This study addressed three key objectives; determined the point prevalence, assessed the drug resistance profile of isolates and identified factors associated with C. jejuni infection. The overall prevalence of C. jejuni was calculated at 14.8%. This finding was comparable with other studies reported in Jimma Ethiopia [23] and Gondar Ethiopia [13], kenya [24] with the isolation rates of 11.9% and 14%, 12.9% respectively. However, the present study showed higher prevalence compared to other African studies conducted in Sudan, 2% [38], Burkina Faso, 1.1% [39] and Zambia,3.5% [40]. Additionally, the present study was higher compared with reports from Asia such as from study in India [41], Iran, Asia [42] and Iran [43] which have an isolation rate of 3.8%, 4.1%and 4.5%,respectively. The discrepancy might related with socio economic, the degree contact with animals and animal products, the sample collection, transportation, culturing conditions and the laboratory methods used. For instance, our study used Preston blood free agar, which has higher sensitivity compared to other [44]. Again, this study demonstrated a lower point prevalence when compared with a study from Pakistan;54.6% [45]. Broadly speaking, Ethiopia is among the top ten countries having the highest number of deaths due to diarrheal diseases among U5C in the world [46]. Community-based cross-sectional study was conducted in Sidama, southern Ethiopia using a total of 537 U5C. The 2 weeks prevalence of diarrhea among U5C was 13.6, 95% CI (10.7, 16.5%)[47]. Another community-based cross-sectional was conducted in Debre Berhan town between 13 and 18 April 2018. The two week prevalence of diarrhea among U5C was gauged at 16.4% (69/351) [48]. Based a systematic review of 31 studies, the pooled prevalence of diarrhea among U5C in Ethiopia was 22% (95%CI: 19, 25%) [49]. The prevalence of diarrheal disease among U5C in Arba Minch Southern Ethiopia and Jabithennan North West Ethiopia showed 30.5% and 21.6% [50, 51], respectively.
In the present study, children who obtain nursery by people other than their mother or father showed significant association for C. jejuni culture positivity rate. This might be related with responsibility, knowledge and skill about child care and hygienic practice at the time of food preparation. Hand washing practice before food preparation was showed a significant reduction in C. jejuni culture positivity rate [52].
Malnutrition had a significant association with C. jejuni culture positivity rate. This result is consistent with previous reports done in Jimma, Ethiopia [12], and Gondar, Ethiopia [13]. This could be due to low immune status of malnourished children. Based on a systematic review of 31 studies, lack of maternal education, lack of availability of latrine, urban residency, and maternal hand washing practices were significantly associated with childhood diarrhea [49]. Based on 2016 Ethiopian demographic health survey (EDHS) data, a total of 10,641 children from 18,008 households were included in a study by Zewudie et al (2016). The under-five child mortality (U5M) was significantly linked with rural residency, none breastfeeding practices, having multiple birth, male gender, having first birth order and having family size six and above [1].
High culture positivity rate was also observed from children who have close contact with domestic animal (hen and cattle). This finding was in line with previous reports done in Jimma, Ethiopia [12, 23], and Gondar, Ethiopia [13]. This is expected because of the fact that, C. jejuni is a zoonotic bacteria. According to Abamecha et al report[10], C. jejuni was isolated from domestic animal feces such as cattle (75.3%), chicken (86.9%), sheep (84.6%) and goat (100%) done in Gambella, Northwest Ethiopia. In Sub-Saharan Africa 31% of children health impact is due to exposure to animal feces and C. jejuni was the common pathogen identified from children lived in close proximity with domestic animals [53].
Although molecular and culturing techniques are the recommended diagnostic methods[54] for C. jejuni infection, sign-symptoms such as duration of the diarrhea (one to five days), abdominal pain and vomiting can be an indicative for C. jejuni infection. However, these sign and symptoms had no significant association in the present study.
In this study, higher sensitivity rate were observed for ciprofloxacin (69%) and nalidixic acid (65.5%) and this finding is in line with similar study done elsewhere in Ethiopia [13] and beyond [55, 56]. Highest sensitivity rate of nalidixic acid (100%) were reported in Jimma, Ethiopia [12], Sudan [38] and Zambia[40] compared to the present study. The resistance rate of tetracycline (82.8%), cefoxitin (82.8%) and erythromycin (62.1%) were higher in this study compared to results done in Gondar Ethiopia[13] and Jimma, Ethiopia [23]. The resistance rate of ampicillin (65.5%) was in lined with a study done in Gondar, Ethiopia [13] and Jimma, Ethiopia [23].Taken together, the susceptibility profile C. jejuni isolates of this study in line with other studies. However, the slight discrepancy could be related with patients and antibiotic stewardship related factors. It must be noted that, disk diffusion technique is a screening test and any resistance report require minimum inhibitory concentration (MIC) test for accurate categorization [35]. The Erythromycin susceptibility report can be used to infer the azithromycin and clarithromycin resistance profile and the quinolone resistance is most reliably detected with nalidixic acid disks [36]. High rate of multidrug resistance was noticed among isolates of this study. The emergency of multidrug resistant pathogens across bacteria, fungi, viruses and parasites is on increasing at a terrifying rate. Despite, drug resistance is a natural evolutionary process, malpractices such as the inappropriate use of antimicrobial drugs, inadequate sanitary conditions, inappropriate food-handling, and poor infection prevention and control practices considered as the driving force for emergence of super bugs [57].
Strength and limitation of the study
This is the first report in the slum area of Bahir Dar City administration focusing on U5C. It assessed several factors and antibiotics. However, this study is not without limitations. The study is conducted on government health facility in which mainly visited by and served for economically disadvantaged community. As such, the finding might not fully inferred to all Bahir Dar City; rather, best inferred for suburban areas of Bahir Dar. The other limitations include the small sample size, failure to recheck the disk diffusion based resistance report with MIC.