MAGNITUDE, ASSOCIATED FACTORS AND DRUG SUSCEPTIBILITY PATTERN OF ESCHERICHIA COLI O157:H7 AMONGUNDER-FIVE CHILDREN WITH ACUTE DIARRHEA ATTENDING HARAMAYA DISTRICT HOSPITAL AND HIWOT-FANA SPECIALIZED UNIVERSITY HOSPITAL, EASTERN ETHIOPIA

Abstract

Background: Escherichia coli O157:H7 is one of the most potent, and zoonotic pathogen emerged as a cause of food borne infection. In under-five children, it causes from mild diarrhea to hemolytic uremic syndrome and even leading to death. Its magnitude was reported up to 39.3% in abroad and 14% in Ethiopia. However, in Ethiopia where; childhood diarrhea is endemic, an alarming rate of insanitary conditions, and close reservoir animals to human interaction, there is no robust information on its epidemiology. Hence, the study was meant to estimate the magnitude, assess the associated factors and drug susceptibility pattern of the isolates among under-five children with acute diarrhea in Haramaya Hospital and Hiwot-Fana Specialized University Hospital, Ethiopia. Methods: A Hospital based cross-sectional study design was carried out from January to March 2018 on 365 under-five children recruited by using consecutive sampling technique. A pretested structured questionnaire was used to collect potential factors. Both the data and stool samples were collected by trained laboratory technicians. Stool specimens were processed by using enrichment, differential and selective medium following manufacturer’s instruction. E. coliO157:H7 latex test (Oxoid, England) was then used for confirmation. Disk diffusion technique was used for antibiotic susceptibility test of 10 antimicrobials. Crude and adjusted odds ratio was determined and p< 0.05 was used as statistically significant. Results: The magnitude of E. coli O157:H7 was found to be 15.3% (95% CI: 11.8- 19.5). Of the isolates, 58.93 % (95% CI: 45.0 -71.9) exhibited multidrug resistance. Higher resistance was seen against Ampicillin (92.9%) whereas sensitivity to ciprofloxacin (87.5%). Among the factors studied; rural residence (AOR=3.75, 95% CI: 1.26-11.20), under cocked meat consumption (AOR = 3.95, 95% CI: 1.23-12.67), raw vegetable and/or fruit juice consumption (AOR 3.37, 95% CI: 1.32-8.62), bloody diarrhea (AOR 4.42, 95% CI: 1.78- 10.94), household with 3-4 under-five children (AOR 7.16, 95% CI: 2.90-17.70), presence of diarrhea in a household (AOR 4.22, 95% CI: 1.84-12.69), animal ownership (AOR 3.87, 95% CI: 1.48-10.12) and mothers with no formal education (AOR 3.14, 95% CI: 1.05-9.42) were found to be an independent predictors of childhood E. coli O157:H7. Conclusion: High magnitude of E. coli O157:H7 compounded by an alarming emerging resistance was seen against quinolones (norfloxacin and nalidixic acid) and gentamycin. Most infections originate from consumption of raw foods and drinks which presumably contaminated with farm animals coupled with substandard hand hygiene practice in house hold. Thus, mother’s education on child care and household sanitation together with preventive hygienic measures associated with animal manure in rural resident children is recommended