Prevalence of Gastrointestinal Pathogens in Sub-Saharan Africa: Systematic Review and Meta-Analysis

A significant proportion of vulnerable people in sub-Saharan Africa (SSA) remain at risk for contracting diarrhoeal diseases due to the presence of many risk factors facilitating their transmission. A systematic review of published articles from the SSA region was done to determine the prevalence and types of diarrhoeal pathogens in circulation; based on a search of databases; including EBSCO host; PubMed; Scopus; Science Direct; Google scholar and Web of Science was done between September 2009 and December 2010. Data were summarized from 27 studies; with pooled data analysed and reported. Pathogens were isolated from between 26.8-65.6of cases; with an overall isolation rate of 55.7(95CI; 48.2-62.9). Isolation rates were highest amongst adult cases followed by children; and the odds of isolating a pathogen was greater in diarrhoeal cases (Odds Ratio 4.93 (95CI; 1.99 to 12.23); than in asymptomatic controls. Overall isolation ranged from 8to 99; and heterogeneity testing suggests differences between age groups (Q=5.806; df=2; P=0. 055). Mixed E. coli spp.; (29.95); Cryptosporidium (21.52); Cyclospora (18); Entamoeba; (13.8); Shigella spp. (10.49); Salmonella spp. (8.36); and Campylobacter spp. (8.33); were most commonly reported; and rotavirus was the most common virus isolated. This is the first review to look at the range of enteric pathogens circulating in SSA; and has confirmed high rates of isolation of pathogens from diarrhoeal cases. Public health practitioners can use this information to understanding the challenges related to diarrhoeal illness and set priorities for their prevention and control

Isolation of enteric pathogens and caliform bacteria from infant feeding bottle content in Addis Ababa; Ethiopia

Gastro-enteritis causing bacterial pathogens were studied in infant feeding bottle-contents collected from 24 feeding bottles which were brought to 5 clinics and 2 hospitals from January to November 1989 in Addis Ababa; Ethiopia. The most frequent bacterial isolates were coliform which included Enterobacter spp.; klebsiella spp.; faecal E. coli and cotrobacter spp. Enteric pathogens like entero-pathogenic E. Coli (EPEC); Shigella spp.; and Staph. aureus; constituted respectively 9 (3. per cent); 1 (0.01 per cent); 9 (2.2 per cent) of the total isolates. Although the percent of isolation of enteric pathogens in this study is low; the frequent isolation of Coliform from samples of bottle-contents suggests that the bottle-feeding serves as vehicle in transmission of the enteric pathogens in the studied population. Bottle-feeding mothers should be constantly taught on proper handling of feeding utensils and feeds. Above all the superior quality of breast milk needs to be emphasized to nursing mothers. Moreover; further and well controlled studies are also recommended to reduce diarrhoeal diseases in infant and young children

An investigation of diarrhoeal disease outbreak at Bilate Military Training Centre

This study was conducted to investigate a reported disease outbreak among higher education student recruits in Bilate Military Centre; Sidamo Administrative Region. Out of the total patients of 5;245 who visited at the out-patient department 1;616 (30.1 per cent) were patients with diarrhoea. There were 99 patients admitted to the hospital out of which 27 (27.2 per cent) were diarrhoeal patients. There were no deaths reported. A total of 965 (75.6 per cent) were treated with antimicrobial; mainly Tetracyclines; Chloramphenicol; Metronidazole and Chloroquine. Only 114 (8.9 per cent) were treated with Oral Rehydration Salts (ORS) while 86 (7.11 per cent) with Anti-diarrhoeal (Charcoal) and ORS. There was no proper excreta disposal and the water source was found to be bacteriologically non-potable. Among the 34 stool specimens collected for culture and sensitivity tests; the genus Shigella was isolated in 6 patients; where 4 were Shigella flexneri (Group B) and 2 were Shigella dysenteriae (Group A) one type 1 (Shiga's Bacillus) and the other type 2 (Schmitz's Bacillus). Shigella dysenteriae serogroups 1 and 2 showed resistance to eight and seven drugs including Trimethoprim Sulpha-Methoxazole (TSM) respectively. This study highlights the importance of safe water and improvement of general hygiene and environmental sanitation for prevention and control of epidemics and indicates the importance of continuous surveillance of drug resistant Shigella for the control of outbreaks of Shigellosis

Preliminary Observations on the Incidence of Diarrhoea in Relation to Excclusive Breastfeeding in the Young Child's Clinic Old Mulago - Kampala

This study arose out of concern for alarming numbers of infants with diarrhoea attended to in the Child Survival Training Unit (CSTU). Most of the children treated for diarrhoea at the CSTU come with malnutrition; which is either the cause or a complication of the diarrhoea. A review of these children's breastfeeding substitutes revealed that they have commonly been established fact that among the first month of life. It is a well estbalished fact that among the properties of breast milk is the anti infective property which inhibits viral and bacterial invasion of the gut. The purpose of this study was to determine whether exclusive breastfeeding for the firsy few months of life offers protection against diarrhoea diseases. Structured interviews were conducted with 63 mothers whose children were aged six months up to one year. Three quarters of the infants had between 1 and 8 diarrhoea episodes lasting from a minimum of one week and a mximum of one month. The period of exclusive breastfeeding for these infants ranged from none at all to about three months. many of them had received prelacteal feeds. Infants who had breastfed exclusively for 5-7 months on the other hand experienced either none or only one or two diarrhoea episodes and these diarrhoea illnesses tended to last for 2-4 days only. In most of these cases breast feeding had been initiated early in the postpartum period and very few infants had received pre-lacteal feeds. Asked what the mothers thought was the cause of the diarrhoea illnesses; many of them blamed the fact that the babies were either teething; sitting up or crawling and walking. Many mothers gave home treatment which included ORS and SSS. They brought children to the health facilities only if there was fever; or the child became weakened by the frequent motions. It was concluded from these results that exclusive breastfeeding for the first months of life protects infants against diarrhoea. Therefore; breast feeding should be emphasised as a preventive strategy

The Use of Prelacteal Feeds in Uganda:Implications for Diarrhoeal Disease Control in Infancy

For a long time; clinical observation has indicated that many Ugandan Mothers offer artificial feeds to their newly delivered infants in the immediate post partum period; contrary to the recommendation by the World Health organisation. In an attempt to further document the use of these prelacteal feeds survey of 488 mothers was carried out at Mulago and Mbarara University teaching hospitals. Results show that 25.2 percent of mothers in this sample gave prelacteal feeds to their infants; confirming an earlier observation in the Uganda Breastfeeding Situation Analysis of 1991 that either there was no milk flow yet or that the babies were crying too much. The dangers associated with the use of prelacteal feeds are discussed. In conclusion; it is recommended that measures be taken to discourage this harmful practice among mothers delivering in our health facilities. The need is expressed to try and document the extent of prelacteal usage among mothers who deliver outside the formal health sector

The Role of Home Visiting as an Intervention to Improve Prevention and Control of Diarrhoea among Children underfive years of age in the Slums of Katanga; Kafero; Mulago and Kawempe in Kampala City

Objectives: To identify and promote appropriate strategies in diarrhoea prevention and control from march-September 1993. Methodology: Observations + questionnaire were used to probe-number of children under five years in the home; feeding practices; source of drinking water; source of home available foods and fluids; hygiene; disposal of faeces and rubbish pits. Discussed and counselled mothers on various aspects. Held discussions with community leaders and land lords. Training of Community Health Workers. Collaboration with other agencies; Resistance Council Leaders; Community Health Workers; Traditional Healers. Lessons Learned: 220 children and discharged from the Child Survival Training Unit were followed up in this study for 6 months. (175) 55had diarrhoea episodes controlled; and (45) 20had repeated episodes 3-4 times. Out of (45) children; 5 were lost to follow up. During that period 80 children from the neighbourhood who never had diarrhoea at that time were visited;(6); 8got at least one episode of diarrhoea during this period; (2) 3had repeated episodes at least thrice; and (71) did not get any episode at all. Strategies identified: Health education and counselling. Good hygiene; proper disposal of faeces and rubbish. Using home available foods; and fluids. breastfeeding; although relactation has been reluctantly accepted; due to cultural beliefs. Income generating activities to sustain the mothers ecomomic status; e.g. making mats and baskets; petty business. Checking weight on every visit and; community participation. Conclusion: Precisely this is only an intervention that started just 2 years ago; from August 1993 and will be a continuous approach to promote prevention and control of diarrhoea; among children under five years of age; yet the challenges are that: This intervention needs dedicated personnel who can spend a lot of time sitting with mothers at their homes; a lot of finances and community participation

Highligts of the 5th AFCODD

"The 5 day Conference addressed Key issues on diarrhoeal diseases and related issues on ""diarrhoea; old and new trends"". the opening was officiated by the Minister of Health representing the President of the Republic of Uganda whose presence was a clear indication of the support for the survival of children in Uganda. About 54 papers were presented by researchers from 15 African countries and 5 international agencies WHO; UNICEF; USAID; CDC Atlanta and ADDR. The objectives of the conference were: To review the present status of CDD Programme activities and relevant research conducted in the various countries. 2. To promote collaboration between different sectors involved in country level CDD Programmes (including traditional care givers). 3. To identify strategies for encouraging the use of research findings for programme planning implementation and control of Diarrhoea or improve on the existing ones. The conference addressed 5 major areas on the problem of diarrhoea. These were (i) Acute diarrhoea (ii) Persistent diarrhoea (iii) Socio-Cultural and Environmental factors and diarrhoea (iv) Prevention of diarrhoea (v) Communication strategies to increase the ORT use. The Global Burden of diarrhoeal diseases was very well illustrated in a Key note address delivered by Dr. Henry Fitzroy from ADDR. In his concluding remarks he observed that dysentry; persistent diarrhoea and their associated conditions demand high priority when planning future diarrhoea control strategies especially in Africa."