Abstract:

Background and objective: Upper Respiratory Tract Infection (URTI) are the worldwide leading causes of childhood morbidity, frequent primary health care visits, and school abseeintism. The epidemiology of URTI is well studied in most of the developed countries, with sparse data in resource limited countries particularly in sub-Saharan Africa. Therefore, this study was designed to establish the etiologies and patterns of URTI among children below five years of age in Mwanza City.

Methods: A cross sectional hospital based study involving 339 children was conducted in Mwanza city from October 2017 to February 2018. A structured pretested data collection tool was used to collect sociodemographic, clinical and other relevant information. Nasapharngeal swabs and ear swabs were collected. Multiplexpolymerase chain reaction (PCR) was done to detect respiratory pathogens, and ear swabs cultured to detect ear pathogens. About 4mls of blood samples was collected from each participant for full blood count and C reactive protein (CRP) analysis. Data was analyzed by STATA version 13 as per study objectives.

Results: The median age of the enrolled children was 16(IQR: 8-34) months. Most of them 279 (82.3%) presented with fever, and 222 (65.5%) had running nose/congestion. Rhinitis 184 (55.9%), was the commonest diagnosis followed by pharyngitis 64 (19.5%), otitis 16(4.9%) and tonsillitis 6 (1.8%). Viruses were isolated in 159 (46%) of children, commonly detected viruses were: Rhinoviruses (23.9%), Adenoviruses (7.4%), followed by Para influenza type3 (6.7%) and Boca virus (5.6%). Nineteen percent of the enrolled children had more than two viruses; Rhinovirus and Enterovirus being the commonest combination. The most common bacteria isolated were Staphylococcus aureus 5/13 (38.5%), Pseudomonas auregnosa 4/13 (30.1%) and Klebsiella pneumoniae 1/13 (7.7%). Children with viral pathogens were more likely to have a right shift of lymphocytes (73%- sensitivity) with significant alteration of CRP than with bacterial infections. All of the bacteria isolates (13/339) were resistant to amoxicillin and trimethoprim/sulphamethaxazole with the majority being sensitive to ciprofloxacin, meropenem, vancomycin and amikacin. The majority (257/339) of children were free of symptoms on the eighth day.

Conclusion and recommendations: Viruses are the commonest cause of URTI in Mwanza city with rhinitis being the most common diagnosis. Rapid diagnostic assays for viral pathogens causing URTI are urgently needed in developing countries to reduce unnecessary antibiotic prescriptions which is associated with increased antibiotic resistance.