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Early child health in Lahore, Pakistan: VIII. Microbiology
K Khalil1, G B Lindblom, K Mazhar
1Department of Paediatrics, King Edward Medical College, Lahore, Pakistan.
Insights
This study identified common causes of acute diarrhea in Pakistani children, finding bacterial and viral pathogens like ETEC-LT and Rotavirus were most frequent. These findings support establishing reliable microbiology labs in developing countries.
Area of Science:
- Pediatric infectious diseases
- Microbiology
- Public health
Background:
- Acute diarrhea remains a significant health concern for children under five globally.
- Understanding enteropathogen prevalence is crucial for effective treatment and prevention strategies.
Purpose of the Study:
- To investigate the causative agents of acute diarrhea in children under five in Lahore, Pakistan.
- To determine the frequencies of common enteropathogens in fecal samples.
- To compare pathogen prevalence across different socio-economic areas.
Main Methods:
- A longitudinal study conducted from 1985-1991 in three distinct socio-economic areas of Lahore.
- Collection and microbiological analysis of fecal samples from children under five presenting with acute diarrhea.
- Utilized standard and modified isolation techniques for pathogen detection.
Main Results:
- A high overall isolation rate of 73.4% for enteropathogens.
- Bacterial pathogens accounted for 53.5% and viral pathogens for 19.9%.
- Enterotoxigenic Escherichia coli-heat labile toxin (ETEC-LT) (23.4%), Rotavirus (19.9%), Enteropathogenic E. coli (EPEC) (15%), and Campylobacter (12%) were the most frequent single pathogens. Campylobacter detection increased significantly after technique modification.
- Shigella prevalence was higher in children over one year old. ETEC-LT diarrhea was more common in peri-urban slums.
Conclusions:
- This study provides valuable data on enteropathogen prevalence in pediatric acute diarrhea in Pakistan.
- The findings highlight the feasibility of establishing robust microbiological diagnostic capabilities even in resource-limited settings.
- Effective control measures and laboratory infrastructure are essential for managing childhood diarrhea in developing countries.
Abstract:
The causative agents of acute diarrhoea were investigated in children under the age of five years from 1985-1991 in three socio-economically different areas in Lahore, Pakistan. The aim was to determine the frequencies of the most common enteropathogens in faeces. The total isolation rate was 73.4%; two thirds (53.5%) were of bacterial and one third (19.9%) of viral origin. ETEC-LT (23.4%), Rota virus (19.9%), EPEC (15%) and Campylobacter (12%) were the single most frequent pathogens in all age groups and areas of living. The positivity of Campylobacter increased from 1.6% to 12% after the change of isolation technique. Shigella was isolated significantly (p > 0.001) more in children over than under one year of age. The incidence of bacterial infections was high during all seasons, while in certain years Rota virus was relatively low in the summer compared to the cooler months. The prevalence of ETEC-LT diarrhoea was higher in the periurban slum as compared to the village and the urban slum. The study is the first of its kind in Pakistan, and the results are similar to other comparable studies. It is thus possible to establish a well functioning and reliable microbiological laboratory in developing countries in a setting with restricted trained personnel and material resources.