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Anticipating the future: prognostic tools as a complementary strategy to improve care for patients with febrile illnesses in resource-limited settings
  1. Arjun Chandna1,2,
  2. Jennifer Osborn3,
  3. Quique Bassat4,5,6,7,8,
  4. David Bell9,
  5. Sakib Burza10,
  6. Valérie D’Acremont11,12,
  7. B Leticia Fernandez-Carballo3,
  8. Kevin C Kain13,
  9. Mayfong Mayxay2,14,15,
  10. Matthew Wiens16,17,18,19,
  11. Sabine Dittrich2,3
  1. 1Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
  2. 2Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
  3. 3Foundation for Innovative New Diagnostics, Geneva, Switzerland
  4. 4ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
  5. 5Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
  6. 6ICREA, Pg. Lluís Companys 23, Barcelona, Spain
  7. 7Pediatrics Department, Hospital Sant Joan de Dé, Universitat de Barcelona, Esplugues, Barcelona, Spain
  8. 8Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
  9. 9Independent Consultant, Issaquah, Washington, USA
  10. 10Médecins Sans Frontières, New Delhi, India
  11. 11Centre for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
  12. 12Swiss Tropical and Public Health Institute, Basel, Switzerland
  13. 13Department of Medicine, University Health Network, Toronto, Ontario, Canada
  14. 14Microbiology Department, Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Lao People's Democratic Republic
  15. 15Institute of Research and Education Development (IRED), University of Health Sciences, Vientiane, Lao People's Democratic Republic
  16. 16Center for International Child Health, BC Children's Hospital, Vancouver, British Columbia, Canada
  17. 17Mbarara University of Science and Technology, Mbarara, Uganda
  18. 18Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
  19. 19Walimu, Kampala, Uganda
  1. Correspondence to Dr Arjun Chandna; arjunchandna{at}; arjun{at}


In low-income and middle-income countries, most patients with febrile illnesses present to peripheral levels of the health system where diagnostic capacity is very limited. In these contexts, accurate risk stratification can be particularly impactful, helping to guide allocation of scarce resources to ensure timely and tailored care. However, reporting of prognostic research is often imprecise and few prognostic tests or algorithms are translated into clinical practice.

Here, we review the often-conflated concepts of prognosis and diagnosis, with a focus on patients with febrile illnesses. Drawing on a recent global stakeholder consultation, we apply these concepts to propose three use-cases for prognostic tools in the management of febrile illnesses in resource-limited settings: (1) guiding referrals from the community to higher-level care; (2) informing resource allocation for patients admitted to hospital and (3) identifying patients who may benefit from closer follow-up post-hospital discharge. We explore the practical implications for new technologies and reflect on the challenges and knowledge gaps that must be addressed before this approach could be incorporated into routine care settings.

Our intention is that these use-cases, alongside other recent initiatives, will help to promote a harmonised yet contextualised approach for prognostic research in febrile illness. We argue that this is especially important given the heterogeneous settings in which care is often provided for patients with febrile illnesses living in low-income and middle-income countries.

  • infections
  • diseases
  • disorders
  • injuries
  • diagnostics and tools
  • health systems

Data availability statement

No data are associated with this work. The findings of the stakeholder consultation conducted by FIND are available at the FIND website:

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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Data availability statement

No data are associated with this work. The findings of the stakeholder consultation conducted by FIND are available at the FIND website:

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  • Handling editor Seye Abimbola

  • Twitter @arji_barji, @sabinedittrich

  • Contributors AC, SD and JO conceived the article; AC wrote the first draft; SD, JO and BLF-C commented on and edited the first draft; All authors commented on, edited and approved the final draft.

  • Funding This research was funded in whole, or in part, by the Wellcome Trust (106698Z/14/Z). For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. FIND received fundinig for this work from the Dutch government and UK AID.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.