Abstract:

Background: Bacterial diarrhea is among of the leading causes of morbidity and mortality among under five children, especially in developing countries. In Mwanza, there is limited information on bacterial diarrhea among under five children in the lower level health care facilities and rural settings. This study evaluate the prevalence of bacterial diarrhea and associated factors among under five children at Ilemela and Sengerema districts.

Methodology: A cross-sectional analytical study was conducted from June 2017 to July 2018 involving under five children with diarrhea in three health facilities (Buzuruga and Karume Health Centers, and Sengerema Hospital). Stool samples were cultured into MacConkey agar, Salmonella Shigella Agar, and CHROMOagar-STEC. Additionally, antimicrobial susceptibility testing was done. Analysis of socio-demographic, clinical and laboratory data was done using STATA version 13 computer software.

Results: Majority of children with diarrhea were infants (46.4%). Approximately three quarters of children, 74.55% (167/224) harbored one or more bacteria, of which E. coli was more prevalent (89.82%), followed by Salmonella spp 9/167 (5.39%) and Shigella spp 8/167 (4.79%). Among 127 E. coli tested in, 28 (22.05%) were Shiga toxin producing E. coli (STEC). Diarrhea due to STEC was significantly associated with diarrhea residing in the urban areas (27.5% versus 8.3%, p-value=0.019); children with previous history of antibiotics use (33.3% versus 17.0%, p-value=0.041), and HIV positive children (75% versus 25%, p-value=0.031). Approximated 21.6% of all E. coli strains were ESBL-producers.

Conclusions and Recommendations: The STEC, Salmonella and Shigella species are prevalent bacteria causing diarrhea among under five children in the current study area. Culture based bacterial species identification and antimicrobial susceptibility testing services are recommended to ensure rational use of antimicrobial agents and thereby, reducing this rising trend of antimicrobial resistance.