Acute childhood diarrhoea in northern Ghana: epidemiological, clinical and microbiological characteristics.
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.
Reither
Klaus
K
Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Berlin, Germany. kreither@mmrp.org
Ignatius
Ralf
R
Weitzel
Thomas
T
Seidu-Korkor
Andrew
A
Anyidoho
Louis
L
Saad
Eiman
E
Djie-Maletz
Andrea
A
Ziniel
Peter
P
Amoo-Sakyi
Felicia
F
Danikuu
Francis
F
Danour
Stephen
S
Otchwemah
Rowland N
RN
Schreier
Eckart
E
Bienzle
Ulrich
U
Stark
Klaus
K
Mockenhaupt
Frank P
FP
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