Prevalence of Group A Rotavirus and Electrolyte profiles in children presenting with Acute Diarrhoea at Kenyatta National Hospital

Abstract

Introduction Diarrhoeal disease is a major cause of morbidity and mortality in children less than five years of age worldwide. It accounts for 21% of all deaths in this age group with rotavirus infection being responsible for a quarter of all the deaths. In Kenya, diarrhoea is the third leading cause of all deaths in children. About 20-30 children present daily with acute diarrhoea at Kenyatta National Hospital (KNH). The admission rate to the paediatrics general wards is 30%. Group A rotavirus is the most important aetiological agent in diarrhoea. The main cause of morbidity and mortality is severe dehydration complicated by electrolytes imbalance and metabolic acidosis. Objectives: The objectives of the study were to determine the prevalence of group A rotavirus infection in children aged 59 months and below presenting with acute diarrhoea at KNH, to compare the serum sodium, potassium, urea and creatinine in the severe forms of dehydration in the Human Rotavirus Positive (HRV +ve) and the HRV negative (-ve) children and to compare their clinical and social-demographic characteristics. Study setting: The study was conducted in KNH Paediatrics Filter Clinic (PFC) and the general paediatrics wards. Study population: The study population consisted of children aged 59 months and below who presented with acute diarrhoea at the PFC in KNH. Study design: This was a hospital based cross sectional survey. Methods: Samples of stool were collected from all recruited children who met the . . inclusion criteria. Rotavirus antigen testing was done using the Enzyme Linked lmmunoSorbent Assay (ELISA) technique. Light microscopy and bacterial cultures on the stool samples were performed. Blood samples were drawn to determine sodium, potassium, urea and creatinine levels in all the children with severe dehydration and those in hypovolemic shock. Results: one hundred and ninety two children were recruited into the study. Rotavirus was positive in 103 of all children with acute diarrhoea thus giving an overall prevalence of 53.4% (95% c.I. 46.3% - 60.9%). Two peaks of rotavirus infection were observed at the fifth and the ninth month of age. Children with only one prior episode of diarrhoea were more likely to have rotavirus diarrhoea than those who had more prior episodes (OR 2.4, 95% CI 1.0-5.6). The duration of rotavirus diarrhoea was significantly shorter with a mean of 3.5 (1-10) days as compared to those negative for rotavirus (p value 0.0001). Children who had severe vomiting of five times and above per day were more than two times likely to have rotavirus diarrhoea (OR 2.6,95% CI 1.3-5.3). Vomiting was reported to have lasted significantly longer (2: 3 days) at presentation to KNH in the rotavirus group than in those who tested negative for rotavirus (p value 0.01). There were 162 stool samples cultured for bacteria infection, 16.6% of the culture tests were positive for bacteria. The organisms grown included Enteropathogenic Escherichia Coli (48%), Shigella (33.3%) and Salmonella (7.4%). Nine children had bacterial coinfection with rotavirus. Electrolyte profiles, urea and creatinine levels were analyzed in 92 children who had the severe forms of dehydration. The derangement profiles were not significantly different between the group positive and that negative of group A rotavirus. The admission rate to the general paediatrics' wards was 41%. The children admitted had severe dehydration, not adequately managed at PFC or were in hypovolemic shock; rotavirus was positive in 59.4% of those admitted. Nineteen children with acute diarrhoea died during the study period, 63% were rotavirus (+ve). The overall case fatality rate for rotavirus-associated diarrhoea was 11.6%. Conclusion: Group A rotavirus is a major cause of diarrhoea in children presenting with acute diarrhoea at KNH. Morbidity and mortality associated with rotavirus diarrhoea is very high. Electrolytes, urea and creatinine derangements are common in acute diarrhoea though they are not significantly worse with rotavirus infection. Infants are more likely to be have rotavirus diarrhoea, with a single prior episode of diarrhoea disease being associated with a higher likelihood of being rotavirus positive Recommendation: Prevalence of rotavirus infection in diarrhoea is high and calls for appropriate measures to reduce its associated mortality and morbidity.