{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T18:16:50Z","timestamp":1787941010158,"version":"build-2784847793"},"reference-count":42,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"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>Despite the introduction and wide coverage of vaccination regimes such as rotavirus vaccination globally, diarrhoea remains as a major public health problem with new studies showing an emerging pattern in its etiology. We assessed the etiology of diarrhoea in a population of children under five years appropriately vaccinated against rotavirus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cross-sectional study of children under five years reporting with diarrhoea at the district health facility in the Anloga district, Ghana. Stool samples of diarrhoea cases were tested for pathogens and co-infections using standard ELISA methods and TAQMAN Array Card RT-PCR Technology. The Vesikari Clinical Severity Scoring System was used to classify diarrhoea severity. Data generated was described descriptively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Median age was 21.5 (IQR:12,30)months, 55.3%(21\/38) with being male. About half of the cases were moderate diarrhoea severity (20\/38). The Rotavirus A prevalence was 2.5%. The pathogen with the highest prevalence was\n                      <jats:italic>Enteroaggregative Escherichia coli (<\/jats:italic>\n                      EAEC) (52.6%, 20\/38),\n                      <jats:italic>Shigella\/ Enteroinvasive Escherichia coli<\/jats:italic>\n                      (Shigella\/EIEC (76.3%, 29\/38), Norovirus (26.3%, 10\/38) and Giardia was the main parasite identified. The rate of co-infection was high (94.7%, 36\/38). Co-infections with bacteria-virus present had more moderate-severe diarrhoea cases (73.3%, 11\/15). Norovirus was present in most of the severe cases (75%, 3\/4).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The leading diarrhoea pathogens found were EAEC, Shigella\/EIEC and Norovirus. The rate of pathogen co-infection was very high with bacteria-virus related co-infections affecting diarrhoea severity. The study recommends periodic diarrhoea pathogen surveillance through Ghana Health Service collaborating with research institutions such as Noguchi Memorial Institute for Medical Research (NMIMR). Also, enhancing water, sanitation and hygiene practices at the district, community and individual levels as a means of diarrhoea prevention in the absence of additional vaccines for other diarrhoea pathogens.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0356904","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T17:23:15Z","timestamp":1787937795000},"page":"e0356904","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Enteric Pathogens in children under five with diarrhoea in a rotavirus vaccinated population in Coastal Ghana, 2023"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0281-5321","authenticated-orcid":true,"given":"Delia Akosua","family":"Bandoh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4709-3182","authenticated-orcid":true,"given":"Mawuli","family":"Dzodzomenyo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernest","family":"Kenu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis Ekow","family":"Dennis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duah","family":"Dwomoh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edwin Andrew","family":"Afari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Armah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"pone.0356904.ref001","unstructured":"WHO. Diarrhoea. Health Topics. https:\/\/www.who.int\/health-topics\/diarrhoea#tab=tab_1 Accessed 2022 May 1."},{"key":"pone.0356904.ref002","unstructured":"World Health Organization. Diarrhoeal disease. Key Facts. 2017."},{"issue":"10238","key":"pone.0356904.ref003","first-page":"1779","article-title":"Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries, 2000\u201317: analysis for the Global Burden of Disease Study 2017","volume":"395","author":"Local Burden of Disease Diarrhoea Collaborators","year":"2020","journal-title":"Lancet"},{"issue":"11","key":"pone.0356904.ref004","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1016\/S1473-3099(18)30362-1","article-title":"Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016","volume":"18","author":"Troeger C, Blacker BF, Khalil IA, Reiner RC","year":"2018","journal-title":"Lancet Infect Dis"},{"key":"pone.0356904.ref005","volume-title":"Rotavirus Vaccine-Preventable Diseases Surveillance Standards","author":"World Health Organization","year":"2018"},{"key":"pone.0356904.ref006","unstructured":"Armah GE. Rotavirus Vaccinating in Africa Ghana Case Study. https:\/\/preventrotavirus.org\/wp-content\/uploads\/2015\/02\/Rotavirus-Vaccination-in-Africa-Ghana.pdf 2015."},{"key":"pone.0356904.ref007","article-title":"Etiology of childhood infectious diarrhea in a developed region of China: Compared to childhood diarrhea in a developing region and adult diarrhea in a developed region","volume":"10","author":"X Wang","year":"2015","journal-title":"PLoS One"},{"issue":"1","key":"pone.0356904.ref008","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1007\/s40475-018-0134-x","article-title":"A Review on Prevention Interventions to Decrease Diarrheal Diseases\u2019 Burden in Children","volume":"5","author":"C Webb","year":"2018","journal-title":"Curr Trop Med Rep"},{"issue":"47","key":"pone.0356904.ref009","doi-asserted-by":"crossref","first-page":"7238","DOI":"10.1016\/j.vaccine.2018.01.010","article-title":"Rotavirus strain distribution in Ghana pre- and post- rotavirus vaccine introduction","volume":"36","author":"BL Lartey","year":"2018","journal-title":"Vaccine"},{"key":"pone.0356904.ref010","doi-asserted-by":"crossref","DOI":"10.1017\/S0950268820000618","article-title":"Enteric pathogens associated with gastroenteritis among children under 5 years in sub-Saharan Africa: a systematic review and meta-analysis","volume":"148","author":"TB Oppong","year":"2020","journal-title":"Epidemiol Infect"},{"issue":"1","key":"pone.0356904.ref011","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1007\/s00431-021-04210-z","article-title":"The evolving epidemiology of acute gastroenteritis in hospitalized children in Italy","volume":"181","author":"B Stanyevic","year":"2022","journal-title":"Eur J Pediatr"},{"issue":"92","key":"pone.0356904.ref012","article-title":"The burden of diarrhea, etiologies, and risk factors in India from 1990 to 2019: evidence from the global burden of disease study","volume":"22","author":"DK Behera","year":"2022","journal-title":"BMC Public Health"},{"key":"pone.0356904.ref013","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1186\/s13099-016-0141-1","article-title":"Case-control study of diarrheal disease etiology in individuals over 5 years in southwest China","volume":"8","author":"SK Zhang","year":"2016","journal-title":"Gut Pathog"},{"issue":"1","key":"pone.0356904.ref014","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2017-1326","article-title":"Astrovirus Infection and Diarrhea in 8 Countries","volume":"141","author":"MP Olortegui","year":"2018","journal-title":"Pediatrics"},{"issue":"9","key":"pone.0356904.ref015","doi-asserted-by":"crossref","DOI":"10.1017\/S1368980019003069","article-title":"Aetiology and outcome of acute diarrhoea in children with severe acute malnutrition: a comparative study","volume":"23","author":"A Jain","year":"2019","journal-title":"Public Health Nutr"},{"key":"pone.0356904.ref016","doi-asserted-by":"crossref","first-page":"1926","DOI":"10.3389\/fmicb.2016.01926","article-title":"The 12 Gastrointestinal Pathogens Spectrum of Acute Infectious Diarrhea in a Sentinel Hospital, Shenzhen, China","volume":"7","author":"H Shen","year":"2016","journal-title":"Front Microbiol"},{"key":"pone.0356904.ref017","volume-title":"2022 Ghana Demographic and Health Survey","author":"Ghana Statistical Service, I C F","year":"2022"},{"key":"pone.0356904.ref018","first-page":"1","article-title":"Prevalence and correlates of diarrhoea among children under five in selected coastal communities in Ghana","author":"DA Bandoh","year":"2024","journal-title":"J Heal Popul Nutr"},{"key":"pone.0356904.ref019","volume-title":"Ghana 2021 Population and Housing Census General Report Volume 3A","author":"Ghana Statistical Service","year":"2021"},{"key":"pone.0356904.ref020","volume-title":"District profile - Anloga.","author":"Anloga District Assembly","year":"2021"},{"key":"pone.0356904.ref021","volume-title":"Technical Guidelines for Integrated Disease Surveillance and Response in the WHO African Region - 3rd Edition","author":"Ghana Health Service","year":"2019"},{"key":"pone.0356904.ref022","volume-title":"Rotavirus Surveillance","author":"WHO Rotavirus Regional Reference Laboratory for West Africa","year":"2022"},{"key":"pone.0356904.ref023","unstructured":"ThermoFisher Scientific. ProSpecT Rotavirus Microplate Assay. 2012."},{"issue":"6","key":"pone.0356904.ref024","article-title":"Optimization of Quantitative PCR Methods for Enteropathogen Detection","volume":"11","author":"J Liu","year":"2016","journal-title":"PLoS One"},{"key":"pone.0356904.ref025","doi-asserted-by":"crossref","first-page":"101707","DOI":"10.1016\/j.mex.2022.101707","article-title":"Simultaneous detection of multiple pathogens with the TaqMan Array Card","volume":"9","author":"R Lappan","year":"2022","journal-title":"MethodsX"},{"issue":"5","key":"pone.0356904.ref026","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0302754","article-title":"A study to evaluate WASH interventions and risk factors of diarrhoea among children under five years, Anloga district, Ghana: A research protocol","volume":"19","author":"DA Bandoh","year":"2024","journal-title":"PLoS One"},{"key":"pone.0356904.ref027","volume-title":"TaqMan TM Gene Expression Assays - TaqManTM Array Cards. 4400263","author":"ThermoFisher Scientific","year":"2021"},{"issue":"5","key":"pone.0356904.ref028","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0302754","article-title":"A study to evaluate WASH interventions and risk factors of diarrhoea among children under five years, Anloga district, Ghana: A research protocol","volume":"19","author":"DA Bandoh","year":"2024","journal-title":"PLoS One"},{"key":"pone.0356904.ref029","unstructured":"Lewis K. Vesikari Clinical Severity Scoring System Manual. May. 2011. https:\/\/www.path.org\/publications\/files\/VAD_vesikari_scoring_manual.pdf"},{"key":"pone.0356904.ref030","volume-title":"Diarrhoeal disease","author":"World Health Organization WHO","year":"2024"},{"key":"pone.0356904.ref031","doi-asserted-by":"crossref","DOI":"10.3389\/fmicb.2022.894319","article-title":"Diarrhea-causing bacteria and their antibiotic resistance patterns among diarrhea patients from Ghana","volume":"13","author":"T Afum","year":"2022","journal-title":"Frontiers in Microbiology"},{"key":"pone.0356904.ref032","unstructured":"World Health Organization WHO. Rotavirus. https:\/\/www.who.int\/teams\/health-product-policy-and-standards\/standards-and-specifications\/vaccines-quality\/rotavirus 2023. Accessed 2023 January 8."},{"key":"pone.0356904.ref033","first-page":"100053","article-title":"The impact of the rotavirus vaccine on diarrhoea, five years following national introduction in Fiji","volume":"6","author":"AWJ Jenney","year":"2020","journal-title":"Lancet Reg Health West Pac"},{"issue":"1","key":"pone.0356904.ref034","first-page":"29","article-title":"The global problem of childhood diarrhoeal diseases: emerging strategies in prevention and management","volume":"5","author":"M Mokomane","year":"2018","journal-title":"Ther Adv Infect Dis"},{"issue":"2","key":"pone.0356904.ref035","doi-asserted-by":"crossref","DOI":"10.3390\/pathogens12020315","article-title":"High burden of co-infection with multiple enteric pathogens in children suffering with diarrhoea from rural and peri-urban communities in South Africa","volume":"12","author":"N Potgieter","year":"2023","journal-title":"Pathogens"},{"issue":"1","key":"pone.0356904.ref036","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1186\/s12879-021-06318-x","article-title":"Detection of diarrhoea associated rotavirus and co-infection with diarrhoeagenic pathogens in the Littoral region of Cameroon using ELISA, RT-PCR and Luminex xTAG GPP assays","volume":"21","author":"RN Ghapoutsa","year":"2021","journal-title":"BMC Infect Dis"},{"issue":"3","key":"pone.0356904.ref037","doi-asserted-by":"crossref","first-page":"563","DOI":"10.4269\/ajtmh.13-0744","article-title":"Identifying Etiological Agents Causing Diarrhea in Low Income Ecuadorian Communities","volume":"91","author":"G Vasco","year":"2014","journal-title":"Am J Trop Med Hyg"},{"issue":"9","key":"pone.0356904.ref038","article-title":"Pathogen-specific burdens of community diarrhoea in developing countries: a multisite birth cohort study (MAL-ED)","volume":"3","author":"JA Platts-Mills","year":"2015","journal-title":"Lancet Glob Health"},{"key":"pone.0356904.ref039","doi-asserted-by":"crossref","first-page":"11786361231196527","DOI":"10.1177\/11786361231196527","article-title":"Occurrence of Diarrheagenic Pathogens and Their Coinfection Profiles in Diarrheic Under Five Children and Tracked Human Contacts in Urban and Rural Settings of Eastern Ethiopia","volume":"16","author":"D Belina","year":"2023","journal-title":"Microbiol Insights"},{"issue":"4","key":"pone.0356904.ref040","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0146280","article-title":"Norovirus Epidemiology in Africa: A Review","volume":"11","author":"J Mans","year":"2016","journal-title":"PLoS One"},{"issue":"9","key":"pone.0356904.ref041","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pntd.0009709","article-title":"Prevalence of diarrhoeal pathogens among children under five years of age with and without diarrhoea in guinea-bissau","volume":"15","author":"S Mero","year":"2021","journal-title":"PLoS Negl Trop Dis"},{"issue":"6","key":"pone.0356904.ref042","doi-asserted-by":"crossref","first-page":"1872","DOI":"10.4269\/ajtmh.17-0282","article-title":"A High Burden of Asymptomatic Gastrointestinal Infections in Traditional Communities in Papua New Guinea","volume":"97","author":"PF Horwood","year":"2017","journal-title":"Am J Trop Med Hyg"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0356904","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T17:23:24Z","timestamp":1787937804000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0356904"}},"subtitle":[],"editor":[{"given":"Flora","family":"De Conto","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,8,28]]},"references-count":42,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,28]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0356904","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,28]]}}}