{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T08:11:30Z","timestamp":1776759090206,"version":"3.51.2"},"reference-count":60,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T00:00:00Z","timestamp":1764892800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      <jats:italic>Streptococcus pneumoniae<\/jats:italic>\n                      colonization is a growing concern globally, including in Ethiopia. School-aged children are a key reservoir that can lead to endogenous infections and a potential source for the transmission in the community. However, little is known about its nasopharyngeal carriage rates in eastern Ethiopia. This study aimed to determine the nasopharyngeal carriage of\n                      <jats:italic>Streptococcus pneumoniae<\/jats:italic>\n                      , associated factors, and antimicrobial susceptibility patterns among primary school children in Babile District, Eastern Ethiopia.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A cross-sectional study was conducted at primary schools in the Babile district, Eastern Ethiopia, from November 15, 2022, to January 8, 2023. A systematic random sampling technique was used to enroll 337 schoolchildren. Data on sociodemographic and a potenail associated factors was collected using structured questionnaires. Nasopharyngeal swab samples were collected, transported in Amies medium, and cultured on blood and chocolate agar.\n                      <jats:italic>Streptococcus pneumoniae<\/jats:italic>\n                      was identified based on colony morphology, Gram staining, hemolysis, and biochemical tests. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method. Data was entered in EpiData and analyzed in SPSS. Bivariate and multivariable logistic regression was used to identify factors associated with pneumococcal carriage, with statistical significance set at p\u2009&lt;\u20090.05 and 95% CI.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall nasopharyngeal carriage of\n                      <jats:italic>Streptococcus pneumoniae<\/jats:italic>\n                      was 16% (54\/337) (95% CI: 12.0\u201320.0). The ages of the children ranged from 7 to 17 years, with a mean age of 12.75 years (SD\u2009\u00b1\u20092.56). Passive smoking (AOR\u2009=\u20092.86, 95% CI: 1.45\u20135.67), single room house (AOR\u2009=\u20092.69, 95% CI: 1.32\u20135.49), greater than or equal to two siblings under 5 years old in the house(AOR\u2009=\u20094.8, 95% CI: 1.88\u201312.25), and previous respiratory tract infection (AOR\u2009=\u20093.24, 95% CI: 1.66\u20136.32) were significantly associated with nasopharyngeal carriage of\n                      <jats:italic>Streptococcus pneumoniae.<\/jats:italic>\n                      The isolated\n                      <jats:italic>Streptococcus pneumoniae<\/jats:italic>\n                      showed higher drug resistance to Tetracycline 23 (42.6%) and Trimethoprim-sulfamethoxazole (TMP-SMX) 18 (33.3%) and was found to be highly susceptible to oxacillin 32(72.2%), Vancomycin 41(75.9%) and Erythromycin 44 (81.48%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      A considerable proportion of asymptomatic nasopharyngeal carriage of\n                      <jats:italic>Streptococcus pneumoniae<\/jats:italic>\n                      in school children was associated with having a history of respiratory tract infection, being passive smokers, having greater than or equal to two siblings under 5 years old in the house, and living in a single-room house. A higher resistance of isolated\n                      <jats:italic>Streptococcus pneumoniae<\/jats:italic>\n                      was observed to tetracycline and trimethoprim-sulfamethoxazole. Thus, it is necessary to regularly assess the trend of antibiotic resistance andthe prevalence of pneumonia among asymptomatic children, and it is impretive to focus on modifiable associated factors in controlling the diseases.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0337950","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T18:23:38Z","timestamp":1764959018000},"page":"e0337950","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Nasopharyngeal carriage of Streptococcus pneumoniae, its associated factors, and antimicrobial susceptibility patterns among school children in Babile district, eastern Ethiopia"],"prefix":"10.1371","volume":"20","author":[{"given":"Fuad 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Marks","year":"2014","journal-title":"Infect Immun"},{"key":"pone.0337950.ref003","author":"CDC","year":"2022"},{"issue":"3","key":"pone.0337950.ref004","first-page":"217","article-title":"Streptococcus pneumoniae: epidemiology and risk factors, evolution of antimicrobial resistance, and impact of vaccines","volume":"16","author":"JP Lynch","year":"2010","journal-title":"Curr Opin Pulm Med"},{"issue":"1","key":"pone.0337950.ref005","doi-asserted-by":"crossref","first-page":"22","DOI":"10.7883\/yoken.66.22","article-title":"Prevalence and risk factors of nasopharyngeal carriage of Streptococcus pneumoniae in healthy children in Japan","volume":"66","author":"M Ueno","year":"2013","journal-title":"Jpn J Infect Dis"},{"key":"pone.0337950.ref006","article-title":"The respiratory microbiome and respiratory infections","author":"SA Unger","year":"2017","journal-title":"J Infect"},{"key":"pone.0337950.ref007","author":"WHO","year":"2022"},{"issue":"12","key":"pone.0337950.ref008","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1016\/S2213-2600(14)70248-6","article-title":"Universal access to pneumonia prevention and care: a call for action","volume":"2","author":"K K\u00e4llander","year":"2014","journal-title":"Lancet Respir Med"},{"issue":"3","key":"pone.0337950.ref009","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/S1473-3099(04)00938-7","article-title":"Streptococcus pneumoniae colonisation: the key to pneumococcal disease","volume":"4","author":"D Bogaert","year":"2004","journal-title":"Lancet Infect Dis"},{"issue":"1","key":"pone.0337950.ref010","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1186\/s13104-019-4376-z","article-title":"Colonization rate of Streptococcus pneumoniae, its associated factors and antimicrobial susceptibility pattern among children attending kindergarten school in Hawassa, southern Ethiopia","volume":"12","author":"AA Haile","year":"2019","journal-title":"BMC Res Notes"},{"issue":"1","key":"pone.0337950.ref011","doi-asserted-by":"crossref","first-page":"171","DOI":"10.2174\/1874285802014010171","article-title":"Nasopharyngeal sarriage of Streptococcus pneumoniae and associated factors among children in Southwest Ethiopia","volume":"14","author":"DD Abateneh","year":"2020","journal-title":"TOMICROJ"},{"issue":"3","key":"pone.0337950.ref012","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.tim.2012.11.005","article-title":"Influence of bacterial interactions on pneumococcal colonization of the nasopharynx","volume":"21","author":"JR Shak","year":"2013","journal-title":"Trends Microbiol"},{"issue":"1","key":"pone.0337950.ref013","doi-asserted-by":"crossref","first-page":"14","DOI":"10.3390\/vaccines9010014","article-title":"Impact of pneumococcal vaccination in the nasopharyngeal carriage of Streptococcus pneumoniae in healthy children of the Murcia Region in Spain","volume":"9","author":"S Alfayate Migu\u00e9lez","year":"2020","journal-title":"Vaccines (Basel)"},{"key":"pone.0337950.ref014","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12879-019-4754-0","article-title":"Changes in pneumococcal carriage prevalence and factors associated with carriage in Norwegian children, four years after introduction of PCV13","volume":"20","author":"A L\u00f8vlie","year":"2020","journal-title":"BMC Infect Dis"},{"issue":"1","key":"pone.0337950.ref015","doi-asserted-by":"crossref","first-page":"12","DOI":"10.3329\/bjid.v8i1.57950","article-title":"Antimicrobial susceptibility pattern of Streptococcus pneumoniae among healthy carrier children under five years old attended at outpatient department of largest teaching hospital in Bangladesh","volume":"8","author":"M Shormin","year":"2022","journal-title":"Bangladesh J Infect 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Quintero","year":"2011","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"pone.0337950.ref019","doi-asserted-by":"crossref","DOI":"10.12688\/f1000research.27583.1","article-title":"Pneumococcal nasopharyngeal carriage and antimicrobial susceptibility profile in children under five in southern Ethiopia","volume":"9","author":"S Hussen","year":"2020","journal-title":"F1000Research"},{"issue":"05","key":"pone.0337950.ref020","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1055\/s-0041-1731343","article-title":"Factors associated with Streptococcus pneumoniae nasopharyngeal carriage and antimicrobial susceptibility among children under the age of 5 years in the Southwestern Colombia","volume":"16","author":"G G\u00e1mez","year":"2021","journal-title":"J Pediatr Infect Dis"},{"key":"pone.0337950.ref021","unstructured":"Negera A, Abelti G. An analysis of the trends, differentials and key proximate determinants of infant and under-five mortality in Ethiopia: further analysis of the 2000, 2005, and 2011 demographic and health surveys. 2013."},{"key":"pone.0337950.ref022","volume-title":"National essential medicine list","author":"Organization WH, Food Medicine and Healthcare Administration and Control Authority of Ethiopia","year":"2015","edition":"8"},{"issue":"1","key":"pone.0337950.ref023","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1186\/s13104-019-4330-0","article-title":"Nasopharyngeal carriage of Streptococcus pneumoniae and antimicrobial susceptibility pattern among school children in South Ethiopia: post-vaccination era","volume":"12","author":"FW Wada","year":"2019","journal-title":"BMC Res Notes"},{"key":"pone.0337950.ref024","volume-title":"Manual for the laboratory identification and antimicrobial susceptibility testing of bacterial pathogens of public health importance in the developing world: Haemophilus influenzae, Neisseria meningitidis, Streptococcus pneumoniae, Neisseria gonorrhoea, Salmonella serotype Typhi, Shigella, and Vibrio cholerae","author":"World Health Organization","year":"2003"},{"key":"pone.0337950.ref025","author":"T Acharya","year":"2023"},{"key":"pone.0337950.ref026","author":"CLSI","year":"2022"},{"key":"pone.0337950.ref027","author":"TL Lisa Worthy","year":"2020"},{"issue":"3","key":"pone.0337950.ref028","doi-asserted-by":"crossref","DOI":"10.1016\/j.cmi.2022.10.021","article-title":"The time-varying association between previous antibiotic use and antibiotic resistance","volume":"29","author":"A Baraz","year":"2023","journal-title":"Clin Microbiol Infect"},{"issue":"1","key":"pone.0337950.ref029","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s12941-023-00557-3","article-title":"Asymptomatic nasopharyngeal bacterial carriage, multi-drug resistance pattern and associated factors among primary school children at Debre Berhan town, North Shewa, Ethiopia","volume":"22","author":"C Belayhun","year":"2023","journal-title":"Ann Clin Microbiol Antimicrob"},{"issue":"3","key":"pone.0337950.ref030","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1007\/s00431-013-2156-7","article-title":"Nasopharyngeal carriage of Streptococcus pneumoniae in healthy Turkish children after the addition of PCV7 to the national vaccine schedule","volume":"173","author":"H Ozdemir","year":"2014","journal-title":"Eur J Pediatr"},{"key":"pone.0337950.ref031","doi-asserted-by":"crossref","first-page":"3464907","DOI":"10.1155\/2020\/3464907","article-title":"Pneumonia among under-five children in Northwest Ethiopia: prevalence and predictors-a community-based cross-sectional study","volume":"2020","author":"Z Andualem","year":"2020","journal-title":"Int J Pediatr"},{"issue":"1","key":"pone.0337950.ref032","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1186\/s13104-019-4283-3","article-title":"Prevalence and risk factors of 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