{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T06:40:58Z","timestamp":1784011258745,"version":"3.55.0"},"reference-count":62,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"vor","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"\u201cLa Caixa\u201d Foundation","award":["100010434"],"award-info":[{"award-number":["100010434"]}]},{"name":"\u201cLa Caixa\u201d Foundation","award":["LCF\/BQ\/DR21\/11880018."],"award-info":[{"award-number":["LCF\/BQ\/DR21\/11880018."]}]},{"name":"\u201cLa Caixa\u201d Foundation","award":["FI-1 01003"],"award-info":[{"award-number":["FI-1 01003"]}]},{"name":"Ajuts Joan Or\u00f3 per a la contractaci\u00f3 de personal investigador en formaci\u00f3"},{"name":"AGAUR-FI"},{"name":"Spanish Ministry of Universities","award":["FPU18\/04260"],"award-info":[{"award-number":["FPU18\/04260"]}]},{"name":"European Union's Horizon Europe Research and Innovation"},{"name":"Marie Sklodowska-Curie","award":["101081334"],"award-info":[{"award-number":["101081334"]}]},{"DOI":"10.13039\/501100024035","name":"ISGlobal","doi-asserted-by":"publisher","award":["CEX2023\u20130001290-S"],"award-info":[{"award-number":["CEX2023\u20130001290-S"]}],"id":[{"id":"10.13039\/501100024035","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100024035","name":"ISGlobal","doi-asserted-by":"publisher","award":["MCIN\/AEI\/10.13039\/501100011033"],"award-info":[{"award-number":["MCIN\/AEI\/10.13039\/501100011033"]}],"id":[{"id":"10.13039\/501100024035","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002809","name":"Generalitat de Catalunya","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"CERCA Program"},{"name":"European Union's Horizon Europe Research and Innovation Programme","award":["101057114"],"award-info":[{"award-number":["101057114"]}]},{"name":"Government of Mozambique"},{"name":"Spanish Agency for International Development"},{"DOI":"10.13039\/501100004892","name":"AECID","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004892","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pediatric febrile illnesses remain a leading cause of health care visits, morbidity, and mortality in low-resource settings. Their etiological diagnosis and outcome evaluation are challenging as available tools are limited. Herein, 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed surveillance morbidity and demographic data from children &amp;lt;15 years old presenting with fever (\u226537.5\u00b0C) at Manhi\u00e7a District Hospital and 5 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 664 223 outpatient visits and 23 166 hospitalizations were included. The median age (interquartile range) was 47.1 (20.0\u201392.3) months for outpatients and 21.2 (10.1\u201341.5) months 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%\u201316%). Malnutrition and HIV infection were major contributors to inpatient mortality. Seizures, edema, dehydration, and reduced consciousness were strong predictors of death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofaf724","type":"journal-article","created":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T13:11:48Z","timestamp":1764162708000},"source":"Crossref","is-referenced-by-count":2,"title":["Epidemiology and Outcomes of Pediatric Fever in a Rural District of Southern Mozambique: 17 Years of Morbidity Surveillance"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9306-6970","authenticated-orcid":false,"given":"David","family":"Torres-Fernandez","sequence":"first","affiliation":[{"name":"Centro Investiga\u00e7\u00e3o em Sa\u00fade de Manhi\u00e7a (CISM) , Maputo ,","place":["Mozambique"]},{"name":"ISGlobal , Barcelona ,","place":["Spain"]},{"name":"Facultat de Medicina i Ciencies de la Salut, Universitat de Barcelona (UB) , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9747-467X","authenticated-orcid":false,"given":"Jessica","family":"Dalsuco","sequence":"additional","affiliation":[{"name":"Centro Investiga\u00e7\u00e3o em Sa\u00fade de Manhi\u00e7a (CISM) , Maputo ,","place":["Mozambique"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9095-2800","authenticated-orcid":false,"given":"Cristina","family":"Garcia-Mauri\u00f1o","sequence":"additional","affiliation":[{"name":"ISGlobal , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3581-0383","authenticated-orcid":false,"given":"N\u00faria","family":"Balanza","sequence":"additional","affiliation":[{"name":"ISGlobal , Barcelona ,","place":["Spain"]},{"name":"Facultat de Medicina i Ciencies de la Salut, Universitat de Barcelona (UB) , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Valente","sequence":"additional","affiliation":[{"name":"Centro Investiga\u00e7\u00e3o em Sa\u00fade de Manhi\u00e7a (CISM) , Maputo ,","place":["Mozambique"]},{"name":"ISGlobal , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6137-8619","authenticated-orcid":false,"given":"Sara","family":"Ajanovic","sequence":"additional","affiliation":[{"name":"Centro Investiga\u00e7\u00e3o em Sa\u00fade de Manhi\u00e7a (CISM) , Maputo ,","place":["Mozambique"]},{"name":"ISGlobal , Barcelona ,","place":["Spain"]},{"name":"Facultat de Medicina i Ciencies de la Salut, Universitat de Barcelona (UB) , Barcelona 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Investiga\u00e7\u00e3o em Sa\u00fade de Manhi\u00e7a (CISM) , Maputo ,","place":["Mozambique"]},{"name":"ISGlobal , Barcelona ,","place":["Spain"]},{"name":"Facultat de Medicina i Ciencies de la Salut, Universitat de Barcelona (UB) , Barcelona ,","place":["Spain"]},{"name":"ICREA, Pg. Lluis Companys 23 , Barcelona ,","place":["Spain"]},{"name":"Pediatrics Department, Hospital Sant Joan de Deu, Universitat de Barcelona, Esplugues , Barcelona ,","place":["Spain"]},{"name":"CIBER de Epidemiolog\u00eda y Salud P\u00fablica, Instituto de Salud Carlos III , Madrid ,","place":["Spain"]},{"name":"Institut Clinic de Medicina i Dermatologia, Hospital Clinic de Barcelona , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,11,28]]},"reference":[{"key":"2025121103020609500_ofaf724-B1","author":"World Health Organization","year":"2013","journal-title":"WHO Informal Consultation on Fever Management in Peripheral Health Care Settings: A Global Review of Evidence and Practice"},{"key":"2025121103020609500_ofaf724-B2","doi-asserted-by":"crossref","first-page":"e1000301","DOI":"10.1371\/journal.pmed.1000301","article-title":"Estimating the number of paediatric fevers associated with malaria 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