title: Bacteremia among children admitted to a rural hospital in Kenya.
abstract: BACKGROUND
  There are few epidemiologic data on invasive bacterial infections among children in sub-Saharan Africa. We studied every acute pediatric admission to a rural district hospital in Kenya to examine the prevalence, incidence, types, and outcome of community-acquired bacteremia.
  
  
  METHODS
  Between August 1998 and July 2002, we cultured blood on admission from 19,339 inpatients and calculated the incidence of bacteremia on the basis of the population served by the hospital.
  
  
  RESULTS
  Of a total of 1783 infants who were under 60 days old, 228 had bacteremia (12.8 percent), as did 866 of 14,787 children who were 60 or more days of age (5.9 percent). Among infants who were under 60 days old, Escherichia coli and group B streptococci predominated among a broad range of isolates (14 percent and 11 percent, respectively). Among infants who were 60 or more days of age, Streptococcus pneumoniae, nontyphoidal salmonella species, Haemophilus influenzae, and E. coli accounted for more than 70 percent of isolates. The minimal annual incidence of community-acquired bacteremia was estimated at 1457 cases per 100,000 children among infants under a year old, 1080 among children under 2 years, and 505 among children under 5 years. Of all in-hospital deaths, 26 percent were in children with community-acquired bacteremia. Of 308 deaths in children with bacteremia, 103 (33.4 percent) occurred on the day of admission and 217 (70.5 percent) within two days.
  
  
  CONCLUSIONS
  Community-acquired bacteremia is a major cause of death among children at a rural sub-Saharan district hospital, a finding that highlights the need for prevention and for overcoming the political and financial barriers to widespread use of existing vaccines for bacterial diseases.
authors.affiliation: Centre for Geographic Medicine Research (Coast), Kilifi, Kenya. jberkley@kilifi.mimcom.net
authors.forename: James A
authors.initials: JA
authors.lastname: Berkley
authors.forename: Brett S
authors.initials: BS
authors.lastname: Lowe
authors.forename: Isaiah
authors.initials: I
authors.lastname: Mwangi
authors.forename: Thomas
authors.initials: T
authors.lastname: Williams
authors.forename: Evasius
authors.initials: E
authors.lastname: Bauni
authors.forename: Saleem
authors.initials: S
authors.lastname: Mwarumba
authors.forename: Caroline
authors.initials: C
authors.lastname: Ngetsa
authors.forename: Mary P E
authors.initials: MP
authors.lastname: Slack
authors.forename: Sally
authors.initials: S
authors.lastname: Njenga
authors.forename: C Anthony
authors.initials: CA
authors.lastname: Hart
authors.forename: Kathryn
authors.initials: K
authors.lastname: Maitland
authors.forename: Mike
authors.initials: M
authors.lastname: English
authors.forename: Kevin
authors.initials: K
authors.lastname: Marsh
authors.forename: J Anthony G
authors.initials: JA
authors.lastname: Scott
mesh_terms: D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D001419:Bacteria / Q000302:isolation & purification; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology; D006192:Haemophilus Infections / Q000453:epidemiology; D019741:Haemophilus influenzae type b / Q000302:isolation & purification; D017052:Hospital Mortality; D006780:Hospitals, Rural; D006801:Humans; D015994:Incidence; D007223:Infant; D007630:Kenya / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000453:epidemiology; D011008:Pneumococcal Infections / Q000453:epidemiology; D011446:Prospective Studies