{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T15:59:22Z","timestamp":1785340762098,"version":"3.55.0"},"reference-count":106,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>Viral diarrhea remains a significant public health concern in Ghana, particularly among children under 5 years of age. While rotavirus remains the leading cause, the growing impact of other viral pathogens, such as norovirus, adenovirus, and astrovirus, necessitates expanded research and intervention efforts. The introduction of the rotavirus vaccine has significantly reduced diarrhea prevalence, but persistent disparities in disease burden highlight the need for comprehensive control strategies. This scoping review maps the existing evidence on the burden, evolution, and control measures of viral diarrhea in Ghana. A systematic search of PubMed, ScienceDirect, and Scopus was conducted to identify relevant studies published between 1996 and 2025. Findings from local studies indicate that, despite improvements in sanitation, access to potable water, and vaccination programs, viral diarrhea remains widespread and unevenly distributed across populations. The review underscores the importance of enhanced diagnostic capacity, robust surveillance systems, and targeted prevention strategies to effectively combat this public health challenge. By synthesizing available evidence, this scoping review highlights knowledge gaps and priority areas for future research, policy, and intervention in Ghana's fight against viral diarrhea.<\/jats:p>","DOI":"10.3389\/fpubh.2026.1840821","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T15:13:52Z","timestamp":1785338032000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Viral diarrhea in Ghana: a scoping review of disease burden, epidemiology, and control strategies"],"prefix":"10.3389","volume":"14","author":[{"given":"Alberta Afua Kekeli","family":"Ayebi","sequence":"first","affiliation":[{"name":"Medical and Scientific Research Center, University of Ghana Medical Center","place":["Accra, Ghana"]},{"name":"College of Health Sciences, University of Ghana","place":["Accra, Ghana"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabastine Eugene","family":"Arthur","sequence":"additional","affiliation":[{"name":"Medical and Scientific Research Center, University of Ghana Medical Center","place":["Accra, Ghana"]},{"name":"Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana","place":["Accra, Ghana"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Yeboah-Manu","sequence":"additional","affiliation":[{"name":"Medical and Scientific Research Center, University of Ghana Medical Center","place":["Accra, Ghana"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica Baaba","family":"Jones","sequence":"additional","affiliation":[{"name":"Medical and Scientific Research Center, University of Ghana Medical Center","place":["Accra, Ghana"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George Boateng","family":"Kyei","sequence":"additional","affiliation":[{"name":"Medical and Scientific Research Center, University of Ghana Medical Center","place":["Accra, Ghana"]},{"name":"Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana","place":["Accra, Ghana"]},{"name":"Departments of Medicine and Molecular Microbiology, Washington University School of Medicine","place":["St. Louis, MO, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"B1","unstructured":"World Health Organization\n          \n          2024"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e1309","DOI":"10.1016\/S2214-109X(18)30349-8","article-title":"Use of quantitative molecular diagnostic methods to assess the aetiology, burden, and clinical characteristics of diarrhoea in children in low-resource settings: a reanalysis of the MAL-ED cohort study","volume":"6","author":"Platts-Mills","year":"2018","journal-title":"Lancet Glob Health."},{"key":"B3","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1186\/s13104-017-2621-x","article-title":"Prevalence of enteric infections among hospitalized patients in two referral hospitals in Ghana","volume":"10","author":"Akuffo","year":"2017","journal-title":"BMC Res Notes"},{"key":"B4","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1080\/1364557032000119616","article-title":"Scoping studies: towards a methodological framework","volume":"8","author":"Arksey","year":"2005","journal-title":"Int J Soc Res Methodol."},{"key":"B5","unstructured":"Ghana Demographic and Health Survey.\n          \n          2022"},{"key":"B6","doi-asserted-by":"publisher","first-page":"958","DOI":"10.1001\/jamapediatrics.2018.1960","article-title":"Rotavirus Vaccination and the global burden of rotavirus diarrhea among children younger than 5 years","volume":"172","author":"Troeger","year":"2018","journal-title":"JAMA Pediatr."},{"key":"B7","doi-asserted-by":"publisher","first-page":"65","DOI":"10.4314\/gmj.v49i2.1","article-title":"Surveillance of bacterial pathogens of diarrhoea in two selected sub metros within the accra metropolis","volume":"49","author":"Dzotsi","year":"2015","journal-title":"Ghana Med J."},{"key":"B8","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1186\/s41043-024-00582-8","article-title":"Prevalence and correlates of diarrhoea among children under five in selected coastal communities in Ghana","volume":"43","author":"Bandoh","year":"2024","journal-title":"J Health Popul Nutr"},{"key":"B9","doi-asserted-by":"publisher","first-page":"871232","DOI":"10.3389\/fepid.2022.871232","article-title":"Spatiotemporal patterns of diarrhea incidence in ghana and the impact of meteorological and socio-demographic factors","volume":"2","author":"Asare","year":"2022","journal-title":"Front Epidemiol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"S200","DOI":"10.1093\/cid\/ciw014","article-title":"Impact and effectiveness of monovalent rotavirus vaccine against severe rotavirus diarrhea in Ghana","volume":"62","author":"Armah","year":"2016","journal-title":"Clin Infect Dis."},{"key":"B11","doi-asserted-by":"publisher","first-page":"148","DOI":"10.3855\/jidc.1667","article-title":"Prevalence of severe acute rotavirus gastroenteritis and intussusceptions in Ghanaian children under 5 years of age","volume":"6","author":"Enweronu-Laryea","year":"2011","journal-title":"J Infect Dev Countries."},{"key":"B12","doi-asserted-by":"publisher","first-page":"716","DOI":"10.1097\/INF.0b013e318223bd85","article-title":"Rotavirus diarrhea among children less than 5 years of age in urban Ghana","volume":"30","author":"Binka","year":"2011","journal-title":"Pediatr Infect Dis J."},{"key":"B13","doi-asserted-by":"publisher","first-page":"331","DOI":"10.7883\/yoken.JJID.2014.407","article-title":"Rotavirus infection in children with diarrhea at Korle-Bu teaching hospital, Ghana","volume":"69","author":"Damanka","year":"2016","journal-title":"Jpn J Infect Dis."},{"key":"B14","doi-asserted-by":"publisher","first-page":"e0309202","DOI":"10.1371\/journal.pone.0309202","article-title":"Reduction in diarrhea cases following implementation of COVID-19 hand hygiene interventions in Ghana: a causal impact analysis","volume":"19","author":"Adu","year":"2024","journal-title":"PLoS ONE"},{"key":"B15","unstructured":"Ghana Demographic and Health Survey 2022: Key Indicators Report. Accra, Ghana, and Rockville, Maryland, USA: GSS and ICF. Accra, Ghana, and Rockville, Maryland, USA\n          \n          2023"},{"key":"B16","doi-asserted-by":"crossref","DOI":"10.1016\/S1473-3099(17)30276-1","article-title":"Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases: a systematic analysis for the Global Burden of Disease Study 2015","volume-title":"Lancet Infect Dis.","author":"Troeger","year":""},{"key":"B17","doi-asserted-by":"publisher","first-page":"S96","DOI":"10.1093\/cid\/civ1013","article-title":"Global, regional, and national estimates of rotavirus mortality in children < 5 years of age, 2000\u20132013","volume":"62","author":"Tate","year":"2016","journal-title":"Clin Infect Dis."},{"key":"B18","doi-asserted-by":"crossref","DOI":"10.1016\/S1473-3099(24)00691-1","article-title":"Global, regional, and national age-sex-specific burden of diarrhoeal diseases, their risk factors, and aetiologies, 1990\u20132021, for 204 countries and territories: a systematic analysis for the Global Burden of Disease Study 2021","author":"Kyu","year":"2025","journal-title":"Lancet Infect Dis."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12889-023-17575-7","article-title":"Prevalence and predictors of diarrhea among children under five in Ghana","volume":"24","author":"Kombat","year":"2024","journal-title":"BMC Public Health."},{"key":"B20","unstructured":"Diarrhoea - UNICEF DATA\n          \n          \n          2024"},{"key":"B21","doi-asserted-by":"publisher","first-page":"269","DOI":"10.5897\/AJEST2019.2802","article-title":"Assessment of the health impacts of WASH interventions in disaster-prone communities in three regions of Northern Ghana","volume":"14","author":"Appiah-Effah","year":"2020","journal-title":"Afr J Environ Sci Technol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1186\/1471-2334-7-104","article-title":"Acute childhood diarrhoea in northern Ghana: epidemiological, clinical and microbiological characteristics","volume":"7","author":"Reither","year":"2007","journal-title":"BMC Infect Dis."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1743-422X-10-287","article-title":"Rotavirus genotypes associated with childhood severe acute diarrhoea in southern Ghana: a cross-sectional study","volume":"10","author":"Enweronu-Laryea","year":"2013","journal-title":"Virol J."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1471-2334-14-431","article-title":"Decline in severe diarrhea hospitalizations after the introduction of rotavirus vaccination in Ghana: a prevalence study","volume":"14","author":"Enweronu-Laryea","year":"2014","journal-title":"BMC Infect Dis."},{"key":"B25","doi-asserted-by":"publisher","first-page":"148","DOI":"10.11604\/pamj.2023.44.148.36783","article-title":"Genetic diversity of rotavirus infection among young children with diarrhoea in the Kassena-Nankana Districts of Northern Ghana: a seasonal cross-sectional survey","volume":"44","author":"Bawa","year":"2023","journal-title":"PAMJ."},{"key":"B26","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1080\/02724936.1994.11747721","article-title":"Seasonality of rotavirus infection in Ghana","volume":"14","author":"Armah","year":"1994","journal-title":"Ann Trop Paediatr."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1790","DOI":"10.1002\/jmv.21231","article-title":"Molecular characterization of enteric viral agents from children in northern region of Ghana","volume":"80","author":"Silva","year":"2008","journal-title":"J Med Virol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"S231","DOI":"10.1086\/653572","article-title":"The Global spread of rotavirus G10 strains: detection in Ghanaian children hospitalized with diarrhea","volume":"202","author":"Armah","year":"2010","journal-title":"J Infect Dis."},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000000045","article-title":"Severe acute rotavirus gastroenteritis in children less than 5 years in southern Ghana: 2006-2011","author":"Enweronu-Laryea","year":"2014","journal-title":"Pediatr Infect Dis J"},{"key":"B30","doi-asserted-by":"publisher","first-page":"e03690","DOI":"10.1016\/j.heliyon.2020.e03690","article-title":"Childhood diarrhoeal diseases in developing countries","volume":"6","author":"Ugboko","year":"2020","journal-title":"Heliyon."},{"key":"B31","first-page":"41","article-title":"Diarrhea","author":"Nemeth","year":"2022","journal-title":"Pocket Guide to IBD, 2nd Edition"},{"key":"B32","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1177\/2049936117744429","article-title":"Goldfarb DM. The global problem of childhood diarrhoeal diseases: emerging strategies in prevention and management","volume":"5","author":"Mokomane","year":"2017","journal-title":"Ther Adv Infect Dis."},{"key":"B33","unstructured":"2010"},{"key":"B34","unstructured":"2017"},{"key":"B35","doi-asserted-by":"publisher","first-page":"S331","DOI":"10.1093\/infdis\/jiaa598","article-title":"The rotavirus vaccine story: from discovery to the eventual control of rotavirus disease","volume":"224","author":"Glass","year":"2021","journal-title":"J Infect Dis."},{"key":"B36","doi-asserted-by":"publisher","first-page":"ofae539","DOI":"10.1093\/ofid\/ofae539","article-title":"Has Ghana's rotavirus vaccine switch met programmatic expectations? an analysis of national surveillance data; 2018\u20132022","volume":"11","author":"Adjei","year":"2024","journal-title":"Open Forum Infect Dis"},{"key":"B37","year":"2008","journal-title":"Demographic and Health Survey"},{"key":"B38","unstructured":"Ghana Demographic and Health Survey.\n          \n          2014"},{"key":"B39","doi-asserted-by":"publisher","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":"Lartey","year":"2018","journal-title":"Vaccine"},{"key":"B40","doi-asserted-by":"publisher","first-page":"7131","DOI":"10.1016\/j.vaccine.2018.02.058","article-title":"Sustained impact of rotavirus vaccine introduction on rotavirus gastroenteritis hospitalizations in children < 5 years of age, Ghana, 2009\u20132016","volume":"36","author":"Enweronu-Laryea","year":"2018","journal-title":"Vaccine."},{"key":"B41","doi-asserted-by":"publisher","first-page":"4820","DOI":"10.1016\/j.vaccine.2020.05.057","article-title":"Modeling of rotavirus transmission dynamics and impact of vaccination in Ghana","volume":"38","author":"Asare","year":"2020","journal-title":"Vaccine"},{"key":"B42","doi-asserted-by":"publisher","first-page":"e70216","DOI":"10.1002\/jmv.70216","article-title":"Clinical impact and genetic analysis of enteric viruses associated with acute gastroenteritis in greater Accra, Ghana: a comprehensive study of five viruses","volume":"97","author":"Ofosu-Appiah","year":"2025","journal-title":"J Med Virol"},{"key":"B43","doi-asserted-by":"publisher","first-page":"2025","DOI":"10.1002\/jmv.25542","article-title":"Distribution of rotavirus genotypes in the postvaccine introduction era in Ashaiman, Greater Accra Region, Ghana, 2014-2016","volume":"91","author":"Letsa","year":"2019","journal-title":"J Med Virol"},{"key":"B44","doi-asserted-by":"publisher","first-page":"2453","DOI":"10.3390\/v15122453","article-title":"Emergence of Intergenogroup Reassortant G9P[4] Strains Following Rotavirus Vaccine Introduction in Ghana","volume":"15","author":"Doan","year":"2023","journal-title":"Viruses"},{"key":"B45","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1093\/cid\/ciad017","article-title":"The full impact of rotavirus vaccines in africa has yet to be realized","volume":"76","author":"Steele","year":"2023","journal-title":"Clin Infect Dis"},{"key":"B46","doi-asserted-by":"publisher","first-page":"2306","DOI":"10.1093\/cid\/ciz912","article-title":"Impact of the introduction of rotavirus vaccine on hospital admissions for diarrhea among children in Kenya: a controlled interrupted time-series analysis","volume":"70","author":"Otieno","year":"2019","journal-title":"Clin Infect Dis."},{"key":"B47","doi-asserted-by":"publisher","first-page":"346","DOI":"10.3390\/vaccines10030346","article-title":"Understanding rotavirus vaccine efficacy and effectiveness in countries with high child mortality","volume":"10","author":"Varghese","year":"2022","journal-title":"Vaccines"},{"key":"B48","doi-asserted-by":"publisher","first-page":"995","DOI":"10.1097\/INF.0000000000001648","article-title":"Reduction in diarrhea- and rotavirus-related healthcare visits among children < 5 years of age following national rotavirus vaccine introduction in Zimbabwe","volume":"36","author":"Mujuru","year":"2017","journal-title":"Pediatr Infect Dis J."},{"key":"B49","doi-asserted-by":"publisher","first-page":"7179","DOI":"10.1016\/j.vaccine.2018.02.091","article-title":"Impact of pentavalent rotavirus vaccine against severe rotavirus diarrhoea in The Gambia","volume":"36","author":"Sanneh","year":"2018","journal-title":"Vaccine."},{"key":"B50","doi-asserted-by":"publisher","first-page":"7170","DOI":"10.1016\/j.vaccine.2017.12.056","article-title":"Impact and effectiveness of pentavalent rotavirus vaccine in children < 5 years of age in Burkina Faso","volume":"36","author":"Bonkoungou","year":"2017","journal-title":"Vaccine"},{"key":"B51","doi-asserted-by":"publisher","first-page":"7192","DOI":"10.1016\/j.vaccine.2017.10.061","article-title":"Impact of rotavirus vaccine on acute gastroenteritis in children under 5 years in Senegal: Experience of sentinel site of the Albert Royer Children's Hospital in Dakar","volume":"36","author":"Diop","year":"2018","journal-title":"Vaccine"},{"key":"B52","unstructured":"1\n          48\n          Geneva\n          World Health Organization\n          Preventing diarrhoea through better water, sanitation and hygiene: exposures and impacts in low- and middle-income countries\n          \n          2014"},{"key":"B53","unstructured":"Diarrhoeal disease\n          \n          2024"},{"key":"B54","doi-asserted-by":"publisher","first-page":"CD013328","DOI":"10.1002\/14651858.CD013328.pub2","article-title":"Interventions to improve sanitation for preventing diarrhoea","volume":"2023","author":"Bauza","year":"2023","journal-title":"Cochrane Database Syst Rev"},{"key":"B55","unstructured":"UNICEF\n          \n          \n            \n              Gros\n              C\n            \n          \n          A New Game to Teach Children Essential Hygiene Practices | UNICEF Office of Innovation\n          \n          2016"},{"key":"B56","unstructured":""},{"key":"B57","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1371\/journal.pone.0171792","article-title":"Infant feeding practices and diarrhoea in sub-Saharan African countries with high diarrhoea mortality","author":"Ogbo","year":"2017","journal-title":"PLoS ONE"},{"key":"B58","doi-asserted-by":"publisher","first-page":"1","DOI":"10.7189\/jogh-11-04001","article-title":"The interrelationship between water access, exclusive breastfeeding and diarrhea in children: a cross-sectional assessment across 19 African countries","volume":"11","author":"Apanga","year":"2021","journal-title":"J Glob Health."},{"key":"B59","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1007\/s40475-014-0015-x","article-title":"The role of maternal breast milk in preventing infantile diarrhea in the developing world","volume":"1","author":"Turin","year":"2014","journal-title":"Curr Trop Med Rep"},{"key":"B60","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1007\/s40475-018-0134-x","article-title":"A review on prevention interventions to decrease diarrheal diseases' burden in children","volume":"5","author":"Webb","year":"2018","journal-title":"Curr Trop Med Rep."},{"key":"B61","unstructured":"First Lady of Republic of Ghana launches one-year infant and young child feeding campaign\n          \n          \n            \n              UNICEF-\n              Ghana\n            \n          \n          \n          2020"},{"key":"B62","unstructured":"Ghana Health Service and its Health Partners engage the media during Breastfeeding Week | WHO | Regional Office for Africa\n          \n          2018"},{"key":"B63","doi-asserted-by":"publisher","first-page":"6","DOI":"10.19030\/iber.v6i6.3378","article-title":"Effects of the law on the marketing of infant foods in Ghana","author":"Alabi","year":"2007","journal-title":"Int Bus Econ Res J"},{"key":"B64","unstructured":"Let's support mothers to breastfeed as long as they want- First Lady of Ghana advocates | WHO | Regional Office for Africa\n          \n          2020"},{"key":"B65","unstructured":"Why Exclusive Breastfeeding Matters | UNICEF Ghana\n          \n          2025"},{"key":"B66","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1746-4358-8-15","article-title":"Re-assessment of selected baby-friendly maternity facilities in Accra, Ghana","volume":"8","author":"Nii Okai Aryeetey","year":"2013","journal-title":"Int Breastfeed J."},{"key":"B67","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/0140-6736(93)91879-Q","article-title":"Vitamin A supplementation in northern Ghana: effects on clinic attendances, hospital admissions, and child mortality","volume":"342","author":"Ross","year":"1993","journal-title":"Lancet."},{"key":"B68","article-title":"Evaluating the vitamin A Supplementation programme in northern ghana: has it contributed to improved child survival?","author":"David","year":"2003","journal-title":"Boston."},{"key":"B69","doi-asserted-by":"publisher","first-page":"264","DOI":"10.9745\/GHSP-D-16-00021","article-title":"Improved childhood diarrhea treatment practices in Ghana: A pre-post evaluation of a comprehensive private-sector program","volume":"4","author":"El-Khoury","year":"2016","journal-title":"Glob Health Sci Pract"},{"key":"B70","unstructured":"Diarrheal diseases\n          \n          \n            \n              Dattani\n              S\n            \n            \n              Spooner\n              F\n            \n            \n              Ritchie\n              H\n            \n            \n              Roser\n              M\n            \n          \n          Our World in Data.\n          \n          2023"},{"key":"B71","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/j.jegh.2015.05.001","article-title":"Household wealth, residential status and the incidence of diarrhoea among children under-five years in Ghana","volume":"6","author":"Kumi-Kyereme","year":"2015","journal-title":"J Epidemiol Glob Health."},{"key":"B72","article-title":"Rotavirus","volume-title":"StatPearls","author":"LeClair","year":"2023"},{"key":"B73","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1080\/20477724.2022.2043223","article-title":"Prevalence and relative risk of Rotavirus Gastroenteritis in children under five years in Nigeria: a systematic review and meta-analysis","volume":"117","author":"Digwo","year":"2023","journal-title":"Pathog Glob Health"},{"key":"B74","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1186\/1471-2431-13-36","article-title":"Bacterial and viral etiology of childhood diarrhea in Ouagadougou, Burkina Faso","volume":"13","author":"Bonkoungou","year":"2013","journal-title":"BMC Pediatr"},{"key":"B75","doi-asserted-by":"publisher","first-page":"e64","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":"Oppong","year":"2020","journal-title":"Epidemiol Infect"},{"key":"B76","volume-title":"Norovirus. Encyclopedia of Food Safety, 2nd Edition","author":"Capece","year":"2025"},{"key":"B77","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1056\/NEJMOA052434","article-title":"Safety and Efficacy of an Attenuated Vaccine against Severe Rotavirus Gastroenteritis","volume":"354","author":"Ruiz-Palacios","year":"2006","journal-title":"N Engl J Med"},{"key":"B78","doi-asserted-by":"publisher","first-page":"S72","DOI":"10.1086\/653549","article-title":"Influence of potential protective mechanisms on the development of live rotavirus vaccines","volume":"202","author":"Ward","year":"2010","journal-title":"J Infect Dis"},{"key":"B79","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1093\/infdis\/jit174","article-title":"Efficacy, immunogenicity, and safety of two doses of a tetravalent rotavirus vaccine RRV-TV in Ghana with the first dose administered during the neonatal period","volume":"208","author":"Armah","year":"2013"},{"key":"B80","doi-asserted-by":"publisher","first-page":"e0150100","DOI":"10.1371\/journal.pone.0150100","article-title":"Association of maternal immunity with rotavirus vaccine immunogenicity in zambian infants","volume":"11","author":"Chilengi","year":"2016","journal-title":"PLoS ONE"},{"key":"B81","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1093\/infdis\/jiw518","article-title":"Significant Correlation between the Infant Gut Microbiome and Rotavirus Vaccine Response in Rural Ghana","volume":"215","author":"Harris","year":"2017","journal-title":"J Infect Dis"},{"key":"B82","unstructured":"Akhondi\n              H\n            \n            \n              Goldin\n              J\n            \n            \n              Simonsen\n              KA\n            \n          \n          Bacterial Diarrhea - PubMed\n          \n          2025"},{"key":"B83","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s41182-022-00473-w","article-title":"Strengthening surveillance in Ghana against public health emergencies of international concern","volume":"50","author":"Adachi","year":"2022","journal-title":"Trop Med Health."},{"key":"B84","unstructured":"Sustaining vaccine gains through stronger rotavirus surveillance in Ghana | WHO | Regional Office for Africa\n          \n          2026"},{"key":"B85","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12889-017-4910-7","article-title":"Situational analysis of antibiotic use and resistance in Ghana: Policy and regulation","volume":"17","author":"Yevutsey","year":"2017","journal-title":"BMC Public Health"},{"key":"B86","unstructured":"Seattle, WA\n          IHME\n          The burden of antimicrobial resistance (AMR) in Ghana\n          \n          2024"},{"key":"B87","unstructured":"Ghana Leads Africa in Advancing a People-Centred Approach to Address Antimicrobial Resistance | WHO | Regional Office for Africa\n          \n          2026"},{"key":"B88","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1007\/s41669-022-00385-9","article-title":"Attributable patient cost of antimicrobial resistance: a prospective parallel cohort study in two public teaching hospitals in Ghana","volume":"7","author":"Otieku","year":"2023","journal-title":"Pharmacoecon Open"},{"key":"B89","doi-asserted-by":"publisher","first-page":"e111045","DOI":"10.1136\/bmjopen-2025-111045","article-title":"Attributable societal cost of antimicrobial resistance in Ghana: a microsimulation study focusing on sociodemographic groups","volume":"16","author":"Fenny","year":"2026","journal-title":"BMJ Open"},{"key":"B90","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12913-015-0960-7","article-title":"The integrated disease surveillance and response system in northern Ghana: challenges to the core and support functions","volume":"15","author":"Adokiya","year":"2015","journal-title":"BMC Health Serv Res."},{"key":"B91","doi-asserted-by":"publisher","first-page":"1480","DOI":"10.1002\/jmv.20722","article-title":"Characterisation of norovirus strains in rural Ghanaian children with acute diarrhoea","volume":"78","author":"Armah","year":"2006","journal-title":"J Med Virol."},{"key":"B92","doi-asserted-by":"publisher","first-page":"1321","DOI":"10.3390\/v12111321","article-title":"Understanding pediatric norovirus epidemiology: a decade of study among ghanaian children","volume":"12","author":"Lartey","year":"2020","journal-title":"Viruses."},{"key":"B93","doi-asserted-by":"publisher","first-page":"e0003568","DOI":"10.1371\/journal.pntd.0003568","article-title":"Gastrointestinal infections and diarrheal disease in Ghanaian infants and children: an outpatient case-control study","volume":"9","author":"Krumkamp","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"key":"B94","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13104-017-2578-9","article-title":"Microbial pathogens associated with acute childhood diarrhoea in Kumasi, Ghana","volume":"10","author":"Ashie","year":"2017","journal-title":"BMC Res Notes"},{"key":"B95","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12889-024-19334-8","article-title":"Etiology-specific incidence and mortality of diarrheal diseases in the African region: a systematic review and meta-analysis","volume":"24","author":"Thystrup","year":"","journal-title":"BMC Public Health"},{"key":"B96","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12889-017-4541-z","article-title":"Spatial variation and hot-spots of district level diarrhea incidences in Ghana: 2010-2014","volume":"17","author":"Osei","year":"2017","journal-title":"BMC Public Health"},{"key":"B97","doi-asserted-by":"publisher","first-page":"672","DOI":"10.1111\/j.1442-200X.1996.tb03729.x","article-title":"Enteric pathogens in severe forms of acute gastroenteritis in Ghanaian children","volume":"38","author":"Hori","year":"1996","journal-title":"Pediatrics International."},{"key":"B98","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1093\/INFDIS\/JIX294","article-title":"Etiology of severe acute watery diarrhea in children in the global rotavirus surveillance network using quantitative polymerase chain reaction","volume":"216","author":"Operario","year":"2017","journal-title":"J Infect Dis"},{"key":"B99","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41598-021-93345-y","article-title":"Gut microbiota signature of pathogen-dependent dysbiosis in viral gastroenteritis","volume":"11","author":"Mizutani","year":"2021","journal-title":"Sci Rep."},{"key":"B100","doi-asserted-by":"publisher","first-page":"e009548","DOI":"10.1136\/bmjgh-2022-009548","article-title":"Aetiology and incidence of diarrhoea requiring hospitalisation in children under 5 years of age in 28 low-income and middle-income countries: findings from the Global Pediatric Diarrhea Surveillance network","volume":"7","author":"Cohen","year":"2022","journal-title":"BMJ Glob Health."},{"key":"B101","doi-asserted-by":"publisher","first-page":"1792","DOI":"10.1016\/j.cmi.2021.03.020","article-title":"Polymicrobial enteric infections in African infants with diarrhoea\u2014results from a longitudinal prospective case\u2013control study","volume":"27","author":"Heinemann","year":"","journal-title":"Clinic Microbiol Infect."},{"key":"B102","doi-asserted-by":"publisher","first-page":"2317","DOI":"10.1128\/JCM.41.6.2317-2322.2003","article-title":"Changing patterns of rotavirus genotypes in Ghana: Emergence of human rotavirus G9 as a major cause of diarrhea in children","volume":"41","author":"Armah","year":"2003","journal-title":"J Clin Microbiol"},{"key":"B103","doi-asserted-by":"publisher","first-page":"840","DOI":"10.1046\/j.1365-3156.2003.01097.x","article-title":"Incidence and risk factors of paediatric rotavirus diarrhoea in northern Ghana","volume":"8","author":"Navrongo","year":"2003","journal-title":"Trop Med Int Health"},{"key":"B104","doi-asserted-by":"publisher","DOI":"10.1086\/653571","article-title":"Diversity of rotavirus strains circulating in west Africa from 1996 to 2000","author":"Armah","year":"2010","journal-title":"J Infect Dis"},{"key":"B105","doi-asserted-by":"publisher","first-page":"1981","DOI":"10.1128\/JCM.39.5.1981-1984.2001","article-title":"Rotavirus G and P genotypes in rural Ghana","volume":"39","author":"Asmah","year":"2001","journal-title":"J Clin Microbiol"},{"key":"B106","doi-asserted-by":"crossref","unstructured":"Asmah, Francis R. Anto, Abraham Rexdford Oduro, Fred Binka, et al\n          \n          67\n          71\n          \n            \n              George E\n              Armah\n            \n            \n              Cara T\n              Pager\n            \n            \n              Richard\n              H\n            \n          \n          Prevalence of unusual human rotavirus strains in Ghanaian children.\n          \n          2001","DOI":"10.1002\/1096-9071(200101)63:1<67::AID-JMV1010>3.3.CO;2-K"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1840821\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T15:13:55Z","timestamp":1785338035000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1840821\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,29]]},"references-count":106,"alternative-id":["10.3389\/fpubh.2026.1840821"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1840821","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,29]]},"article-number":"1840821"}}