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: 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.