Shigella Serogroups Distribution, Antimicrobial Susceptibility and Risk Factors of Shigellosis Among Children Presenting with Diarrhoea at Banadir Hospital in Mogadishu, Somalia
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Date
2022
Authors
Ali, Bilan Sheikh
Journal Title
Journal ISSN
Volume Title
Publisher
Kenyatta University
Abstract
Bacillary dysentery (shigellosis) is a public health concern globally, ranking second
among the top killer diseases in children aged five years and below. The burden of
shigellosis is disproportionately higher in middle and low-income countries due to poor
sanitation and insufficient clean drinking. With shigellosis treatment facing
unprecedented challenges arising from multidrug-resistant (MDR) Shigella strains,
understanding the local epidemiology is vital to inform prevention and control
interventions. This study determined Shigella serogroups distribution, antimicrobial
susceptibility (AS) patterns and shigellosis associated factors among children with
diarrhoea at Banadir Hospital, Somalia. The study design was cross-sectional, and
participants purposively recruited to include children aged five years and below with
diarrhoea, whose parent/guardian gave formal consent. With participants sociodemographic and clinical data sought using a questionnaire, 180 stool and rectal swab
samples were collected and processed following the standard microbiological
methods. Shigella serogroups AS patterns were elucidate using the Kirby- Bauer method.
The data were generated and presented in tables, and the association between the
shigellosis, socio-demographic and environmental characteristics of the participants, was
computed using the Chi-square (χ
2
) and Pearson correlation statistics using IBM SPSS
version 23 software for Windows. The children majority were females 111/180 (61.7%),
while males accounted for 38.35% (69/180) of the total samples collected. The children
mean age was 20.1 months with 12.87 months standard deviation (SD). Generally,
shigellosis prevalence among children with diarrhoea was 20.6% (37/180). While S.
boydii was absent among the bacteriologic cause of bacillary dysentery, the other three
(3) Shigella serogroups were isolated; S. flexneri, S. sonnei and S. dysenteriae type 1
(shiga bacillus). Of these, the predominant serogroup was Shigella flexneri (26/37,
70.3%) and the least prevalent was shiga bacillus (5/37, 13.5%) (t = 15.187; p = 0.0001).
There was 100% resistance to ampicillin, trimethoprim-sulfamethoxazole, and
tetracycline among the Shigella serogroups isolated. Except for S. dysenteriae type 1,
which remained susceptible to ciprofloxacin, 19.2% (5/26) of S. flexneri and 50% (3/6)
of S. sonnei isolates showed resistance. Forty per cent of the Shiga bacillus were
ceftriaxone (CRO) nonsusceptible. Shigella sonnei had the highest CRO resistance
(66.7%, 4/6) and the least resistant was S. flexneri (38.5%, 10/26). All the serogroups
were susceptible to azithromycin. MDR phenotype AMP/SXT/TE (37/37, 100%) was the
most dominant, and the least prevalent was AMP/SXT/TE/CIP/CRO (8.1%, 3/37). There
was no significant association of shigellosis among children aged five years and below
with the risk factors investigated in Banadir Hospital. This study showed high shigellosis
prevalence, and S. flexneri and Shiga bacillus as the most and least prevalent serogroup,
respectively, among children (≤ 5 years) in Banadir Hospital. CIP and CRO
resistant Shigella, including MDR strains, have emerged among children (≤ 5 years) in
Mogadishu, Somalia. Therefore, prevention and control interventions are urgently
required to mitigate MDR Shigella associated infections in Banadir Hospital and the
surrounding regions.
Description
A Thesis Submitted In Partial Fulfillment Of The Requirements For The Award of the Degree of Master of Science Infectious Diseases (Bacteriology) in the School of Medicine of Kenyatta University
Keywords
Shigella Serogroups, Distribution,, Antimicrobial, Susceptibility, Factors Shigellosis, Children Presenting, Diarrhoea, Banadir Hospital, Mogadishu, Somalia