Abstract:

Background: Escherichia coli is among the most common causes of bacterial gastroenteritis in children under five years of age in developing countries. The burden of diarrhea diseases in developing countries is still high, ranking the second most common cause of morbidity and mortality after acute respiratory illness. Information on the role of stiga toxin-producing E. coli (STEC) in childhood diarrhea is limited in Tanzania. This study was conducted to determine the magnitude of STEC and other enteropathogenic infection among under-five with diarrhea in Mwanza city, Tanzania.

Material and Methods: Between July, 2015 and March, 2016, a total of 304 children below five years with diarrhea were enrolled to the study. Demographics and relevant information were recorded in a data collection tool. Stool specimens were inoculated onto MacConkey and Salamonella-Shigella Agars, incubated aerobically at 37C, and examined for growth after 24 hours. Confirmed E. coli isolates were then inoculated onto STEC Agar to screen for STEC. Antimicrobial susceptibility testing was performed to pathogenic bacteria using Kirby-Bauer disc diffusion method. Data were analyzed using STATA-13 Software.

Results: The mean age of the enrolled children was 1.43 ± 1.03 years. Of the 304 children enrolled, 185 (60.9%) were males. Two hundred and eighty three (93.1%) of the 304 children with diarrhea had positive culture, of which 32 (10.5%) were due to STEC infection. Out of the 304 children, 44 (14.5%) were found to have diarrhea due to pathogenic bacteria (Salamonella spp, Shigella spp. and STEC). Among 32 STEC isolates 22 (68.8%) and 20 (62.5%) were resistant to amoxicillin/clavulanic acid and trimethoprim-sulfamethoxazole respectively while 3 (9.4%) were ESBL-producing E. coli. Number of children within the family and use of water from wells to significantly associate with diarrhea infection caused by pathogenic bacteria (p=0.034 vs. 0.006).

Conclusion: Diarrheal infection caused by STEC is prevalent in this population. A significant proportion of diarrheal infection was caused by pathogenic bacteria. More than 60% of pathogenic bacteria detected in this study were resistant to amoxicillin/clavulanic acid and trimethoprim-sulfamethoxazole. It is time for clinicians to consider STEC among potential pathogens causing diarrhea in the region. Provision of safe water, health education together with improvements in sanitation and personal hygiene are key factors to reduce these infections.