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. 2015 Mar 4;9(3):e0003568.
doi: 10.1371/journal.pntd.0003568. eCollection 2015 Mar.

Gastrointestinal infections and diarrheal disease in Ghanaian infants and children: an outpatient case-control study

Ralf Krumkamp  1 , Nimako Sarpong  2 , Norbert Georg Schwarz  3 , Julia Adlkofer  3 , Wibke Loag  3 , Daniel Eibach  3 , Ralf Matthias Hagen  4 , Yaw Adu-Sarkodie  5 , Egbert Tannich  1 , Jürgen May  1
Affiliations

Gastrointestinal infections and diarrheal disease in Ghanaian infants and children: an outpatient case-control study

Ralf Krumkamp et al. PLoS Negl Trop Dis. .

Erratum in

Abstract

Introduction: Diarrheal diseases are among the most frequent causes of morbidity and mortality in children worldwide, especially in resource-poor areas. This case-control study assessed the associations between gastrointestinal infections and diarrhea in children from rural Ghana.

Methods: Stool samples were collected from 548 children with diarrhea and from 686 without gastrointestinal symptoms visiting a hospital from 2007-2008. Samples were analyzed by microscopy and molecular methods.

Results: The organisms most frequently detected in symptomatic cases were Giardia lamblia, Shigella spp./ enteroinvasive Escherichia coli (EIEC), and Campylobacter jejuni. Infections with rotavirus (adjusted odds ratio [aOR] = 8.4; 95% confidence interval [CI]: 4.3-16.6), C. parvum/hominis (aOR = 2.7; 95% CI: 1.4-5.2) and norovirus (aOR = 2.0; 95%CI: 1.3-3.0) showed the strongest association with diarrhea. The highest attributable fractions (AF) for diarrhea were estimated for rotavirus (AF = 14.3%; 95% CI: 10.9-17.5%), Shigella spp./EIEC (AF = 10.5%; 95% CI: 3.5-17.1%), and norovirus (AF = 8.2%; 95% CI 3.2-12.9%). Co-infections occurred frequently and most infections presented themselves independently of other infections. However, infections with E. dispar, C. jejuni, and norovirus were observed more often in the presence of G. lamblia.

Conclusions: Diarrheal diseases in children from a rural area in sub-Saharan Africa are mainly due to infections with rotavirus, Shigella spp./EIEC, and norovirus. These associations are strongly age-dependent, which should be considered when diagnosing causes of diarrhea. The presented results are informative for both clinicians treating gastrointestinal infections as well as public health experts designing control programs against diarrheal diseases.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Proportions of case and control children by age group infected by various organisms.
All organisms detected in more than 50 samples are shown. Median ages in months (IQR) at the time of infection are shown in brackets.
Fig 2
Fig 2. Age adjusted attributable fractions (AF) and their 95% confidence intervals of gastrointestinal infections on diarrhea.
See this image and copyright information in PMC

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