Enteric pathogens and factors associated with acute bloody diarrhoea, Kenya.
Shigellosis is the major cause of bloody diarrhoea worldwide and is endemic in most developing countries. In Kenya, bloody diarrhoea is reported weekly as part of priority diseases under Integrated Disease Surveillance and Response System (IDSR) in the Ministry of Health.



We conducted a case control study with 805 participants (284 cases and 521 controls) between January and December 2012 in Kilifi and Nairobi Counties. Kilifi County is largely a rural population whereas Nairobi County is largely urban. A case was defined as a person of any age who presented to outpatient clinic with acute diarrhoea with visible blood in the stool in six selected health facilities in the two counties within the study period. A control was defined as a healthy person of similar age group and sex with the case and lived in the neighbourhood of the case.



The main presenting clinical features for bloody diarrhoea cases were; abdominal pain (69 %), mucous in stool (61 %), abdominal discomfort (54 %) and anorexia (50 %). Pathogen isolation rate was 40.5 % with bacterial and protozoal pathogens accounting for 28.2 % and 12.3 % respectively. Shigella was the most prevalent bacterial pathogen isolated in 23.6 % of the cases while Entamoeba histolytica was the most prevalent protozoal pathogen isolated in 10.2 % of the cases. On binary logistic regression, three variables were found to be independently and significantly associated with acute bloody diarrhoea at 5 % significance level; storage of drinking water separate from water for other use (OR = 0.41, 95 % CI 0.20-0.87, p = 0.021), washing hands after last defecation (OR = 0.24, 95 % CI 0.08-.076, p = 0.015) and presence of coliforms in main source water (OR = 2.56, CI 1.21-5.4, p = 0.014). Rainfall and temperature had strong positive correlation with bloody diarrhoea.



The main etiologic agents for bloody diarrhoea were Shigella and E. histolytica. Good personal hygiene practices such as washing hands after defecation and storing drinking water separate from water for other use were found to be the key protective factors for the disease while presence of coliform in main water source was found to be a risk factor. Implementation of water, sanitation and hygiene (WASH) interventions is therefore key in prevention and control of bloody diarrhoea.
Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya. njugunach@who.int.|World Health Organization, Nairobi, Kenya. njugunach@who.int.
Charles
C
Njuguna
Ministry of Health, Nairobi, Kenya.
Ian
I
Njeru
Ministry of Health, Nairobi, Kenya.
Elizabeth
E
Mgamb
Ministry of Health, Nairobi, Kenya.
Daniel
D
Langat
Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
Anselimo
A
Makokha
University of Nairobi, Nairobi, Kenya.
Dismas
D
Ongore
World Health Organization, Nairobi, Kenya.|Kenya Medical Research Institute, Nairobi, Kenya.
Evan
E
Mathenge
Kenya Medical Research Institute, Nairobi, Kenya.
Samuel
S
Kariuki
D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology; D004405:Dysentery, Bacillary / Q000453:epidemiology* / Q000382:microbiology; D004755:Enterobacteriaceae / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012424:Rural Population; D012499:Sanitation; D012760:Shigella / Q000302:isolation & purification; D055815:Young Adult
Acute bloody diarrhoea; Case; Control; Enteric pathogens; Factors; Kilifi; Nairobi