Background: Fever remains one of the most frequent reasons for medical consultation. In low and middle resource settings, particularly in Benin, it is often presumed to be of infectious origin—most commonly malaria—due to the endemicity of the parasite. However, the gradual decline in malaria prevalence and the growing diversity of potential etiologies warrant a re-evaluation of the epidemiological profile of febrile illnesses in this context. This study aimed to describe the epidemiology of febrile illnesses in three hospitals located in southern Benin. Methods: A prospective descriptive study was conducted from October 9, 2023, to January 15, 2024, in the pediatric, internal medicine, and emergency departments of the National University Hospital Centre Hubert Koutoukou Maga (CNHU-HKM) in Cotonou, the Abomey-Calavi District Hospital, and the Ouidah District Hospital. The study included patients 308 presenting with fever upon admission or developing fever during hospitalization, defined as a temperature ≥ 38°C in individuals under 18 years and ≥ 37.6°C in those aged 18 years and older. For each participant, detailed interviews and complete clinical examinations were performed to collect sociodemographic and clinical data. Relevant laboratory findings were extracted from medical records. Results: A total of 308 febrile patients were enrolled. Males were predominant (54.22%), and the most represented age group was 31–40 years. The most common functional symptoms were asthenia (73.05%), anorexia (56.16%), and headache (51.30%). Neurological manifestations were the most frequent (38.69%), followed by pleuropulmonary (21.10%) and cutaneous signs (17.86%). Anemia was observed in 40.91% of patients, while leukocytosis occurred in 30.19%. Infectious diseases accounted for 79.22% of identified etiologies, dominated by malaria (50%), followed by bacterial infections. Acute cerebrovascular accidents were the leading non-infectious causes (5.84%). The main treatments included antimalarial and antibiotic therapies. The outcome was favorable in 78.57% of cases, while the case fatality rate was 10.06%. Conclusion: In southern Benin, fever remains predominantly of infectious origin, with malaria still representing the leading cause. However, the increasing proportion of bacterial and neurological etiologies highlights the need to strengthen diagnostic capacities for more accurate and effective management of febrile illnesses.
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Fever remains a common clinical symptom reflecting the body’s response to an aggression, most often of infectious origin. In sub-Saharan Africa, where the burden of communicable diseases remains high, febrile illnesses constitute a major cause of outpatient visits and hospital admissions
[1]
World Health Organization. World malaria report 2023. Geneva: WHO; 2023.
[7]
Bouyou-Akotet MK, et al. Etiologies of fever in hospitalized patients in sub-Saharan Africa: a review. Int J Infect Dis. 2020; 96: 421–8.
. For a long time, malaria—caused by Plasmodium falciparum—was considered the predominant etiology, leading to systematic presumptive treatment before the introduction of rapid diagnostic tests (RDTs).
Since the World Health Organization (WHO) recommended in 2010 the systematic use of RDTs to confirm malaria diagnosis
[1]
World Health Organization. World malaria report 2023. Geneva: WHO; 2023.
[2]
World Health Organization. World malaria report 2022. Geneva: WHO; 2022.
[1, 2]
, many cases previously attributed to malaria have been identified as non-malarial, underscoring the importance of a broader diagnostic approach
[3]
Newton PN, Guerin PJ. Febrile illness mapping—much of the world without data and without evidence-based treatments. BMC Med. 2020; 18(1): 287.
In Benin, the diagnostic workup of fever remains limited by the high cost of complementary laboratory investigations
[5]
Hounkonnou GIE. Profil épidémiologique et étiologique des fièvres dans les services de médecine interne du CNHU-HKM Cotonou et du CHUD-OP Porto-Novo. [Epidemiological and etiological profile of fevers in the internal medicine departments of CNHU-HKM Cotonou and CHUD-OP Porto-Novo]. Cotonou: Faculty of Health Sciences, University of Abomey-Calavi; 2018.
[5]
. Similar challenges have been documented in other low-resource settings
[4]
D’Acremont V, Kilowoko M, Kyungu E, et al. Beyond malaria—causes of fever in outpatient Tanzanian children. N Engl J Med. 2014; 370(9): 809–17.
, where the lack of accessible diagnostics complicates patient management. The decline in malaria morbidity, due to the distribution of insecticide-treated nets, the widespread use of RDTs, and the availability of artemisinin-based combination therapies (ACTs)
[6]
National Malaria Control Programme (NMCP). Rapport annuel 2023. [Annual report 2023]. Cotonou: Ministry of Health; 2023.
[6]
, has been accompanied by the emergence of other infectious etiologies, such as respiratory infections, septicemia, meningitis, and acute viral infections
[7]
Bouyou-Akotet MK, et al. Etiologies of fever in hospitalized patients in sub-Saharan Africa: a review. Int J Infect Dis. 2020; 96: 421–8.
Akelew Y, Pareyn M, Lemma M, Negash M, Bewket G, Derbew A, et al. Aetiologies of acute undifferentiated febrile illness at the emergency ward of the University of Gondar Hospital, Ethiopia. Trop Med Int Health. 2022; 27(3): 271–9.
The lack of knowledge regarding the current profile of non-malarial febrile illnesses poses a challenge for clinicians, leading to diagnostic uncertainty, irrational prescriptions, and worsening of infectious morbidity
[9]
Assogba F, et al. Prescription d'antibiotiques dans les hôpitaux du Bénin : enjeux et perspectives. [Antibiotic prescription in hospitals in Benin: issues and perspectives]. Med Trop Int Health. 2018; 8(1): 23–30.
[9]
. A better understanding of the causes of fever, their epidemiological patterns, and the most affected populations is essential to improve hospital case management. This study therefore aims to describe the epidemiology of febrile illnesses in three health facilities in southern Benin: the CNHU-HKM of Cotonou, the Abomey-Calavi District Hospital, and the Ouidah District Hospital.
2. Materials and Methods
2.1. Study and Population Area
This was a prospective descriptive study conducted from October 9, 2023, to January 15, 2024, in the pediatric, internal medicine, and emergency departments of three hospitals: the Hubert Koutoukou Maga National University Hospital Center (CNHU-HKM) in Cotonou, the Abomey-Calavi District Hospital, and the Ouidah District Hospital. These facilities were selected to ensure representativeness of the southern region of Benin, combining a top-tier national referral center (CNHU-HKM) with peripheral district hospitals covering semi-urban and rural populations.
The study included patients presenting with a febrile episode during hospitalization or admitted for fever to the emergency, internal medicine, or pediatric wards of the selected hospitals.
Inclusion criteria were: age ≥ 1 year, hospitalization in one of the targeted departments, and fever defined as ≥ 38°C in patients under 18 years and ≥ 37.6°C in those aged 18 years or older. Patients who did not provide informed consent were excluded.
2.2. Data Collection
Each participant underwent a detailed interview and a comprehensive physical examination to collect sociodemographic and clinical data. Laboratory and biological information were extracted from medical records.
2.3. Variables
The dependent variable was the presence of fever. Independent variables included: sociodemographic, clinical, paraclinical, physical. therapeutic and outcome data.
2.4. Data Analysis
Data were analyzed using Microsoft Excel 2019. Qualitative variables were expressed as frequencies and percentages, while quantitative variables were summarized as means ± standard deviation (SD).
2.5. Ethics
The study adhered to principles of anonymity and patient confidentiality. Participants were informed about the study objectives and data handling procedures and gave free and informed consent. Administrative authorization was obtained from the relevant authorities of the three hospitals prior to data collection.
3. Results
3.1. Sociodemographic Characteristics of the Study Population
A total of 308 patients were included in the study. The study population was predominantly male (54.22%), corresponding to 1.18 sex ratio M/F. The mean age of participants was 30 ± 18 years, with a median of 28 years and a range from 1 to 95 years. The 31–40-year age group was the most represented (31.42%) (Table 1).
Table 1. Characteristics of the study population (N= 308).
Characteristics
N (%)
Sex
Female
141 (45.78)
Male
167 (54.22)
Age (years) (mean ± SD)
30 ± 18
3.2. Clinical and Paraclinical Characteristics of Patients
The most common medical histories were hypertension (20.13%), diabetes mellitus (7.79%), and sickle-cell disease (6.17%). Among surgical histories, digestive (6.17%) and gynecological (4.87%) conditions were the most frequent. Other medical histories (asthma, Human Immunodeficiency Virus [HIV], stroke, hepatitis, rhinitis) and surgical histories (cardiac, urological, dermatologic) were less frequent, each accounting for fewer than 5% of cases. At admission, nearly half of the patients consulted within 24 hours after the onset of symptoms. The predominant functional signs were asthenia, anorexia, and headache. The mean body temperature at admission was 38.5°C, ranging from 37.6°C to 40.7°C. Tachycardia was observed in 50.6% of patients and tachypnea in 37.66%. The most frequently observed physical signs were neurological (38.9%), followed by pleuropulmonary (21.10%) and cutaneous (17.86%) manifestations.
Anemia was the most common hematological abnormality (40.91%), followed by hyperleukocytosis (30.19%). Among the etiological investigations, thick blood film and malaria rapid diagnostic test (RDT) were the most frequently performed (51.95% and 35.39%, respectively), with positivity in the majority of tested patients. Blood culture and HIV serology were positive in 3.57% of cases.
3.3. Etiology of Febrile Conditions
Infectious diseases were the leading causes of fever (79.2%), followed by acute stroke (5.8%), tumoral diseases (4.9%), and non-infectious inflammatory diseases (4.6%) (Table 2). Among the identified infectious diseases, malaria predominated (50%), followed by respiratory infections (18.5%) and digestive infections (10.7%). The most frequently isolated bacteria were Klebsiella pneumoniae (4.63%) and Escherichia coli (3.70%). Among non-bacterial pathogens, Plasmodium falciparum (29.63%), HIV (10.19%), and Cryptococcus neoformans (0.93%) were the most frequently identified.
Table 2. Etiology of febrile illnesses (N=308).
Diagnose
N (%)
Infectious diseases
244 (79.22)
Malaria
154 (50.00)
Respiratory tract infections
57 (18.51)
Gastrointestinal infections
33 (10.71)
Acute stroke
18 (5.84)
Neoplastic diseases
15 (4.87)
Non-infectious inflammatory diseases
14 (4.55)
3.4. Therapeutic Management and Clinical Outcomes
The most prescribed therapeutic classes were antimalarial agents (51.6%) and antibiotics (47.7%). Among antibiotics, third-generation cephalosporins, particularly ceftriaxone, were the most commonly used (Table 3). The mean duration of hospitalization was 8.4 days, ranging from 1 to 83 days. The most frequently observed complication was respiratory distress; other complications, such as coma and neurological sequelae, occurred in less than 1% of cases. The clinical outcome was favorable in 78.57% of patients, while the case fatality rate was 10.06%, and 5.52% of patients were lost to follow-up.
Table 3. Treatment and clinical outcomes of patients (N = 308).
Treatment and clinical outcomes
N (%)
Treatment
Antimalarial drugs
159 (51.62)
Antibiotic therapy
147 (47.73)
Others
29 (9.42)
Outcome
Favorable
242 (78.57)
Death
31 (10.06)
Lost to follow-up
35 (11.36)
4. Discussion
The median age of the patients was 28 years (range: 1-95 years), reflecting the significant contribution of young individuals to febrile morbidity. This predominance of youth in the study population corroborates the findings of Mariko
[10]
Mariko SL. Étiologies des fièvres dans les camps du complexe minier de Loulo-Gounkoto, dans le district de Kenieba (étude de 1 540 cas). [Etiologies of fevers in the camps of the Loulo-Gounkoto mining complex in the Kenieba district (a study of 1,540 cases)]. Bamako: University of Sciences, Techniques and Technologies of Bamako; 2021.
[10]
, who reported a median age of 30 years. This observation can be explained by the country’s demographic structure characterized by a predominantly young population as well as by the increased susceptibility of children and young adults to infections in low- and middle-income countries
[7]
Bouyou-Akotet MK, et al. Etiologies of fever in hospitalized patients in sub-Saharan Africa: a review. Int J Infect Dis. 2020; 96: 421–8.
The male predominance observed (54.22%) is consistent with data from Akelew et al.
[8]
Akelew Y, Pareyn M, Lemma M, Negash M, Bewket G, Derbew A, et al. Aetiologies of acute undifferentiated febrile illness at the emergency ward of the University of Gondar Hospital, Ethiopia. Trop Med Int Health. 2022; 27(3): 271–9.
. However, such variation may reflect the composition of hospital wards and the higher exposure of men to occupational or environmental risks in certain African contexts
[12]
Agossou J, et al. Profil étiologique des maladies fébriles non palustres dans les hôpitaux du sud du Bénin. [Etiological profile of non-malarial febrile illnesses in hospitals of southern Benin]. Afr J Public Health. 2019; 16(2): 45–53.
[12]
.
Regarding consultation delay, nearly half of the patients (48.70%) sought medical care within 24 hours of symptom onset. Although relatively short, this delay remains longer than that reported by Moutsinga
[11]
Moutsinga MAD. Prolonged fever in adults: retrospective study of 101 cases in an internal medicine department. [Prolonged fever in adults: retrospective study of 101 cases in an internal medicine department]. Libreville; 2014.
[11]
(22.7% before 24 hours). This sociodemographic behavior is critical for clinical outcomes, as delays often result in more severe presentations upon admission. These differences may reflect disparities in healthcare access, perception of illness severity, or patients’ financial capacity
[5]
Hounkonnou GIE. Profil épidémiologique et étiologique des fièvres dans les services de médecine interne du CNHU-HKM Cotonou et du CHUD-OP Porto-Novo. [Epidemiological and etiological profile of fevers in the internal medicine departments of CNHU-HKM Cotonou and CHUD-OP Porto-Novo]. Cotonou: Faculty of Health Sciences, University of Abomey-Calavi; 2018.
[5]
. Improving early care-seeking behavior remains a key strategy for reducing infectious complications.
The most frequent medical histories included hypertension (20.13%), diabetes mellitus (7.79%), and sickle-cell disease (6.17%). These proportions, slightly lower than those reported by Hounkonnou
[5]
Hounkonnou GIE. Profil épidémiologique et étiologique des fièvres dans les services de médecine interne du CNHU-HKM Cotonou et du CHUD-OP Porto-Novo. [Epidemiological and etiological profile of fevers in the internal medicine departments of CNHU-HKM Cotonou and CHUD-OP Porto-Novo]. Cotonou: Faculty of Health Sciences, University of Abomey-Calavi; 2018.
[5]
, may be explained by the diversity of hospital wards and the broader age range in our study. The notable prevalence of sickle-cell disease reflects the persistence of this genetic disorder in West Africa
[13]
Tshilolo L, et al. Sickle-cell disease in sub-Saharan Africa: epidemiology and challenges. Blood Rev. 2019; 37: 100588.
. Meanwhile, the high rates of hypertension and diabetes illustrate the country’s ongoing epidemiological transition, where non-communicable diseases now coexist with infectious pathologies.
The most frequently reported clinical symptoms were asthenia, anorexia, and headache, non-specific yet common manifestations in febrile infectious syndromes. The mean temperature (38.52°C) is comparable to that reported by Hounkonnou
[5]
Hounkonnou GIE. Profil épidémiologique et étiologique des fièvres dans les services de médecine interne du CNHU-HKM Cotonou et du CHUD-OP Porto-Novo. [Epidemiological and etiological profile of fevers in the internal medicine departments of CNHU-HKM Cotonou and CHUD-OP Porto-Novo]. Cotonou: Faculty of Health Sciences, University of Abomey-Calavi; 2018.
[5]
, confirming the moderately febrile nature of most cases. From a clinical examination standpoint, neurological involvement (38.96%) was predominant, followed by pulmonary and dermatological manifestations. These findings are consistent with those of Mariko
[10]
Mariko SL. Étiologies des fièvres dans les camps du complexe minier de Loulo-Gounkoto, dans le district de Kenieba (étude de 1 540 cas). [Etiologies of fevers in the camps of the Loulo-Gounkoto mining complex in the Kenieba district (a study of 1,540 cases)]. Bamako: University of Sciences, Techniques and Technologies of Bamako; 2021.
[10]
, although the proportions differ. The neurological signs observed may reflect the substantial contribution of infectious neuropathologies and acute cerebrovascular accidents in our cohort
[14]
Dougnon TV, et al. Neurological complications of febrile illnesses in sub-Saharan Africa. Afr Health Sci. 2022; 22(1): 45–52.
Anemia (40.91%) and hyperleukocytosis (30.19%) were the most frequent hematological abnormalities. These rates are lower than those reported in a previous Beninese study (54% and 36%, respectively)
[5]
Hounkonnou GIE. Profil épidémiologique et étiologique des fièvres dans les services de médecine interne du CNHU-HKM Cotonou et du CHUD-OP Porto-Novo. [Epidemiological and etiological profile of fevers in the internal medicine departments of CNHU-HKM Cotonou and CHUD-OP Porto-Novo]. Cotonou: Faculty of Health Sciences, University of Abomey-Calavi; 2018.
[5]
. This discrepancy could be attributed to limited diagnostic resources and the high cost of laboratory investigations. Nonetheless, these abnormalities remain typical of systemic infections, particularly malaria and bacterial sepsis
[15]
Blanc F, et al. Profils hématologiques des infections systémiques [Hematologic patterns in systemic infections]. Rev Med Interne. 2020; 41(9): 612–8.
The most frequently performed biological tests were thick blood film (Giemsa-stained blood smear), rapid diagnostic test (RDT) for malaria, HIV serology, and blood culture. This pattern aligns with Hounkonnou
[5]
Hounkonnou GIE. Profil épidémiologique et étiologique des fièvres dans les services de médecine interne du CNHU-HKM Cotonou et du CHUD-OP Porto-Novo. [Epidemiological and etiological profile of fevers in the internal medicine departments of CNHU-HKM Cotonou and CHUD-OP Porto-Novo]. Cotonou: Faculty of Health Sciences, University of Abomey-Calavi; 2018.
[5]
, underscoring the persistent centrality of malaria in the etiological assessment of fever in African hospitals. The limited use of blood cultures reflects constraints related to access to advanced laboratories and the high cost of bacteriological investigations
[5]
Hounkonnou GIE. Profil épidémiologique et étiologique des fièvres dans les services de médecine interne du CNHU-HKM Cotonou et du CHUD-OP Porto-Novo. [Epidemiological and etiological profile of fevers in the internal medicine departments of CNHU-HKM Cotonou and CHUD-OP Porto-Novo]. Cotonou: Faculty of Health Sciences, University of Abomey-Calavi; 2018.
[5]
.
Infectious diseases represented the dominant etiology (79.22%), a proportion higher than the 60% reported in a Moroccan study
[16]
Maamar M, Aouni M, Tazi M, Harmouche H, Adnaoui M, Maaouni A. Fièvre prolongée : à propos de 101 cas [Prolonged fever: about 101 cases]. Casablanca; 2016.
[16]
. This finding illustrates the predominance of infectious pathologies in tropical regions, where hygiene conditions, parasite density, and immunization coverage strongly influence febrile morbidity
[7]
Bouyou-Akotet MK, et al. Etiologies of fever in hospitalized patients in sub-Saharan Africa: a review. Int J Infect Dis. 2020; 96: 421–8.
. Cerebrovascular diseases ranked second (5.84%), confirming the increasing burden of non-communicable diseases in African hospital settings.
Malaria remained the leading identified cause (50%), followed by respiratory infections (18.51%), consistent with Mariko
[10]
Mariko SL. Étiologies des fièvres dans les camps du complexe minier de Loulo-Gounkoto, dans le district de Kenieba (étude de 1 540 cas). [Etiologies of fevers in the camps of the Loulo-Gounkoto mining complex in the Kenieba district (a study of 1,540 cases)]. Bamako: University of Sciences, Techniques and Technologies of Bamako; 2021.
[10]
. This persistence underscores the continuing burden of malaria despite control efforts and the growing contribution of respiratory infections related to domestic and urban pollution
[17]
Pope CA, et al. Air pollution and respiratory infections in low-income settings. Environ Res. 2021; 197: 111–223.
. At the microbiological level, the most frequently isolated bacteria were Klebsiella pneumoniae and Escherichia coli, followed by Staphylococcus aureus and Mycobacterium tuberculosis. These opportunistic agents are typical of severe nosocomial and community-acquired infections, as also reported by Maamar et al.
[16]
Maamar M, Aouni M, Tazi M, Harmouche H, Adnaoui M, Maaouni A. Fièvre prolongée : à propos de 101 cas [Prolonged fever: about 101 cases]. Casablanca; 2016.
[16]
. The most frequently detected virus was HIV, followed by dengue virus and cytomegalovirus, confirming the endemic circulation of dengue in Benin despite its underdiagnosis. The predominant parasite was Plasmodium falciparum, consistent with Maamar
[16]
Maamar M, Aouni M, Tazi M, Harmouche H, Adnaoui M, Maaouni A. Fièvre prolongée : à propos de 101 cas [Prolonged fever: about 101 cases]. Casablanca; 2016.
[16]
.
Non-infectious inflammatory diseases accounted for 4.55% of cases, a rate higher than the 1.5% reported in an Ivorian study
[20]
Kone D, Kone S, Yapo MT, Toure KH, Kone F, Kouame KGR, et al. Étiologies des fièvres prolongées inexpliquées au service de médecine interne du CHU de Bouaké (Côte d’Ivoire). [Etiologies of unexplained prolonged fevers in the Internal Medicine Department of Bouake University Hospital (Côte d’Ivoire)]. Afr J Intern Med. 2022; 9(2): 19–25.
[20]
. This difference may reflect diagnostic challenges due to limited access to specialized imaging and laboratory testing in many African facilities. Neoplastic diseases accounted for 4.87% of cases, slightly below the 5.9% reported by Agbodande et al.
[18]
Agbodande KA, Dovonou C, Azon-Kouanou A, Attinsounon C, Wanvoegbe F, Zannou D, et al. Étiologies et mortalité des fièvres prolongées en médecine interne dans un hôpital de référence de premier niveau du sud du Bénin (hôpital de district de Come) en 2013. [Etiologies and fatality of prolonged fevers in internal medicine at a first-level referral hospital in southern Benin (Come District Hospital) in 2013]. Ser Sci Sante. 2019; 9(2): 45–52.
[18]
. These findings highlight the growing recognition of cancer cases in African hospitals, likely due to improved diagnostic capabilities and increased public awareness.
Regarding therapeutic variables, more than half of the patients (51.62%) received antimalarial treatment, and 47.73% were treated with antibiotics. These rates are similar to those reported in a Burkinabe study
[19]
Gansane A, et al. Causes of fever in rural Burkina Faso: results from a prospective cohort study. BMC Infect Dis. 2020; 20: 667.
, reflecting the frequent use of combined therapies in a syndromic diagnostic context. However, the empirical use of antibiotics remains a concern, exposing populations to the heightened risk of antimicrobial resistance
[9]
Assogba F, et al. Prescription d'antibiotiques dans les hôpitaux du Bénin : enjeux et perspectives. [Antibiotic prescription in hospitals in Benin: issues and perspectives]. Med Trop Int Health. 2018; 8(1): 23–30.
[9]
.
In terms of outcome data, results were favorable in most cases (78.57%), but the case fatality rate reached 10.06%, mainly associated with infectious diseases and acute strokes. African studies have reported fatality rates of 12.53% for cancers
[5]
Hounkonnou GIE. Profil épidémiologique et étiologique des fièvres dans les services de médecine interne du CNHU-HKM Cotonou et du CHUD-OP Porto-Novo. [Epidemiological and etiological profile of fevers in the internal medicine departments of CNHU-HKM Cotonou and CHUD-OP Porto-Novo]. Cotonou: Faculty of Health Sciences, University of Abomey-Calavi; 2018.
[5]
and 8% for infectious diseases
[16]
Maamar M, Aouni M, Tazi M, Harmouche H, Adnaoui M, Maaouni A. Fièvre prolongée : à propos de 101 cas [Prolonged fever: about 101 cases]. Casablanca; 2016.
[16]
. These discrepancies may reflect differences in case mix and disparities in access to intensive care, particularly given that some patients were managed in internal medicine wards where oncologic cases are also handled.
5. Conclusion
Fever poses a genuine diagnostic challenge for clinicians due to its broad etiological spectrum. Infectious diseases remain the principal cause of febrile conditions, with malaria leading the list. The associated mortality is non-negligible, underscoring the need to strengthen early management of febrile syndromes in Africa and to develop more efficient diagnostic capacities to improve survival outcomes.
Abbreviations
ACTs
Artemisinin-based Combination Therapies
CNHU-HKM
National University Hospital Centre Hubert Koutoukou Maga
HIV / AIDS
Human Immunodeficiency Virus / Acquired Immunodeficiency Syndrome
NMCP
National Malaria Control Programme
RDTs
Rapid Diagnostic Tests
SD
Standard Deviation
WHO
World Health Organization
Acknowledgments
We extend our gratitude to all study participants and to the medical staff of the hospitals where this research was conducted.
Hounkonnou GIE. Profil épidémiologique et étiologique des fièvres dans les services de médecine interne du CNHU-HKM Cotonou et du CHUD-OP Porto-Novo. [Epidemiological and etiological profile of fevers in the internal medicine departments of CNHU-HKM Cotonou and CHUD-OP Porto-Novo]. Cotonou: Faculty of Health Sciences, University of Abomey-Calavi; 2018.
[6]
National Malaria Control Programme (NMCP). Rapport annuel 2023. [Annual report 2023]. Cotonou: Ministry of Health; 2023.
[7]
Bouyou-Akotet MK, et al. Etiologies of fever in hospitalized patients in sub-Saharan Africa: a review. Int J Infect Dis. 2020; 96: 421–8.
Akelew Y, Pareyn M, Lemma M, Negash M, Bewket G, Derbew A, et al. Aetiologies of acute undifferentiated febrile illness at the emergency ward of the University of Gondar Hospital, Ethiopia. Trop Med Int Health. 2022; 27(3): 271–9.
Assogba F, et al. Prescription d'antibiotiques dans les hôpitaux du Bénin : enjeux et perspectives. [Antibiotic prescription in hospitals in Benin: issues and perspectives]. Med Trop Int Health. 2018; 8(1): 23–30.
[10]
Mariko SL. Étiologies des fièvres dans les camps du complexe minier de Loulo-Gounkoto, dans le district de Kenieba (étude de 1 540 cas). [Etiologies of fevers in the camps of the Loulo-Gounkoto mining complex in the Kenieba district (a study of 1,540 cases)]. Bamako: University of Sciences, Techniques and Technologies of Bamako; 2021.
[11]
Moutsinga MAD. Prolonged fever in adults: retrospective study of 101 cases in an internal medicine department. [Prolonged fever in adults: retrospective study of 101 cases in an internal medicine department]. Libreville; 2014.
[12]
Agossou J, et al. Profil étiologique des maladies fébriles non palustres dans les hôpitaux du sud du Bénin. [Etiological profile of non-malarial febrile illnesses in hospitals of southern Benin]. Afr J Public Health. 2019; 16(2): 45–53.
[13]
Tshilolo L, et al. Sickle-cell disease in sub-Saharan Africa: epidemiology and challenges. Blood Rev. 2019; 37: 100588.
Maamar M, Aouni M, Tazi M, Harmouche H, Adnaoui M, Maaouni A. Fièvre prolongée : à propos de 101 cas [Prolonged fever: about 101 cases]. Casablanca; 2016.
[17]
Pope CA, et al. Air pollution and respiratory infections in low-income settings. Environ Res. 2021; 197: 111–223.
Agbodande KA, Dovonou C, Azon-Kouanou A, Attinsounon C, Wanvoegbe F, Zannou D, et al. Étiologies et mortalité des fièvres prolongées en médecine interne dans un hôpital de référence de premier niveau du sud du Bénin (hôpital de district de Come) en 2013. [Etiologies and fatality of prolonged fevers in internal medicine at a first-level referral hospital in southern Benin (Come District Hospital) in 2013]. Ser Sci Sante. 2019; 9(2): 45–52.
[19]
Gansane A, et al. Causes of fever in rural Burkina Faso: results from a prospective cohort study. BMC Infect Dis. 2020; 20: 667.
Kone D, Kone S, Yapo MT, Toure KH, Kone F, Kouame KGR, et al. Étiologies des fièvres prolongées inexpliquées au service de médecine interne du CHU de Bouaké (Côte d’Ivoire). [Etiologies of unexplained prolonged fevers in the Internal Medicine Department of Bouake University Hospital (Côte d’Ivoire)]. Afr J Intern Med. 2022; 9(2): 19–25.
Romeo, P. S. G., Romeo, A., Ahouangan, O. L., Houeto, E., Ohouko, A., et al. (2025). Epidemiology of Febrile Illnesses in Three Hospitals in Southern Benin. Central African Journal of Public Health, 11(6), 432-437. https://doi.org/10.11648/j.cajph.20251106.22
Romeo, P. S. G.; Romeo, A.; Ahouangan, O. L.; Houeto, E.; Ohouko, A., et al. Epidemiology of Febrile Illnesses in Three Hospitals in Southern Benin. Cent. Afr. J. Public Health2025, 11(6), 432-437. doi: 10.11648/j.cajph.20251106.22
Romeo PSG, Romeo A, Ahouangan OL, Houeto E, Ohouko A, et al. Epidemiology of Febrile Illnesses in Three Hospitals in Southern Benin. Cent Afr J Public Health. 2025;11(6):432-437. doi: 10.11648/j.cajph.20251106.22
@article{10.11648/j.cajph.20251106.22,
author = {Padonou Setondji Geraud Romeo and Adegbite Romeo and Olivia Lucette Ahouangan and Elisee Houeto and Abraham Ohouko and Olofindji Jennifer and Aguemon Badirou},
title = {Epidemiology of Febrile Illnesses in Three Hospitals in Southern Benin},
journal = {Central African Journal of Public Health},
volume = {11},
number = {6},
pages = {432-437},
doi = {10.11648/j.cajph.20251106.22},
url = {https://doi.org/10.11648/j.cajph.20251106.22},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cajph.20251106.22},
abstract = {Background: Fever remains one of the most frequent reasons for medical consultation. In low and middle resource settings, particularly in Benin, it is often presumed to be of infectious origin—most commonly malaria—due to the endemicity of the parasite. However, the gradual decline in malaria prevalence and the growing diversity of potential etiologies warrant a re-evaluation of the epidemiological profile of febrile illnesses in this context. This study aimed to describe the epidemiology of febrile illnesses in three hospitals located in southern Benin. Methods: A prospective descriptive study was conducted from October 9, 2023, to January 15, 2024, in the pediatric, internal medicine, and emergency departments of the National University Hospital Centre Hubert Koutoukou Maga (CNHU-HKM) in Cotonou, the Abomey-Calavi District Hospital, and the Ouidah District Hospital. The study included patients 308 presenting with fever upon admission or developing fever during hospitalization, defined as a temperature ≥ 38°C in individuals under 18 years and ≥ 37.6°C in those aged 18 years and older. For each participant, detailed interviews and complete clinical examinations were performed to collect sociodemographic and clinical data. Relevant laboratory findings were extracted from medical records. Results: A total of 308 febrile patients were enrolled. Males were predominant (54.22%), and the most represented age group was 31–40 years. The most common functional symptoms were asthenia (73.05%), anorexia (56.16%), and headache (51.30%). Neurological manifestations were the most frequent (38.69%), followed by pleuropulmonary (21.10%) and cutaneous signs (17.86%). Anemia was observed in 40.91% of patients, while leukocytosis occurred in 30.19%. Infectious diseases accounted for 79.22% of identified etiologies, dominated by malaria (50%), followed by bacterial infections. Acute cerebrovascular accidents were the leading non-infectious causes (5.84%). The main treatments included antimalarial and antibiotic therapies. The outcome was favorable in 78.57% of cases, while the case fatality rate was 10.06%. Conclusion: In southern Benin, fever remains predominantly of infectious origin, with malaria still representing the leading cause. However, the increasing proportion of bacterial and neurological etiologies highlights the need to strengthen diagnostic capacities for more accurate and effective management of febrile illnesses.},
year = {2025}
}
TY - JOUR
T1 - Epidemiology of Febrile Illnesses in Three Hospitals in Southern Benin
AU - Padonou Setondji Geraud Romeo
AU - Adegbite Romeo
AU - Olivia Lucette Ahouangan
AU - Elisee Houeto
AU - Abraham Ohouko
AU - Olofindji Jennifer
AU - Aguemon Badirou
Y1 - 2025/12/29
PY - 2025
N1 - https://doi.org/10.11648/j.cajph.20251106.22
DO - 10.11648/j.cajph.20251106.22
T2 - Central African Journal of Public Health
JF - Central African Journal of Public Health
JO - Central African Journal of Public Health
SP - 432
EP - 437
PB - Science Publishing Group
SN - 2575-5781
UR - https://doi.org/10.11648/j.cajph.20251106.22
AB - Background: Fever remains one of the most frequent reasons for medical consultation. In low and middle resource settings, particularly in Benin, it is often presumed to be of infectious origin—most commonly malaria—due to the endemicity of the parasite. However, the gradual decline in malaria prevalence and the growing diversity of potential etiologies warrant a re-evaluation of the epidemiological profile of febrile illnesses in this context. This study aimed to describe the epidemiology of febrile illnesses in three hospitals located in southern Benin. Methods: A prospective descriptive study was conducted from October 9, 2023, to January 15, 2024, in the pediatric, internal medicine, and emergency departments of the National University Hospital Centre Hubert Koutoukou Maga (CNHU-HKM) in Cotonou, the Abomey-Calavi District Hospital, and the Ouidah District Hospital. The study included patients 308 presenting with fever upon admission or developing fever during hospitalization, defined as a temperature ≥ 38°C in individuals under 18 years and ≥ 37.6°C in those aged 18 years and older. For each participant, detailed interviews and complete clinical examinations were performed to collect sociodemographic and clinical data. Relevant laboratory findings were extracted from medical records. Results: A total of 308 febrile patients were enrolled. Males were predominant (54.22%), and the most represented age group was 31–40 years. The most common functional symptoms were asthenia (73.05%), anorexia (56.16%), and headache (51.30%). Neurological manifestations were the most frequent (38.69%), followed by pleuropulmonary (21.10%) and cutaneous signs (17.86%). Anemia was observed in 40.91% of patients, while leukocytosis occurred in 30.19%. Infectious diseases accounted for 79.22% of identified etiologies, dominated by malaria (50%), followed by bacterial infections. Acute cerebrovascular accidents were the leading non-infectious causes (5.84%). The main treatments included antimalarial and antibiotic therapies. The outcome was favorable in 78.57% of cases, while the case fatality rate was 10.06%. Conclusion: In southern Benin, fever remains predominantly of infectious origin, with malaria still representing the leading cause. However, the increasing proportion of bacterial and neurological etiologies highlights the need to strengthen diagnostic capacities for more accurate and effective management of febrile illnesses.
VL - 11
IS - 6
ER -
Romeo, P. S. G., Romeo, A., Ahouangan, O. L., Houeto, E., Ohouko, A., et al. (2025). Epidemiology of Febrile Illnesses in Three Hospitals in Southern Benin. Central African Journal of Public Health, 11(6), 432-437. https://doi.org/10.11648/j.cajph.20251106.22
Romeo, P. S. G.; Romeo, A.; Ahouangan, O. L.; Houeto, E.; Ohouko, A., et al. Epidemiology of Febrile Illnesses in Three Hospitals in Southern Benin. Cent. Afr. J. Public Health2025, 11(6), 432-437. doi: 10.11648/j.cajph.20251106.22
Romeo PSG, Romeo A, Ahouangan OL, Houeto E, Ohouko A, et al. Epidemiology of Febrile Illnesses in Three Hospitals in Southern Benin. Cent Afr J Public Health. 2025;11(6):432-437. doi: 10.11648/j.cajph.20251106.22
@article{10.11648/j.cajph.20251106.22,
author = {Padonou Setondji Geraud Romeo and Adegbite Romeo and Olivia Lucette Ahouangan and Elisee Houeto and Abraham Ohouko and Olofindji Jennifer and Aguemon Badirou},
title = {Epidemiology of Febrile Illnesses in Three Hospitals in Southern Benin},
journal = {Central African Journal of Public Health},
volume = {11},
number = {6},
pages = {432-437},
doi = {10.11648/j.cajph.20251106.22},
url = {https://doi.org/10.11648/j.cajph.20251106.22},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cajph.20251106.22},
abstract = {Background: Fever remains one of the most frequent reasons for medical consultation. In low and middle resource settings, particularly in Benin, it is often presumed to be of infectious origin—most commonly malaria—due to the endemicity of the parasite. However, the gradual decline in malaria prevalence and the growing diversity of potential etiologies warrant a re-evaluation of the epidemiological profile of febrile illnesses in this context. This study aimed to describe the epidemiology of febrile illnesses in three hospitals located in southern Benin. Methods: A prospective descriptive study was conducted from October 9, 2023, to January 15, 2024, in the pediatric, internal medicine, and emergency departments of the National University Hospital Centre Hubert Koutoukou Maga (CNHU-HKM) in Cotonou, the Abomey-Calavi District Hospital, and the Ouidah District Hospital. The study included patients 308 presenting with fever upon admission or developing fever during hospitalization, defined as a temperature ≥ 38°C in individuals under 18 years and ≥ 37.6°C in those aged 18 years and older. For each participant, detailed interviews and complete clinical examinations were performed to collect sociodemographic and clinical data. Relevant laboratory findings were extracted from medical records. Results: A total of 308 febrile patients were enrolled. Males were predominant (54.22%), and the most represented age group was 31–40 years. The most common functional symptoms were asthenia (73.05%), anorexia (56.16%), and headache (51.30%). Neurological manifestations were the most frequent (38.69%), followed by pleuropulmonary (21.10%) and cutaneous signs (17.86%). Anemia was observed in 40.91% of patients, while leukocytosis occurred in 30.19%. Infectious diseases accounted for 79.22% of identified etiologies, dominated by malaria (50%), followed by bacterial infections. Acute cerebrovascular accidents were the leading non-infectious causes (5.84%). The main treatments included antimalarial and antibiotic therapies. The outcome was favorable in 78.57% of cases, while the case fatality rate was 10.06%. Conclusion: In southern Benin, fever remains predominantly of infectious origin, with malaria still representing the leading cause. However, the increasing proportion of bacterial and neurological etiologies highlights the need to strengthen diagnostic capacities for more accurate and effective management of febrile illnesses.},
year = {2025}
}
TY - JOUR
T1 - Epidemiology of Febrile Illnesses in Three Hospitals in Southern Benin
AU - Padonou Setondji Geraud Romeo
AU - Adegbite Romeo
AU - Olivia Lucette Ahouangan
AU - Elisee Houeto
AU - Abraham Ohouko
AU - Olofindji Jennifer
AU - Aguemon Badirou
Y1 - 2025/12/29
PY - 2025
N1 - https://doi.org/10.11648/j.cajph.20251106.22
DO - 10.11648/j.cajph.20251106.22
T2 - Central African Journal of Public Health
JF - Central African Journal of Public Health
JO - Central African Journal of Public Health
SP - 432
EP - 437
PB - Science Publishing Group
SN - 2575-5781
UR - https://doi.org/10.11648/j.cajph.20251106.22
AB - Background: Fever remains one of the most frequent reasons for medical consultation. In low and middle resource settings, particularly in Benin, it is often presumed to be of infectious origin—most commonly malaria—due to the endemicity of the parasite. However, the gradual decline in malaria prevalence and the growing diversity of potential etiologies warrant a re-evaluation of the epidemiological profile of febrile illnesses in this context. This study aimed to describe the epidemiology of febrile illnesses in three hospitals located in southern Benin. Methods: A prospective descriptive study was conducted from October 9, 2023, to January 15, 2024, in the pediatric, internal medicine, and emergency departments of the National University Hospital Centre Hubert Koutoukou Maga (CNHU-HKM) in Cotonou, the Abomey-Calavi District Hospital, and the Ouidah District Hospital. The study included patients 308 presenting with fever upon admission or developing fever during hospitalization, defined as a temperature ≥ 38°C in individuals under 18 years and ≥ 37.6°C in those aged 18 years and older. For each participant, detailed interviews and complete clinical examinations were performed to collect sociodemographic and clinical data. Relevant laboratory findings were extracted from medical records. Results: A total of 308 febrile patients were enrolled. Males were predominant (54.22%), and the most represented age group was 31–40 years. The most common functional symptoms were asthenia (73.05%), anorexia (56.16%), and headache (51.30%). Neurological manifestations were the most frequent (38.69%), followed by pleuropulmonary (21.10%) and cutaneous signs (17.86%). Anemia was observed in 40.91% of patients, while leukocytosis occurred in 30.19%. Infectious diseases accounted for 79.22% of identified etiologies, dominated by malaria (50%), followed by bacterial infections. Acute cerebrovascular accidents were the leading non-infectious causes (5.84%). The main treatments included antimalarial and antibiotic therapies. The outcome was favorable in 78.57% of cases, while the case fatality rate was 10.06%. Conclusion: In southern Benin, fever remains predominantly of infectious origin, with malaria still representing the leading cause. However, the increasing proportion of bacterial and neurological etiologies highlights the need to strengthen diagnostic capacities for more accurate and effective management of febrile illnesses.
VL - 11
IS - 6
ER -
,
Adegbite Romeo
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