Prevalence and predictors of bacteraemia among children with severe acute malnutrition admitted at dodoma regional referral hospital. Dodoma, tanzania

ABSTRACT

Background: Severe Acute Malnutrition is a major public health concern and the leading cause of death among children under five years. Therefore, this study was done to determine the prevalence and predictors of bacteraemia among children with Severe Acute Malnutrition aged 6 to 59 months admitted at Dodoma Regional Referral Hospital. Methods: This was a hospital based, analytical, cross section study conducted from January to June 2020. All children aged 6 to 59 months admitted at Dodoma Regional Referral Hospital with severe acute malnutrition were recruited. Structured questionnaire was used to collect social demographic data, clinical and physical characteristics of participants. Blood samples were collected for Blood culture, Full blood picture, C Reactive protein and HIV test. Bacterial isolates were isolated using standard bacteriological procedure and antimicrobial patterns were determined using Kirby Bauer technique. Results: A total of 232 children with Severe Acute Malnutrition admitted at Dodoma Regional Referral Hospital were recruited in the study. Majority of the children (n = 149, 64.2%) were males. The most common form of Severe Acute Malnutrition was marasmus, present in 181 (78%) children. Blood culture was positive in 22% (n = 51) of all the children. Salmonella typhi (39.2%, n = 20/51) and Escherichia coli (23.5%, n = 12/51) were the predominant gram-negative pathogens isolated, while Staphylococcus aureus 19.6%, n = 10/51) and S. pneumoniae (7.8%, n = 4/51) were the leading gram-positive pathogens. Most isolates were resistant to WHO’s recommended first line antibiotic regimen. Children with Diarrheal [AOR 2.3 (CI 1.081-4.697) P= 0.030], hypoglycaemia [AOR 14.6 (CI 6.583-23.432) P< 0.001] and high C - reactive protein [AOR 2.9(CI 1.347-6.612) P= 0.007] were independent factors associated with positive blood culture. Conclusion and Recommendations: The prevalence of bacteraemia is high in children with severe acute malnutrition. Most children presented with diarrhoea, hypoglycaemia and high C reactive protein, had positive blood culture. Most of the isolated bacteria were resistant to the WHO first line antibiotics regime, therefore progressive anti-microbial resistant surveillance should guide on local prescriptions.