Introduction years are most likely to get shigellosis, but

Introduction
Despite the decline in diarrheal mortality, diarrhea
remains one of the principal causes of morbidity and mortality in children.
Diarrhea thus still accounts for 1.6–2.5 million deaths annually, and each
child in the developing world experiences an average of three episodes of
diarrhea per year 1. In developing countries
microbes are responsible for most under five diarrheic children such as
rotavirus, Shigella spp., enterotoxigenic E. coli and Salmonella 2 and 3.
The Enterobacteriaceae are a large, heterogeneous group
of gram-negative rods whose natural habitat is the intestinal tract of humans
and animals. The family includes many genera (Escherichia, Shigella,
Salmonella, Enterobacter, Klebsiella, Serratia, Proteus, and others).
Some enteric organisms, eg, Escherichia coli, are part of the normal
flora and incidentally cause disease, while others, the salmonellae and
shigellae, are regularly pathogenic for humans. The Enterobacteriaceae are
facultative anaerobes or aerobes, ferment a wide range of carbohydrates,
possess a complex antigenic structure, and produce a variety of toxins and
other virulence factors 4.
Shigella is a germ that causes a disease called
shigellosis. Children younger than 5 years are most likely to get
shigellosis, but people from all age groups can get this disease. Most people
with shigellosis will get better within 5 to 7 days without medical
treatment. However, Shigella bacteria can cause more severe illness in
infants, the elderly, or people with immune systems weakened by cancer,
cancer treatments, or other serious conditions (like diabetes, kidney failure,
liver disease, and HIV/AIDS) 5.
Salmonellae are classified as either typhoid or enteric
regarding the relevant clinical pictures and epidemiologies. It is not known
why typhoid salmonellae only cause systemic disease in humans, where as
enteric salmonella infections occur in animals as well and are usually
restricted to the intestinal tract 6.
Healthcare providers may prescribe antibiotics to people
with severe cases of shigellosis and Salmonellosis to help them get better
faster. However, some antibiotics are not effective against certain types of
Shigella and Salmonella. Healthcare providers can order laboratory tests to
determine which antibiotics are likely to work 5
Despite high prevalence and
resistant to different antibiotic of Shigella and Salmonella worldwide and in
Ethiopia to our knowledge there is limited information in Adigrat General
Hospital. Therefore, this study will determine prevalence of Salmonella and
Shigella and antibiotic susceptibility test among under Five diarrheic
Children At Adigrat General Hospital, North Ethiopia where there is dearth of
information.

 

Statement of the
problem
Even though mortality from diarrhea has decreased
substantially but that morbidity has remained high over the last four
decades. Diarrhea is one of the important causes of morbidity and mortality
among children in developing countries. In 2003, on the basis of an estimate
from studies published between 1992 and 2000; 4.9 children per 1000 per year
in these areas died as a result of diarrheal illness in the first 5 years of
life, responsible for 2.5 million deaths per year 1. This indicates a decrease
from 4.6 million in 1982 and 3.0 million in 1992  7.
Microorganisms are responsible for most of diarrheal
disease in developing countries. Rotavirus was commonest among
6-11-month-olds, accounting for 20% of all cases in this age group; 71% of
all rotavirus episodes occurred during the first year of life. Shigella species
were commonest among those aged 12-23 months and 24-35 months, accounting for
22% and 27% of the cases, respectively 2. Enteropathogenic E. coli
is also the majority isolate followed by Salmonella, Shigella and
campylobacter 8.
Salmonella infections are major cause of public health problems worldwide.
Globally more than 21 million
illnesses and more than 210, 000 deaths during 2000 are caused
due to typhoid fever and that paratyphoid fever caused more than 5 million illnesses 9. In US Salmonella infections
resulted in 15,000 hospitalizations and 400 deaths annually 10.
Over 400,000 of the typhoidal and paratyphoidal illnesses occurred In Africa 9. Invasive
Nontyphoidal Salmonella disease is also a major cause of illness and
death globally, particularly in Africa. Where infants, young children, and
young adults are most affected, had the highest incidence (227 cases per
100,000 populations) and 1.9 million cases with 681,316 deaths annually 11
The annual number of Shigella episodes throughout the
world was estimated to be 164.7 million, of which 163.2 million were in
developing countries (with 1.1 million deaths) and 1.5 million in
industrialized countries. A total of 69% of all episodes and 61% of all
deaths attributable to shigellosis involved children under 5 years of age 12.
In Ethiopia, Between 1990 and 2013 the under-5
mortality rate declined from 203.9 deaths/1000 live births to 74.4 deaths/
1000 live births with an annual rate of change of 4.6%, yielding a total
reduction of 64% 13. The country achieved the
MDG related to child survival. However, the under-5 mortality rate in
Ethiopia is still higher compared to the mortality rate in many low- and
middle-income countries (LMIC) (14, 15, 16 and 17). Lower respiratory tract
infection (LRI), diarrheal diseases, and neonatal syndromes accounted for 54%
of the total under-5 deaths in 2013 13  Child mortality in Tigray has dropped from
204 deaths per 1,000 live births in 1983 EFY (Ethiopian Fiscal Year) to 67
deaths per 1000 live births by 2006 EFY, a 67% decrease.
Many studies have been conducted to assess diarrhea
among under five children in Africa as well as different region of Ethiopia.
The range of Shigella and Salmonella infection in Ethiopia among
diarrheic under five children was from ­­­­­2.3-13.3%
and 6.2-11.5% respectively 18, 19, 20.
Healthcare providers may prescribe antibiotics to people
with severe cases of shigellosis and Salmonellosis to help them get better
faster. However, some antibiotics are not effective against certain types of
Shigella and Salmonella 5. Resistance to antimicrobial drugs, and particularly
multidrug resistance is a major problem in Enterobacteriaceae in both developing
and developed countries throughout the world, affecting a wide range of
genera, including Salmonella enterica, Shigella species and Escherichia coli 21. Healthcare providers must
order antimicrobial susceptibility tests to determine which antibiotics are
likely to work 5
Currently, although excellent data are available from
the developed world and in some developing countries, to our knowledge little
epidemiologic information is available on prevalence of Salmonella and
Shigella in Adigrat General Hospital.
Hence this study will be conducted in order to
determine the prevalence of Salmonella, Shigella and its antibiotic
susceptibility in Adigrat General Hospital: 

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Ø  To provide
awareness to the mother/guardian about the severity of diarrhea in children.
Ø  To administer
antibiotics to children those are culture positive.
Ø  To provide
information to health personnel’s not to give those that are resistance to Salmonella
and Shigella routinely to treat diarrhea in children.
Ø  To be used as
a base line data for other scholars for further study
Moreover, it may provide useful information that can
optimize the potential benefit of isolation and antimicrobial susceptibility
testing of Salmonella and Shigella in diarrheic Children.