Urbanicity and Paediatric Bacteraemia in Ghana—A Case-Control Study within a Rural-Urban Transition Zone

Abstract

BackgroundSystemic bacterial infections are a major cause of paediatric febrile illness in sub-Saharan Africa. Aim of this study was to assess the effects of social and geographical determinants on the risk of bacteraemia in a rural-urban transition zone in Ghana.MethodsChildren below 15 years of age with fever were recruited at an outpatient department in the suburban belt of Kumasi, Ghana’s second largest city. Blood was taken for bacterial culture and malaria diagnostics. The socio-economic status of participants was calculated using Principle Component Analysis. A scale, based on key urban characteristics, was established to quantify urbanicity for all communities in the hospital catchment area. A case-control analysis was conducted, where children with and without bacteraemia were cases and controls, respectively.ResultsBacteraemia was detected in 72 (3.1%) of 2,306 hospital visits. Non-typhoidal Salmonella (NTS; n = 24; 33.3%) and Salmonella typhi (n = 18; 25.0%) were the most common isolates. Logistic regression analysis showed that bacteraemia was negatively associated with urbanicity (odds ratio [OR] = 0.8; 95% confidence interval [CI]: 0.7–1.0) and socio-economic status (OR = 0.8; 95% CI: 0.6–0.9). Both associations were stronger if only NTS infections were used as cases (OR = 0.5; 95% CI: 0.3–0.8 and OR = 0.6; 95% CI: 0.4–1.0, respectively).ConclusionsThe results of this study highlight the importance of individual as well as community factors as independent risk factors for invasive bacterial infection (IBI) and especially NTS. Epidemiological data support physicians, public health experts and policy makers to identify disease prevention and treatment needs in order to secure public health in the transitional societies of developing countries.

Population-based incidence, seasonality and serotype distribution of invasive salmonellosis among children in Nanoro, rural Burkina Faso

“…The present results confirm iNTS as the predominant BSI pathogen in children in rural Africa [ 44 ]. It shows that the combined case load of invasive Salmonella Typhi and Salmonella non-Typhi infection was higher than that of severe malaria in children across different ages in rural Burkina Faso.…”

Serum cytokine responses in Rickettsia felis infected febrile children, Ghana

“…Malaria microscopy and blood cultures were performed as described previously [34]. Blood cultures from the participants of this study remained sterile.…”

“…Blood samples were taken within the first week after onset of fever (≥ 38 °C tympanic). Malaria microscopy and blood cultures were performed as described previously [ 34 ]. Blood cultures from the participants of this study remained sterile.…”

Correlates of non-typhoidal Salmonella bacteraemia: A case–control study

“…The incidence of NTS bacteraemia is increasing, especially in Sub-Saharan Africa (Ao et al, 2015;Gordon et al, 2001;Bronzan et al, 2007;Feasey et al, 2012), where HIV infection and malnutrition are common (Feasey et al, 2012). NTS has been reported to be among the most common causes of bacteraemia in such settings (Bronzan et al, 2007;Feasey et al, 2012;Sothmann et al, 2015), mostly without symptoms of gastroenteritis (Feasey et al, 2012). In developed countries, and even in less-developed regions, NTS bacteraemia occurs in persons with immunosuppression and chronic comorbidities (Hohmann, 2001;Brown and Eykyn, 2000;Galofre et al, 1994;Yombi et al, 2015;Matheson et al, 2010).…”