Clinical Features and Outcome of Children Admitted with Rotavirus Diarrhoea at a Tertiary Health Facility in the Gambia

Abstract

Background : Diarrhoea causes about 1.5 million deaths per year. Rotavirus causes 20% of these. We aimed to assess any changes in the clinical features and outcome of rotavirus diarrhoea (RD) at the Royal Victoria Teaching Hospital (RVTH), since the last report 15 years ago. Methods : In this cross-sectional study, children aged < 5years, admitted with diarrhoea from 1st Jan-31st Mar 2006, had. Their clinical and laboratory features including rotavirus antigen test (RT) of stools using ELISA documented. Results : Of the 536 admissions, 187 had acute diarrhoea (AD) of whom 118( 89.7%) were <12months old. There were 37(25%) rotavirus- negative and 111(75%) positive cases, 90(81.1%) being <12months old. The major associated symptoms were fever (87.8%), vomiting (95.3%) and cough (62.8%). Vomiting and fever were significantly more prominent in rotavirus-positive cases (OR (95%CI): for vomiting = 0.12 (0.02- 0.63), p = <0.001 and for fever; 0.28(0.10 - 0.76), p = 0.01), as was dehydration ( X 2 =4.24, p = 0.04). The predominant co-morbidities associated with rotavirus-diarrhoea were acute respiratory infections (ARI) and malaria. All ARI and malaria cases were < 24 months and 72.2% were <12months. Duration of Rotavrus diarrhoea was significantly shorter than diarrhoea from other causes - mean 7.21 days vrs 10.11 days (t = -3.91, p = <0.001). Fourteen (7.5%) off the 187 cases died. Mortality for both rotavirus-positive and rotavirus-negative cases was 3.4%. The case fatality rate for RD was 4.5%, all deaths occurring in infants aged 3-7months. The cause of death in 4(80%) of the rotavirus-positive deaths was severe dehydration and irreversible shock. Conclusion : Rotavirus remains a leading cause of diarrhoea disease in Gambia, especially in young infants. The significant clinical features are fever, vomiting and dehydration.