Rotavirus infection among children under two years of age with acute diarrhoeal illness seen at Moi Teaching and Referral Hospital

Abstract

Background: Diarrhoea carries an unacceptably high morbidity and mortality rate in Sub-Saharan Africa. Rotavirus infection in the pre-vaccine era had been the leading cause of diarrhoea in Kenya. There is limited data on the etiology and characteristics of diarrhoea following the inclusion of Rotavirus vaccination, in the regular vaccination schedule in Kenya in July 2014. The rotavirus vaccine is a monovalent vaccine targeting Group A rotavirus, the commonest strain in this region. Objective: To determine the proportion of children with rotavirus associated diarrhoea among children, presenting with Acute Diarrhoeal Illness seen at Moi Teaching and Referral Hospital’s (MTRH) Paediatric emergency department. Methods: This was a cross-sectional study carried out at MTRH Paediatric Emergency Department between November 2015 and June 2016. Children aged two years and below with Acute Diarrhoeal Illness were recruited. The participants’ parents/guardians were interviewed and a rapid Certest® rotavirus stool antigen test carried out. Data was collected on the socio-demographic and clinical characteristics of the participants. Results: A total of 311 participants were recruited. The median age was 12 months (IQR 8,19). The largest proportion of participants were between 6-12 months of age 35%(109/311). The prevalence of rotavirus infection was, 55.6% (173/311), with the peak during the months of February and March. Rotavirus vaccine coverage was at 85.2%(265/311). Age appropriate completion of the standard Ministry of Health Kenya vaccines was 83.3%(259/311). Majority of the participants were undernourished (WHZ <-1) at 38.9%(121/311). Incomplete rotavirus vaccination (p=0.005), not having age appropriate completion of routine vaccination (p=0.030), and under-nutrition (p=0.009) were positively associated with rotavirus infection. On logistic regression, mild wasting (WLZ >-2 TO -1) (OR 2.581; 95% CI [1.068-6.236]; p=0.035) and moderate wasting(WLZ -3 TO -2) (OR 3.424; 95% CI [1.221-9.604]; p=0.019) were associated with rotavirus infection. Severe malnutrition was not statistically significant (OR 0.795; 95% CI [0.373-1.692]; p=0.552). Having Received two rotavirus vaccines (OR 0.151; 95% CI [0.032-0.709];p=0.017) and age appropriate completion of routine vaccination (OR 0.478; 95% CI [0.256-0.892];p=0.003) decreased the odds of rotavirus infection. Receiving a single dose of rotavirus vaccine was not protective against rotavirus infection. Socio-demographic characteristics such as age (p=0.244), gender (p=0.901)and the child’s primary caregiver (p=0.783)were not associated with rotavirus infection. Although majority of the children with rotavirus positive diarrhoea had non-severe dehydration 63% (109/173) this was also not significant (OR 1.066; 95% CI 0.6695-1.699;p=0.786). Bristol grade 6 and 7 stool consistency was positively associated with rotavirus infection (OR1.941; 95% CI [0.999-3.77]; p=0.05). Conclusions: Prevalence of rotavirus diarrhoea is still high among children aged two years and below in our setup, with those undernourished being more likely to have rotavirus infection. Completion of rotavirus vaccination and the other routine childhood vaccinations is protective against rotavirus associated diarrhoea. Recommendations: Rotavirus vaccination and completion of the other routine childhood vaccination should be intensified. Studies looking into the effect of nutritional status on rotavirus diarrhoea should be carried out.