Mycologist, Makerere University Kampala
To estimate the prevalence of pathogenic E. coli among children less than five years of age with acu
Study site, settings and population
The study was conducted in Rakai General Hospital in Rakai district. The district is bordered by Masaka in the North and North East, Mbarara in the West and North-west and the Republic of Tanzania in the South. The 100 beds capacity hospital serves over 200 children per week. Microbiological analysis of the stool was performed at Kakuuto health centre IV Microbiology laboratory because of its capacity to handle microbiology cultures. The PCR procedures were performed in the Molecular biology laboratory at the department of Immunology and Molecular Biology at Makerere University, College of Health Sciences.
This study targeted children aged six months to less than five years presenting to Rakai hospital with acute diarrhoea. All children aged 6 months to 5 years presenting with acute diarrhoea (3 or more loose motions per 24 hour period lasting less than 2 weeks) were eligible for study. However, very sick/moribund children and those whose parents/guardians declined consent were excluded.
Identification and recruitment of participants
The nurses at the outpatient clinics and wards were asked to inform parents/guardians of all children with diarrhoea about the study and refer them for screening by a research assistant. The assistant informed the parents/guardian about the study and asked for their willingness to participate.
Following a health talk with the research assistant, those willing to participate in the study were screened for inclusion and exclusion criteria. Those that satisfied the eligibility criteria were taken through the consent process and the case record form (Appendix 2) administered for those where consent had been obtained. Participants were recruited in a consecutive manner and up to 272 participants were registered to take part in the study. Specimens were obtained as described below Blood collection and screening for HIV-serostatus For children aged 18 months and above, finger prick whole blood was collected for HIV rapid testing. For the children younger than 18 months, dried blood spots (DBS) were collected, triple packaged and transported by Posta Uganda services to Central Public Health Laboratories (CPHL) for testing by DNA PCR. Caretakers/parents to participants with unknown HIV status were counseled for HIV testing and thereafter, the children were subjected to a rapid antibody test using the national algorithm (Determine HIV ½, Statpak and Unigold HIV kits were emplo
Abstract: Rotavirus remains the commonest cause of severe dehydrating diarrhea among children worldwide. Children in developing countries die more because of several factors including poorer access to hydration therapy and greater prevalence of malnutrition. Hitherto, the magnitude of rotavirus disease in Uganda has remained unknown. This study was therefore done to determine the prevalence and factors associated with rotavirus infection among children aged 3-59 months admitted with acute diarrhea to paediatric emergency ward of Mulago Hospital, UgandaThree hundred and ninety children, aged between 3-59 months with acute diarrhoea were recruited. The clinical history, socio-demographic characteristics, physical examination findings and laboratory investigations were recorded. Stool samples were tested for rotavirus antigens using the DAKO IDEIA rotavirus EIA detection kit.The prevalence of rotavirus infection was 45.4%. On multivariate analysis rotavirus was significantly associated with a higher education (above secondary) level of the mother [OR 1.8; 95% CI 1.1-2.7]; dehydration [OR 1.8; 95% CI 1.1-3.0] and breastfeeding [OR 2.6; 95% CI 1.4-4.0]. Although age was significantly associated with rotavirus on bivariate analysis; this association disappeared on multivariate analysis. No significant association was found between rotavirus infection and nutritional status, HIV status and attendance of day care or school.Rotavirus infection is highly prevalent among children with acute diarrhoea admitted to Mulago Hospital in Uganda.
Pub.: 28 Sep '10, Pinned: 16 Sep '17
Abstract: HIV infection is an established risk for diarrhoeal severity, less is known about specific enteric pathogens associated with HIV status. We determined associations of selected enteric pathogens with HIV infection and HIV exposure among Kenyan children.A cross-sectional study among 6 months to 15 year olds presenting to two Western Kenya District hospitals with acute diarrhoea between 2011 and 2013.Stool was tested using standard bacterial culture and microscopy for ova and parasites. HIV status was obtained from children and mothers. Enteric pathogen prevalence was compared between HIV-infected and HIV-uninfected children and between HIV-exposed uninfected (HEU) and HIV-unexposed. Unadjusted and adjusted prevalence ratios for selected pathogens by HIV status were estimated using relative risk (RR) regression. Age, site, income, household crowding, water source/treatment, anthropometrics, cotrimoxazole use and breastfeeding history were accounted for in multivariable models.Among 1076 children, median age was 22 months (interquartile range: 11-42 months), 56 (5.2%) were HIV-infected and 105 (11.3%) of 926 HIV-uninfected children in whom maternal HIV status was obtained were HIV-exposed. The following organisms were most frequently isolated from stool: enteroaggregative Escherichia coli (13.3%), Giardia species (spp.) (11.1%), Campylobacter spp. (6.3%), enteropathogenic E. coli (EPEC) (6.1%) and Cryptosporidium spp. (3.7%). Accounting for age, HIV-infection was associated with typical EPEC infection (prevalence ratio 3.70, P = 0.002) while HIV-exposure was associated with Cryptosporidium among HIV-uninfected children (prevalence ratio 2.81, P = 0.005).EPEC and Cryptosporidium infections were more common in HIV-infected and HIV-exposed children, respectively. This could explain the increased mortality attributed to these pathogens in other studies. Interventions targeting EPEC and Cryptosporidium may reduce morbidity and mortality in high HIV-prevalence settings.
Pub.: 17 Jul '14, Pinned: 16 Sep '17