Abstract
BackgroundAcute diarrhoea is a major cause of childhood morbidity and mortality in sub-Saharan Africa. Its microbiological causes and clinico-epidemiological aspects were examined during the dry season 2005/6 in Tamale, urban northern Ghana.MethodsStool specimens of 243 children with acute diarrhoea and of 124 control children were collected. Patients were clinically examined, and malaria and anaemia were assessed. Rota-, astro-, noro- and adenoviruses were identified by (RT-) PCR assays. Intestinal parasites were diagnosed by microscopy, stool antigen assays and PCR, and bacteria by culturing methods.ResultsWatery stools, fever, weakness, and sunken eyes were the most common symptoms in patients (mean age, 10 months). Malaria occurred in 15% and anaemia in 91%; underweight (22%) and wasting (19%) were frequent. Intestinal micro-organisms were isolated from 77% of patients and 53% of controls (P < 0.0001). The most common pathogens in patients were rotavirus (55%), adenovirus (28%) and norovirus (10%); intestinal parasites (5%) and bacteria (5%) were rare. Rotavirus was the only pathogen found significantly more frequently in patients than in controls (odds ratio 7.7; 95%CI, 4.2–14.2), and was associated with young age, fever and watery stools. Patients without an identified cause of diarrhoea more frequently had symptomatic malaria (25%) than those with diagnosed intestinal pathogens (12%, P = 0.02).ConclusionRotavirus-infection is the predominant cause of acute childhood diarrhoea in urban northern Ghana. The abundance of putative enteropathogens among controls may indicate prolonged excretion or limited pathogenicity. In this population with a high burden of diarrhoeal and other diseases, sanitation, health education, and rotavirus-vaccination can be expected to have substantial impact on childhood morbidity.
Highlights
Acute diarrhoea is a major cause of childhood morbidity and mortality in sub-Saharan Africa
Diarrhoea is a major cause of childhood morbidity and mortality in socio-economically developing countries
More than one billion episodes of diarrhoea occur every year among children under five years of age causing approximately 2.5 million deaths [1,2] The WHO Child Health Epidemiology Reference Group estimates that 16% of deaths in African children younger than five years are directly attributable to diarrhoeal diseases [3]
Summary
Acute diarrhoea is a major cause of childhood morbidity and mortality in sub-Saharan Africa. Diarrhoea is a major cause of childhood morbidity and mortality in socio-economically developing countries. More than one billion episodes of diarrhoea occur every year among children under five years of age causing approximately 2.5 million deaths [1,2] The WHO Child Health Epidemiology Reference Group estimates that 16% of deaths in African children younger than five years are directly attributable to diarrhoeal diseases [3]. For many sub-Saharan countries, studies on the prevalence and clinical significance of different diarrhoeal pathogens are incomplete or not available at all. The contribution of the various pathogens to diarrhoea may differ substantially between regions depending on local meteorological, geographic, and socio-economic conditions. Underlying reasons for the spread of diarrhoeal diseases are found in poor hygiene and sanitation, limited access to safe drinking water as well as in inadequate education of health care providers and recipients [4,5]
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