Prevalence of group A Streptococcal infection in Africa to inform GAS vaccines for rheumatic heart disease: A systematic review and meta-analysis

Health-seeking behaviour and beliefs around sore throat in The Gambia: A qualitative study

Group A Streptococcus (Strep A) bacteria causes a broad spectrum of diseases. The most common manifestations of Strep A infection are sore throat and pus-producing skin infections such as impetigo. Complications of Strep A infection can lead to inflammation in the bones, muscles, joints, and internal organs causing acute rheumatic fever and rheumatic heart disease (RHD). In The Gambia, the RHD burden is thought to be very high. However, epidemiological data is minimal, and Strep A control programmes do not exist. This study aimed to explore common beliefs and practices related to sore throats among primary caregivers of children, and healthcare providers in a community with a high Strep A disease burden. Four informal conversations with providers and fifteen semi-structured interviews with caregivers were conducted in the peri-urban area of Sukuta, The Gambia. Sampling was purposive and gradual, beginning from households identified to have recently experienced sore throat through a parallel cohort study. Themes explored in qualitative analysis included: sore throat causal attributions and diagnoses, care practises, health-seeking behaviour, and perceived barriers to using the biomedical sector. We found that sore throats were typically perceived to affect one child in a family, disproportionately or exclusively. Sore throats were rarely perceived as life-threatening, and awareness of links between sore throat and ARF or RHD was not reported among caregivers or providers in this study population. Most cases of sore throat were initially managed at home using traditional medicine which delayed resort to antibiotics, though in two instances of severe pain with the presence of exudate, fear that the child's life was at risk prompted care-seeking through the formal health system. Our findings can inform the development of tailored strategies to increase community knowledge of the potential long-term consequences of sore throats and appropriate care-seeking, alongside improvements in the health system, to prevent Strep A sequelae effectively.

Throat carriage rate, associated factors, and antimicrobial susceptibility pattern of group A Streptococcus among healthy school children in Jigjiga City, Eastern Ethiopia

Background

Group A Streptococcus has been recognized as an important human pathogen and it remains among the top ten causes of mortality from an infectious disease. Group A Streptococcus throat carriage plays an important role in the development of infection and transmission to contacts. In Ethiopia, there is little information about screening of children for group A Streptococcus carriage.

Objective

This study was aimed to assess the magnitude of throat carriage, associated factors, and antimicrobial susceptibility pattern of group A Streptococcus among healthy school children in Jigjiga city, Eastern Ethiopia from 12 April to 27 May 2021.

Method

A cross-sectional study was conducted enrolled by simple random sampling. Data on socio-demographic and related characteristics were gathered using pretested structured questionnaire. The throat sample was collected from 462 healthy school children and immediately transported to Jigjiga University Sultan Sheik Hassan referral hospital laboratory for investigation. Identification of group A Streptococcus was done by colony characterstics, gram staining, catalase negativity, bacitracin sensitivity, and Pyrrolidonyl arylamidase tests. Antibiotic susceptibility test was done on Muller-Hinton agar containing 5% sheep blood by modified Kirby-Bauer disc diffusion method. The data were coded, cleaned, and entered onto EpiData Version 3.1 then exported to SPSS version 26.0 for analysis. Bivariate and multivariable logistic regression through adjusted odds ratio (AOR) was used to determine the relationship between culture-positivity rates of GAS and predictor variables. A p-value < 0.05 was taken as statistically significant on multivariable analysis.

Results

The overall prevalence of group A Streptococcus throat culture rate was 10.6% (95%CI; 8.1%—13.7%). Previous family member who had a sore throat, children living with larger families (more than 11 members), and children living with non-immediate families were significantly associated with culture-positivity rates of GAS. Children who live with a family member with a sore throat compared with those who lived with in a family with no history of sore throat (AOR = 2.51; 95%CI 1.09–5.73), children who live with a large family comared to children living in families with less members (AOR = 4.64; 95% CI 1.53–14.1), and children who live with non-immediate families compared to children living with their mothers (AOR = 3.65; 95% CI 1.39 – 9.61), showed significant association with group A Streptococcus carriage rate. Resistance to all other antibiotics tested was low (< 5%). Multidrug resistance was found in 4.1% of isolates.

Conclusion

The present study showed 10.6% throat carriage of group A Streptococcus. Family member with a sore throat, having a large family, and living with non-immediate families have all been identified as independent predictors of carriage prevalence.