title: Low Bacteremia Prevalence Among Febrile Children in Areas of Differing Malaria Transmission in Rural Kenya: A Cross-Sectional Study.
abstract: BACKGROUND
  With malaria declining, other causes of fever may account for a substantial portion of severe childhood illness in sub-Saharan Africa. We determined prevalence, etiologies, and correlates of bacteremia among children in Western Kenya.
  
  
  METHODS
  In a cross-sectional study, febrile children aged 6 months to 15 years presenting to Kisii (low malaria endemicity) and Homabay (high malaria endemicity) Hospitals were enrolled and screened for malaria, human immunodeficiency virus (HIV) infection and bacteremia. Correlates of bacteremia were evaluated using logistic regression.
  
  
  RESULTS
  Among 1476 children enrolled, 48 (3.3%) had bacteremia (23 of 734, 3.1% in Kisii and 25 of 734, 3.4% in Homabay). Salmonella spp (19 typhi and 21 nontyphoidal salmonella) accounted for 83% (40 of 48) of isolates. The distribution of Salmonella spp was similar between sites. Bacteremia was associated with incomplete vaccination (adjusted odds ratio [aOR] = 2.1; 95% confidence interval [CI], 1.1-4.1), before treatment with antimalarials (aOR = 2.7; 95% CI, 1.4-4.1), having sought care elsewhere (aOR = 2.2; 95% CI, 1.2-4.0) and lower education of caregiver (aOR = 2.5; 95% CI, 1.1-4.8). Nontyphoidal salmonella bacteremia was associated with HIV (aOR = 6.8; 95% CI, 1.1-35.1) and anemia (hemoglobin <8 g/dL) (aOR = 5.2; 95% CI, 1.4-18.9).
  
  
  CONCLUSIONS
  Bacteremia was relatively uncommon, but children with HIV, anemia, incomplete vaccination, and/or persistent fever despite malaria treatment may have higher risk and may benefit from targeted bacterial culture and/or empiric antibiotic therapy.
authors.affiliation: Department of Epidemiology.|Kenya Medical Research Institute, Centre for Clinical Research, Nairobi.
authors.forename: Frankline M
authors.initials: FM
authors.lastname: Onchiri
authors.affiliation: Department of Epidemiology.
authors.forename: Patricia B
authors.initials: PB
authors.lastname: Pavlinac
authors.affiliation: Kenya Medical Research Institute, Centre for Clinical Research, Nairobi.
authors.forename: Benson O
authors.initials: BO
authors.lastname: Singa
authors.affiliation: Department of Pediatrics.|Kenya Medical Research Institute, Centre for Clinical Research, Nairobi.
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Naulikha
authors.affiliation: Walter Reed Project, United States Army Medical Research Unit, Kericho, Kenya.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Odundo
authors.affiliation: Department of Epidemiology.|Department of Global Health.|Department of Medicine, University of Washington, Seattle.
authors.forename: Carey
authors.initials: C
authors.lastname: Farquhar
authors.affiliation: Department of Biostatistics.|Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, Seattle, Washington.
authors.forename: Barbra A
authors.initials: BA
authors.lastname: Richardson
authors.affiliation: Department of Epidemiology.|Department of Pediatrics.|Department of Global Health.|Department of Medicine, University of Washington, Seattle.
authors.forename: Grace
authors.initials: G
authors.lastname: John-Stewart
authors.affiliation: Department of Epidemiology.|Department of Pediatrics.|Department of Global Health.|Department of Medicine, University of Washington, Seattle.
authors.forename: Judd L
authors.initials: JL
authors.lastname: Walson
mesh_terms: D000740:Anemia / Q000453:epidemiology; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology*; D003430:Cross-Sectional Studies; D005260:Female; D005334:Fever / Q000453:epidemiology* / Q000469:parasitology*; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008288:Malaria / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population
keywords: Africa; bacteremia; children; fever; malaria