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EPIDEMIOLOGY OF SPORADIC BLOODY DIARRHEA IN RURAL WESTERN KENYA

We conducted laboratory-based surveillance and a case-control study to characterize the epidemiology of bloody diarrhea in rural Western Kenya. From May 1997 through April 2001, we collected stool from 451 persons with bloody diarrhea presenting to four rural clinics. Cultures of 231 (51%) specimens yielded 247 bacterial pathogens: 198 Shigella (97 S. flexneri, 41 S. dysenteriae type 1, 39 S. dysenteriae type non-1, 13 S. boydii, 8 S. sonnei), 33 Campylobacter, 15 non-typhoidal Salmonella, and 1 Vibrio cholerae O1. More than 90% of the isolates (excluding Campylobacter) were resistant to trimethoprim-sulfamethoxazole and tetracycline, and more than 80% were resistant to ampicillin. Most (74%) ill persons received medication to which their isolate was resistant. Drinking Lake Victoria water and sharing latrines between multiple households increased risk of bloody diarrhea. Washing hands after defecating was protective. Providing safe drinking water and more latrines, and promoting hand washing could reduce the burden of illness from bloody diarrhea while limiting injudicious antimicrobial use.

Received December 26, 2002. Accepted for publication March 3, 2003.

Acknowledgments: We thank Mark Eberhard, Kimberly Won, John Gimnig, and Allen Hightower (Centers for Disease Control and Prevention), and Judith Achieng, Judith Akuku, Charles Ayuyo, Helen Moige, Henry Moseti, Vincent Nyadwa, Benjamin Ochieng, George Ochola, Caleb Okonji, Johnson Okulo, Sophie Odhiambo, Daniel Ogaja, Lucy Okuogo, Johnson Okulo, Samuel Olango, Maurice Ombok, Nicholas Omondi, Joseph Orurre, Julius Otieno, Jane Oyiengo, Eric Shoute, Rosemary Wanga, Boaz Watanga, and William Yongo, (Kenya Medical Research Institute) for helping with this study. We also thank Dr. Davey Koech (Director of the Kenya Medical Research Institute) for his permission to publish this paper.

Authors’ addresses: John T. Brooks, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-45 Atlanta, GA 30333, Telephone: 404-639-3894, Fax: 404-639-6127, E-mail: zud4{at}cdc.gov. Roger L. Shapiro, Infectious Disease Division, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Kennedy 6, Boston, MA 02215, Telephone: 617-632-7706, Fax: 617-632-7626. Lata Kumar, Joy G. Wells, and Eric Mintz, Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop A-38, 1600 Clifton Road NE, Atlanta, GA 30333, Telephone: 404-639-2206, Fax: 404-639-2205. Penelope A. Phillips-Howard, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop F-22, 4770 Buford Highway, Atlanta, GA 30341. Ya-Ping Shi, John M. Vulule, and Laurence Slutsker, Centers for Disease Control and Prevention/Kenya Medical Research Institute Field Station, PO Box 1578, Kisumu, Kenya, Telephone: 254-35-22902, Fax: 254-35-22981. Robert M. Hoekstra, Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop C-09, 1600 Clifton Road NE, Atlanta, GA 30333, Telephone: 404-639-4712.

Reprint requests: Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop A-38, 1600 Clifton Road NE, Atlanta, GA 30333.

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