Diarrhoea remains a leading cause of illness among children under five globally and in Ghana despite wide adoption of rotavirus vaccination. Transmission is predominantly fecal–oral via contaminated water, food or person‑to‑person spread. In settings with limited water and sanitation infrastructure, interventions focus on improving water, sanitation and hygiene (WASH) and vaccination where available. Ghana introduced the rotavirus A vaccine into routine immunization in 2012 and reported high coverage (94% in 2022), yet diarrhoea prevalence among under‑fives persisted. Emerging studies suggest shifts in diarrhoeal aetiology following rotavirus vaccine rollout, motivating local pathogen surveillance to inform clinical management and public health interventions. The present study assessed diarrhoea severity and the spectrum of enteric pathogens in children under five attending a district health facility in a rotavirus‑vaccinated coastal population.
The investigation was a cross‑sectional, facility‑based study conducted from November 2022 to August 2023 at the district health facility in the Anloga district, Volta region, Ghana. Anloga is a coastal district with a population of about 94,895 and substantial lagoon/river coverage. The district’s health infrastructure includes six health centres, four CHPS compounds and three private facilities. Drinking water sources in the district include pipe‑borne water, wells, boreholes and surface sources; approximately 29.1% of households used public toilets.
Eligible participants were children under five years who met a diarrhoea case definition adapted from the IDSR third edition: passage of three or more loose or watery stools in the past 24 hours, with dehydration classified according to standard clinical signs. Facility clinicians confirmed cases and caregivers provided consent for enrollment and stool sampling. The authors reported a calculated minimum sample of 83 for rotavirus testing based on prior rotavirus prevalence estimates in Ghana; a subset was selected for further molecular analysis, as presented in the paper.
Caregivers provided stool samples in sterile containers; samples were labelled, stored below 2°C and transported to the laboratory. The paper reports ELISA testing for rotavirus antigen using the ProSpecT Rotavirus Microplate Assay on the collection of samples intended for rotavirus detection. Molecular testing for a broader range of enteropathogens was performed using TAQMAN Array Card RT‑PCR technology. The manuscript describes preparing 10% stool suspensions and following manufacturer instructions for ELISA testing. Specific sample counts reported in different sections of the paper include the calculated rotavirus testing cohort and a molecular analysis subset; details on the exact number analysed by each method are provided in the source document.
Reported participant characteristics include a median age of 21.5 months (IQR 12–30) and 55.3% male. Severity assessment using the Vesikari Clinical Severity Scoring System indicated that about half of cases were of moderate severity. The source presents descriptive analyses of clinical features alongside laboratory findings.
Key pathogen prevalence figures reported in the paper include low rotavirus A detection (2.5%) and higher prevalences for several other enteric agents. The leading bacterial and viral pathogens reported were Enteroaggregative Escherichia coli (EAEC) (52.6%), Shigella/Enteroinvasive E. coli (Shigella/EIEC) (76.3%) and Norovirus (26.3%). Giardia was reported as the principal parasite identified. The study found a very high overall rate of co‑infection among tested cases (94.7%).
The authors report that co‑infections involving both bacteria and viruses were associated with higher proportions of moderate to severe diarrhoea; specifically, bacteria–virus co‑infections had 73.3% of cases categorized as moderate to severe. Norovirus was present in most of the severe cases described (reported 75% of severe cases). These observations support the concept that multiple concurrent enteropathogens may influence clinical severity.
In this coastal Ghanaian district with high rotavirus vaccine coverage, rotavirus detection was low while bacterial agents—particularly EAEC and Shigella/EIEC—and Norovirus predominated among children presenting with diarrhoea. The high frequency of co‑infections, and the association of bacteria–virus co‑infections with greater severity, indicate the complexity of diarrhoeal aetiology in this setting and suggest that rotavirus vaccination alone does not eliminate the diarrhoea burden. The authors emphasize the value of periodic, location‑specific pathogen surveillance to guide clinical care and public health priorities. They also highlight continued emphasis on strengthening WASH interventions as primary prevention in the absence of vaccines for other common diarrhoeal pathogens.
The study concludes that EAEC, Shigella/EIEC and Norovirus were the leading enteric pathogens among children under five with diarrhoea in this rotavirus‑vaccinated population, with a very high rate of co‑infection; bacteria–virus co‑infections were linked to increased diarrhoea severity. The authors recommend routine diarrhoea pathogen surveillance by the Ghana Health Service in collaboration with research institutions (for example, NMIMR) and sustained investments in WASH at district, community and household levels to reduce diarrhoea incidence.
Note: the source article presents multiple sample counts across sections (calculated sample size for rotavirus testing, the number of samples processed for ELISA, and the subset used for molecular analysis). The figures and methodological descriptions above are drawn directly from the published paper.