Etiology of Febrile Illness in Eastern Indonesia (EFEK Study)


Principal Investigators
Associate Professor Raph Hamers
Dr Dodi Safari

Kupang, East Nusa Tenggara, Indonesia

November 2019 – December 2022

This study aims to evaluate the community-acquired causes of acute febrile illness and evaluate clinical manifestations and outcomes in Kupang, Nusa Tenggara Timur, in order to develop evidence to guide clinical management protocols.


In low-resource settings, clinicians often make a diagnosis of patients presenting with an acute febrile illness solely on their clinical presentation, and in many settings it is left to health care workers to decide what type of treatment febrile patients receive, given the lack of laboratory diagnostic capacities, high costs of specialized diagnostic testing, or the inability of a majority of patients to afford testing.

This can lead to inappropriate clinical management and inappropriate use of antibiotics, which may contribute to increased morbidity, mortality and increasing levels of antibiotic drug resistance. In Indonesia, acute febrile illness accounts for 20-25% of hospitalizations.

Few studies to date have systematically collected clinical data, outcomes, and spectrum of etiologies in eastern Indonesia. Nusa Tenggara Timur (NTT) is one of the most impoverished provinces of Indonesia. Availability, access to and quality of health services poses particular challenges.

Major public health problems include poor immunization coverage and high infectious diseases burdens such as HIV, tuberculosis, endemic malaria, infant respiratory and diarrheal diseases, and neglected tropical diseases.


Health research has been historically neglected in NTT province, leading to important knowledge gaps concerning disease burdens, determinants of morbidity and mortality.

Children and adults who presented with acute febrile illness in the emergency ward and outpatient division were recruited and followed for convalescence during 28 days.


Participant recruitment and follow-up has been completed (with an interruption caused by the COVID-19 pandemic). Laboratory diagnostic testing is currently ongoing, with results expected in Q1 2023.



Dodi Safari

Dr Dodi Safari

RSUD Johannes

Prof. Dr. W.Z. Johannes Hospital


University of Nusa Cendana

Skip to content