Abstract:
Background. With malaria declining, other causes of fever may account for a substantial portion of severe
childhood illness in sub-Saharan Africa. We determined prevalence, etiologies, and correlates of bacteremia
among children in Western Kenya.
Methods. In a cross-sectional study, febrile children aged 6 months to 15 years presenting to Kisii (low malaria
endemicity) and Homabay (high malaria endemicity) Hospitals were enrolled and screened for malaria, human
immunodeficiency virus (HIV) infection and bacteremia. Correlates of bacteremia were evaluated using logistic
regression.
Results. Among 1476 children enrolled, 48 (3.3%) had bacteremia (23 of 734, 3.1% in Kisii and 25 of 734,
3.4% in Homabay). Salmonella spp (19 typhi and 21 nontyphoidal salmonella) accounted for 83% (40 of 48) of
isolates. The distribution of Salmonella spp was similar between sites. Bacteremia was associated with
incomplete vaccination (adjusted odds ratio [aOR] = 2.1; 95% confidence interval [CI], 1.1–4.1), before
treatment with antimalarials (aOR = 2.7; 95% CI, 1.4–4.1), having sought care elsewhere (aOR = 2.2; 95% CI,
1.2–4.0) and lower education of caregiver (aOR = 2.5; 95% CI, 1.1–4.8). Nontyphoidal salmonella bacteremia
was associated with HIV (aOR = 6.8; 95% CI, 1.1–35.1) and anemia (hemoglobin <8 g/dL) (aOR = 5.2; 95%
CI, 1.4–18.9).
Conclusions. Bacteremia was relatively uncommon, but children with HIV, anemia, incomplete vaccination,
and/or persistent fever despite malaria treatment may have higher risk and may benefit from targeted bacterial
culture and/or empiric antibiotic therapy.
