Prevalence, antimicrobial resistance, and risk factors of pneumococcal disease among preschool children in Bushenyi District, Uganda

BACKGROUND: Pneumococcal disease remains a major cause of morbidity and mortality among children in low-resource settings, with Streptococcus pneumoniae being the leading bacterial pathogen. This study sought to determine the prevalence, antimicrobial resistance (AMR) patterns, and the socio-environmental risk factors associated with S. pneumoniae among hospitalized preschool children. METHODS: A cross-sectional study was conducted among 293 children aged five years and below presenting with symptoms of pneumonia. Nasopharyngeal swabs were collected and cultured to isolate S. pneumoniae and other bacterial pathogens. Antibiotic susceptibility testing was performed using the Kirby-Bauer disk diffusion method to assess resistance patterns. Factors associated with infection were analyzed using Chi-square tests, followed by multivariable logistic regression to identify independent predictors of pneumococcal carriage. RESULTS: The prevalence of S. pneumoniae was 20.14% (n = 59). The isolates showed 100% resistance to ampicillin and cotrimoxazole, 88% to azithromycin, and 76.3% to chloramphenicol. Erythromycin and gentamicin showed the highest susceptibility (61%). In the multivariable analysis, children of mothers aged 30-34 years had significantly lower odds of infection compared to those of mothers aged 25-29 years (aOR 0.258; 95% CI: 0.122-0.546, p < 0.001). Conversely, indoor cooking was a strong independent risk factor, with children from these households being over three times more likely to test positive for S. pneumoniae (aOR 3.294; 95% CI: 1.413-7.679, p = 0.006). Maternal education was associated with infection in bivariate analysis, though small cell sizes limited its precision in the final model. CONCLUSION: Approximately one in five children hospitalized with clinical pneumonia carried Streptococcus pneumoniae in the nasopharynx. Children of younger mothers (25-29 years), mothers with no formal education, and households where cooking was done indoors had higher rates of S. pneumoniae infection. These findings emphasize the need for improved maternal health education, reduction of indoor air pollution, and antimicrobial stewardship programs. These findings are specific to hospitalized children in Bushenyi District.