Socio-Economic Risk Factors of Pathogenic Enterobacteria Infection and Antibiotic Resistance in Ranomafana Commune, Madagascar Open Access

Abstract

Background Diarrheal diseases represent a primary cause of mortality and morbidity among individuals - particularly those under the age of 5 - who live in rural areas of low-income nations characterized by limited access to safe and reliable water and sanitation infrastructure. The progressive emergence of bacterial resistance to antibiotics threatens the effectiveness of drug treatment against the pathogens responsible.

Methodology From July 1st - July 14th, 2014, 20 households were randomly selected within the Ranomafana Commune of Madagascar, to participate in this cross-sectional study. Within each household, in-person interviews were administered to assess risk-factors. All survey participants were asked to provide a fresh fecal specimen for analysis via PCR assays to detect for diarrheal pathogen infection and the absence/presence of genes that encode for antibiotic resistance (AR).

Principle Findings The prevalence of enteric virulence markers were: 22.04% for Shigella spp., 5.4% for Salmonella spp., 0.35% for Vibrio cholerae, and 7.11% for Yersinia spp. No significant association was found between enteric infection and: sex, access to household latrine, primary water treatment methods, or experiencing diarrhea within four weeks prior to the study. However, children aged 5-14 showed an increase in the odds of enteric infection when compared to individuals under the age of five.

The prevalence of genes encoding AR were: 42.11% for β-lactam, 54.29% for sul1 sulfonamide, 31.77% for sul2 sulfonamide, 50.47% for aminoglycoside, and 43.41% for dfrA7 trimethoprim resistance. No significant associations were found between AR carriage and: sex, cluster, or - curiously - antibiotic usage. However, the odds of harboring any AR encoding gene were 4.27 times higher among individuals belonging to households defined as being in the bottom 80% of the household wealth index compared to those individual belonging to a household in the top 20%.

Conclusions The high prevalence of Shigella spp. observed highlights the need to introduce a targeted intervention that works to disrupt the traditional transmission pathways of Shigella. Additionally, the high prevalence of divergent genes encoding antibiotic resistance in this region suggests that clinical treatment of bacterial diarrheal infections with conventional antibiotics may prove ineffective. These results demonstrate the need to establish health and hygiene sensitization programs that reach out to those of lower wealth standing.

Table of Contents

Introduction ................................................................................1

Background .................................................................................2

Methods ......................................................................................6

Results .......................................................................................12

Discussion ..................................................................................15

Conclusions and Recomendations .................................................20

Refrences ....................................................................................21

Tables .........................................................................................24

Appendix I ..................................................................................29

Appendix II .................................................................................30

About this Master's Thesis

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School	Rollins School of Public Health
Department	Environmental Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Biology, Microbiology Health Sciences, Epidemiology
Keyword	Madagascar Antibiotic Resistance Wealth Epidemiology Enteric Infection WASH
Committee Chair / Thesis Advisor	Gillespie, Thomas R., Emory University
Committee Members	Tolbert, Paige, Emory University
Partnering Agencies	International Non-governmental organization (e.g., CARE, Inc.) University, college or educational institution (other than Emory) CDC

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