Abstract:
Diarrhoea is a major public health problem that affects the physical and cognitive
development of young children. Anthropometric data was collected from 274
children, 170 with diarrhoea and 104 without diarrhoea. Stool specimens were
analyzed by conventional culture, PCR for EAEC, Shigella, Cryptosporidium,
Entamoeba, and Giardia species, as well as by ELISA for faecal lactoferrin
levels. Additionally, all E. coli recovered from culture were PCR screened for
EAEC, and compared with those obtained from the stool DNA. Multiple gene loci
(aaiC, aap, attA and aggR) were sought for EAEC. About 50% of the study
population was mildly to severely malnourished. Mild to severe malnutrition
(WAZ <-l), moderate to severe stunting (HAZ < -2) and moderate to severe
wasting (WHZ < -2) were associated with diarrhoea (p = 0.023, 0.026 and 0.062,
respectively). In only 1 of 170 diarrhoea stool specimen was Shigella flexneri
recovered by culture. EAEC and Cryptosporidium were associated with diarrhoea
(p = 0.048 and 0.011, respectively), and malnourished children who had diarrhoea
were often co-infected with both Cryptosporidium and EAEC. About 27 % (4/15)
C. parvum genotypes were identified by HRM analysis. Faecal lactoferrin levels
were higher in children with diarrhoea (p = 0.019). Children who had EAEC
infection, with or without diarrhoea had high mean lactoferrin levels irrespective
of nutritional status. In conclusion, the current study identified high levels of
growth deficits among the children with/without diarrhoea. The use of DNAbiomarkers
revealed that EAEC and Cryptosporidium were common intestinal
pathogens in Accra, and that elevated faecal lactoferrin was associated with diarrhoea in this group of children. EAEC’s dispersin gene (aap) was significantly
associated with diarrhoea in both the faecal and bacterial DNAs, in the children
studied (p < 0.05).
Publication: Part o f the data presented in this thesis is published as follows:
Opintan JA et al. (2010). Pediatric Diarrhea in Southern Ghana: Etiology and
Association with Intestinal Inflammation and Malnutrition. Am J. Trop Med Hyg.
83: 936 - 943.
