RISK FACTORS AND BACTERIAL PATHOGENS ASSOCIATED WITH ACUTE DIARRHOEA AMONG UNDER-FIVE CHILDREN AT LAGOS STATE UNIVERSITY TEACHING HOSPITAL, IKEJA, LAGOS, NIGERIA

Abstract

The current study was carried out to determine the prevalence of acute diarrhoea, risk factors,
bacterial aetiological pathogens and symptoms associated with various enteric bacterial organisms
causing acute diarrhoea among under-five children in LASUTH. Children were recruited from the
Children Emergency Room and General Out-Patient Clinic of Lagos State University Teaching
Hospital (LASUTH), Ikeja, Lagos, South-Western Nigeria.
It was a cross-sectional, descriptive study carried out from August 2015 to December 2015. Using
a proforma specifically designed for the current study, a total of four hundred under-five children
with acute diarrhoea that met the study criteria and whose parents or care-givers gave informed
consent were recruited. Information was obtained on socio-demographic characteristics,
environmental/ hygienic practices, feeding practices and immunization status. Stool samples were
collected into sterile universal bottles. Microscopy, culture and sensitivity were done on all stool
samples using Mac-Conkey agar, Chocolate agar and Blood agar culture media. Gram staining,
Catalase tests, Oxidase tests, Coagulase tests were done on the stool samples and Oxoid Microbact
12A and 12B used to identify enteric bacterial pathogens, finally sensitivity pattern of the isolates
obtained using Mueller-Hinton agar.
The burden of acute diarrhoea in the current study was 8.3%, with 49.5% of these children aged
less than twelve months old and 73.7% of the children aged less than two years. The associated
risk factors for acute diarrhoea among children aged less than two years were use of feeding bottles
(OR 12.4; 95% CI 1.8-7.2; p 0.000), failure to complete immunization (OR 13.0; 95% CI 3.1-43.3;
p 0.000), attendance of crèches (OR 47.1; 95% CI 15.6-141.1; p 0.000), failure to exclusively
breastfeed (OR 6.7; 95% CI 1.3-6.7; p 0.010) and malnutrition assessed by Modified Wellcome
Classification (OR 3.9; 95% CI 1.0-20.3; p 0.049). All the bacterial enteric pathogens isolated
were Gram negative organisms. Three hundred and eighty-two (96.0%) children had bacterial
isolates in stool. The commonest bacterial enteric organism in this study was Escherichia coli
accounting for 54.5% of stool isolates detected amongst the study population. All blood-stained
stool samples had enteric bacterial isolates such as E. coli (3.1%), Klebsiella oxytoca (0.8%),
Proteus mirabilis (0.3%) and Enterobacter agglomerans (0.6%).
In conclusion, the current study has documented that acute diarrhoea in under-five children in
LASUTH is still a significant public health burden. The independent determinants for acute
diarrhoea among the study population were; attendance of crèches, use of feeding bottles, failure
to complete immunization, failure to exclusively breastfeed and malnutrition, and these are similar
to risk factors reported by other studies. The common bacterial enteric isolates for acute watery
diarrhoea among under-five children in LASUTH were E. coli, Klebsiella oxytoca and Proteus
mirabilis. These same enteric isolates were associated with acute bloody diarrhoea in the study
population.

RISK FACTORS AND BACTERIAL PATHOGENS ASSOCIATED WITH ACUTE DIARRHOEA AMONG UNDER-FIVE CHILDREN AT LAGOS STATE UNIVERSITY TEACHING HOSPITAL, IKEJA, LAGOS, NIGERIA