Epidemiology and outcomes of pediatric fever in a rural district of Southern Mozambique: 17 years of morbidity surveillance

Background Pediatric febrile illnesses remain a leading cause of healthcare visits, morbidity, and mortality in low-resource settings. Their etiological diagnosis and outcome evaluation is challenging as available tools are limited. Hereby, we describe the epidemiology, trends, and clinical outcomes of febrile pediatric outpatient clinic visits and inpatients during a 17-year-long period in southern Mozambique. Methods We retrospectively analyzed surveillance morbidity and demographic data from children <15 years old presenting with fever (≥37.5°C) at Manhiça District Hospital and five peripheral health posts, from 2004 to 2020. We characterized diagnoses and clinical signs, stratified by outpatient clinic visits and hospitalizations, and calculated 7-day mortality odds, case fatality ratios (CFRs), and minimum community-based incidence rates (MCBIRs). Results A total of 664,223 outpatient visits and 23,166 hospitalizations were included. The median age was 47.1 months (IQR 20.0-92.3) for outpatients, and 21.2 months (IQR 10.1-41.5) for inpatients. The most frequent first encounter diagnoses included malaria (33.5%), upper (27.8%) and lower (10.1%) respiratory tract infections, and acute gastrointestinal infection (6.0%), whose frequencies showed a marked annual decline from 2004 to 2020, particularly among inpatients. All-cause 7-day mortality was 0.1% and 2.2% among outpatients and inpatients, respectively. Sepsis and meningitis were less common, but presented the highest CFRs (9%-16%). Malnutrition and HIV infection were major contributors to inpatient mortality. Seizures, edema, dehydration, and reduced consciousness were strong predictors of death. Conclusion Malaria, respiratory tract, and acute gastrointestinal infections represented the predominant causes of fever and mortality, with decreasing trends over time. This analysis underscores the value of epidemiological surveillance and the need for improved early diagnosis and clinical management tools for febrile children.