title: Urbanicity and Paediatric Bacteraemia in Ghana-A Case-Control Study within a Rural-Urban Transition Zone.
abstract: BACKGROUND
  Systemic bacterial infections are a major cause of paediatric febrile illness in sub-Saharan Africa. Aim of this study was to assess the effects of social and geographical determinants on the risk of bacteraemia in a rural-urban transition zone in Ghana.
  
  
  METHODS
  Children below 15 years of age with fever were recruited at an outpatient department in the suburban belt of Kumasi, Ghana's second largest city. Blood was taken for bacterial culture and malaria diagnostics. The socio-economic status of participants was calculated using Principle Component Analysis. A scale, based on key urban characteristics, was established to quantify urbanicity for all communities in the hospital catchment area. A case-control analysis was conducted, where children with and without bacteraemia were cases and controls, respectively.
  
  
  RESULTS
  Bacteraemia was detected in 72 (3.1%) of 2,306 hospital visits. Non-typhoidal Salmonella (NTS; n = 24; 33.3%) and Salmonella typhi (n = 18; 25.0%) were the most common isolates. Logistic regression analysis showed that bacteraemia was negatively associated with urbanicity (odds ratio [OR] = 0.8; 95% confidence interval [CI]: 0.7-1.0) and socio-economic status (OR = 0.8; 95% CI: 0.6-0.9). Both associations were stronger if only NTS infections were used as cases (OR = 0.5; 95% CI: 0.3-0.8 and OR = 0.6; 95% CI: 0.4-1.0, respectively).
  
  
  CONCLUSIONS
  The results of this study highlight the importance of individual as well as community factors as independent risk factors for invasive bacterial infection (IBI) and especially NTS. Epidemiological data support physicians, public health experts and policy makers to identify disease prevention and treatment needs in order to secure public health in the transitional societies of developing countries.
authors.affiliation: Research Group Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Division of Tropical Medicine, 1st Department of Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Sothmann
authors.affiliation: Research Group Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Centre for Infection Research (DZIF), partner site Hamburg-Borstel-Lübeck, Hamburg, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Krumkamp
authors.affiliation: Research Group Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Division of Tropical Medicine, 1st Department of Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; German Centre for Infection Research (DZIF), partner site Hamburg-Borstel-Lübeck, Hamburg, Germany.
authors.forename: Benno
authors.initials: B
authors.lastname: Kreuels
authors.affiliation: Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana.
authors.forename: Nimako
authors.initials: N
authors.lastname: Sarpong
authors.affiliation: Research Group Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Institute of Microbiology and Hygiene, Charité-University Medicine, Berlin, Germany.
authors.forename: Clemens
authors.initials: C
authors.lastname: Frank
authors.affiliation: Research Group Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
authors.forename: Lutz
authors.initials: L
authors.lastname: Ehlkes
authors.affiliation: School of Public Health, University of Ghana, Accra, Ghana.
authors.forename: Julius
authors.initials: J
authors.lastname: Fobil
authors.affiliation: Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana.
authors.forename: Kennedy
authors.initials: K
authors.lastname: Gyau
authors.affiliation: Research Group Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Jaeger
authors.affiliation: Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana.
authors.forename: Benedicta
authors.initials: B
authors.lastname: Bosu
authors.affiliation: International Vaccine Institute (IVI), Seoul, Korea.
authors.forename: Florian
authors.initials: F
authors.lastname: Marks
authors.affiliation: Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana.
authors.forename: Ellis
authors.initials: E
authors.lastname: Owusu-Dabo
authors.affiliation: Department of Internal Medicine I, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Salzberger
authors.affiliation: Research Group Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Centre for Infection Research (DZIF), partner site Hamburg-Borstel-Lübeck, Hamburg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: May
mesh_terms: D016470:Bacteremia / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002947:Cities; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D025341:Principal Component Analysis; D012423:Rural Health / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data; D012475:Salmonella / Q000302:isolation & purification / Q000502:physiology; D012480:Salmonella Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D012485:Salmonella typhi / Q000302:isolation & purification / Q000502:physiology; D012923:Social Class; D014504:Urban Health / Q000706:statistics & numerical data*; D014505:Urban Population / Q000706:statistics & numerical data; D014507:Urbanization / Q000639:trends*