Close
Explore more Centres, Projects and Groups
Welcome
Welcome Banner
Blood-samples. Credit: Antonio Mendes

Febrile Illness Evaluation in a Broad Range of Endemicities (FIEBRE)

FIEBRE aims to reveal leading causes of fever in sub-Saharan Africa and southeast Asia. What are the main infections causing fever in children and adults, and how should they be treated?

Bottom Content
About us

Rapid diagnostic testing for malaria has revealed that most febrile patients in Africa and Asia do not have malaria. FIEBRE will find out what they have and how to treat them.

Who we are

Funded by the UK Department for International Development, FIEBRE collaborators include LSHTM, Liverpool School of Tropical Medicine, Universities of Oxford, Barcelona and Otago, and partners in Laos, Malawi, Mozambique, Myanmar and Zimbabwe.

Publications

Study protocols, standard operating procedures, data collection tools and related materials will be made available as they are finalised and approved.

About
About FIEBRE

The objective of FIEBRE is to provide evidence:

  • on the most common infectious causes of fever;
  • on antibiotic susceptibility of bacterial causes;
  • on how local perceptions of fever affect treatment practices including the use of diagnostics and antimicrobial drugs;
  • to inform clinical guidelines and algorithms on how to manage non-malarial fevers.

The FIEBRE study will help to fill the gaps in evidence by means of a multi-centre study in countries with a high burden of infectious disease from which few or no data are available. The clinical and laboratory components of the study will focus on detecting infections that are treatable and/or preventable. Ethnographic work with community members, prescribers and public health workers will seek to understand how fever is understood by different communities of practice, and how this affects treatment practices.

The results will help to inform updated, evidence-based algorithms for the management of febrile illness, and provide data that may be used to design new diagnostics and rational approaches to disease surveillance. These outputs will ultimately help health systems and providers to provide more appropriate care to patients and lead to better clinical outcomes.

Who we are
Who we are FIEBRE

FIEBRE is funded by the UK Department for International Development. It is a multi-centre study conducted by the LSHTM, Liverpool School of Tropical Medicine, Barcelona Institute for Global Health (ISGlobal), Universities of Oxford and Otago, and partner institutions in Lao PDR, Malawi, Mozambique, Myanmar and Zimbabwe, and collaborating reference laboratories.

Partners

Country partners

Meet the team

LSHTM

Prof David Mabey, Principal Investigator
Dr Amit Bhasin, Programme Manager 
Dr John Bradley, Co-investigator, Statistician
Dr Heidi Hopkins, Co-investigator, Scientific Programme Coordinator 
Sham Lal, Co-investigator, Electronic Data Management System
Ruth Lorimer, Communications Officer 
Dr Chrissy Roberts, Co-investigator, ODK specialist and Laboratory Lead 
Karen Slater, Administrative support 
Dr Shunmay Yeung, Co-investigator, Paediatric Lead

Partner teams

The principal investigators for the partners are: 

Prof Quique Bassat, ISGlobal
Prof John Crump, University of Otago
Prof David Lalloo, LSTM
Prof Paul Newton, University of Oxford

For more details about each country team see the Where we work section.

Social science team

Dr Clare Chandler, Co-investigator, Social Science Lead
Dr Justin Dixon, Co-investigator, Social Scientist
Dr Coll Hutchison, Co-investigator, Social Scientist
Pat Ng, Project Manager, Social science team

Malawi
Eleanor MacPherson, Social Science lead (LSTM)
Chawanangwa Mahebere Chirambo, Social Science Co-lead and PhD Student
 
Myanmar
Yuzana Khine Zaw, PhD Student

Zimbabwe
Salome Manyau, Social Science Lead and PhD Student

Study governance

An External Advisory Committee (EAC) has been established to provide scientific oversight of the FIEBRE study. The members of the EAC are:

Prof Chris Whitty (Chair), Interim Government Chief Scientific Adviser & Professor of Public and International Health, London School of Hygiene & Tropical Medicine, UK
Dr David Meya, Associate Professor, College of Health Sciences, Makerere University, Uganda
Dr T Jacob John, Professor Emeritus, Christian Medical College, (CMC) Vellore, India
Dr Amanda Walsh, Senior Scientist, Emerging Infections and Zoonoses, National Infection Service, Public Health England, UK

Where we work
FIEBRE study sites

The FIEBRE study sites are in Laos, Malawi, Mozambique, Myanmar and Zimbabwe. 

Lao

Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU)

The Mahidol Oxford Tropical Medicine Research Unit (MORU) develops effective and practical means of diagnosing and treating malaria and other neglected diseases such as melioidosis, typhus, TB and leptospirosis. MORU was established in 1979 as a research collaboration between Mahidol University (Thailand), Oxford University (UK) and the Wellcome Trust UK. It is a network of a diversity of subunits including the Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Lao PDR (LOMWRU). This is a small clinical tropical medicine research group based at Mahosot Hospital, Vientiane . LOMWRU builds diagnostic, clinical and research capacity to help improve global, regional and Lao public health. LOMWRU’s main areas of research interest are in the diagnosis, epidemiology and treatment of malaria, rickettsial infections, leptospirosis, melioidosis, community-acquired septicaemia, central nervous system infections, the causes of acute fevers and public health aspects of medicine quality problems.  

Malawi

Malawi-Liverpool Wellcome Trust Research Programme (MLW)

The Malawi site will be Chikwawa district in the southern region of Malawi. Chikwawa district is 5,000 km2 with a population of 350,000 and is served by Chikwawa Hospital.  

The work will be based out of the Malawi-Liverpool Wellcome Trust Clinical Research Programme (MLW) . Established in 1995, MLW is an internationally-recognised health research institution led by Malawian and international scientists with the aim of improving the health of people in sub-Saharan Africa. MLW is built around laboratories, located at Queen Elizabeth Central Hospital, in Blantyre.  

The principal investigator is Dr Nicholas Feasey and the study doctor is Dr Ed Green.   

Mozambique

Centro de Investigacao em Saude de Manhica (CISM)

In Mozambique, FIEBRE is coordinated by the Centro de Investigação em Saúde da Manhiça (CISM) in collaboration with the Barcelona Institute of Global Health (IS Global). 

CISM was established in 1996 with the objective of conducting biomedical research in those diseases that affect the most poor and vulnerable. The Centre includes a fully equipped laboratory including parasitology, haematology, biochemistry, microbiology, (including biosafety level III premises), molecular biology (including PCR and RT-PCR) and immunology. CISM has been running a Demographic Surveillance System (DSS) since 1996, covering the whole district’s population and it set up a morbidity surveillance system at Manhiça District Hospital (MDH) in 1998. Overall, data on over 70,000 paediatric admissions and more than 1.2 million outpatient visits have been collected in the past 18 years. CISM’s other activities include: malaria screening, microbiological surveillance; pneumonia surveillance and conducting studies on issues with an important impact on public health policies in the country. 

The study will be conducted in the district of Manhiça (population 182,000 inhabitants, 2300 km2), a rural area located 90 km away from the capital Maputo. MDH acts as the referral health facility for the area. 

The study’s Principal Investigator at the site is Professor Quique Bassat, supported by co-investigators Dr Antonio Sitoe, Dr Lola Madrid, Dr Rubao Bila, in addition to a larger team of Mozambican-based supporting staff.  

Myanmar

University of Medicine 1, Yangon

Researchers from the University of Medicine 1, Yangon, Myanmar, will be implementing research activities  for the FIEBRE study with colleagues at Thanlyin District Hospital through the longstanding University of Otago – University of Medicine 1 Collaboration. The research team will be based at Thanlyin District Hospital a busy district hospital in south Yangon. 

The Myanmar Principal Investigator is Professor Wah Win Htike, Professor and Head, Department of Microbiology, University of Medicine 1. She leads a team including Professor Hla Hla Win, Professor and Head, Department of Preventive and Social Medicine and Professor Zaw Lynn Aung, Professor and Head, Department of Medicine, University of Medicine 1. Dr Win Thandar Oo, a University of Medicine 1 medical microbiologist, will study towards a University of Otago PhD linked to the work at the Myanmar FIEBRE site.  

Professor John Crump, McKinlay Professor of Global Health and Co-Director of the Otago Global Health Institute, University of Otago, will support this work. Professor Crump has been instrumental in the design and development of the FIEBRE study, and has coordinated reference laboratory engagement. 

Zimbabwe

Biomedical Research and Training Institute (BRTI)

The researchers in Zimbabwe are based at the Biomedical Research and Training Institute (BRTI) in Harare. Established in 1995, the BRTI provides effective and professional research facilities including laboratory facilities for molecular diagnostics, micro-biology, serology, TB and immunology. BRTI aims to improve health and quality of life in Africa through conducting research and training. Its role is to provide the infrastructural support that researchers in all aspects of health need to become effective in influencing policy. 

The study site incorporates major hospitals in Harare (urban setting) Harare Central Hospital (HCH) and Chitungwiza Hospital. These hospitals have both inpatient and outpatients care of all age groups with patients referred from local clinics and provincial hospitals. The hospitals serve urban and peri-urban communities in southern Harare. In addition, outpatients will be recruited from polyclinics in south-western Harare.  

The BRTI team is led by Professor Rashida Ferrand (Principal investigator) and comprises: Dr Ioana Olaru (Study coordinator), Ethel Dauya (Field manager), Tsitsi Bandason (Data manager), Salome Manyau (Social science lead), Beauty Makamure (Laboratory manager) and Tendai Muchena (Administrator). Partners include the Department of Medicine and Paediatrics at Harare Hospital and Chitungwiza Hospital, the University of Zimbabwe and Harare City Health Services.

Publications

Publications, research and data produced and contributed to by FIEBRE team members is available including:

  • Journal articles
  • Conferences, workshops and presentations
  • Books, chapters and sections
  • Seminars and lectures
  • Media
Publications List Block
A comparison of patients' local conceptions of illness and medicines in the context of C-reactive protein biomarker testing in Chiang Rai and Yangon
Khine Zaw, Y., Charoenboon, N., Haenssgen, M. J., Lubell, Y. (2018)
2018
American Journal of Tropical Medicine and Hygiene
The social role of C-reactive protein point-of-care testing to guide antibiotic prescription in Northern Thailand
Haenssgen, M. J., Charoenboon, N., Althaus, T., Greer, R. C., Intralawan, D., & Lubell, Y. (2018).
2018
Social Science & Medicine, 202, 1-12. Epub 2018 Feb 23
It is time to give social research a voice to tackle antimicrobial resistance?
Haenssgen, M. J., Charoenboon, N., & Khine Zaw, Y. (2018)
2018
Journal of Antimicrobial Chemotherapy, Volume 73, Issue 4, 1 April 2018, Pages 1112–1113 doi.org/10.1093
Malaria-free but still sick: What’s giving millions of kids fevers?
Gretchen Vogel
2018
Science; doi:10.1126/science.aat5098
The epidemiology of febrile illness in sub-Saharan Africa: implications for diagnosis and management
Maze MJ, Bassat Q, Feasey NA, Mandomando I, Musicha P, Crump JA
2018
Clin Microbiol Infect. 2018 Feb 15 doi: 10.1016/j.cmi.2018.02.011
Addressing Antimicrobial Resistance Through Social Theory: An Anthropologically Oriented Report.
Chandler, C; Hutchinson, E; Hutchison, C
2016
Technical Report. London School of Hygiene & Tropical Medicine
Estimating the Burden of Febrile Illnesses
Crump JA, Kirk MD.
2015
PLoS Negl Trop Dis; 9(12): e0004040
Etiology of Severe Febrile Illness in Low- and Middle-Income Countries: A Systematic Review
Prasad N, Murdoch DR, Reyburn H, Crump JA.
2015
PLoS One; 10(6): e0127962
Etiology of severe non-malaria febrile illness in Northern Tanzania: a prospective cohort study
Crump JA, Morrissey AB, Nicholson WL, et al.
2013
PLoS Negl Trop Dis; 7(7): e2324
Causes of non-malarial fever in Laos: a prospective study
Mayxay M, Castonguay-Vanier J, Chansamouth V, et al.
2013
Lancet Glob Health; 1(1): e46-54
Estimating the incidence of typhoid fever and other febrile illnesses in developing countries
Crump JA, Youssef FG, Luby SP, et al.
2003
Emerg Infect Dis; 9(5): 539-44