Abstract:
BACKGROUND: This study aimed to determine the age-specific aetiologic agents of
diarrhoea in children aged less than five years. The study also assessed the
efficacy of the empiric treatment of childhood diarrhoea using Integrated
Management of Childhood Illness (IMCI) guidelines.
METHODS: This study included 280 children aged less than 5 years, admitted with
diarrhoea to any of the four major hospitals in Dar es Salaam. Bacterial
pathogens were identified using conventional methods. Enzyme Linked Immunosorbent
Assay (ELISA) and agglutination assay were used to detect viruses and intestinal
protozoa, respectively. Antimicrobial susceptibility was determined using
Kirby-Bauer disk diffusion method.
RESULTS: At least one of the searched pathogens was detected in 67.1% of the
cases, and mixed infections were detected in 20.7% of cases. Overall, bacteria
and viruses contributed equally accounting for 33.2% and 32.2% of all the cases,
respectively, while parasites were detected in 19.2% patients. Diarrhoeagenic
Escherichia coli (DEC) was the most common enteric pathogen, isolated in 22.9% of
patients, followed by Cryptosporidium parvum (18.9%), rotavirus (18.1%) and
norovirus (13.7%). The main cause of diarrhoea in children aged 0 to 6 months
were bacteria, predominantly DEC, while viruses predominated in the 7-12 months
age group. Vibrio cholerae was isolated mostly in children above two years.
Shigella spp, V. cholerae and DEC showed moderate to high rates of resistance to
erythromycin, ampicillin, chloramphenicol and tetracycline (56.2-100%). V.
cholerae showed full susceptibility to co-trimoxazole (100%), while DEC and
Shigella showed high rate of resistance to co-trimoxazole; 90.6% and 93.3%
respectively. None of the bacterial pathogens isolated showed resistance to
ciprofloxacin which is not recommended for use in children. Cefotaxime resistance
was found only in 4.7% of the DEC.
CONCLUSION: During the dry season, acute watery diarrhoea is the most common type
of diarrhoea in children under five years in Dar es Salaam and is predominantly
due to DEC, C. parvum, rotaviruses and noroviruses. Constant antibiotic
surveillance is warranted as bacteria were highly resistant to various
antimicrobial agents including co-trimoxazole and erythromycin which are
currently recommended for empiric treatment of diarrhoea.
