Burden of Shigella and enterotoxigenic Escherichia coli infections among children under 5 years in Ethiopia, Kenya and Malawi: a systematic review and meta-analysis
Abstract
Diarrhoea remains a major problem among children in low- and middle-income countries, driven by multiple pathogens including rotavirus, Shigella and enterotoxigenic Escherichia coli (ETEC). Rotavirus vaccines have notably reduced diarrhoea deaths. However, the health consequences associated with Shigella and ETEC, along with rising antimicrobial resistance (AMR), have prompted the WHO to prioritise vaccine development against these two pathogens. Understanding their disease burden is crucial for guiding this effort and informing preparedness for vaccine adoption.We conducted a systematic review and meta-analysis of primary peer-reviewed literature to establish the prevalence, subtypes and AMR patterns of Shigella and ETEC-associated diarrhoea in Ethiopia, Kenya and Malawi, where the authors have established a multidisciplinary research programme addressing gastrointestinal infections. We searched in PubMed, among other databases, for English-language publications from 1 January 2000 to 28 July 2023. The meta-analysis used a random effects model to estimate pooled prevalence.43 studies were included. Malawi exhibited a higher estimated prevalence of Shigella (24% (95% CI 10% to 39%)) than Ethiopia and Kenya (both with an estimated prevalence of 6%), most likely explained by the application of sensitive, molecular detection methods in Malawi. The overall pooled prevalence of Shigella was 8% (95% CI 6% to 9%). Malawi again displayed higher ETEC prevalence (24% (95% CI 14% to…
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