Sothmann Peter, Krumkamp Ralf, Kreuels Benno, Sarpong Nimako, Frank Clemens, Ehlkes Lutz, Fobil Julius, Gyau Kennedy, Jaeger Anna, Bosu Benedicta, Marks Florian, Owusu-Dabo Ellis, Salzberger Bernd, May Jürgen
Research Group Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Division of Tropical Medicine, 1st Department of Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
Research Group Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Centre for Infection Research (DZIF), partner site Hamburg-Borstel-Lübeck, Hamburg, Germany.
PLoS One. 2015 Sep 29;10(9):e0139433. doi: 10.1371/journal.pone.0139433. eCollection 2015.
Systemic bacterial infections are a major cause of paediatric febrile illness in sub-Saharan Africa. Aim of this study was to assess the effects of social and geographical determinants on the risk of bacteraemia in a rural-urban transition zone in Ghana.
Children below 15 years of age with fever were recruited at an outpatient department in the suburban belt of Kumasi, Ghana's second largest city. Blood was taken for bacterial culture and malaria diagnostics. The socio-economic status of participants was calculated using Principle Component Analysis. A scale, based on key urban characteristics, was established to quantify urbanicity for all communities in the hospital catchment area. A case-control analysis was conducted, where children with and without bacteraemia were cases and controls, respectively.
Bacteraemia was detected in 72 (3.1%) of 2,306 hospital visits. Non-typhoidal Salmonella (NTS; n = 24; 33.3%) and Salmonella typhi (n = 18; 25.0%) were the most common isolates. Logistic regression analysis showed that bacteraemia was negatively associated with urbanicity (odds ratio [OR] = 0.8; 95% confidence interval [CI]: 0.7-1.0) and socio-economic status (OR = 0.8; 95% CI: 0.6-0.9). Both associations were stronger if only NTS infections were used as cases (OR = 0.5; 95% CI: 0.3-0.8 and OR = 0.6; 95% CI: 0.4-1.0, respectively).
The results of this study highlight the importance of individual as well as community factors as independent risk factors for invasive bacterial infection (IBI) and especially NTS. Epidemiological data support physicians, public health experts and policy makers to identify disease prevention and treatment needs in order to secure public health in the transitional societies of developing countries.
在撒哈拉以南非洲地区，全身性细菌感染是儿童发热性疾病的主要病因。本研究旨在评估社会和地理因素对加纳城乡过渡地带菌血症风险的影响。
在加纳第二大城市库马西郊区的一家门诊部招募15岁以下发热儿童。采集血液进行细菌培养和疟疾诊断。采用主成分分析法计算参与者的社会经济地位。基于关键城市特征建立一个量表，以量化医院服务区域内所有社区 的城市化程度。进行病例对照分析，菌血症患儿和未患菌血症患儿分别作为病例组和对照组。
在2306次就诊病例中，72例（3.1%）检测到菌血症。非伤寒沙门氏菌（24例；33.3%）和伤寒沙门氏菌（18例；25.0%）是最常见的分离菌株。逻辑回归分析显示，菌血症与城市化程度（比值比[OR]=0.8；95%置信区间[CI]：0.7 - 1.0）和社会经济地位（OR = 0.8；95% CI：0.6 - 0.9）呈负相关。若仅将非伤寒沙门氏菌感染作为病例，则两种相关性更强（OR分别为0.5；95% CI：0.3 - 0.8和OR = 0.6；95% CI：0.4 - 1.0）。
本研究结果突出了个体因素和社区因素作为侵袭性细菌感染（尤其是非伤寒沙门氏菌）独立危险因素的重要性。流行病学数据有助于医生、公共卫生专家和政策制定者确定疾病预防和治疗需求，以保障发展中国家转型社会的公众健康。
