Published in PLOS One on 2026-08-28, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. HealthSignal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Delia Akosua Bandoh, Mawuli Dzodzomenyo, Ernest Kenu, Francis Ekow Dennis, Duah Dwomoh, Edwin Andrew Afari, George Armah, Flora De Conto
Source: PLOS One • DOI 10.1371/journal.pone.0356904
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
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.
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.
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 Enteroaggregative Escherichia coli (EAEC) (52.6%, 20/38), Shigella/ Enteroinvasive Escherichia coli (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).
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.
Introduction
Over the years, diarrhoea has remained a disease of public health importance with vulnerable groups such as children under five years bearing the greatest brunt, recording more than 1.7 billion cases each year [1, 2]. The known transmission pathway of diarrhoea has been pathogens transported to host through contaminated food or water and person to person fecal-oral transmissions. Developing countries like Ghana with water and sanitation problems therefore record the highest number of cases [3,4]. Therefore, the main interventions used in such settings to reduce diarrhoea incidence have been improving water, sanitation and hygiene (WASH) and vaccination against pathogens.
One of the main virulent pathogens, rotavirus has been known to be the major cause of diarrhoea morbidity and mortality among children under five globally [5–8]. Thus, the introduction of the rotavirus vaccine 20 years ago, led to a decline in diarrhoea cases [9]. This has also been confirmed by different studies on aetiology of diarrhoea in under-fives in sub-Saharan Africa which reported a decline in rotavirus cases and attributed it to vaccine effectiveness and changes in the circulating rotavirus strain [10–12]. It is widely known that the presence of multiple enteropathogens can affect the severity of gastrointestinal illnesses [13,14]. However, in recent years, new patterns in the aetiology of diarrhoea are emerging. Some studies on diarrhoea in children under five years in India and China observed changes in diarrhoea pathogens and concluded on that the changing pattern of diarrhoea [15,16]
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider hospital systems desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Delia Akosua Bandoh, Mawuli Dzodzomenyo, Ernest Kenu, Francis Ekow Dennis, Duah Dwomoh, Edwin Andrew Afari, George Armah, Flora De Conto. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by HealthSignal. The researchers are the authors of the source study, not members of HealthSignal’s staff.
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