|dc.description.abstract||Background. In low-resource, malaria-endemic settings, accurate diagnosis of febrile illness in children is challenging. The
World Health Organization (WHO) currently recommends laboratory-confirmed diagnosis of malaria prior to starting treatment
in stable children. Factors guiding management of children with undifferentiated febrile illness outside of malaria are not well
Methods. This study examined clinical presentation and management of a cohort of febrile Kenyan children at 5 hospital/clinic
sites from January 2014 to December 2017. Chi-squared and multivariate regression analyses were used to compare frequencies and
correlate demographic, environmental, and clinical factors with patient diagnosis and prescription of antibiotics.
Results. Of 5735 total participants, 68% were prescribed antibiotic treatment (n = 3902), despite only 28% given a diagnosis of
bacterial illness (n = 1589). Factors associated with prescription of antibiotic therapy included: negative malaria testing, reporting
head, ears, eyes, nose and throat (HEENT) symptoms (ie, cough, runny nose), HEENT findings on exam (ie, nasal discharge, red
throat), and having a flush toilet in the home (likely a surrogate for higher socioeconomic status).
Conclusion. In a cohort of acutely ill Kenyan children, prescription of antimalarial therapy and malaria test results were well
correlated, whereas antibiotic treatment was prescribed empirically to most of those who tested malaria negative. Clinical manage ment of febrile children in these settings is difficult, given the lack of diagnostic testing. Providers may benefit from improved clin ical education and implementation of enhanced guidelines in this era of malaria testing, as their management strategies must rely
primarily on critical thinking and decision-making skills.||en_US