Socio-demographic characteristics
Out of 295 school children who participated in the present study, 147(51.2%) were males, 250(87.8%) were within the age of 5-12 years. About 41.8% of the study participant’s parents/guardian found to have no formal education. A fifty percent of students’ mothers were a house-wife. About 162(56.4%) of a total children’s parents/guardian had a monthly income between 500-900ETB, 33(11.5%) had 1000-1500 ETB and 92(32.1%) had higher than 1500ETB per month. However, the average income source of this area was 1560.00 ETB.
The prevalence of S. pyogenes
Among 287 school children 35(12.2%) 95% CI [19-27.8] were confirmed to have S. pyogenes in throat swabs. A colonization rate of S. pyogene among children who were 5-8 years old, 9-12 years old, 13-15 years old, those who live with employed mother, those who live with poor income source were 12(17.1%), 18(10.0%), 5(13.5%), 8(17.0%), and 26(16%) respectively (Table 3).
The prevalence of S. pyogenes was higher among children with employed mother 8(17.0%) than other occupations. Highest carriage rate was detected in low socioeconomic class 500-900ETB per month 26(16.0%) followed by 1000-1500ETB 4(12.1%). Among a total of 35(12.2%) S. pyogenes isolates, the highest carriage rate was observed in student’s family size more than 5 person per house 23(12.6%).
Out of 35 S. pyogenes isolated in this study, 35(100%), 26(74.3%), and 15(42.9%) were susceptible to penicillin, Vancomycin and Tetracycline respectively. About 34(97.1%) of S. pyogens isolates were sensitive to Erythromycine, Chloramphenicol, Ceftraxone and Amoxacline (Table 1 and 2).
Table 1 Antimicrobial susceptibility pattern of S. pyogens isolated from school children at Hawassa city from May-October 2018 (n=35)
Antimicrobial agents
|
Resistant
n (%)
|
Susceptible
n (%)
|
Penicillin
|
0(0.0%)
|
35(100%)
|
Vancomycin
|
9(25.7%)
|
26(74.3%)
|
Erythromycin
|
1(2.9%)
|
34(97.1%)
|
Chloramphenicol
|
1(2.9%)
|
34(97.1%)
|
Ceftriaxone
|
1(2.9%)
|
34(97.1%)
|
Amoxacline
|
1(2.9%)
|
34(97.1%)
|
Tetracycline
|
20(57.1%)
|
15(42.9%)
|
Table 2 The predominant multiple antibiotic resistant phenotypes for S. pyogenes isolated from school children at Hawassa city from May-October 2018 (n=24)
Phenotypes
|
Isolates tested
N (%)
|
Tetracycline
|
13(54.2)
|
Vancomycine
|
4(16.7)
|
Tetracycline, Amoxicillin
|
1(4.2)
|
Tetracycline, Ceftriaxone
|
1(4.2)
|
Tetracycline, Vancomycine
|
4(16.7)
|
Tetracycline, Vancomycine, Erythromycin
|
1(4.2)
|
Risk factor analysis for pharyngeal carriage
The possible risk factors such as age, sex, children living status, parents/guardians occupation, parents/guardians education, income of parents, family size, person per bed room sharing, and past history of recurrences of URTI were evaluated for pharyngeal carriage of S. pyogenes. It was observed in bivariate analysis that, female children (COR =2.212; 95%CI= 1.055-.638; p=.013), low income of parents (COR =3.326; 95%CI= 1.231-8.990; p=0.001), children being with mother(COR=0.34; 95%CI=0.2-1.6; p=0.301), and occupational status of mothers (COR =1.8(1.2-4.40) 95%CI=1.2-4.40; p=0.02 were observed.
The female children (AOR=2.730; 95%CI=1.24-6.037; p=0.013), and low income of parents (AOR=11.917; 95%CI=2.729-2.032; p=0.001) were associated with S. pyogenes carriage. Conversely, Occupational status of mothers (AOR=100; 95%CI=.023-.437; p=0.002) was associated with reduced likelihood of risk for asymptomatic pharyngeal carriage of S. pyogenes (Table 3).
Table 3 Distribution and association of S. pyogenes among school children in Hawassa from May-October 2018
Variables
|
Total S. pyogenes
|
|
Total N=287(100%)
|
P value
|
Present
n=35(12.2%)
|
Absent
n=252(87.8%)
|
COR(95% CI)
|
Sex
|
Female
|
23(16.4)
|
117(83.6)
|
1
|
140(48.8)
|
0.013
|
Male
|
12(8.2)
|
135(91.8)
|
2.21(1.8-3.14)
|
147(51.2)
|
|
Age
|
5-8
|
12(17.1)
|
58(82.9)
|
0.76(0.5-1.8
|
70(24.4)
|
0.123
|
9-12
|
18(10.0)
|
162(90.0)
|
1.41(0.8-3.20)
|
180(62.7)
|
0.626
|
13-15
|
5(13.5)
|
32(86.5)
|
1
|
37(12.9)
|
|
Children Living Status
|
With others*
|
7(14.9)
|
40(85.1)
|
0.64(0.3-1.90)
|
47(16.4)
|
0.427
|
Mother only
|
7(25.0)
|
21(75.0)
|
0.34(0.2-1.6)
|
28(9.8)
|
0.301
|
Father Only
|
0(0.0)
|
4(100.0)
|
0
|
4(1.4)
|
0.264
|
Both parent
|
21(10.1)
|
187(89.9)
|
1
|
208(72.5)
|
|
Educational status of parents
|
Illiterate
|
19(15.8)
|
101(84.2)
|
0.89(0.5-2.20)
|
120(41.8)
|
0.365
|
1-4
|
1(5.0)
|
19(95.0)
|
3.2(1.8-4.80)
|
20(6.7)
|
0.309
|
5-12
|
10(8.9)
|
102(91.1)
|
1.7(0.9-2.6)
|
112(39.0)
|
0.546
|
>12
|
5(14.3)
|
30(85.7)
|
1
|
35(12.2)
|
|
Occupational status of Mothers
|
Others**
|
10(10.2)
|
88(89.8)
|
1.8(1.2-4.40)
|
98(34.1)
|
0.002
|
House Wife
|
17(12.0)
|
125(88.0)
|
1.5(0.7-3.20)
|
142(49.5)
|
0.002
|
Employed
|
8(17.0)
|
39(83.0)
|
1
|
47(16.4)
|
|
Occupational status of Fathers
|
Others***
|
21(14.8)
|
121(85.2)
|
0.35(0.2-1.50)
|
142(49.5)
|
0.446
|
Farmer
|
7(10.8)
|
58(89.2)
|
0.26(0.18-1.94)
|
65(22.6)
|
0.602
|
Employed
|
7(8.8)
|
73(91.2)
|
1
|
80(27.9)
|
|
Family income
|
500-900
|
26(16.0)
|
136(84.0)
|
0.3(0.2-1.68)
|
162(56.4)
|
0.001
|
1000-1500
|
4(12.1)
|
29(87.9)
|
0.42(0.3-2.20)
|
33(11.5)
|
0.042
|
>1500
|
5(5.4)
|
87(94.6)
|
1
|
92(32)
|
|
Past history of recurrent of URTI/RHD
|
Yes
|
6(14.6)
|
35(85.4)
|
0.78(0.6-1.70)
|
41(14.3)
|
0.607
|
No
|
29(11.8)
|
217(88.2)
|
1
|
246(85.7)
|
|
Number of family per house
|
<5
|
12(12.5)
|
84(87.5)
|
1
|
96(33.4)
|
0.208
|
>5
|
23(12.0)
|
168(88.0)
|
10.9 (4.0-22.0)
|
191(66.6)
|
|
Residence
|
Urban
|
16(22.9)
|
54(77.1)
|
1
|
70 (24.4)
|
|
Rural
|
19(8.8)
|
198(91.2)
|
3.1 (1.7-5.8)
|
217(75.6)
|
0.002
|
Cooking in bed room
|
Yes
|
10(7.0)
|
133(93.0)
|
2.79(1.2-6.4)
|
143(49.8)
|
0.321
|
No
|
25(17.4)
|
119(82.6)
|
1
|
144(50.2)
|
|
Previous any disease
|
Yes
|
25(12.8)
|
170(87.2)
|
0.83(0.6-2.1)
|
195(67.9)
|
|
No
|
10(10.9)
|
82(89.1)
|
1
|
92(32.1)
|
-
|
History of Hospitalization
|
Yes
|
22(9.1)
|
220(90.9)
|
4.1(1.9-9.2)
|
44(15.33)
|
0.000
|
No
|
13(28.9)
|
32(71.1)
|
1
|
45(15.7)
|
|
*=guardians/care givers, **= both mother and father, *** =daily labor, merchant, students