IMPORTANCE OF ENTERIC BACTERIA AS A CAUSE OF PNEUMONIA, MENINGITIS AND SEPTICEMIA AMONG CHILDREN IN A RURAL-COMMUNITY IN THE GAMBIA, WEST-AFRICA

Two thousand eight hundred ninety-eight children younger than 5 years old were investigated during a 2-year period in a rural area of The Ga mbia for possible pneumonia, meningitis or septicemia. After clinical examination and appropriate investigations, 1014 children were diagnos ed as having pneumonia, 31 as having meningitis and 100 as having sept icemia. Nine hundred seven children had a final diagnosis of malaria i ncluding 702 who satisfied the World Health Organization criteria for a diagnosis of pneumonia. A bacterial etiology was established in 115 (11%) patients with a final diagnosis of pneumonia, in 25 (81%) with m eningitis and in 29 (29%) with suspected septicemia. Overall the pneum ococcus was the leading pathogen identified among children with pneumo nia and meningitis and ranked third among those with septicemia. Howev er, during the wet season, when malaria transmission was highest, 50% of blood culture isolates obtained from children satisfying the World Health Organization criteria for a diagnosis of pneumonia were Salmone lla or coliform species, and the pneumococcus and Haemophilus influenz ae type b accounted for only 43% of isolates. Thus enteric bacteria ma y be as important as those bacteria more usually associated with respi ratory disease among children presenting with a clinical picture of pn eumonia during the wet season. This finding has important implications for case management and surveillance for antibiotic resistance.