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.
