Clinical features, risk factors, and impact of antibiotic treatment of diarrhea caused by in children less than 5 years in Manhiça District, rural Mozambique.

OBJECTIVES

During the period from December 2007 to November 2012, the epidemiology of diarrhea caused by was studied among children <5 years of age residing in Manhiça District, Southern Mozambique.

MATERIALS AND METHODS

Children from 0 to 5 years with moderate-to-severe diarrhea (MSD) and less severe diarrhea (LSD) were enrolled along with matched controls (by age, gender, and neighborhood). Age-stratified logistic regression analyses were conducted to identify clinical features and risk factors associated with positivity in cases of diarrhea. The impact of antibiotic treatment was assessed for patients with known outcome.

RESULTS

A total of 916 cases of MSD and 1979 matched controls, and 431 cases of LSD with equal number of controls were enrolled. was identified as significant pathogen in both cases of MSD and LSD compared to their respective controls. was detected in 3.9% (17/431) of LSD compared to 0.5% (2/431) in controls (=0.001) and in 6.1% (56/916) of MSD cases compared to 0.2% (4/1979) in controls (<0.0001), with an attributable fraction of 8.55% (95% CI: 7.86-9.24) among children aged 12-23 months. Clinical symptoms associated to among MSD cases included dysentery, fever, and rectal prolapse. Water availability, giving stored water to child, washing hands before preparing baby's food, and mother as caretaker were the protective factors against acquiring diarrhea caused by . Antibiotic treatment on admission was associated with a positive children outcome.

CONCLUSION

remains a common pathogen associated with childhood diarrhea in Mozambique, with dysentery being a significant clinical feature of shigellosis. Adherence to the basic hygiene rules and the use of antibiotic treatment could contribute to the prevention of most of diarrhea due to .