BackgroundIn malaria endemic areas, fever has been used as an entry point for presumptive treatment of malaria. At present, the decrease in malaria transmission in Africa implies an increase in febrile illnesses related to other causes among underfives. Moreover, it is estimated that more than half of the children presenting with fever to public clinics in Africa do not have a malaria infection. Thus, for a better management of all febrile illnesses among under-fives, it becomes relevant to understand the underlying aetiology of the illness. The present study was conducted to determine the relative prevalence and predictors of P. falciparum malaria, urinary tract infections and bacteremia among under-fives presenting with a febrile illness at the Makongoro Primary Health Centre, North-Western Tanzania.MethodsFrom February to June 2011, a cross-sectional analytical survey was conducted among febrile children less than five years of age. Demographic and clinical data were collected using a standardized pre-tested questionnaire. Blood and urine culture was done, followed by the identification of isolates using in-house biochemical methods. Susceptibility patterns to commonly used antibiotics were investigated using the disc diffusion method. Giemsa stained thin and thick blood smears were examined for any malaria parasites stages.ResultsA total of 231 febrile under-fives were enrolled in the study. Of all the children, 20.3% (47/231, 95%CI, 15.10-25.48), 9.5% (22/231, 95%CI, 5.72-13.28) and 7.4% (17/231, 95%CI, 4.00-10.8) had urinary tract infections, P. falciparum malaria and bacteremia respectively. In general, 11.5% (10/87, 95%CI, 8.10-14.90) of the children had two infections and only one child had all three infections. Predictors of urinary tract infections (UTI) were dysuria (OR = 12.51, 95% CI, 4.28-36.57, P < 0.001) and body temperature (40-41 C) (OR = 12.54, 95% CI, 4.28-36.73, P < 0.001). Predictors of P. falciparum severe malaria were pallor (OR = 4.66 95%CI, 1.21-17.8, P = 0.025) and convulsion (OR = 102, 95% CI, 10-996, P = 0.001). Escherichia coli were the common gram negative isolates from urine (72.3%, 95% CI, 66.50-78.10) and blood (40%, 95%CI, and 33.70-46.30). Escherichia coli from urine were 100% resistant to ampicillin, 97% resistant to co-trimoxazole, 85% resistant to augmentin and 32.4% resistant to gentamicin; and they were 100%, 91.2% and 73.5% sensitive to meropenem, ciprofloxacin and ceftriaxone respectively.ConclusionUrinary tract infection caused by multi drug resistant Escherichia coli was the common cause of febrile illness in our setting. Improvement of malaria diagnosis and its differential diagnosis from other causes of febrile illnesses may provide effective management of febrile illnesses among children in Tanzania

Background: Escherichia coli is among the most common causes of diarrhoea in children below five years of age in developing countries. Diarrhoeal diseases rank the second most common cause of morbidity and mortality in developing countries. Here we report the magnitude of Shiga toxin-producing Escherichia coli (STEC) infection among underfives with diarrhoea in Mwanza, Tanzania. Methods: This study was carried out at Nyamagana and Sekou Toure hospitals in Mwanza, Tanzania. Between July, 2015 and March, 2016, children aged < 5 years with diarrhoea were included in the study. Demographics and relevant information were recorded. Stool specimens were cultured onto MacConkey and Salmonella-Shigella Agars. CHROMagar STEC was used to identify STEC. Antimicrobial susceptibility testing was performed to all pathogenic bacteria using disc diffusion method. Results: A total of 304 children were include in the study. The mean (±standard deviation) age of the enrolled children was 1.4 (±1.03) years. Out of 304 diarrhoea cases, 32 (10.5%) were positive for STEC and 12 (3.9%) were due to other pathogenic bacteria (Salmonella and Shigella species.). Of 32 STEC isolates, 22 (68.8%) and 20 (62.5%) were resistant to amoxicillin/clavulanic acid and trimethoprim-sulfamethoxazole respectively and 3 (9.4%) were found to produce extended spectrum beta lactamases (ESBL). Use of water from wells (p=0.006) was found to be the predictor of the presence of pathogenic bacteria. Conclusion: Clinicians should consider STEC as the potential pathogens causing diarrhoea in the region. More than 60% of pathogenic bacteria were resistant to commonly prescribed antimicrobials like amoxicillin/clavulanic acid and trimethoprim-sulfamethoxazole. There is a need to emphasize on the provision of safe water, health education together with improvements in sanitation and personal hygiene as key strategies to reduce these infections.