Universal versus conditional three-day follow-up for children with uncomplicated fever at the community level: A cluster-randomized, community-based, non-inferiority trial

Fevers in childhood are common and usually resolve without medication. According to the WHO’s guidelines for community case management (CCM), a febrile child with no danger signs and a negative assessment for malaria, pneumonia, and diarrhea should be sent home with an antipyretic and advised to return in three days for a follow-up visit. These follow-up visits create an added burden for caregivers and community health workers. We hypothesize that health outcomes for these cases will be equivalent if the guidance recommends follow-up visits only if symptoms have not resolved. This hypothesis will be tested in Kalemie, a rural region of the DRC where the IRC has a large CCM program. We will conduct a cluster-randomized, community-based non-inferiority trial covering 28 health centers and enroll an anticipated sample size of 3,730 children under five years old. If the hypothesis is validated, it will justify simplifying the guidance and result in fewer unnecessary follow-up visits, reducing costs to both providers and caretakers.