Directorate of Postgraduate Studies
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Browsing Directorate of Postgraduate Studies by Subject "Antimicrobial"
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Item Acute diarrhea in under five children in Dar es salaam: the burden of disease bacterial causes and pattern of antimicrobial resistance(Hubert Kairuki Memorial University, 2016) Mpongo, Pauline L.Background: Diarrhea is the second leading cause of morbidity and mortality in Sub-Saharan Africa; Tanzania included and is the leading cause of malnutrition globally. Each year diarrhea kills around 760,000 children less than five years and it is both preventable and treatable. Globally, there are nearly 1.7 billion cases of diarrhea disease every year. The aim of this study was to determine the burden of disease, microbial causes and pattern of antimicrobial resistant in children less than five years of age with acute diarrhea in Dar es Salaam, Tanzania. Method: This was a cross sectional descriptive study in which all children less than five years with acute diarrhea in the outpatient and inpatient of the 3 regional referral hospitals in Dar es Salaam. Stool samples were collected from 202 children and microbial pathogens were identified from stools by use of conventional method while viral rapid tests were used to identify viruses. Wet microscopic preparations for parasites and antimicrobial sensitivity were done using Kirby-Breuer disk diffusion method. Results: Most children with acute diarrhea 169 (83.7%) were below 24 months of age and only 33(16.3%) were above 24 months of age. More males 127 (62.9%) than females 75(37.1%) children were affected by acute diarrhea. Only male children in the age group less than 24 months had severe dehydration (1.8%). Fever was more common among children with bacteria diarrheal. In this study bacteria contributed to (7.5 %). B.coli (46.7%) being the commonest followed by Salmonella and Shigella 20% each. Least was V. cholera (13.3%). Viruses were the commonest causes of diarrhea in this study and were as follows:, Rotavirus, Adenovirus and Norovirus: 42%, 29% and 3.5% respectively. There was no case of Astrovirus isolated in this study. Protozoa and intestinal worms were identified in 5% each, while nonspecific findings were identified in 8% cases. All bacteria isolates of this study were susceptible to ciprofloxacin 91% and to Ceftriaxone 100%. On the other hand, all isolates were resistant to Cotrimoxazole except for Shigella which was moderately resistant (50%).Item Urinary tract infection: prevalence pathogens and antimicrobial susceptibility pattern among febrile children at Mwananyamala Hospital Tanzania(Hubert Kairuki Memorial University, 2013) Barongo, Aileen K.Background: Urinary tract infection (UTI) is a common and important cause of morbidity in the pediatric population in developing countries. Prevalence rates of urinary tract infection in children range from 3.3% in the United States to 39.7% in Northwestern Tanzania. Diagnosis of Urinary Tractjnfection in children is difficult to establish in our setup, therefore in resource-limited settings most children with Urinary Tract Infection are either misdiagnosed or given empiric treatment without laboratory confirmation of the infection. Moreover, many uropathogens are developing resistance to antibiotics recommended by World health Organization (WHO) to treat urinary tract infection. The magnitude, etiology and antimicrobial susceptibility of Urinary Tract Infection in Tanzanian febrile children are not well defined. All published studies to date on the prevalence and etiology of UTI in febrile children have not included a control group which is necessary to investigate false positives due to poor collection procedures or a latent period before the sample is inoculated to the agar growth media. The urine collected for urinalysis or microscopic needs to be tested as soon as possible so as to prevent multiplications of organisms. If the urine has to be cultured, it should be refrigerated during transit and held refrigerated until cultured. Objective: The objectives of this study was to determine the prevalence of Urinary Tract Infection, aetiologic pathogens and antimicrobial susceptibility of these pathogens in febrile children aged two to five (2-5) years in Mwananyamala District Hospital. Methodology: This was a Cross-sectional descriptive hospital-based study which was conducted among febrile children aged two to five years. Febrile and afebrile children were consecutively recruited from the paediatric and the Reproductive and vii Child health (RCH) clinics at Mwananyamala District Hospital. The study was carried out for six months, i.e. from July to December 2012. Urine was collected by use of clean catch method into a sterile container. The diagnosis of Urinary Tract Infection was confumed by bacteriological culture of urine specimen. If bacterial uropathogens was isolated from the urine specimen, antimicrobial susceptibility testing was performed using discs for the following antimicrobials: Cotrimoxazole, Amoxicillin, Erythromycin, Gentamycin, Ceftriaxone, Ciprofloxacin and Amikacin Results: A total of 556 children fulfilled the eligibility criteria and were enrolled into the study. Of these 370 (66.5%) were febrile and 186 (33.5%) were afebrile. Among the 370 febrile children 29 children were confirmed to have urinary tract infection by urine culture, giving an overall prevalence rate of 7.8%. Females were noted to have higher prevalence of UTI than males, however, the difference was not statistically significant (P^ 0.418). Of the 186 afebrile children 11 were confirmed by urine culture to have urinary tract infection giving an overall prevalence rate of 5.9%. Febrile children were noted to have higher prevalence of urinary tract infection than afebrile children, however the difference was not statistically significant (P= 0.729). Escherichia coli was the most commonly isolated organism accounting for 38%, followed by Klebsiella species which accounted for 21%. Other organisms isolated included Proteus species, Pseudomonas species and Staphylococcus aureus. Resistance rates of the isolated uropathogens to, Co-trimoxazole, Erythromycin and Amoxillin were 100%, 89.7% and 86.2%, respectively. Gentamycin and Ceftriaxone had slightly lower resistance rates of 48% and 57% respectively while Amikacin and Ciprofloxacin had least resistance rates of 0% and 6.9%respectively. Conclusion: Prevalence of Urinary Tract Infection among febrile children aged two to five (2-5) years attending the Paediatric and the Reproductive and Child Health Clinics in Mwananyamala District Hospital, Dar es Salaam is 7.8%. The commonest bacterial Uropathogens isolated fi^om the urine of these children were Exoli and Klebsiella Species. The isolated bacterial uropathogens showed a relatively high resistance to Amoxillin, Co-trimoxazole and Erythromycin. Recommendations: One study conducted at Mwananyamala District Hospital in children aged 2 to 5 years is not enough to make a recommendation on the prevalence and pattern of organisms causing Urinary Tract Infection in children between two and five years in Dar es Salaam. It is proposed that further long term studies be conducted in order to produce results to advice government to change the current standard of antibiotic treatment for urinary tract infection.