title: Acute childhood diarrhoea in northern Ghana: epidemiological, clinical and microbiological characteristics.
abstract: BACKGROUND
  Acute diarrhoea is a major cause of childhood morbidity and mortality in sub-Saharan Africa. Its microbiological causes and clinico-epidemiological aspects were examined during the dry season 2005/6 in Tamale, urban northern Ghana.
  
  
  METHODS
  Stool specimens of 243 children with acute diarrhoea and of 124 control children were collected. Patients were clinically examined, and malaria and anaemia were assessed. Rota-, astro-, noro- and adenoviruses were identified by (RT-) PCR assays. Intestinal parasites were diagnosed by microscopy, stool antigen assays and PCR, and bacteria by culturing methods.
  
  
  RESULTS
  Watery stools, fever, weakness, and sunken eyes were the most common symptoms in patients (mean age, 10 months). Malaria occurred in 15% and anaemia in 91%; underweight (22%) and wasting (19%) were frequent. Intestinal micro-organisms were isolated from 77% of patients and 53% of controls (P < 0.0001). The most common pathogens in patients were rotavirus (55%), adenovirus (28%) and norovirus (10%); intestinal parasites (5%) and bacteria (5%) were rare. Rotavirus was the only pathogen found significantly more frequently in patients than in controls (odds ratio 7.7; 95%CI, 4.2-14.2), and was associated with young age, fever and watery stools. Patients without an identified cause of diarrhoea more frequently had symptomatic malaria (25%) than those with diagnosed intestinal pathogens (12%, P = 0.02).
  
  
  CONCLUSIONS
  Rotavirus-infection is the predominant cause of acute childhood diarrhoea in urban northern Ghana. The abundance of putative enteropathogens among controls may indicate prolonged excretion or limited pathogenicity. In this population with a high burden of diarrhoeal and other diseases, sanitation, health education, and rotavirus-vaccination can be expected to have substantial impact on childhood morbidity.
authors.affiliation: Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Berlin, Germany. kreither@mmrp.org
authors.forename: Klaus
authors.initials: K
authors.lastname: Reither
authors.forename: Ralf
authors.initials: R
authors.lastname: Ignatius
authors.forename: Thomas
authors.initials: T
authors.lastname: Weitzel
authors.forename: Andrew
authors.initials: A
authors.lastname: Seidu-Korkor
authors.forename: Louis
authors.initials: L
authors.lastname: Anyidoho
authors.forename: Eiman
authors.initials: E
authors.lastname: Saad
authors.forename: Andrea
authors.initials: A
authors.lastname: Djie-Maletz
authors.forename: Peter
authors.initials: P
authors.lastname: Ziniel
authors.forename: Felicia
authors.initials: F
authors.lastname: Amoo-Sakyi
authors.forename: Francis
authors.initials: F
authors.lastname: Danikuu
authors.forename: Stephen
authors.initials: S
authors.lastname: Danour
authors.forename: Rowland N
authors.initials: RN
authors.lastname: Otchwemah
authors.forename: Eckart
authors.initials: E
authors.lastname: Schreier
authors.forename: Ulrich
authors.initials: U
authors.lastname: Bienzle
authors.forename: Klaus
authors.initials: K
authors.lastname: Stark
authors.forename: Frank P
authors.initials: FP
authors.lastname: Mockenhaupt
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology* / Q000628:therapy / Q000821:virology*; D005243:Feces / Q000821:virology; D005440:Fluid Therapy; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D007223:Infant; D016015:Logistic Models; D012401:Rotavirus / Q000302:isolation & purification*; D012400:Rotavirus Infections / Q000453:epidemiology* / Q000628:therapy / Q000821:virology*; D011795:Surveys and Questionnaires; D014505:Urban Population