Diarrheal diseases are major causes of morbidity and mortality among children in developing countries. We have analyzed the causative agents of diarrhea in children under five years of age who resided in rural environments but attended a hospital in Malindi, a coastal town in Kenya. Bacterial diarrhea was found in 239 (27.7%) of 862 patients with diarrhea. Diarrheagenic Escherichia coli, including enteropathogenic, enterotoxigenic, and enterohaemorrhagic strains, was isolated from 119 (13.8%) patients, followed by Salmonella spp. (63 cases, 7.3%) and Shigella spp. (56 cases, 6.5%). Intestinal parasites were found in 109 (12.6%) of the patients. Entamoeba histolytica and Giardia lamblia were found in 67 (7.8%) and 42 (4.9%) of the cases, respectively. Rotavirus was found in 69 (16.1%) of 428 cases, a part of the 862 cases. Significant differences in age distribution were seen in diarrheal cases due to Campylobacter spp., G. lamblia, and rotavirus. No significant seasonal incidence of specific pathogens was found, but the number of diarrheal patients was significantly correlated to rainfall. Drinking water was contaminated with bacteria at concentrations ranging from 103 to 106 CFU/ml in 98% of the households and by coliform bacteria at concentrations of 102 to 10s CFU/ml in 72% of the households. These results suggest that the main routes of infection may be contaminated drinking water and fecal-oral transmission of enteric pathogens. Consequently, we propose that the enhancement of hygienic practice through health education is a feasible control measure of diarrhea in the study area.

Physiochemical characteristics and flora of diarrhoeal and recovery faeces were investigated in 14 Kenyan children with acute gastro-enteritis. Causative micro-organisms were Shigella, Campylobacter, enterotoxigenic Escherichia coli, rotavirus and unknown in 6, 2, 1, 2 and 3 patients, respectively. The mean values of the pH of the diarrhoeal specimens were significantly higher than those of the recovery specimens. Large amounts of acetic acid and many other kinds of fatty acids were detected in the recovery specimens, but small amounts and few kinds of fatty acids were detected in the diarrhoeal specimens. Bacterial counts of anaerobic organisms, such as Bacteroides, Bifidobacterium, Lactobacillus and Eubacterium, were lower in the diarrhoeal specimens than in the recovery ones. The normal anaerobic intestinal flora is remarkably disturbed in patients with acute gastro-enteritis. This may result in changes in fatty acid contents and in the pH of diarrhoeal faeces.