MRSA is resistant to a large group of antibiotics called the beta lactams. Methicillin is a
In Ethiopia, no population based study had been carried out on nasal carriage rate, antibiotic susceptibility pattern, and associated risk factors of
The study was conducted in five governmental urban elementary schools in Gondar town and five governmental rural elementary schools surrounding Gondar town; Gondar town is the capital of North Gondar administrative zone, in Amhara region, Northwest Ethiopia.
A community-based comparative cross-sectional study was conducted to determine nasal carriage rate, antimicrobial susceptibility pattern, and associated factors of
School children from recruited schools who gave sociodemographic information and nasal swab samples were included whereas children who were unable to give sociodemographic information, nasal swab specimen, and those who were on antibiotic therapy at the time of data collection were excluded
All randomly selected school children from recruited schools who have agreed to give sociodemographic information and nasal swab samples were included
Children who were unable to give sociodemographic information and nasal swab specimen and those who were involuntary to participate in the study due to different reasons and children who were on antibiotic therapy at the time of data collection were also excluded
Single population proportion formula was used to determine the sample size and the calculated sample size was 258. However, adding 20% nonresponse rate and a design effect of two, the final calculated sample size was 622. A multistage sampling technique was used to select schools by using simple random sampling technique and stratifying the schools to grades and sections. The number of study participants were allocated proportionally to each schools and grades based on the school sampling frame and the study subjects were selected by simple random sampling technique (lottery method).
A pretested questionnaire based on postulated or known risk factors were developed and modified to explore the objectives of the study. Then sociodemographic characteristics and other relevant information were collected. Nasal swab specimen were collected by using sterile cotton tip swabs prewetted with sterile saline for each anterior nares by inserting the swab and gently rotating four to five times both in clockwise and in anticlockwise direction from each study participants. The nasal swabs were collected and inoculated immediately in a properly labeled sterile Tryptone Soya Broth (TSY) (Oxoid Ltd. England) and transported by using vaccine carrier which has ice box to maintain the temperature at 2-8°C until it reaches the laboratory.
Each nasal sample was inoculated onto mannitol salt agar (Oxoid Ltd. England) and the plate was incubated aerobically at 37°C for 24 hrs. The sample that was positive for mannitol fermentation and golden yellow colonies on mannitol salt agar was further inoculated on blood agar (Oxoid Ltd. England) plate and incubated at 37°C for 24 hrs. The isolates obtained were identified using standard microbiological methods including colony morphology, Gram’s stain reaction, and biochemical tests such as catalase and coagulase. Finally isolates that were golden yellow colony on mannitol salt agar and blood agar pate, Gram-positive cocci in clusters, catalase, and coagulase positive were confirmed as
A suspension of pure colony from each confirmed culture isolate was done in sterile normal saline and incubated at 37°C for at least 15 minutes. The suspension was adjusted at 0.5% MacFarland standard. Then Modified Kirby-Bauer disk diffusion technique was implemented for antibiotic susceptibility pattern using different antibiotics such as penicillin (10
All
Data was entered using EPI-Info version 7 and its completeness and clearance was checked and then transferred to SPSS version 20 for analysis. The characteristics of the study population were summarized using frequencies, mean, and standard deviation. Binary logistic regression was done to determine the association of variables with
A total of 622 urban and rural elementary school children were included in the study; of these, 317/622 (51%) were males. The ages of the study participants ranged from 6 to 25 years with a mean age of 11.9 years (SD+2.9). Most of the study participants, 345/622 (55.5%), belonged to the age group of 11-15 years of age and 345/622 (55.5%) were from urban elementary schools while the rest, 277/622 (44.5%), were from rural schools. Among the study participants, 321/622 (51.6%) had a family size of greater than five members and 271/622 (43.6%) had mothers who were unable to read and write (Table
Sociodemographic characteristics of study participants among elementary school children in Gondar, Northwest Ethiopia, 2018.
| | | |
---|---|---|---|
| Urban | 345 | 55.5 |
Rural | 277 | 44.5 | |
| |||
| Male | 317 | 51 |
Female | 305 | 49 | |
| |||
| 6 -10 years | 221 | 35.5 |
10 -15 years | 345 | 55.5 | |
> 15 years | 56 | 9.0 | |
| |||
| Grade 1-4 | 308 | 49.5 |
Grade 5-8 | 314 | 50.5 | |
| |||
| Less than 500 birr | 295 | 47.4 |
500-1000 birr | 130 | 20.9 | |
Greater than 1000 birr | 197 | 31.7 | |
| |||
| 2-5 | 301 | 48.4 |
Greater than 5 | 321 | 51.6 | |
| |||
| 21-40 | 75 | 12.1 |
41-60 | 486 | 78.1 | |
> 60 | 61 | 9.8 | |
| |||
| Yes | 77 | 12.4 |
No | 545 | 87.6 | |
| |||
| Yes | 100 | 16.1 |
No | 522 | 83.9 | |
| |||
| Yes | 39 | 6.3 |
No | 583 | 93.7 | |
| |||
| Yes | 299 | 48.1 |
No | 323 | 51.9 | |
| |||
| Yes | 71 | 11.4 |
No | 551 | 88.6 | |
| |||
| Yes | 93 | 15.0 |
No | 529 | 85.0 | |
| |||
| Yes | 91 | 14.6 |
No | 531 | 85.4 | |
| |||
| Unable to read & write | 271 | 43.6 |
Informal education | 68 | 10.9 | |
Primary school | 153 | 24.6 | |
Secondary school | 81 | 13.0 | |
Above grade 12 | 49 | 7.9 | |
| |||
| Unable to read & write | 211 | 33.9 |
Informal education | 97 | 15.6 | |
Primary school | 146 | 23.5 | |
Secondary school | 103 | 16.6 | |
Above grade 12 | 65 | 10.5 |
Majority of the study participants, 545/622(87.6%), had no history of chronic disease, but from the total of participants, almost half, 299/622(48.1%), of the study participants had history of visit to hospitals/clinics. On top of that, 522/622(83.9%) had not history of hospitalization; 583/622 (93.7%) had not history of surgery; 551/622 (88.6%) had not history of contact with health care worker; 529/622(85%) had not history of antibiotic usage in the past 4 weeks; and the rest, 531/622 (85.4%), had not history of respiratory infection (Table
Majority, 295/622 (47.4%), of the study participant’s family’s average monthly income was less than 18 dollar followed by 197/622 (31.7%), greater than 36 dollar, and 130/622 (20.9%), 18-36 dollar incomers. Majority of the fathers of the study participants, 211/622 (33.9%), were unable to read and write followed by 146/622 (23.5%), primary school; 103/622 (16.6%), secondary school; 97/622 (15.6%), informal education; and 65/622 (10.5%), above grade 12 attenders (Table
Out of 622 study participants, the overall prevalence of
Prevalence of
| | | ||||||
---|---|---|---|---|---|---|---|---|
| | |||||||
| | | | | | |||
| 6-10 years | 221 (35.53) | 30 (22.73) | 7 (23.33) | 102 (77.27) | 18 (20.23) | 1 (5.56) | 71 (79.78) |
11-15 years | 345 (55.47) | 50 (26.32) | 4 (8) | 140 (73.68) | 31 (20) | 0 (0) | 124 (80) | |
> 15 years | 56 (9.0) | 3 (13.04) | 2 (8.70) | 20 (86.96) | 11 (33.33) | 0 (0) | 22 (66.67) | |
Total | 622 (100) | 83 (24.06) | 13 (15.66) | 262 (75.94) | 60 (21.66) | 1 (1.67) | 217 (78.34) | |
| ||||||||
| Male | 317 (50.97) | 45 (25.57) | 6 (13.33) | 128 (72.73) | 34 (23.61) | 1 (2.94) | 110 (76.39) |
Female | 305 (49.04) | 38 (22.09) | 7 (18.42) | 134 (77.91) | 26 (19.55) | 0 (0 ) | 107 (80.45) | |
Total | 622 (100) | 83 (24.06) | 13 (15.66) | 262 (75.94) | 60 (21.66) | 1(1.67) | 217 (78.34) | |
| ||||||||
| 2-5 | 301 (48.39) | 44 (22.45) | 8 (18.18) | 152 (77.55) | 18 (17.14) | 0 (0) | 87 (82.86) |
> 5 | 321 (51.61) | 39 (26.17) | 5 (12.82) | 110 (73.83) | 42 (24.42) | 1 (2.38) | 130 (75.58) | |
Total | 622 (100) | 83 (24.06) | 13 (15.66) | 262 (75.94) | 60 (21.66) | 1 (1.67) | 217 (78.34) | |
| ||||||||
| 622 (100) | 83 (24.06) | 13 (15.66) | 262 (75.94) | 60 (21.66) | 1 (2.67) | 217 (78.34) | |
| ||||||||
| Grade 1 | 74 (11.9) | 9 (23.68) | 1(11.11) | 29 (76.32) | 8 (22.22) | 0 (0) | 28 (77.78) |
Grade 2 | 75 (12.06) | 8 (18.18) | 1 (12.5) | 36 (81.81) | 8 (25.81) | 1 (12.5) | 23 (74.19) | |
Grade 3 | 79 (12.7) | 7 (18.42) | 2 (28.57) | 31 (81.58) | 5 (122) | 0 (0) | 36 (87.81) | |
Grade 4 | 78 (12.54) | 16 (37.21) | 2 (12.5) | 27 (62.79) | 10 (28.57) | 0 (0) | 25 (71.43) | |
Grade 5 | 87 (13.99) | 11 (21.15) | 3 (27.27) | 41 (78.85) | 6 (17.14) | 0 (0) | 29 (82.86) | |
Grade 6 | 81 (13.02) | 11 (26.19) | 1 (9.09) | 31 (73.81) | 6 (15.39) | 0 (0) | 33 (84.62) | |
Grade 7 | 77 (12.38) | 11 (26.19) | 0 (0) | 31 (73.81) | 10 (28.57) | 0 (0) | 25 (71.43) | |
Grade 8 | 71 (11.42) | 10 (21.74) | 3 (30) | 36 (78.26) | 7 (28) | 0 (0) | 18 (72) | |
Total | 622 (100) | 83 (24.06) | 13 (15.66) | 262 (75.94) | 60 (21.66) | 1 (1.67) | 217 (78.34) |
In urban elementary schools, the
The frequency of
Among urban elementary school children, high rate of
Frequency of total
Frequency of total
The antimicrobial susceptibility pattern result showed that, among 143
Antibiotic susceptibility patterns of
| | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
| | | | |||||||||
| | | | |||||||||
| | | | | | | | | | | | |
| 0 (0) | 0 (0) | 70 (100) | 1 (1.7) | 0 (0 ) | 58 (98.31) | 0 (0) | 0 (0) | 13 (100) | 0 (0) | 0 (0) | 1 (100) |
| 42 (60) | 21 (30) | 7 (10) | 32 (54.4) | 9 (15.3) | 18 (30.5) | 3 (23.08) | 2 (15.39) | 8 (61.54 ) | 1(100) | 0 (0) | 0 (0) |
| 65 (92.9) | 2 (2.88) | 3 (4.29) | 59 (100) | 0 (0) | 0 (0) | 9 (69.23) | 0 (0) | 4 (30.77 ) | 1 (100) | 0 (0) | 0 (0) |
| 69 (98.57) | 0 (0) | 1 (1.43) | 59 (100) | 0 (0) | 0 (0) | 12 (92.31) | 1 (7.69) | 0 (0 %) | 1 (100 ) | 0 (0) | 0 (0) |
| 59 (84.29) | 6 (8.57) | 5 (7.14) | 51 (86.44) | 2 (3.39) | 6 (10.17) | 9 (69.23) | 1 (7.69) | 3 (23.08) | 1 (100) | 0 (0) | 0 (0) |
| 70 (100) | 0 (0) | 0 (0) | 59 (100) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 13 (100) | 0 (0 ) | 0 (0) | 1 (100) |
| 63 (90) | 6 (8.57) | 1 (1.43) | 59 (100) | 0 (0) | 0 (0) | 10 (76.92) | 1 (7.69) | 2 (15.38) | 1 (100) | 0 (0) | 0 (0) |
| 11 (15.71) | 14 (20) | 45 (64.29) | 7 (11.86) | 4 (6.78) | 48 (81.67) | 1 (7.36) | 4 (30.77) | 8 (61.54) | 0 (0) | 0 (0) | 1 (100) |
S= susceptible, I = intermediate, and R = resistance.
Among 622 elementary school children included in the study, father’s educational status (P = 0.039; AOR = 1.98; CI =1.063-3.685) and number of students in classroom belonged to 41-60 (P = 0.031; AOR = 0.41; CI = 0.18-0.92) and 21-40 category (P = 0.046; AOR = 0.38; CI = 0.15 -0.98) were significant risk factors for nasal colonization of
Epidemiologic risk factors for
| | | ||||||
---|---|---|---|---|---|---|---|---|
| | | | | | |||
| Urban | 345 (55.47) | 83 (24.06) | 262 (75.94) | 0.87 | 0.48 | - | - |
Rural | 277 (44.53) | 60 (21.66) | 217 (78.34) | 1(ref) | 1(ref) | - | - | |
| ||||||||
| Male | 317 (51) | 79 (24.92) | 238 (75.08) | 0.8 | 0.244 | - | - |
Female | 305 (49) | 64 (20.98) | 241(79.02) | 1(ref) | 1(ref) | - | - | |
| ||||||||
| 6-10 years | 221 (35.5) | 48 (21.72) | 173 (78.28) | 1.20 | 0.599 | - | - |
10-15 years | 345 (55.5) | 81 (23.48) | 264 (76.52) | 1.09 | 0.804 | - | - | |
> 15 years | 56 (9.0) | 14 (25) | 42 (75) | 1(ref) | 1(ref) | - | - | |
| ||||||||
| Grade 1-4 | 308 (49.5) | 71 (23.05) | 237 (76.95) | 0.99 | 0.971 | - | - |
Grade 5-8 | 314 (50.5) | 72 (22.93) | 242 (77.07) | 1(ref) | 1(ref) | - | - | |
| ||||||||
| <500 birr | 295 (47.4) | 59 (20) | 236 (80) | 1.51 | 0.056 | 1.38 | 0.214 |
500-1000 birr | 130 (20.9) | 30 (23.08) | 100 (76.92) | 1.26 | 0.380 | 1.13 | 0.66 | |
>1000 birr | 197 (31.7) | 54 (27.41) | 143 (72.59) | 1(ref) | 1(ref) | 1(ref) | 1(ref) | |
| ||||||||
| 2-5 | 301 (48.4) | 62 (20.6) | 239 (79.40) | 1.30 | 0.17 | 1.33 | 0.148 |
>5 | 321 (51.6) | 81 (25.23) | 24 0 (74.77) | 1(ref) | 1(ref) | 1(ref) | 1(ref) | |
| ||||||||
| 21-40 | 75 (12.06) | 19 (25.3) | 56 (74.7) | 0.38 | 0.046 | 0.38 | 0.046 |
41-60 | 486 (78.14) | 117 (24.1) | 369 (75.9) | 0.41 (0.18-0.9 | 0.031 | 0.41 | 0.031 | |
>60 | 61 (9.8) | 7 (11.5) | 54 (88.5) | 1(ref) | 1(ref) | 1(ref) | 1(ref) | |
| ||||||||
| Yes | 77 (12.4) | 18 (23.38) | 59 (76.62) | 1.03 | 0.931 | - | - |
No | 545 (87.6) | 125 (22.94) | 420 (77.06) | 1(ref) | 1(ref) | - | - | |
| ||||||||
| Yes | 100 (16.1) | 23 (23) | 77 (77) | 1.00 | 0.998 | - | - |
No | 522 (83.9) | 120 (22.99) | 402 (77.01) | 1(ref) | 1(ref) | - | - | |
| ||||||||
| Yes | 39 (6.3) | 9 (23) | 30 (77) | 1.01 | 0.989 | - | - |
No | 583 (93.7) | 134 (21.27) | 449 (77.02) | 1(ref) | 1(ref) | - | - | |
| ||||||||
| Yes | 299 (48.1) | 71 (23.75) | 228 (76.25) | 1.09 | 0.667 | - | - |
No | 323 (51.9) | 72 (22.29) | 251 (77.71) | 1(ref) | 1(ref) | - | - | |
| ||||||||
| Yes | 71 (11.4) | 18 (25.35) | 53 (74.65) | 1.16 | 0.616 | - | - |
No | 551 (88.6) | 125 (22.69) | 426 (77.31) | 1(ref) | 1(ref) | - | - | |
| ||||||||
| Yes | 93 (15.0) | 20 (21.51) | 73 (78.5) | 0.90 | 0.712 | - | - |
No | 529 (85.0) | 123 (23.21) | 406 (76.75) | 1(ref) | 1(ref) | - | - | |
| ||||||||
| Completed | 73 (11.7) | 13 (17.81) | 60 (82.19) | 1.406 | 0.291 | - | - |
Not completed | 18 (2.9) | 6 (33.33) | 12 (66.67) | 1(ref) | 1(ref) | - | - | |
| ||||||||
| Yes | 91 (14.6) | 22 (24.18) | 69 (75.82) | 1.08 | 0.771 | - | - |
No | 531 (85.4) | 121 (22.79) | 410 (77.21) | 1(ref) | 1(ref) | - | - | |
| ||||||||
| Unable to read & write | 271 (43.6) | 57(21.033) | 214 (78.97) | 1.2 | 0.039 | 1.57 | 0.253 |
Informal education | 68 (10.9) | 17 (25) | 51 (75) | 1.594 | 0.256 | 1.49 | 0.371 | |
Primary school | 153 (24.6) | 35 (22.88) | 118 (77.12) | 1.79 | 0.102 | 1.47 | 0.299 | |
Secondary school | 81 (13.0) | 17 (20.99) | 64 (79.01) | 2.0 | 0.087 | 1.68 | 0.217 | |
Above grade 12 | 49 (7.9) | 17 (34.69) | 32 (65.30) | 1(ref) | 1(ref) | 1(ref) | 1(ref) | |
| ||||||||
| Unable to read & write | 211 (33.9) | 41 (19.43) | 170 (80.57) | 1.98 | 0.031 | 1.98 | 0.039 |
Informal education | 97 (15.6) | 28 (28.87) | 69 (71.13) | 1.18 | 0.640 | 1.18 | 0.715 | |
Primary school | 146 (23.5) | 31 (21.23) | 115 (78.77) | 1.77 | 0.087 | 1.77 | 0.105 | |
Secondary school | 103 (16.6) | 22 (21.36) | 81 (78.64) | 1.76 | 0.115 | 1.78 | 0.132 | |
Above grade 12 | 65 (10.5) | 21 (32.31) | 44 (67.69) | 1(ref) | 1(ref) | 1(ref) | 1(ref) |
Risk factors for MRSA nasal colonization among elementary school children in Gondar town, Northwest Ethiopia, 2018.
| | | ||||||
---|---|---|---|---|---|---|---|---|
| | | | | | |||
| Urban | 83 (58.04) | 13 (15.66) | 70 (84.34) | 0.09 | 0.023 | 0.107 | 0.036 |
Rural | 60 (41.96) | 1 (1.67) | 59 (98.33) | 1(ref) | 1(ref) | 1(ref) | 1(ref) | |
| ||||||||
| Male | 79 (55.2) | 7 (8.86) | 72 (91.14) | 1.26 | 0.678 | - | - |
Female | 64 (44.8) | 7 (10.94) | 57 (89.06) | 1(ref) | 1(ref) | - | - | |
| ||||||||
| 6-10 years | 48 (33.6) | 8 (16.67) | 40 (83.33) | 0.83 | 0.831 | - | - |
10-15 years | 81 (56.6) | 4 (4.94) | 77 (95.06) | 3.21 | 0.205 | - | - | |
> 15 years | 14 (9.8) | 2 (14.29) | 12 (85.714) | 1(ref) | 1(ref) | - | - | |
| ||||||||
| Grade 1-4 | 71 (49.65) | 7 (9.86) | 64 (90.14) | 0.99 | 0.978 | - | - |
Grade 5-8 | 72 (50.35) | 7 (9.72) | 65 (90.28) | 1(ref) | 1(ref) | - | - | |
| ||||||||
| Less than 500 birr | 59 (41.26) | 4 (6.78) | 55 (93.22) | 1.72 | 0.422 | - | - |
500-1000 birr | 30 (20.98) | 4 (13.33) | 26 (86.67) | 0.81 | 0.763 | - | - | |
>1000 birr | 54 (37.76) | 6 (11.11) | 48 (88.89) | 1(ref) | 1(ref) | - | - | |
| ||||||||
| 2-5 | 62 (43.4) | 8 (12.90) | 54 (87.1) | 0.54 | 0.279 | - | - |
>5 | 81 (56.6) | 6 (7.41) | 75 (92.59) | 1(ref) | 1(ref) | - | - | |
| ||||||||
| Yes | 18 (12.59) | 4 (22.22) | 14 (77.78) | 3.29 | 0.07 | 2.4 | 0.313 |
No | 125 (87.41) | 10 (8) | 115 (92) | 1(ref) | 1(ref) | 1(ref) | 1(ref) | |
| ||||||||
| Yes | 23 (16.1) | 4 (17.91) | 19 (82.61) | 2.32 | 0.191 | 1.29 | 0.71 |
No | 120 (83.9 ) | 10 (8.33) | 110 (91.67) | 1(ref) | 1(ref) | 1(ref) | 1(ref) | |
| ||||||||
| Yes | 9 (6.3) | 2 (22.22) | 7 (77.78) | 2.905 | 0. 213 | - | - |
No | 134 (93.7) | 12 (8.96) | 122 (91.05) | 1(ref) | 1(ref) | - | - | |
| ||||||||
| Yes | 71 (49.7) | 8 (11.27) | 63 (88.72) | 1.4 | 0.556 | - | - |
No | 72 (50.3) | 6 (8.333) | 66 (91.67) | 1(ref) | 1(ref) | - | - | |
| ||||||||
| Yes | 18 (12.6) | 3 (16.67) | 15 (83.33) | 2.07 | 0.302 | - | - |
No | 125 (87.4) | 11 (8.8) | 114 (91.2) | 1(ref) | 1(ref) | - | - | |
| ||||||||
| Yes | 20 (14.0) | 4 (20) | 16 (80) | 2.83 | 0.11 | 2.66 | 0.149 |
No | 123 (86.0) | 10 (8.13) | 113 (91.87) | 1(ref) | 1(ref) | 1(ref) | 1(ref) | |
| ||||||||
| Completed | 13 (65) | 2 (15.85) | 11 (84.62) | 0.48 | 0.384 | - | - |
Not completed | 7 (35) | 2 (28.57) | 5 (71.43) | 1(ref) | 1(ref) | - | - | |
| ||||||||
| Yes | 22 (15.39) | 1 (4.55) | 21 (95.45) | 0.4 | 0.384 | - | - |
No | 121 (84.62) | 13 (10.74) | 108 (89.26) | 1(ref) | 1(ref) | - | - | |
| ||||||||
| Unable to read & write | 57 (39.9) | 3 (5.26) | 54 (94.74) | 3.86 | 0.121 | 1.49 | 0.683 |
Informal education | 17 (11.9) | 3 (17.65) | 14 (82.35) | 1.00 | 1.00 | 0.66 | 0.657 | |
Primary school | 35 (24.5) | 3 (8.57) | 32 (91.43) | 2.29 | 0.346 | 1.14 | 0.891 | |
Secondary school | 17 (11.9) | 2 (11.77) | 15 (88.24) | 1.61 | 0.63 | 1.124 | 0.912 | |
Above grade 12 | 17 (11.9) | 3 (17.65) | 14 (82.35) | 1(ref) | 1(ref) | 1(ref) | 1(ref) | |
| ||||||||
| Unable to read & write | 41 (28.7) | 2 (4.88) | 39 (95.12) | 3.25 | 0.218 | - | - |
Informal education | 28 (19.6) | 2 (7.14) | 26 (92.86) | 2.17 | 0.422 | - | - | |
Primary school | 31 (21.7) | 4 (12.9) | 27 (87.1) | 1.13 | 0.886 | - | - | |
Secondary school | 22 (15.4) | 3 (13.64) | 19 (86.36) | 1.06 | 0.951 | - | - | |
Above grade 12 | 21 (14.7) | 3 (14.29) | 18 (85.71) | 1(ref) | 1(ref) | - | - |
According to studies which were conducted on nasal colonization of
In this study,
The nasal carriage rate of MRSA among school children was 9.79%. This nasal carriage of MRSA was less than the WHO 2014 estimated range of MRSA for African region (12-80%) [
In this study, among 143 children who had
Regarding the antimicrobial susceptibility pattern result there were more than 99% and 70% resistance strains to penicillin and tetracycline, respectively. In this study antimicrobial susceptibility test showed that penicillin and tetracycline were the least effective agent with more than 70% bacterial resistance. This result of penicillin resistant was in line with various studies which was conducted on healthy children in China (87.5%), Nigeria (100%), Ghana (95%), Jimma (100%), and Bahir Dar (100%) [
Majority of the isolated
The majority of the isolated
Among elementary school children, high rate of isolation of MRSA was reported in urban elementary schools. The high prevalence of MRSA in urban schools than rural might be due to reasons; for example, urban schools were more closer to health care facility; high antibiotic selective pressure in urban settings and overcrowding was more prominent in urban than rural schools.
Several studies showed that sociodemographic characteristics and risk factors contribute a lot to the nasal carriage of
Number of students in classroom was significant risk factors for nasal colonization of
Living in urban of children involved in this study was statistically significant risk factor for nasal colonization of MRSA. This study showed that being urban elementary school children had more likely hood for nasal carriage of MRSA than rural school children. The possible reason might be due to children living in the urban community which makes them contact with health care workers more frequently and more exposed to health care facilities and overcrowding in the urban area which increases nasal carriage of MRSA in urban schools.
We did not perform vancomycin minimum inhibitory concentration due to resource constraints and advanced molecular techniques like PCR which may underestimate the true prevalence in the study population.
The prevalence of
American Type of Culture Collection
Confidence Interval
Clinical and Laboratory Standards Institute
Epidemiological Information
Methicillin Resistance
Methicillin Susceptible
Adjusted odds ratio
Penicillin binding protein
Staphylococcal Cassette Chromosome mec
Standard Deviation
Statistical Package for Social Sciences
Trimethoprim-sulfamethoxazole
Tryptone Soya Broth
World Health Organization.
All data generated or analyzed during this study are included in this article. Data that support the findings of this study are also available from the corresponding author upon reasonable request.
Ethical clearance was obtained from University of Gondar Ethical Review Committee. Written permission was obtained from Gondar Town Administration Health Office.
A written informed consent from parents and assent from children were obtained. Additionally confidentiality of information was assured.
The authors declare that they do not have conflicts of interest.
Abiye Tigabu contributed to conception of research idea, study design, data collection, analysis and interpretation, manuscript writing, and review. Moges Tiruneh contributed to research idea, data collection, analysis, and interpretation. Feleke Mekonnen contributed to supervision, analysis, interpretation, thesis preparation, manuscript writing, and review. All authors read and approved the final manuscript.
We would like to thank all participants of this research, all the study participants, and directors of each elementary school for their active and voluntary participation and cooperation.