Gastrointestinal infections and diarrheal disease in Ghanaian infants and children: an outpatient case-control study.
BACKGROUND
Diarrheal diseases are among the most frequent causes of morbidity and mortality in children worldwide, especially in resource-poor areas. This case-control study assessed the associations between gastrointestinal infections and diarrhea in children from rural Ghana.


METHODS
Stool samples were collected from 548 children with diarrhea and from 686 without gastrointestinal symptoms visiting a hospital from 2007-2008. Samples were analyzed by microscopy and molecular methods.


RESULTS
The organisms most frequently detected in symptomatic cases were Giardia lamblia, Shigella spp./ enteroinvasive Escherichia coli (EIEC), and Campylobacter jejuni. Infections with rotavirus (adjusted odds ratio [aOR] = 8.4; 95% confidence interval [CI]: 4.3-16.6), C. parvum/hominis (aOR = 2.7; 95% CI: 1.4-5.2) and norovirus (aOR = 2.0; 95%CI: 1.3-3.0) showed the strongest association with diarrhea. The highest attributable fractions (AF) for diarrhea were estimated for rotavirus (AF = 14.3%; 95% CI: 10.9-17.5%), Shigella spp./EIEC (AF = 10.5%; 95% CI: 3.5-17.1%), and norovirus (AF = 8.2%; 95% CI 3.2-12.9%). Co-infections occurred frequently and most infections presented themselves independently of other infections. However, infections with E. dispar, C. jejuni, and norovirus were observed more often in the presence of G. lamblia.


CONCLUSIONS
Diarrheal diseases in children from a rural area in sub-Saharan Africa are mainly due to infections with rotavirus, Shigella spp./EIEC, and norovirus. These associations are strongly age-dependent, which should be considered when diagnosing causes of diarrhea. The presented results are informative for both clinicians treating gastrointestinal infections as well as public health experts designing control programs against diarrheal diseases.
Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany; German Center for Infection Research (DZIF), partner site Hamburg-Borstel-Lübeck, Germany.
Ralf
R
Krumkamp
Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana.
Nimako
N
Sarpong
Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany.
Norbert Georg
NG
Schwarz
Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany.
Julia
J
Adlkofer
Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany.
Julia
J
Adelkofer
Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany.
Wibke
W
Loag
Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany.
Daniel
D
Eibach
Department of Tropical Medicine at the BNITM, German Armed Forces Hospital of Hamburg, Hamburg, Germany.
Ralf Matthias
RM
Hagen
Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana.
Yaw
Y
Adu-Sarkodie
Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany; German Center for Infection Research (DZIF), partner site Hamburg-Borstel-Lübeck, Germany.
Egbert
E
Tannich
Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany; German Center for Infection Research (DZIF), partner site Hamburg-Borstel-Lübeck, Germany.
Jürgen
J
May
D000293:Adolescent; D017677:Age Distribution; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000209:etiology*; D005243:Feces / Q000382:microbiology; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology*; D005869:Ghana; D006801:Humans; D007223:Infant; D007239:Infections / Q000209:etiology*; D008297:Male; D010045:Outpatients