Prevalence, severity and factors of rotavirus diarrhoea in children presenting at Kampala City Council Authority health facilities post vaccine introduction

Abstract

INTRODUCTION: Diarrhoea is the second most common cause of fatal childhood diseases, estimated to cause approximately half a million deaths among children aged <5 years annually. Rotavirus infection is the commonest cause of diarrhoea leading to severe dehydration and death. Although rotavirus vaccines were introduced and have proven to be safe, this mortality continues to occur in the lowest-income countries especially in Africa where almost half of all rotavirus diarrhoea deaths are. In Uganda, the pre-vaccination prevalence of rotavirus diarrhea ranged from 32.7% to 45.4%. Rotavirus vaccination was introduced into the Uganda Expanded Program on Immunization (UEPI) in 2018. Unknown is the magnitude and severity of rotavirus diarrhea among children attending KCCA healthy facilities post vaccine introduction. OBJECTIVES: To determine the prevalence, severity and factors associated with rotavirus infection among children aged 3-59 months presenting with acute diarrhoea at Kampala City Council Authority (KCCA) health facilities after introduction of rotavirus vaccine. METHODS: This was a cross sectional study conducted in 5 KCCA health facilities from November 2021- February 2022. Participants were children aged 3-59 months, with acute diarrhoea whose caretakers consented to participation. Data was collected on the sociodemographic characteristics, immunization and clinical history, and clinical features on physical examination. The data was recorded on a pretested case record form together with a sample of stool was obtained by inserting nasogastric tube per rectal and aspirated 5mls of stool. Stool samples were tested for rotavirus antigen using enzyme-linked immunosorbent assay (ProSpecT™ Rotavirus microplate assay). Rotavirus infection severity was assessed using the 20 points Vesikari Clinical Severity Score. RESULTS: Four hundred and twenty children were recruited. The median age was 14 months with interquartile range IQR ((10-22) months, 239/420 (56.9%) were male and 402/420 (95.8%) were vaccinated. with dose (one) 1 and 361/420 (85.9%) with dose 2 (two). A total of 58 (13.8%) tested positive for rotavirus. Among the positive children, 54/58 (93.1%) were fully vaccinated. Of the 58 children, 25 (43.1%) had severe rotavirus associated diarrhoea, 20 (34.5%) had moderate and 13 (22.4%) had mild diarrhoea using the Vesikari Clinical Severity Score. At multivariate analysis, the factors significantly associated with rotavirus diarrhoea were: a higher number of children in a household ≥3 [AOR 2.36, 95% CI (1.26, 4.42), p=0.007], caretakers with no or primary level of education [AOR 2.05, 95% CI (1.10, 3.84), p= 0.024], children of caretakers’ who had no knowledge of the schedule of immunization with the rotavirus vaccine [AOR 5.98, 95% CI (2.53, 14.2), p<0.001], and households whose sources of drinking water was tap water [AOR 3.13 95% CI (1.26, 7.76), p=0.014]. xiii CONCLUSION AND RECOMMENDATION: The prevalence of rotavirus infection among children with acute diarrhoea attending the urban primary healthcare facilities in Kampala was 13.8%. This is a significant decrease from 45.4% since the introduction of the rotavirus vaccine. Children of caretakers with low levels of formal education and/or do not know the vaccine schedules are particularly affected. Public health education campaigns should be conducted to further promote rotavirus vaccination and National Water should examine water sources for contamination.