{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T04:34:24Z","timestamp":1784608464985,"version":"3.55.0"},"update-to":[{"DOI":"10.1371\/journal.pntd.0010283","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2022,4,18]],"date-time":"2022-04-18T00:00:00Z","timestamp":1650240000000}}],"reference-count":48,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2022,3,31]],"date-time":"2022-03-31T00:00:00Z","timestamp":1648684800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009633","name":"eunice kennedy shriver national institute of child health and human development","doi-asserted-by":"publisher","award":["R01 HD079695"],"award-info":[{"award-number":["R01 HD079695"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Children who have been discharged from hospital in sub-Saharan Africa remain at substantial risk of mortality in the post-discharge period. Antimicrobial resistance (<jats:bold>AMR<\/jats:bold>) may be an important factor. We sought to determine the prevalence and risk factors associated with AMR in commensal <jats:italic>Escherichia coli<\/jats:italic> <jats:bold>(<jats:italic>E<\/jats:italic>. <jats:italic>coli<\/jats:italic>)<\/jats:bold> from Kenyan children at the time of discharge.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methodology\/Principle findings<\/jats:title>\n<jats:p>Fecal samples were collected from 406 children aged 1\u201359 months in western Kenya at the time of discharge from hospital and cultured for <jats:italic>E<\/jats:italic>. <jats:italic>coli<\/jats:italic>. Susceptibility to ampicillin, ceftriaxone, cefotaxime, ceftazidime, cefoxitin, imipenem, ciprofloxacin, gentamicin, combined amoxicillin\/clavulanic acid, trimethoprim-sulfamethoxazole, azithromycin, and chloramphenicol was determined by disc diffusion according to guidelines from the Clinical and Laboratory Standards Institute (CLSI). Poisson regression was used to determine associations between participant characteristics and the presence of extended-spectrum beta-lactamases (<jats:bold>ESBL<\/jats:bold>) producing <jats:italic>E<\/jats:italic>. <jats:italic>coli<\/jats:italic>. Non-susceptibility to ampicillin (95%), gentamicin (44%), ceftriaxone (46%), and the presence of ESBL (44%) was high. Receipt of antibiotics during the hospitalization was associated with the presence of ESBL (aPR = 2.23; 95% CI: 1.29\u20133.83) as was being hospitalized within the prior year (aPR = 1.32 [1.07\u20131.69]). Open defecation (aPR = 2.02; 95% CI: 1.39\u20132.94), having a toilet shared with other households (aPR = 1.49; 95% CI: 1.17\u20131.89), and being female (aPR = 1.42; 95% CI: 1.15\u20131.76) were associated with carriage of ESBL <jats:italic>E<\/jats:italic>. <jats:italic>coli<\/jats:italic><\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusions\/Significance<\/jats:title>\n<jats:p>AMR is common among isolates of <jats:italic>E<\/jats:italic>. <jats:italic>coli<\/jats:italic> from children at hospital discharge in Kenya, including nearly half having detectable ESBL.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0010283","type":"journal-article","created":{"date-parts":[[2022,3,31]],"date-time":"2022-03-31T18:10:45Z","timestamp":1648750245000},"page":"e0010283","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":29,"title":["Antimicrobial resistance including Extended Spectrum Beta Lactamases (ESBL) among E. coli isolated from kenyan children at hospital discharge"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1681-1620","authenticated-orcid":true,"given":"Stephanie N.","family":"Tornberg-Belanger","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0215-1887","authenticated-orcid":true,"given":"Doreen","family":"Rwigi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1448-837X","authenticated-orcid":true,"given":"Michael","family":"Mugo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1496-7605","authenticated-orcid":true,"given":"Lynnete","family":"Kitheka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Onamu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derrick","family":"Ounga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mame M.","family":"Diakhate","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1932-2563","authenticated-orcid":true,"given":"Hannah E.","family":"Atlas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Wald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2574-4201","authenticated-orcid":true,"given":"R. Scott","family":"McClelland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8504-2319","authenticated-orcid":true,"given":"Olusegun O.","family":"Soge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirkby D.","family":"Tickell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Kariuki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6605-324X","authenticated-orcid":true,"given":"Benson O.","family":"Singa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judd L.","family":"Walson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0051-9131","authenticated-orcid":true,"given":"Patricia B.","family":"Pavlinac","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,3,31]]},"reference":[{"key":"pntd.0010283.ref001","first-page":"52","volume-title":"Levels and Trends in Child Mortality: Report 2019.","author":"United Nations Children\u2019s Fund S, World Health Organization S, World Bank Group S, United Nations Population Division S"},{"key":"pntd.0010283.ref002","author":"World Health Organization S","year":"2018","journal-title":"Antimicrobial Resistance Fact Sheet"},{"key":"pntd.0010283.ref003","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.ijid.2016.09.026","article-title":"Poverty and prevalence of antimicrobial resistance in invasive isolates","volume":"52","author":"G Alvarez-Uria","year":"2016","journal-title":"International Journal of Infectious Diseases"},{"key":"pntd.0010283.ref004","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1186\/1471-2180-12-155","article-title":"Analysis of \u03b2-lactamase phenotypes and carriage of selected \u03b2-lactamase genes among Escherichia coli strains obtained from Kenyan patients during an 18-year period","volume":"12","author":"J Kiiru","year":"2012","journal-title":"BMC Microbiology"},{"issue":"2","key":"pntd.0010283.ref005","doi-asserted-by":"crossref","first-page":"e33","DOI":"10.1016\/S1473-3099(17)30467-X","article-title":"Antimicrobial resistance among children in sub-Saharan Africa","volume":"18","author":"PCM Williams","year":"2018","journal-title":"Lancet Infect Dis"},{"key":"pntd.0010283.ref006","article-title":"Global Antimicrobial Resistance Surveillance System (GLASS) Report: Early Implementation 2016\u20132017","author":"World Health Organization S","year":"2017"},{"issue":"29","key":"pntd.0010283.ref007","article-title":"Estimating the burden of antimicrobial resistance in Malawi: protocol for a prospective observational study of the morbidity, mortality and economic cost of third-generation cephalosporin resistant bloodstream infection [version 1; peer review: 1 approved with reservations].","volume":"5","author":"R Lester","year":"2020","journal-title":"Wellcome Open Res"},{"issue":"89","key":"pntd.0010283.ref008","doi-asserted-by":"crossref","first-page":"725","DOI":"10.2471\/BLT.11.089235","article-title":"Excess child mortality after discharge from hospital in Kilifi, Kenya: a retrospective cohort analysis","author":"JC Mo\u00efsi","year":"2011","journal-title":"Bull World Health Organ"},{"issue":"12","key":"pntd.0010283.ref009","doi-asserted-by":"crossref","first-page":"1832","DOI":"10.1111\/j.1651-2227.2007.00562.x","article-title":"Increased mortality in the year following discharge from a paediatric ward in Bissau, Guinea-Bissau.","volume":"96","author":"JE Veirum","year":"2007","journal-title":"Acta P\u00e6diatrica"},{"issue":"1","key":"pntd.0010283.ref010","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2018-0606","article-title":"Postdischarge Mortality Prediction in Sub-Saharan Africa","volume":"143","author":"L Madrid","year":"2019","journal-title":"Pediatrics"},{"issue":"4","key":"pntd.0010283.ref011","doi-asserted-by":"crossref","first-page":"883","DOI":"10.4314\/ahs.v16i4.2","article-title":"Pediatric out-of-hospital deaths following hospital discharge: a mixed-methods study","volume":"16","author":"L English","year":"2016","journal-title":"Afr Health Sci"},{"issue":"9888","key":"pntd.0010283.ref012","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/S0140-6736(13)60844-2","article-title":"Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study","volume":"382","author":"KL Kotloff","year":"2013","journal-title":"Lancet"},{"issue":"3","key":"pntd.0010283.ref013","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1111\/ppe.12348","article-title":"Mortality after Inpatient Treatment for Severe Pneumonia in Children: a Cohort Study","volume":"31","author":"MM Ngari","year":"2017","journal-title":"Paediatric and Perinatal Epidemiology"},{"issue":"10","key":"pntd.0010283.ref014","doi-asserted-by":"crossref","first-page":"e1306","DOI":"10.1016\/S2214-109X(19)30373-0","article-title":"Seeking interventions to reduce post-discharge mortality among children in sub-Saharan Africa","volume":"7","author":"AJ Prendergast","year":"2019","journal-title":"Lancet Glob Health"},{"issue":"7","key":"pntd.0010283.ref015","doi-asserted-by":"crossref","first-page":"3997","DOI":"10.1128\/AAC.02558-14","article-title":"Pediatric Infection and Intestinal Carriage Due to Extended-Spectrum-Cephalosporin-Resistant Enterobacteriaceae","volume":"58","author":"D Zerr","year":"2014","journal-title":"Antimicrobial Agents and Chemotherapy"},{"issue":"4","key":"pntd.0010283.ref016","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1073\/pnas.1113246109","article-title":"Gut inflammation can boost horizontal gene transfer between pathogenic and commensal Enterobacteriaceae","volume":"109","author":"B Stecher","year":"2012","journal-title":"Proceedings of the National Academy of Sciences of the United States of America"},{"issue":"11","key":"pntd.0010283.ref017","doi-asserted-by":"crossref","first-page":"e0225464","DOI":"10.1371\/journal.pone.0225464","article-title":"Gut carriage of antimicrobial resistance genes among young children in urban Maputo, Mozambique: Associations with enteric pathogen carriage and environmental risk factors","volume":"14","author":"D Berendes","year":"2019","journal-title":"PLoS One"},{"issue":"5","key":"pntd.0010283.ref018","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1093\/cid\/ciy976","article-title":"Carriage and Acquisition of Extended-spectrum \u03b2-Lactamase-producing Enterobacterales Among Neonates Admitted to Hospital in Kilifi, Kenya","volume":"69","author":"N Kagia","year":"2019","journal-title":"Clin Infect Dis"},{"issue":"12","key":"pntd.0010283.ref019","doi-asserted-by":"crossref","first-page":"e0168024","DOI":"10.1371\/journal.pone.0168024","article-title":"High Prevalence of Faecal Carriage of ESBL-Producing Enterobacteriaceae among Children in Dar es Salaam, Tanzania","volume":"11","author":"MG Tellevik","year":"2016","journal-title":"PLOS ONE."},{"key":"pntd.0010283.ref020","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.3855\/jidc.7616","article-title":"Intestinal carriage of Extended Spectrum Beta-Lactamase producing E. coli in women with urinary tract infections, Cameroon.","volume":"10","author":"I Djuikoue","year":"2016","journal-title":"J Infect Dev Ctries"},{"issue":"3","key":"pntd.0010283.ref021","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1093\/cid\/ciw283","article-title":"Fecal Colonization With Extended-spectrum Beta-lactamase\u2013Producing Enterobacteriaceae and Risk Factors Among Healthy Individuals: A Systematic Review and Metaanalysis","volume":"63","author":"S Karanika","year":"2016","journal-title":"Clinical Infectious Diseases"},{"issue":"10","key":"pntd.0010283.ref022","doi-asserted-by":"crossref","first-page":"891.e1","DOI":"10.1016\/j.cmi.2016.07.001","article-title":"High rate of faecal carriage of extended-spectrum \u03b2-lactamase-producing Enterobacteriaceae in healthy children in Bangui, Central African Republic","volume":"22","author":"A Farra","year":"2016","journal-title":"Clinical Microbiology and Infection"},{"key":"pntd.0010283.ref023","doi-asserted-by":"crossref","first-page":"160","DOI":"10.12688\/wellcomeopenres.15514.1","article-title":"Gut mucosal colonisation with extended-spectrum beta-lactamase producing Enterobacteriaceae in sub-Saharan Africa: a systematic review and meta-analysis","volume":"4","author":"JM Lewis","year":"2019","journal-title":"Wellcome Open Res"},{"issue":"4","key":"pntd.0010283.ref024","doi-asserted-by":"crossref","first-page":"e0215177","DOI":"10.1371\/journal.pone.0215177","article-title":"High prevalence of extended-spectrum beta-lactamase-producing Gram-negative pathogens from patients attending Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Amhara region","volume":"14","author":"F Moges","year":"2019","journal-title":"PLoS One"},{"issue":"12","key":"pntd.0010283.ref025","doi-asserted-by":"crossref","first-page":"e019170","DOI":"10.1136\/bmjopen-2017-019170","article-title":"Azithromycin to prevent post-discharge morbidity and mortality in Kenyan children: a protocol for a randomised, double-blind, placebo-controlled trial (the Toto Bora trial).","volume":"7","author":"PB Pavlinac","year":"2017","journal-title":"BMJ Open"},{"key":"pntd.0010283.ref026","author":"World Health Organization S","year":"2011"},{"key":"pntd.0010283.ref027","first-page":"5","volume-title":"Identification system for Enterobacteriaceae and other non-fastidious Gram-negative rods.","author":"sa b. api\u00ae 20 E.","year":"2002"},{"key":"pntd.0010283.ref028","volume-title":"CLSI supplement M100","author":"Clinical and Laboratory Standards Institute (CLSI) S","year":"2020","edition":"3"},{"key":"pntd.0010283.ref029","volume-title":"M100 Cs","author":"CLSI","year":"2017","edition":"28"},{"issue":"3","key":"pntd.0010283.ref030","doi-asserted-by":"crossref","first-page":"263","DOI":"10.4103\/0974-777X.68531","article-title":"Extended-spectrum \u03b2-lactamases in Gram Negative Bacteria.","volume":"2","author":"D Rawat","year":"2010","journal-title":"Journal of Global Infectious Diseases"},{"key":"pntd.0010283.ref031","author":"World Health Organization S, UNICEF S","year":"2012"},{"issue":"20","key":"pntd.0010283.ref032","doi-asserted-by":"crossref","first-page":"1941","DOI":"10.1056\/NEJMoa2002606","article-title":"Macrolide and Nonmacrolide Resistance with Mass Azithromycin Distribution","volume":"383","author":"T Doan","year":"2020","journal-title":"N Engl J Med"},{"issue":"3","key":"pntd.0010283.ref033","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1080\/21548331.2018.1464872","article-title":"Point prevalence survey of antibiotic use and resistance at a referral hospital in Kenya: findings and implications","volume":"46","author":"C Okoth","year":"2018","journal-title":"Hosp Pract (1995)."},{"key":"pntd.0010283.ref034","article-title":"Technical Updates of the Guidelines on the Integrated Management of Childhood Illness (IMCI)","author":"S. World Health Organization","year":"2005"},{"issue":"20","key":"pntd.0010283.ref035","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.clinmicnews.2018.10.001","article-title":"What\u2019s That Resistance Mechanism? Understanding Genetic Determinants of Gram-Negative Bacterial Resistance.","volume":"40","author":"A Bello","year":"2018","journal-title":"Clinical Microbiology Newsletter"},{"issue":"10","key":"pntd.0010283.ref036","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1097\/01.aids.0000174449.32756.c7","article-title":"Cotrimoxazole prophylaxis by HIV-infected persons in Uganda reduces morbidity and mortality among HIV-uninfected family members","volume":"19","author":"J Mermin","year":"2005","journal-title":"Aids"},{"issue":"9","key":"pntd.0010283.ref037","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1086\/323647","article-title":"Carriage of Antibiotic-Resistant Fecal Bacteria in Nepal Reflects Proximity to Kathmandu","volume":"184","author":"JL Walson","year":"2001","journal-title":"The Journal of Infectious Diseases"},{"issue":"12","key":"pntd.0010283.ref038","doi-asserted-by":"crossref","first-page":"1736","DOI":"10.1086\/421094","article-title":"Population-based laboratory surveillance for Escherichia coli-producing extended-spectrum beta-lactamases: importance of community isolates with blaCTX-M genes","volume":"38","author":"JD Pitout","year":"2004","journal-title":"Clin Infect Dis"},{"issue":"4","key":"pntd.0010283.ref039","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1136\/archdischild-2013-303889","article-title":"Gender bias in child care and child health: global patterns","volume":"99","author":"R Khera","year":"2014","journal-title":"Arch Dis Child"},{"issue":"10","key":"pntd.0010283.ref040","doi-asserted-by":"crossref","first-page":"e0005974","DOI":"10.1371\/journal.pntd.0005974","article-title":"Correlates of multi-drug non-susceptibility in enteric bacteria isolated from Kenyan children with acute diarrhea","volume":"11","author":"RL Brander","year":"2017","journal-title":"PLoS Negl Trop Dis"},{"issue":"3","key":"pntd.0010283.ref041","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1017\/ice.2019.336","article-title":"Household carriage and acquisition of extended-spectrum \u03b2-lactamase-producing Enterobacteriaceae: A systematic review.","volume":"41","author":"R Martischang","year":"2020","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"3","key":"pntd.0010283.ref042","doi-asserted-by":"crossref","first-page":"149","DOI":"10.4103\/jrpp.JRPP_18_68","article-title":"Antibiotic Prescribing Patterns at a Leading Referral Hospital in Kenya: A Point Prevalence Survey","volume":"8","author":"L Momanyi","year":"2019","journal-title":"J Res Pharm Pract"},{"key":"pntd.0010283.ref043","first-page":"106189","article-title":"A pharmacist-led prospective antibiotic stewardship intervention improves compliance to community-acquired pneumonia guidelines in 39 public and private hospitals across South Africa","volume":"2020","author":"D van den Bergh","journal-title":"Int J Antimicrob Agents"},{"issue":"9","key":"pntd.0010283.ref044","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1016\/S1473-3099(16)30012-3","article-title":"Antimicrobial stewardship across 47 South African hospitals: an implementation study","volume":"16","author":"AJ Brink","year":"2016","journal-title":"Lancet Infect Dis"},{"issue":"1","key":"pntd.0010283.ref045","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/s12879-018-3615-6","article-title":"Rates of hospitalization and death for all-cause and rotavirus acute gastroenteritis before rotavirus vaccine introduction in Kenya, 2010\u20132013","volume":"19","author":"R Omore","year":"2019","journal-title":"BMC Infect Dis"},{"issue":"Suppl 1","key":"pntd.0010283.ref046","doi-asserted-by":"crossref","first-page":"S34","DOI":"10.1097\/INF.0000000000000049","article-title":"High burden of rotavirus gastroenteritis in young children in rural western Kenya, 2010\u20132011","volume":"33","author":"S Khagayi","year":"2014","journal-title":"Pediatr Infect Dis J"},{"issue":"6","key":"pntd.0010283.ref047","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1016\/j.ijid.2007.03.006","article-title":"The epidemiology of hospitalized pneumonia in rural Kenya: the potential of surveillance data in setting public health priorities","volume":"11","author":"JA Tornheim","year":"2007","journal-title":"Int J Infect Dis"},{"issue":"2","key":"pntd.0010283.ref048","doi-asserted-by":"crossref","first-page":"102","DOI":"10.2471\/BLT.10.080796","article-title":"Sensitivity of hospital-based surveillance for severe disease: a geographic information system analysis of access to care in Kilifi district, Kenya","volume":"89","author":"JC Mo\u00efsi","year":"2011","journal-title":"Bull World Health Organ"}],"updated-by":[{"DOI":"10.1371\/journal.pntd.0010283","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2022,4,18]],"date-time":"2022-04-18T00:00:00Z","timestamp":1650240000000}}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0010283","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,18]],"date-time":"2022-04-18T17:37:27Z","timestamp":1650303447000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0010283"}},"subtitle":[],"editor":[{"given":"Husain","family":"Poonawala","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,3,31]]},"references-count":48,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,3,31]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0010283","relation":{"new_version":[{"id-type":"doi","id":"10.1371\/journal.pntd.0010283","asserted-by":"object"}]},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,31]]}}}