Prevalence and Clinico-Demographic Characteristics Associated with Bacterial Diarrhea among HIV Positive and Negative Children Aged Below Five Years at Moi Teaching and Referral Hospital, Kenya
American Journal of Life Sciences
Volume 2, Issue 6-3, December 2014, Pages: 1-8
Received: Jul. 9, 2014;
Accepted: Jul. 18, 2014;
Published: Jul. 31, 2014
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Rono Salinah J., University of Kabianga, Department of Biological Sciences, Kericho, Kenya; Maseno University, Department of Biomedical Sciences, P.O Private Bag, Maseno, Kenya
Kakai Rose, Maseno University, Department of Medical microbiology, P.O Private Bag, Maseno, Kenya
Esamai Fabian, Moi University, Department of Paediatrics and Child Health, P.O Box 4660, Eldoret, Kenya
Diarrhea is the second leading cause of morbidity and mortality worldwide. It accounts for over 2 million deaths in children aged below 5 years, majority being from Sub-Saharan Africa. Diarrhea is ranked third as a cause of death and the third leading cause of pediatric admissions in Kenya. The objective of this study was to determine the prevalence and clinico-demographic characteristics associated with diarrhea in relation to patient HIV status. This was a cross-sectional comparative study of 216 HIV seropositive and seronegative children aged below 5 years admitted with diarrhea at Moi Teaching and Referral Hospital in Western Kenya. Clinico-demographic characteristics associated with diarrhea were obtained using questionnaires. Stool samples were collected and analyzed using standard microbiological methods to determine their bacterial etiology. The mean (standard deviation) 24.11(15.61) vs. 11.77(7.88), median and inter quartile range 22(10, 36) vs. 10 (6, 16) was higher among HIV positive than negative cases with no statistically significant differences with regard to gender. The prevalence of diarrhea was 17.1% with 64.4% (139) of our cases being male and 35.6% (77) female. The prevalence of bacterial and non bacterial diarrhea was 8.5% (118) and 7.1% (98) respectively. The main bacterial enteropathogens isolated among HIV positive and negative cases were Escherichia coli 88.9% (38 vs. 67), Shigella 5.1 %( 1, 5), Salmonella 4.2% (0, 5) and other enteric species 1.7% (0, 2). EAEC (17.7%) was the main diarrheagenic E coli (DEC) followed by EHEC (5.1%), EPEC (3.4%), EIEC (2.5%) and ETEC (1.7%). Other were S.typhimurium 4.2% (0, 5), S.typhi 3.4%) (0, 4), S. dyenteriae and S. flexneri 2.5% (0, 3) each respectively. HIV positive individuals recorded more mixed infections (72% vs. 28%) than HIV negative cases. Some of illnesses recorded in HIV positive cases included tuberculosis 4(100%) and meningitis 8(100%) whereas pneumonia 21(71.4 % vs. 28.6), oral thrush 13 (76.9% vs. 23.1%), malaria 19 (57.9% vs. 42.1%) and protein energy malnutrition 13 (61.5% vs. 38.5 %) were recorded in both HIV positive and negative cases respectively. Education level of parent/guardian, socioeconomic status, housing, water, sanitation and seasonal variations were significantly associated with diarrhea. The study depicts a positive correlation between clinico-demographic characteristics and HIV status on prevalence and etiology of diarrhea. We recommend improved hygienic practices, definitive diagnosis of diarrhea etiology and patient HIV status for effective management of childhood diarrhea.
Rono Salinah J.,
Prevalence and Clinico-Demographic Characteristics Associated with Bacterial Diarrhea among HIV Positive and Negative Children Aged Below Five Years at Moi Teaching and Referral Hospital, Kenya, American Journal of Life Sciences. Special Issue: Microbiology Research.
Vol. 2, No. 6-3,
2014, pp. 1-8.
WHO (2001). IMCI Integrated Management of Childhood Illness. WHO/FCH/CAH/00.40. Geneva Management of severe malnutrition: a manual for physicians and other senior health workers.
Prasad KN, Nag VL, Dholes TN and Ayyagari A, 2000. Identification of enteric pathogens in HIV- Positive Patients with diarrhea in northern India. Journal of Health Population and Nutrition, 18:23-6.
Navaneethan U and Giannella RA, 2008. Mechanisms of infectious diarrhea. Nature Clinical Practice. Gastroenterology & Hepatology, 5 (11): 637–647.
UNICEF (United Nations Children’s Fund) and WHO (World Health Organization), Diarrhea. Why Children Are Dying and What Can Be Done? UNICEF, New York, 2009.
Kenya National Bureau of Statistics (KNBS), ICF Macro 2010. Kenya Demographic and Health Survey 2008-09. KNBS and ICF Macro, Calverton, Maryland.
Nguyen TV, Phuong VL, Chinch HL, and Weintraub A, 2005. Antibiotic Resistance in Diarrheagenic Escherichia coli and Shigella Strains Isolated from Children in Hanoi, Vietnam. Journal of Antimicrobial Agents and Chemotherapy 49 (2): 816-819
Abu-Elamreen FH, Abed AA, Sharif FA, 2008. Viral, bacterial and parasitic etiology of pediatric diarrhea in Gaza, Palestine. Med Princ. Pract.17: 296-301
Ahmed IS, Elton AR, Karrer ZA and Gerbil AR. 1994. Knowledge, attitudes and practices of mothers regarding diarrhea among children in a Sudanese rural community. E Afr Med J71:716-719.
Medina AM, Rivera FP, Romero LM, Kolevic LA, Castillo ME, Verne E, Hernandez R, Mayor YE, Barletta F, Mercado E, Ochoa TJ, 2010. Diarrheagenic Escherichia coli in human immunodeficiency virus (HIV) pediatric patients in Lima, Peru. American Journal of Tropical Medicine and Hygiene, 83(1): 158-63.
Madigan MT and Martinko JM, 2006. Brock Biology of Microorganisms (11th Ed). Pearson. ISBN 0-13-196893-9.
WHO/UNICEF Joint Monitoring Program for Water Supply and Sanitation, 2010. A snapshot of drinking water and sanitation in the MDG region sub Saharan Africa CIA. The World Fact book. (Accessed at https://www.cia.gov/library/publications/the-world- fact book/geos/ke.htm.
Nel, E. 2010. Diarrhea and malnutrition. South African Journal of Clinical Nutrition; Supplement: S15-S18
Brooks JT, Ochieng JB, Kumar L, Okoth G, Shapiro RL, 2009. Surveillance for bacterial diarrhea and antimicrobial resistance in rural western Kenya. Clinical Infectious Diseases; 43:393–401.
van Eijka AM, Brooks JT, Adeoeke PM, Garrette V, Eberhardd M, .Rosend DH Ayisie JG, Ochieng JB, Kumarc L, .Gentschf JR, Nahlend BR, Mintzc ED and Slutskerd T, 2010. Diarrhea in children less than two years of age with known HIV status in Kisumu, Kenya. International Journal of Infectious Diseases 14: e220–e225.
Onyango DM and Angienda PO, 2010. Epidemiology of Waterborne Diarrheal Diseases among Children aged 6-36 months in Busia – Western Kenya. International Journal of Biological and Life Sciences 6:2
Sang WK, Oundo V. and Schnabel D, 2012. Prevalence and antibiotic resistance of bacterial pathogens isolated from childhood diarrhea in four provinces of Kenya. J Infect Dev Countries 6(7):572-578.
Makobe CK, Sang WK, Kikuvi G and Kariuki S, 2012. Molecular characterization of virulence factors in diarrheagenic Escherichia coli isolates from children in Nairobi, Kenya J Infect Dev Ctries 6(8):598-604.
US. Center for Disease Control and Prevention, 2008. Revised classification system for human immunodeficiency virus infection in children less than 13 years of age. MMWR Morb Mortal Wkly Rep 43: 1-10
Murray PR, Baron EJ, Pfaller MA, Tenover F.C and Yolken R, 2000. Manual of Clinical Microbiology, American Society for Microbiology, Washington DC, 6: 1342-1349.
Baron EJ, Peterson LR, Feingold SM, 1994. Bailey and Scott's Diagnostic Microbiology. 9th ed. CV Mosby, St. Louis.
Gassama A., Papa SS, Fatou F, Path C, Hovette P, Aksatou GN, Rkmonie S Badara S and Souleymane M, 2001. Ordinary and Opportunistic Enteropathogens Associated with Diarrhea in Senegalese Adults in Relation to Human Immunodeficiency Virus Serostatus. Medical Journal 39:190-196
Esamai F and Buku GM, 1994. HIV Seropositivity in children admitted with diarrhea at Eldoret District Hospital, Kenya; East African Medical Journal 71:631-634
Gassama-Sow A , Sow PS, Guèye M , Guèye-N’diaye A , Perret JL, M’boup S, Aïdara-Kane A. 2005. Characterization of pathogenic Escherichia coli in human immunodeficiency virus-related diarrhea in Senegal. J Infect Dis. 189: 75 –78.
Musoke RN and Revathi G. 2000. Emergence of Multidrug-resistant Gram- negative organisms. Unpublished conference proceedings from the Global Antibiotic Resistance Partnership inaugural Meeting, Nairobi, Kenya. 2009, Washington, DC.
Nyamwange C, Mkoji GM and Mpoke S, 2012. Cryptosporidiosis among HIV positive patients in the North Rift region of Kenya Afr J Health Sci. 21:92-106
Cegielski JP, Msengi AE, Dukes CS, Mbise R Redding-Lallinger R, Minjas JN, Wilson ML, Shao J, Durack DT, 1993. Intestinal parasites and HIV Infection in Tanzanian Children with Diarrhoea. AIDS 7: 13-22
Moyo SJ, Gro N, Matee MI, Kitundu J, Myrmel H, Haima M, Maselle SY and Langeland N, 2011. Age specific etiological agents of diarrhea in hospitalized children aged less than five years in Dar es Salaam, Tanzania. BMC Journal 11:19
Antonios SN, Tolba OA, Othman AA, Saad MA, 2010. .A preliminary study on the prevalence of parasitic infections in immunocompromised children. Journal of the Egyptian Society of Parasitology 40(3): 617-630.
Rossit AR, de Almeida MT , Nogueira CA , da Costa Oliveira JG , Barbosa DM , Moscardini AC , Mascarenhas JD , Gabbay YB , Marques FR , Cardoso LV , Cavasini CE and Machado RL, 2007. Bacterial, yeast, parasitic, and viral enteropathogens in HIV infected children from São Paulo State, southeastern Brazil. Diagn Microbiol Infect Dis. 57: 59–66.
Njuguna J and Miruka C, 2011. Diarrhea and Malnutrition among Children in a Kenyan District: A Correlational Study; J Rural Trop Public Health 10: 35 ‐ 38
Siraj FA, Farheen A, Muzaffar A, Mattoo GM, 2008. Prevalence of Diarrheal Disease, its Seasonal and age Variation in under-fives in Kashmir, India. International Journal of Health Sciences 2: 126-33.
Janoff EN and Smith PD, 2010. Perspectives on gastrointestinal infections in AIDS healthy Subjects in Southeast Nigeria. J Health Popul Nutr 28(3): 245–252.
Pavia AT , Long EG , Ryder RW , Nsa W , Puhr ND , Wells JG , Martin P, Tauxe RV , PM, 1992. Diarrhea among African children born to human immunodeficiency virus 1-infected mothers: clinical, microbiologic and epidemiologic features. Pediatr Infect Dis J 11: 996 – 1003
Villamor E, Fataki MR, Bosch RJ, Mbise RL, Fawzi WW (2004) Human immunodeficiency virus infection, diarrheal disease and sociodemographic predictors of child growth. Acta Paediatr 93:372– 379.
Boru WG, Kikuvi G, Omollo J, 2013. Etiology and factors associated with bacterial diarrheal diseases amongst urban refugee children in Eastleigh, Kenya: A case control study. Afr J Lab Med 2(1):63-69
Karambu S, Matiru V, Kiptoo M, Oundo J 2013. Characterization and associated with diarrheal diseases caused by enteric bacterial pathogens among children aged five years and below attending Igembe District Hospital, Kenya. The Pan African Medical Journal 16:37
Crushell E, Harty S, Sharif F, Bourke B, 2004. Enteric Campylobacter: Purging Its Secrets? Pediatr Res 55: 3-12.
Fernández-Cruz A, Muñoz P, Mohedano R, Valerio M, Marín M, Alcalá L, Rodriguez- Créixems M, Cercenado E, Bouza E, 2010. Campylobacter bacteremia: Clinical characteristics, incidence, and outcome over 23 years. Medicine (Baltimore) 89(5):319-30
Samie A, Bessong PO, Obi CL, Dillingham R and Guerrant RL, 2012. Bacterial and Parasitic Agents of Infectious Diarrhea in the Era of HIV and AIDS - The Case of a Semi Rural Community in South Africa 8:143-182
Germani Y, Minssart P, Vohito M, Yassibanda S, Glaziou P, Hocquet D, Berthelemy P, Morvan J, (1998). Etiologies of acute, persistent, and dysenteric diarrheas in adults in Bangui, Central African Republic, in relation to human immunodeficiency virus serostatus. Am J Trop Med Hyg 59:1008-1014.
Nweze EI, 2010. Etiology of Diarrhea and Virulence Properties of Diarrheagenic Escherichia coli among Patients and Healthy Subjects in Southeast Nigeria. J Health Popul Nutr. 28(3): 245–252. PMCID: PMC2980889