Nontyphoidal Salmonella among Children under 5 Years Old in Sub-Saharan Africa and South Asia in the Global Enteric Multicenter Study.

Rina Das,Md Ahshanul Haque,Abu Syed Golam Faruque,Mohammod Jobayer Chisti,Tahmeed Ahmed

doi:10.4269/ajtmh.21-0762

Abstract

ABSTRACT.Factors associated with nontyphoidal Salmonella (NTS) infection have not been well characterized to date. We aimed to compare the associated factors among children under age 5 years with NTS infection in sub-Saharan Africa and South Asia. Data from children having moderate-to-severe diarrhea (MSD) and asymptomatic children with NTS isolated from fecal specimens were extracted from the Global Enteric Multicenter Study (GEMS), conducted from December 2007 to March 2011. Compared with NTS-negative children, NTS-associated MSD cases in South Asia were associated with the presence of goat in the house (adjusted odds ratio [aOR]: 2.15; 95% confidence interval [CI]: 1.25–3.70) and handwashing after handling an animal (aOR: 2.26; 95% CI: 1.36–3.74). In sub-Saharan Africa, children with NTS associated MSD had a greater association with stunting (1.21 95% CI: 1.01–1.45), longer duration of diarrhea (aOR: 1.25 95% CI: 1.19–1.31); presence of cow in house (aOR: 1.54 95% CI: 1.09–2.16), handwashing after handling animal (aOR: 2.41 95% CI: 1.74–3.33). Drinking tube well water (aOR: 0.54 95% CI: 0.32–0.91), availability of toilet facility (aOR: 0.58 95% CI: 0.53–0.65), and handwashing before eating (aOR: 0.76 95% CI: 0.57–1.00) and after defecation (aOR: 0.80 95% CI: 0.69, 0.94) were found to be protective. The differentials between children of both regions having fecal NTS are distinct and underscore the need for policymaking for preventive and control strategies targeting stunted children.

Highlights

Nontyphoidal Salmonella (NTS) is a Gram-negative bacterium responsible for causing disease in both humans and animals worldwide
Sixty-five percent had fowl/rodent and 44% had a cow in the house, and 50% of families indicated the presence of a dog or cat in the house
Irrespective of moderate-to-severe diarrhea (MSD), when we considered both the regions combined, we found that all NTS-positive children who either presented with MSD or as asymptomatic had greater odds of being stunted, and the mother was less often the primary caretaker of the child

Summary

Introduction

Nontyphoidal Salmonella (NTS) is a Gram-negative bacterium responsible for causing disease in both humans and animals worldwide. Approximately 3.4 million cases of NTS infection are detected each year.[1] The Institute of Health Metrics and Evaluation reported that more than 30,000 child deaths were associated with invasive NTS disease and more than 20,000 of such cases of child mortality in 2017 were from western sub-Saharan Africa.[2,3,4] The majority of illnesses in humans caused by NTS are related to gastrointestinal problems, uncommonly, it invades the bloodstream. INTS found in the bloodstream of children is emerging with new pathogenic features.[6] 5% of the NTS infections occur due to extraintestinal and invasive NTS (iNTS). iNTS found in the bloodstream of children is emerging with new pathogenic features.[6]

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