Karambu Shirley, Matiru Viviene, Kiptoo Michael, Oundo Joseph
Field epidemiology and Laboratory training programme, Kenya ; Ministry of Public Health and Sanitation, Kenya.
Jomo Kenyatta University of Agriculture and Technology, Kenya.
Pan Afr Med J. 2013 Oct 4;16:37. doi: 10.11604/pamj.2013.16.37.2947. eCollection 2013.
Diarrhoea remains a major public health problem in East African nations such as Kenya. Surveillance for a broad range of enteric pathogens is necessary to accurately predict the frequency of pathogens and potential changes in antibiotic resistance patterns.
A cross sectional study was conducted in Igembe District Hospital in Meru County to determine the burden and factors associated enteric bacterial infection among children aged five years and below. Stool samples were collected between March and July 2012. Bacterial pathogens were identified and antibiotic susceptibility of bacterial isolates was ascertained. Questionnaire was administered to the 308 study participants to identify the modifiable risk factors. Data was entered and analyzed using Epi Info version 3.5.3.
The study recruited 308 children. The mean age was 27.25 months, median of 26.0 months and age range between 2-60 months. The bacterial isolation rates were ETEC 9.1%, EPEC 6.8% and EAEC 12.3%, Salmonella paratyphoid (10.4%), Shigella flexineri (1.9%) and Shigella dysentriae (0.9%). Over 95%, of the isolates were resistance to amoxicillin, sulphinatozole, cotrimoxazole. Six factors were independently associated with diarrhoeal diseases, occupation of the parent/ guardian (miraa business) (OR=1.8, CI:1.44-4.99),care taker not washing hands after changing napkins (OR= 1.6, CI:1.2-19.7), child drank untreated water from the river (OR= 2.7, CI:2.4-9.9) child not exclusively breastfed (OR= 2.4, CI:2.1-10.5),child did not Wash hands before eating (OR=2.2, CI:1.91-16.3) and after visiting toilet (OR=3.7,CI:2.8-39.4). Eating of mangoes was found to be protective against diarrhoea (OR=0.5, CI:0.03-0.89).
The bacterial pathogens were found to be a significant cause of diarrhoea in the study participants. We established higher resistance to several commonly prescribed antibiotics. Several factors were significantly association with diarrhoea illness. We recommend multifaceted approach that acknowledges the public health aspects that would reduce the burden of diarrhoea infections as identified in this study.
腹泻仍是肯尼亚等东非国家的一个主要公共卫生问题。监测多种肠道病原体对于准确预测病原体的出现频率以及抗生素耐药模式的潜在变化很有必要。
在梅鲁县伊根贝区医院开展了一项横断面研究，以确定5岁及以下儿童肠道细菌感染的负担及相关因素。于2012年3月至7月间收集粪便样本。鉴定细菌病原体，并确定细菌分离株的抗生素敏感性。对308名研究参与者进行问卷调查，以确定可改变的风险因素。使用Epi Info 3.5.3版本录入并分析数据。
该研究招募了308名儿童。平均年龄为27.25个月，中位数为26.0个月，年龄范围在2至60个月之间。细菌分离率分别为：产毒性大肠杆菌9.1%、肠致病性大肠杆菌6.8%、肠集聚性大肠杆菌12.3%、副伤寒沙门氏菌（10.4%）、福氏志贺菌（1.9%）和痢疾志贺菌（0.9%）。超过95%的分离株对阿莫西林、舒巴坦、复方新诺明耐药。六个因素与腹泻疾病独立相关，父母/监护人的职业（经营阿拉伯茶生意）（比值比=1.8，可信区间：1.44 - 4.99）、护理人员更换尿布后不洗手（比值比=1.6，可信区间：1.2 - 19.7）、儿童饮用未经处理的河水（比值比=2.7，可信区间：2.4 - 9.9）、儿童非纯母乳喂养（比值比=2.4，可信区间：2.1 - 10.5）、儿童饭前不洗手（比值比=2.2，可信区间：1.91 - 16.3）以及便后不洗手（比值比=3.7，可信区间：2.8 - 39.4）。食用芒果被发现对腹泻有预防作用（比值比=0.5，可信区间：0.03 - 0.89）。
在研究参与者中，细菌病原体被发现是腹泻的一个重要原因。我们发现对几种常用抗生素的耐药性较高。几个因素与腹泻疾病显著相关。我们建议采取多方面的方法，承认公共卫生方面的因素，以减轻本研究中确定的腹泻感染负担。
