Teshale Amete Mihret, Abegaz Woldaregay Erku, Azmeraye Binyam Moges, Degefaw Desalegne, LaPolt Devin, Bonger Zelalem, Kalayu Alem Abrha, Tigabu Eyasu, Gazu Lina, Yimer Getnet, Abate Ebba, Tsige Estifanos, Tasew Geremew, Dessie Yadeta, Biks Gashaw, Barkley James A, Garsow Ariel V, Beckiewicz Aaron, Alonso Silvia, Kowalcyk Barbara
National Clinical Bacteriology and Mycology Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
PLOS Glob Public Health. 2025 Apr 21;5(4):e0004407. doi: 10.1371/journal.pgph.0004407. eCollection 2025.
Diarrheal illness remains a major global health challenge, causing millions of deaths annually. Non-typhoidal Salmonella (NTS), Shiga toxin-producing Escherichia coli (STEC), and Campylobacter species (CAMPY) significantly contribute to this burden. Given the limited information on these pathogens in Ethiopia, this study aimed to estimate their prevalence among diarrhea patients in Ethiopia and identify risk factors for infection. A cross-sectional study was conducted from October 2021 to November 2022 in three hospitals in Ethiopia (Addis Ababa, Gondar, and Harar). Sociodemographic characteristics, clinical signs and symptoms were collected from study participants using a structured questionnaire. Stool samples were tested for NTS, STEC, and CAMPY using standardized methods. The prevalence of targeted pathogens was estimated overall and by study sites. Univariable and multivariable logistic regression were used to identify associated factors. A total of 2,331 patients were enrolled. The overall prevalence of NTS, STEC (stx only), STEC (stx + eae), and CAMPY was 1.29% (95%CI: 0.91, 1.84), 12.56% (95%CI: 11.29, 13.98), 3.43% (95%CI: 2.77, 4.25), and 4.46% (95%CI: 4.61, 8.00), respectively. Harar had the highest prevalence of all the pathogens compared to Addis Ababa and Gondar. Odds of NTS in Harar were over 10 (AOR: 10.43: 95%CI: 2.95, 69.20) and 3.5 times (AOR: 3.57: 95%CI: 1.50, 9.90) higher than that in Addis Ababa and Gondar, respectively. Odds of STEC (stx only) in the dry (AOR: 1.97: 95%CI: 1.37, 2.90) and long rainy (AOR: 1.80: 95%CI: 1.20, 2.69) seasons were nearly twice the odds in the short rainy season. Odds of CAMPY infection decreased by 3.29% (AOR: 0.97: 95%CI: 0.95, 0.98) with every one-year increase in age. Moreover, the odds of CAMPY infection for rural residents (AOR: 1.93, 95%CI: 1.15, 3.19) were nearly twice that of urban residents. This is the first study to estimate the prevalence of NTS, STEC, and CAMPY simultaneously across all age groups and diverse regions in Ethiopia, revealing significant variations. Results can be used to understand the burden of disease, inform clinical management and risk mitigation strategies to reduce illness in Ethiopia.
腹泻病仍然是一项重大的全球卫生挑战，每年导致数百万人死亡。非伤寒沙门氏菌（NTS）、产志贺毒素大肠杆菌（STEC）和弯曲杆菌属（CAMPY）是造成这一负担的重要因素。鉴于埃塞俄比亚关于这些病原体的信息有限，本研究旨在估计它们在埃塞俄比亚腹泻患者中的流行率，并确定感染的风险因素。2021年10月至2022年11月在埃塞俄比亚的三家医院（亚的斯亚贝巴、贡德尔和哈勒尔）开展了一项横断面研究。使用结构化问卷从研究参与者那里收集社会人口学特征、临床体征和症状。采用标准化方法对粪便样本进行NTS、STEC和CAMPY检测。总体及按研究地点估计了目标病原体的流行率。采用单变量和多变量逻辑回归来确定相关因素。共纳入2331名患者。NTS、STEC（仅stx）、STEC（stx + eae）和CAMPY的总体流行率分别为1.29%（95%CI：0.91，1.84）、12.56%（95%CI：11.29，13.98）、3.43%（95%CI：2.77，4.25）和4.46%（95%CI：4.61，8.00）。与亚的斯亚贝巴和贡德尔相比，哈勒尔所有病原体的流行率最高。哈勒尔NTS感染几率比亚的斯亚贝巴和贡德尔分别高出10倍以上（调整后比值比[AOR]：10.43；95%CI：2.95，69.20）和3.5倍（AOR：3.57；95%CI：1.50，9.90）。旱季（AOR：1.97；95%CI：1.37，2.90）和长雨季（AOR：1.80；95%CI：1.20，2.69）STEC（仅stx）感染几率几乎是短雨季的两倍。年龄每增加一岁，CAMPY感染几率降低3.29%（AOR：0.97；95%CI：0.95，0.98）。此外，农村居民CAMPY感染几率（AOR：1.93，95%CI：1.15，3.19）几乎是城市居民的两倍。这是第一项在埃塞俄比亚所有年龄组和不同地区同时估计NTS、STEC和CAMPY流行率的研究，揭示了显著差异。研究结果可用于了解疾病负担，为临床管理和风险缓解策略提供信息，以减少埃塞俄比亚的疾病发生。
