Investigation of common bacteria isolates in malnourished children five (5) years and below admiited in Tamale Teaching Hospital in the Northern Region of Ghana

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OBJECTIVE:The research work was carried out to investigate or determine common bacteria isolates in malnourished children five (5) years and below admitted in Tamale Teaching Hospital in the northern region of Ghana, Tamale. STUDY DESIGN: This research was a hospital based cross -sectional study. DURATIONOF STUDY: from April 2013 to January 2014 at the Hospital. PLACE OF STUDY: Malnutrition unit of the Pediatric ward of Tamale teaching hospital in the northern region of Ghana, Tamale. MATERIAL AND METHODS: All children 0 to 60 months old and admitted to the malnutrition unit of the department of child health of the Tamale Teaching Hospital, Tamale. Mid Upper Arm Circumference (MUAC) ≤11.5cm and ≤ 12.5cm, All Children who Show symptom of sepsis, UTI, diarrhoea, Children who are able to produce stool and urine and Parent/guardian signs consent form were included in this study.To determine the types of bacterial infection commonly associated with malnourished children five years and below in blood, urine and stool culture reports were analyzed for bacterial isolates along with their antibiotic sensitivity pattern. RESULTS: Out of this number, 29/198 representing 14.6% were positive blood cultures, children whose parents did not sign consent form for their blood sample to be taken recorded 2/200 representing 1%.Out of total 29 cases of culture proven bacteraemia, the isolates were Staphylococcus (34.5%), Streptococcus (6.9%) Klebsiella (27.6%), E.coli ((10.3%), Pseudonomas (10.3%) and Proteus (10.3%).. Regarding antibiotic resistance pattern; E.coli was 100% resistant to ampicillin and gentamicin, 66.7% to ciprofloxacin ,87.5% of klebsiella was resistant to cotrimoxazole, ciprofloxacin and amikacin, and 50% to levofloxacin, staphylococcus aureus was 80% resistant to ampicillin and cotrimoxazole, 90% to gentamicin and 10% cephalexin. xiii 49/180 representing 27.2% of positive urine cultures and children who were not able to produce urine sample recorded 20/200 representing 10%. Out of total 49 cases of culture proven UTI, the isolates were as follow; klebsiella(38.8%), proteus(16.3%),pseudomonas(16.3%),E.coli(10.2%), citrobacter(8.2%), S.aureus(6.1%), enterobacter(2.0%) and enterococcus (2.0%).88% klebsiella was resistant to gentamicin, 70% to levofloxacin 30% to norvofloxacin, 21.1% to cotrimoxazole and 10.5% to ampicillin. Proteus was 100% resistant to gentamicin, 75% to cephalexin, 62.5% to levofloxacin, and 12.5% to ampicillin, cotrimoxazole and tetracycline. 3/199 representing 1.5% of positive stool cultures, children who could not produce stool sample were 1/200(0.5%), whislt169/198 (85.4%), 131/180 (72.8%) and 196 /199 (98.5%) were tested negative for blood, urine and stool respectively. 100% Shigella while was resistant to gentamicin, Amikacin and Levofoxacin, and 33% to cotrimoxazole and ampicillin. From the controlled analysis (nourished children), 22/198 representing 11.1% positive blood cultures, 13/112 representing 11.6% positive urine cultures and 1/71 representing 1.4% positive stool cultures. Whilst 176/198 (88.9%), 99/112 (88.4%), 70/71 (98.6) were tested negative for blood, urine and stool respectively.The age group 12-23 months showed a significant statistical difference(p <0.05) among Severe Acute Malnutrition (SAM), Moderate Acute Malnutrition (MOAM), Mild Acute Malnutrition (MAM) and Adequate Nutrition. Severe acute malnutrition (SAM) was seen to be higher among age group zero (0)-five years old children admitted to the Tamale Teaching Hospital. Males were more susceptible to bacterial infection than females.In conclusion, there is a significantly higher prevalence of bacteial infection in the malnourished children.
A Thesis Submitted to the Department of Clinical Microbiology, School Of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, for the Award of Master of Philosophy (Mphil) Degree in Clinical Microbiology, 2014