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Open Access Highly Accessed Research article

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

Klaus Reither123*, Ralf Ignatius4, Thomas Weitzel1, Andrew Seidu-Korkor6, Louis Anyidoho5, Eiman Saad12, Andrea Djie-Maletz4, Peter Ziniel2, Felicia Amoo-Sakyi2, Francis Danikuu5, Stephen Danour6, Rowland N Otchwemah5, Eckart Schreier7, Ulrich Bienzle1, Klaus Stark7 and Frank P Mockenhaupt1

Author Affiliations

1 Institute of Tropical Medicine and International Health, Charité – University Medicine Berlin, Berlin, Germany

2 Northern Region Malaria Project, NORMAP, Tamale, Ghana

3 Department of Infectious Diseases and Tropical Medicine, University of Munich, Munich, Germany

4 Institute of Microbiology and Hygiene, Charité – University Medicine Berlin, Berlin, Germany

5 School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana

6 Regional Health Administration, Ministry of Health, Tamale, Ghana

7 Robert Koch Institute, Berlin, Germany

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BMC Infectious Diseases 2007, 7:104  doi:10.1186/1471-2334-7-104

Published: 6 September 2007

Abstract

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%CI, 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.