to Kisantu Hospital

 -  Have a suspected bloodstream infection, which is defined as the presence of objective
 fever, hypothermia or a history of fever during the past 48 hours and at least one of
 the following criteria: Hypotension, confusion or increased respiratory rate/Suspicion
 of severe localized infection: pneumonia, meningitis, osteomyelitis, complicated
 urinary tract infection, abscess, skin/soft tissue infection or abdominal infection/
 Suspicion of typhoid fever/ Suspicion of severe malaria

 -  Having a caregiver willing and able to provide written informed consent

 Exclusion Criteria:

 -