PATHOGENIC AGENTS AND SERUM ZINC LEVELS IN CHILDREN AGED TWO MONTHS TO FIVE YEARS WITH ACUTE DIARRHOEA SEEN AT UNIVERSITY OF ILORIN TEACHING HOSPITAL

Abstract

Acute diarrhoea due to different pathogenic agents contributes significantly to morbidity and
mortality in under-five children especially in the developing world with micronutrient
deficiency, such as zinc, playing a pivotal role in the determination of its outcome. Research has
been conducted extensively on zinc and diarrhoea; however knowledge gaps exist in the
relationship between the pathogenic agents, zinc levels and disease outcome. This study
therefore sets out to determine the viral and bacterial aetiology of acute diarrhoea, serum zinc
levels, and the relationship with clinical outcome in the children.
The study was a comparative cross-sectional study conducted in Ilorin, North Central Nigeria in
which 100 children aged two months to five years with acute diarrhoea and age- and gender-
matched healthy controls were recruited. Socio-demographic, anthropometric and clinical details
were obtained. Blood samples were collected for determining the serum zinc, total protein,
albumin and C-reactive protein and analyzed with JenwayTM spectrophotometer. Stool samples
were analyzed for viral and bacterial agents. Data analysis was with SPSS 20 software package.
The prevalence of infective diarrhoea in the subjects was 90.0% with viral-bacterial co-infections
occurring in 45.0%. The overall prevalence of viruses was 62.0% with Rotavirus, Adenovirus
and Norovirus detected in 30.0%, 21.0% and 11.0% respectively. Viruses were isolated as the
sole pathogens in 17 subjects (17.0%). The overall prevalence of bacterial pathogens in the
subjects was 73.0% with Escherichia coli (39.0%), Klebsiella spp.(28.0%), Proteus spp.(4.0%)
and Pseudomonas aeruginosa (2.0%) detected as isolates. Single infections due to bacteria were
detected in 28 subjects (28.0%). Pathogenic agents were detected in eight (8.2%) of the controls
with Rotavirus, Escherichia coli and Klebsiella spp. accounting for 2.0%, 4.1% and 2.1%
respectively.

The mean serum zinc levels of 65.3±2.0µg/dl in the subjects were significantly lower than
67.0±1.5µg/dl in the controls (p<0.001). Furthermore, there was a high prevalence of zinc
deficiency in the study population with 47.0% recorded in children with acute diarrhoea which
was significantly higher than 32.0% in controls (p=0.030). Children with pathogenic agents as
cause of acute diarrhoea had significantly lower mean zinc levels of 65.0±2.2µg/dl compared to
those without isolates (72.8±1.8µg/dl) [p<0.001] . Furthermore, there was a significant difference
in the mean serum zinc levels among the viral and bacterial pathogens isolated (p<0.001).
The study did not show a significant relationship between the pathogenic agents of acute
diarrhoea and the mean duration of hospitalization (p>0.05), as well as duration of diarrhoea
(p>0.05). However, children with low serum zinc levels had a significantly higher mean duration
of hospitalization of 3.8±1.3 days when compared with 3.0±1.6 days in those with normal zinc
levels (p=0.008). Furthermore, a significant though weak negative correlation existed between
the serum zinc levels and duration of hospitalization (r= -0.278; p=0.044) while the duration of
diarrhoea was not influenced by the serum zinc levels in the children (p=0.915).
This study concluded that children with acute diarrhoea had lower serum zinc levels compared
with healthy controls, the pathogenic agents influence the zinc levels, and zinc levels correlated
negatively with duration of hospitalization.
It is recommended that health education on zinc supplementation particularly in children with
diarrhoea, zinc fortification schemes in the population, as well as other public control strategies
aimed at reducing childhood morbidity and mortality due to acute diarrhoea should be instituted
in the country.

PATHOGENIC AGENTS AND SERUM ZINC LEVELS IN CHILDREN AGED TWO MONTHS TO FIVE YEARS WITH ACUTE DIARRHOEA SEEN AT UNIVERSITY OF ILORIN TEACHING HOSPITAL