Njuguna Amos, Maingi John M, Mbae Cecilia, Otieno Phelgona, Kering Kelvin, Mbithi Winfred, Kioko Christine, Osman Rahma, Kibet Evans, Kariuki Samuel
Department of Microbiology, Biochemistry and Biotechnology, Kenyatta University, Nairobi, Kenya.
Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
Front Microbiol. 2025 Aug 15;16:1637369. doi: 10.3389/fmicb.2025.1637369. eCollection 2025.
Enterotoxigenic (ETEC) is a significant cause of diarrheal morbidity and mortality among children under 5 years, particularly in low and middle-income countries. This study aimed to determine the prevalence of ETEC and associated risk factors among children under five presenting with diarrhea in health facilities in Mukuru slums of Nairobi, Kenya, where poor sanitation and hygiene practices are prevalent.
Using a cross-sectional design, we recruited 387 children under five years of age with acute diarrhea. Total nucleic acid (TNA) was extracted from stool samples and analyzed using a PCR-based customized TaqMan Array Card (TAC), which included three ETEC toxin genes (LT, STh, and STp) and six ETEC colonization factors (CFs). A structured questionnaire was employed to collect participants information.
ETEC was detected in 148/387 samples, yielding a prevalence of 38.2% (95% CI: 34.2-42.2%). Both heat-labile and heat-stable (LT/ST) enterotoxin genes were the most common (43%) followed by heat-labile (30%), and heat-stable (27%). Colonization factors (CF) were present in 52% (77/148) of ETEC-positive samples with CS6 being the most frequently detected CF at 36.3% (28/77). Children aged 13-24 months had significantly elevated odds of infection (aOR = 2.48; 95% CI: 1.36-4.52, = 0.003), as well as those aged 25-36 month (aOR = 2.12; 95% CI: 1.10-4.10, = 0.025), 37-48 months (aOR = 2.45; 95% CI: 1.21-4.97, = 0.013), and 49-59 months (aOR = 2.59; 95% CI: 1.12-6.01, = 0.027). Households lacking access to private flush toilets exhibited a tripled risk (aOR = 3.04; 95% CI: 1.38-6.71, = 0.006) of ETEC positivity.
These findings highlight the urgent need for targeted public health interventions, including improved sanitation and hygiene practices and vaccine introduction, to mitigate the burden of ETEC-related diarrhea among high-risk populations in disease endemic settings.
产肠毒素大肠杆菌（ETEC）是5岁以下儿童腹泻发病和死亡的重要原因，在低收入和中等收入国家尤为如此。本研究旨在确定肯尼亚内罗毕穆库鲁贫民窟卫生设施中出现腹泻的5岁以下儿童中ETEC的流行率及相关风险因素，该地区卫生条件差和卫生习惯不良的情况普遍存在。
采用横断面设计，我们招募了387名5岁以下患有急性腹泻的儿童。从粪便样本中提取总核酸（TNA），并使用基于PCR的定制TaqMan阵列卡（TAC）进行分析，该阵列卡包括三个ETEC毒素基因（LT、STh和STp）和六个ETEC定植因子（CFs）。采用结构化问卷收集参与者信息。
在148/387份样本中检测到ETEC，流行率为38.2%（95%CI：34.2 - 42.2%）。不耐热和耐热（LT/ST）肠毒素基因最为常见（43%），其次是不耐热（30%）和耐热（27%）。52%（77/148）的ETEC阳性样本中存在定植因子（CF），其中CS6是最常检测到的CF，占36.3%（28/77）。13 - 24个月大的儿童感染几率显著升高（调整后比值比[aOR]=2.48；95%CI：1.36 - 4.52，P = 0.003），25 - 36个月大的儿童也是如此（aOR = 2.12；95%CI：1.10 - 4.10，P = 0.025），37 - 48个月大的儿童（aOR = 2.45；95%CI：1.21 - 4.97，P = 0.013）以及49 - 59个月大的儿童（aOR = 2.59；95%CI：1.12 - 6.01，P = 0.027）。无法使用私人冲水厕所的家庭ETEC阳性风险增加两倍（aOR = 3.04；95%CI：1.38 - 6.71，P = 0.006）。
这些发现凸显了迫切需要采取有针对性的公共卫生干预措施，包括改善卫生条件和卫生习惯以及引入疫苗，以减轻疾病流行地区高危人群中与ETEC相关的腹泻负担。
