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Published on: March 3, 2023
Prevalence, Antimicrobial Resistance, and Risk Factors of Enteric Bacterial Infections Among Children Under Five in
Davis Kimile1, Perpetual Ndung'u1, Peter Karanja1
1Department of Medical Laboratory Sciences, School of Biomedical Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
Insights
Childhood diarrhea in Nairobi is mainly bacterial, linked to poor sanitation and widespread antimicrobial resistance (AMR). Interventions must improve hygiene and antibiotic stewardship to combat this public health threat.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Diarrheal disease is a leading cause of child mortality globally, particularly in sub-Saharan Africa.
- Nairobi, Kenya, faces a significant burden of childhood diarrhea.
- Understanding the bacterial causes, resistance patterns, and risk factors is crucial for effective control.
Purpose of the Study:
- To investigate the bacterial etiology of childhood diarrhea in Nairobi.
- To determine the prevalence of antimicrobial resistance (AMR) in pediatric diarrhea pathogens.
- To identify key risk factors associated with childhood diarrhea in this setting.
Main Methods:
- A cross-sectional study involving 216 children (0-60 months) with diarrhea in Nairobi.
- Bacterial culture of stool samples and antimicrobial susceptibility testing against eight antibiotics.
- Caregiver questionnaires to assess risk factors, with statistical analysis using Fisher's exact test and odds ratios.
Main Results:
- 204 bacterial isolates were recovered, with *Escherichia coli* (38.2%) being the most common pathogen.
- High prevalence of enteric bacterial infection (94.4%) and widespread AMR (82.8% resistant to at least one antibiotic, 58.3% multidrug-resistant).
- Significant risk factors included lack of soap (OR: 7.4), poor sanitation (OR: 4.8), and unsafe water (OR: 12.9). High resistance to ampicillin and amoxicillin-clavulanic acid was observed.
Conclusions:
- Childhood diarrhea in Nairobi is primarily bacterial, driven by pathogens with high levels of antimicrobial resistance.
- Poor hygiene and sanitation are significant risk factors contributing to infection.
- Integrated interventions focusing on WASH, rational antibiotic use, and AMR surveillance are urgently needed.
Background:
Diarrheal disease remains a major cause of morbidity and mortality in children under 5 years, with the highest burden in sub-Saharan Africa. This study investigated the bacterial etiology, antimicrobial resistance (AMR), and risk factors in childhood diarrhea in Nairobi, Kenya.
Methods:
A cross-sectional study was conducted among 216 children aged 0-60 months presenting with diarrhea at hospitals in Nairobi County. Stool samples were cultured and isolates tested against eight antibiotics. Caregiver questionnaires assessed risk factors. Associations were evaluated using Fisher's exact test and odds ratios (ORs) were calculated to determine effect sizes.
Results:
A total of 204 bacterial isolates were recovered. Escherichia coli was the most frequent (38.2%), followed by Shigella sonnei (11.8%) and Enterobacter cloacae (9.8%). The overall prevalence of enteric bacterial infection was 94.4%. Key risk factors significantly associated with infection included the absence of consistent soap availability (OR: 7.4, 95% CI: 3.7-15.0), visible poor sanitation (OR: 4.8, 95% CI: 1.7-13.8), and lack of safe drinking water (OR: 12.9, 95% CI: 1.7-98.9). AMR was widespread, with 82.8% of isolates resistant to at least one antibiotic and 58.3% classified as multidrug-resistant (MDR). High resistance to ampicillin and amoxicillin-clavulanic acid was common, exceeding 70% in key pathogens like E. coli and E. cloacae. In contrast, meropenem, amikacin, gentamicin, and ciprofloxacin retained near-complete efficacy.
Conclusion:
Childhood diarrhea in Nairobi is predominantly bacterial, driven by diverse pathogens and exacerbated by poor hygiene and alarmingly high AMR. Urgent integrated interventions are needed, including strengthening WASH infrastructure, promoting rational antibiotic use, and enhancing AMR surveillance. These findings provide a critical baseline for public health action and underscore the need to safeguard last-line antibiotics.
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