Variations of Invasive Salmonella Infections by Population Size in Asante Akim North Municipal, Ghana

Clin Infect Dis. 2016 Mar 15;62 Suppl 1:S17-22. doi: 10.1093/cid/civ787.


Background: The Typhoid Fever Surveillance in Africa Program (TSAP) estimated adjusted incidence rates (IRs) for Salmonella enterica serovar Typhi and invasive nontyphoidal S. enterica serovars (iNTS) of >100 cases per 100 000 person-years of observation (PYO) for children aged <15 years in Asante Akim North Municipal (AAN), Ghana, between March 2010 and May 2012. We analyzed how much these rates differed between rural and urban settings.

Methods: Children recruited at the Agogo Presbyterian Hospital and meeting TSAP inclusion criteria were included in the analysis. Towns with >32 000 inhabitants were considered urban; towns with populations <5200 were considered rural. Adjusted IRs for Salmonella bloodstream infections were estimated for both settings. Setting-specific age-standardized incidence rates for children aged <15 years were derived and used to calculate age-standardized rate ratios (SRRs) to evaluate differences between settings.

Results: Eighty-eight percent (2651/3000) of recruited patients met inclusion criteria and were analyzed. IRs of Salmonella bloodstream infections in children <15 years old were >100 per 100 000 PYO in both settings. Among rural children, the Salmonella Typhi and iNTS rates were 2 times (SRR, 2.2; 95% confidence interval [CI], 1.3-3.5) and almost 3 times (SRR, 2.8; 95% CI, 1.9-4.3) higher, respectively, than rates in urban children.

Conclusions: IRs of Salmonella bloodstream infections in children <15 years old in AAN, Ghana, differed by setting, with 2 to nearly 3 times higher rates in the less populated setting. Variations in the distribution of the disease should be considered to implement future studies and intervention strategies.

Keywords: Ghana; Salmonella; rates; rural; urban.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Cohort Studies
  • Female
  • Ghana / epidemiology
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Male
  • Public Health Surveillance
  • Residence Characteristics / statistics & numerical data
  • Risk Factors
  • Rural Population / statistics & numerical data*
  • Salmonella Infections / epidemiology*
  • Salmonella Infections / microbiology
  • Salmonella enterica
  • Urban Population / statistics & numerical data*