Prevalence and risk factors for nasopharyngeal carriage of streptococcus pneumoniae in Lira Municipality

ABSTRACT

"Streptococcus pneumoniae causes more than half of episodes of pneumonia in developing countries. It is the most common cause of Otitis media in children; and of Meningitis in adults. Over the last decades; resistance of this organism to penicillin and other drugs has emerged and been reported world wide; including Uganda. High nasopharyngeal carriage rates of up to 60have been reproted; the peak being in children below two years of age. Invasive disease often results from colonization of this site in children; the elderly and debilitated persons. Risk factors for carriage have been shown to be good predictors for invasive disease. Studies done in europe and USA have identified some factors associated with increased risk of pneumococcal carriage and drug resistance. In developing countries; such as Uganda; the magnitude of carriage; risk factors for resistance to drugs and sensitivity patterns are not well documented. A study done in Kampala; Uganda; documented high carriage rates in children but risk factors were not adequately explored. A cross sectional study was done in Lira Municipality to determine the prevalence of nasopharyngeal carriage; define the potential risk factors for carriage and resistance to five selected antibiotics. Thirty local Council 1 villages were selected at random to form ""clusters"" of households. Seven households were then selected at random and children aged four years and below living in these households were eligible for recruitment. Data on socio -demographic and risk factors were collected by trained field assistants using close ended; and open handed questionnaires administered to each subject. Laboratory samples were obtained by swabbing the nasopharynx of study subject with sterile aluminum swabs and immediately inoculating these on 5human blood agar media. Identification of pneumococci was based on sensitivity to optchin. Tests for susceptibility were done on Mueller-Hinton medium; using the disk diffusion method and diameters of zone of growth inhibition compared to a standard (NCCLS) table of zone diameter breakpoints (in mm). Data was entered; cleaned and analysed using EPI Info package in the Institute of Public Health. One hundred and eighty seven children were sampled. Mean age was 17.2 months; range 7 weeks to 48 months; standard deviation of 11.47 months. There were 91(48.7) girls and 96 (51.3) girls. Pneumococci were recovered from 90 (48.1) of the girls; but this was not significant (X2"