Etiologies of acute febrile illness among hospitalized patients: A retrospective hospital-based study in Mogadishu, Somalia

Abstract

Background: Acute febrile illness (AFI) is a major cause of hospitalization in tropical regions. While it is often initially diagnosed as malaria in Africa, its specific causes in Somalia remain largely unknown. This study aimed to identify the etiology and clinical outcomes of AFI among hospitalized adults in Mogadishu, Somalia. Methods: Medical records of adult patients presented with fever (≥15 years, temperature ≥37.5 °C) who were hospitalized from January 1, 2021 to 31 December 2023 at Somalia Mogadishu-Turkish Teaching and Research Hospital, Somalia were retrospectively examined. We described the demographic data, clinical characteristics, laboratory parameters, treatment modalities, and outcomes among these patients. Univariate and multivariate analyses were then performed to identify factors associated with severe outcomes. Results: A total of 1648 cases were initially collected. After applying the inclusion criteria and removing duplicates and mislabeled files, 702 cases (42.6 %) were included in the study. Etiologies were identified in 24.2 % of these cases, with the most common being acute hepatitis A (9.5 %) and malaria (7.7 %). Antibiotics were used in 83.3 % of patients. Factors associated with an identified etiology included pre-existing medical conditions, genitourinary involvement, and a shorter fever duration. Overall, 61.4 % of patients recovered, while the mortality rate was 10.5 %, with the highest rate attributed to urinary tract sepsis (2.7 %). Poor outcomes were significantly associated with an elevated white blood cell count, elevated serum creatinine, and advanced age. Conclusion: These findings underscore diagnostic limitations and antimicrobial misuse, emphasizing the need for expanded laboratory capabilities with pathogen-specific testing to better identify AFI in Somalia.