Prevalence and clinico-demographic characteristics associated with bacterial diarrhea among HIV positive and negative children aged below five years at Moi Teaching and Referral Hospital, Kenya

Abstract

Diarrhea is the second leading cause of morbidity and mortality worldwide. It accounts for over 2 million deaths in children aged below 5 years, majority being from Sub-Saharan Africa. Diarrhea is ranked third as a cause of death and the third leading cause of pediatric admissions in Kenya. The objective of this study was to determine the prevalence and clinico-demographic characteristics associated with diarrhea in relation to patient HIV status. This was a cross- sectional comparative study of 216 HIV seropositive and seronegative children aged below 5 years admitted with diarrhea at Moi Teaching and Referral Hospital in Western Kenya. Clinico-demographic characteristics associated with diarrhea were obtained using questionnaires. Stool samples were collected and analyzed using standard microbiological methods to determine their bacterial etiology. The mean (standard deviation) 24.11(15.61) vs. 11.77(7.88), median and inter quartile range 22(10, 36) vs. 10 (6, 16) was higher among HIV positive than negative cases with no statistically significant differences with regard to gender. The prevalence of diarrhea was 17.1% with 64.4% (139) of our cases being male and 35.6% (77) female. The prevalence of bacterial and non bacterial diarrhea was 8.5% (118) and 7.1% (98) respectively. The main bacterial enteropathogens isolated among HIV positive and negative cases were Escherichia coli 88.9% (38 vs. 67), Shigella 5.1 %( 1, 5), Salmonella 4.2% (0, 5) and other enteric species 1.7% (0, 2). EAEC (17.7%) was the main diarrheagenic E coli (DEC) followed by EHEC (5.1%), EPEC (3.4%), EIEC (2.5%) and ETEC (1.7%). Other were S.typhimurium 4.2% (0, 5), S.typhi 3.4%) (0, 4), S. dyenteriae and S. flexneri 2.5% (0, 3) each respectively. HIV positive individuals recorded more mixed infections (72% vs. 28%) than HIV negative cases. Some of illnesses recorded in HIV positive cases included tuberculosis 4(100%) and meningitis 8(100%) whereas pneumonia 21(71.4 % vs. 28.6), oral thrush 13 (76.9% vs. 23.1%), malaria 19 (57.9% vs. 42.1%) and protein energy malnutrition 13 (61.5% vs. 38.5 %) were recorded in both HIV positive and negative cases respectively. Education level of parent/guardian, socioeconomic status, housing, water, sanitation and seasonal variations were significantly associated with diarrhea. The study depicts a positive correlation between clinico-demographic characteristics and HIV status on prevalence and etiology of diarrhea. We recommend improved hygienic practices, definitive diagnosis of diarrhea etiology and patient HIV status for effective management of childhood diarrhea.