Aetiology and risk factors of bacterial gastroenteritis among febrile outpatients at the Dschang District Hospital, West Region of Cameroon: a cross-sectional study

Abstract

ObjectivesTo investigate the bacterial aetiologies and associated risk factors of gastroenteritis among typhoid suspected cases.DesignCross-sectional study.SettingThis study was conducted at Dschang District Hospital of the Menoua Division, West Region of Cameroon, between April–November 2019 and June 2020.ParticipantsParticipants aged ≥2 years (mean 34±18.77 years) and of both sex suspected of having typhoid fever were included, while non-suspected typhoid cases were excluded. Self-reported sociodemographic and health information at recruitment was obtained from 556 participants.MethodsCollected stool samples were examined macroscopically and microscopically and subjected to culture. After culture, Gram staining was performed, followed by biochemical testing and characterisation using the Analytical Profile Index (API-20E) test kit.Interventions’No intervention was done during the period of study.Outcome measuresWe identified bacterial causing gastroenteritis, and associated risk factors calculated using binary regression, adjusting for sociodemographic and health variables.ResultsOf 556 patients, 74.28% tested positive for gastroenteritis. Among pathogens responsible for gastroenteritis, Escherichia coli was found to be the main cause (21.1%), followed by Salmonella typhi (10.4%), Citrobacter diversus (8.2%), and Proteus mirabilis (8.2%), Proteus vulgaris (7.3%), whereas Citrobacter spp and Yersinia enterocolitica were less represented among pathogens causing the disease among patients. A significant difference (p=0.002) was observed between abdominal pain and all the micro-organisms isolated from the patients. Patients having primary level of education were significantly associated (p=0.017; 3.163 (95% CI 1.228 to 8.147)) with the prevalence of gastroenteritis. Consumption of beverages (Wald statistic: 4.823; OR: 2.471; 95% CI (1.102 to 5.539); p=0.028), use of modern toilet (Wald statistic: 4.471; OR: 1.723; 95% CI (1.041 to 2.852); p=0.034) were strongly associated with gastroenteritis and rearing of bird (Wald statistic: 4.880; OR: 0.560; 95% CI (0.335 to 0.937); p=0.027), was found to be protective.ConclusionAcute bacterial gastroenteritis is a significant cause of morbidity in Dschang, with the prevalence of 74.28%. Many pathogens accounted for gastroenteritis, and E. coli (21.1%) could be a major cause, followed by S. typhi (10.4%), C. diversus (8.2%), P. mirabilis (8.2%), P. vulgaris (7.3%), whereas Citrobacter spp and Y. enterocolitica were less represented. Gastroenteritis was highly associated with primary level of education, consumption of beverages, use of modern toilet while rearing of birds was unexpectedly found to be protective against Gastroenteritis. Further characterisation is planned.