Acute childhood diarrhoea in northern Ghana: epidemiological, clinical and microbiological characteristics

Background: Acute diarrhoea is a major cause of childhood morbidity
and mortality in sub-Saharan Africa. Its microbiological causes and
clinico-epidemiological aspects were examined during the dry season
2005/6 in Tamale, urban northern Ghana. Methods: Stool specimens of
243 children with acute diarrhoea and of 124 control children were
collected. Patients were clinically examined, and malaria and
anaemia were assessed. Rota-, astro-, noro- and adenoviruses were
identified by (RT-) PCR assays. Intestinal parasites were diagnosed
by microscopy, stool antigen assays and PCR, and bacteria by
culturing methods. Results: Watery stools, fever, weakness, and
sunken eyes were the most common symptoms in patients (mean age, 10
months). Malaria occurred in 15% and anaemia in 91%; underweight
(22%) and wasting (19%) were frequent. Intestinal micro-organisms
were isolated from 77% of patients and 53% of controls (P <
0.0001). The most common pathogens in patients were rotavirus
(55%), adenovirus (28%) and norovirus (10%); intestinal parasites
(5%) and bacteria (5%) were rare. Rotavirus was the only pathogen
found significantly more frequently in patients than in controls
(odds ratio 7.7; 95% Cl, 4.2-14.2), and was associated with young
age, fever and watery stools. Patients without an identified cause
of diarrhoea more frequently had symptomatic malaria (25%) than
those with diagnosed intestinal pathogens (12%, P = 0.02).
Conclusion: Rotavirus-infection is the predominant cause of acute
childhood diarrhoea in urban northern Ghana. The abundance of
putative enteropathogens among controls may indicate prolonged
excretion or limited pathogenicity. In this population with a high
burden of diarrhoeal and other diseases, sanitation, health
education, and rotavirus-vaccination can be expected to have
substantial impact on childhood morbidity.