Diarrhoea-causing organisms in the human population of Mathare, Nairobi, Kenya
Mimano, Lucy Nyokabi
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Diarrhoea is a common problem in both livestock and humans, especially in children in Kenya. Among the people of Mathare North, water is generally not adequate and many cases of food and / or waterborne diarrhoeal diseases have been reported, including amoebiases and gastro-enteritis. No detailed study has been carried out to investigate the causes of diarrhoea in Mathare North area. This study was carried out in order to establish the etiology of diarrhoea in Mathare north, Nairobi District. One hundred and seventy two faecal samples from patients presenting with diarrhoea at Upendo health centre were collected. Examinations of wet preparations were done using direct microscopy to detect parasites. Samples were then transported to the Walter Reed Institute-KEMRI for bacteriological, biochemical, serological and drug sensitivity testing by disc diffusion method. Molecular characterization of Campylobacter spp. and Escherichia coli spp. were performed using Polymerase Chain Reaction (PCR). Among the parasitic pathogens causing diarrhoea, Entamoeba histolytica had the greatest prevalence of 34.3%, followed by Giardia lamblia 21%, Hookworm 4.1%, Ascaris lumbricoides 3.5%, Trichuris trichura 3.5%, Schistosoma mansoni 3.5%, Cryptosporidium spp 1.7%, Strongyloides stercolaris 1.2%, H nana 1.2% and A. duodenale 1.2%. Among the bacterial pathogens, the causes of diarrhoea were Shigella spp 29.6% (S sonnei 1.7%, S boydii 4.7%, S dysenteriae 5.8% and S flexneri 17.4%), Escherichia coli spp. 5.8% (E. coli eaeA 4.1%, E. coli LT I 0.6%, E. coli ST 1 0.6% and E. coli Inve 0.6%), Campylobacter spp. 5.2% (C coli 2.3% and Cjejuni 2.9%) and Salmonella 09 2.8%. Among the bacterial pathogens, all except C coli were susceptible to norfloxacin, nalidixic acid and gentamicin. C jejuni was 100% susceptible to only gentamicin. However all the bacteria were resistant, at varying degrees, to trimethoprirn-sulphamethoxazole, erythromycin, tetracycline, chloramphenicol and ampicillin. xix The results also indicated that 31.4% (54 cases) of the diarrhoeal patients had more than two types ofpathogens. The findings of this study indicate that bacteria, helminthes and protozoans are a major causeof diarrhoea in Mathare North. The management of diarrhoea in this community would therefore requirea combination of antibiotics, anthelmintics, antiprotozoal and antiviral drugs. The antibiotic resistance data indicated that all isolates were resistant to at least four antibiotics but fluoroquinolones and gentamicin were the most effective antibiotics. This multi drug resistance pattern observedin the Mathare North Community is similar to that observed by other studies.