title: Sporadic paediatric diarrhoeal illness in urban and rural sites in Nyanza Province, Kenya.
abstract: OBJECTIVE
  Investigate differences in the infectious aetiology, health seeking behaviour, and provider practices with regard to diarrhoeal illness among children presenting to urban versus rural clinics in Western Kenya.
  
  
  METHODS
  Laboratory-based, passive surveillance.
  
  
  METHODS
  The urban portion of the study was conducted at the paediatric outpatient clinic of Nyanza Provincial Hospital in Kisumu. The rural portion of the study was conducted at four outpatient clinics in the Asembo Bay community approximately 20 kilometers west of Kisumu.
  
  
  METHODS
  Children aged less than five years presenting to medical facilities for the treatment of diarrhoea from October 2001-October 2003 at the urban site and May 1997-April 2003 for the rural sites.
  
  
  RESULTS
  Among the 1303 urban and 1247 rural specimens collected, 24% of specimens yielded a bacterial pathogen (24% urban, 25% rural). Campylobacter was the predominant bacterial pathogen (17% urban, 15% rural), followed by Shigella and nontyphoidal Salmonella (both 4% urban and 5% rural). In both communities, susceptibilities of these pathogens to the most commonly prescribed antibiotics was low (< or = 50%); 70% of all episodes of diarrhoea were prescribed antibiotic treatment. Urban health practitioners prescribed fewer antibiotics, chose drugs more likely to be effective, and were more likely to prescribe oral rehydration therapy for bloody diarrhoea.
  
  
  CONCLUSIONS
  Most characteristics of diarrhoeal disease and their causes were similar in paediatric patients presenting to urban and rural clinics. Urban providers were more compliant with WHO recommendations.
authors.affiliation: Division of Foodborne, Bacterial and Mycotic Diseases, National Center for Zoonotic, Vectorborne, and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: M E
authors.initials: ME
authors.lastname: Beatty
authors.forename: J B
authors.initials: JB
authors.lastname: Ochieng
authors.forename: W
authors.initials: W
authors.lastname: Chege
authors.forename: L
authors.initials: L
authors.lastname: Kumar
authors.forename: G
authors.initials: G
authors.lastname: Okoth
authors.forename: R L
authors.initials: RL
authors.lastname: Shapiro
authors.forename: J G
authors.initials: JG
authors.lastname: Wells
authors.forename: M B
authors.initials: MB
authors.lastname: Parsons
authors.forename: C
authors.initials: C
authors.lastname: Bopp
authors.forename: T
authors.initials: T
authors.lastname: Chiller
authors.forename: J
authors.initials: J
authors.lastname: Vulule
authors.forename: E
authors.initials: E
authors.lastname: Mintz
authors.forename: L
authors.initials: L
authors.lastname: Slutsker
authors.forename: J T
authors.initials: JT
authors.lastname: Brooks
mesh_terms: D017677:Age Distribution; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology*; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology* / Q000628:therapy; D004352:Drug Resistance, Microbial; D005243:Feces / Q000382:microbiology; D005260:Female; D005440:Fluid Therapy; D006090:Gram-Negative Bacteria / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D007630:Kenya / Q000453:epidemiology; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011159:Population Surveillance; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012424:Rural Population; D016896:Treatment Outcome; D014505:Urban Population
chemical_list: D000900:Anti-Bacterial Agents