dc.contributor.author | Gatinu, Bernard W | |
dc.date.accessioned | 2013-05-27T11:48:12Z | |
dc.date.available | 2013-05-27T11:48:12Z | |
dc.date.issued | 2007 | |
dc.identifier.citation | M.Med (Paediatrics and Child health) Thesis | en |
dc.identifier.uri | http://erepository.uonbi.ac.ke:8080/xmlui/handle/11295
/26204 | |
dc.description | Master of Medicine | en |
dc.description.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. | en |
dc.description.sponsorship | University of Nairobi | en |
dc.language.iso | en | en |
dc.title | Prevalence of Group A Rotavirus and Electrolyte profiles in children presenting with Acute Diarrhoea at Kenyatta National Hospital | en |
dc.type | Thesis | en |
dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |
local.publisher | Department of Paediatrics and Child health, University of Nairobi | en |