Shigella Serogroups Distribution, Antimicrobial Susceptibility and Risk Factors of Shigellosis Among Children Presenting with Diarrhoea at Banadir Hospital in Mogadishu, Somalia

Abstract

Bacillary dysentery (shigellosis) is a public health concern globally, ranking second among the top killer diseases in children aged five years and below. The burden of shigellosis is disproportionately higher in middle and low-income countries due to poor sanitation and insufficient clean drinking. With shigellosis treatment facing unprecedented challenges arising from multidrug-resistant (MDR) Shigella strains, understanding the local epidemiology is vital to inform prevention and control interventions. This study determined Shigella serogroups distribution, antimicrobial susceptibility (AS) patterns and shigellosis associated factors among children with diarrhoea at Banadir Hospital, Somalia. The study design was cross-sectional, and participants purposively recruited to include children aged five years and below with diarrhoea, whose parent/guardian gave formal consent. With participants sociodemographic and clinical data sought using a questionnaire, 180 stool and rectal swab samples were collected and processed following the standard microbiological methods. Shigella serogroups AS patterns were elucidate using the Kirby- Bauer method. The data were generated and presented in tables, and the association between the shigellosis, socio-demographic and environmental characteristics of the participants, was computed using the Chi-square (χ 2 ) and Pearson correlation statistics using IBM SPSS version 23 software for Windows. The children majority were females 111/180 (61.7%), while males accounted for 38.35% (69/180) of the total samples collected. The children mean age was 20.1 months with 12.87 months standard deviation (SD). Generally, shigellosis prevalence among children with diarrhoea was 20.6% (37/180). While S. boydii was absent among the bacteriologic cause of bacillary dysentery, the other three (3) Shigella serogroups were isolated; S. flexneri, S. sonnei and S. dysenteriae type 1 (shiga bacillus). Of these, the predominant serogroup was Shigella flexneri (26/37, 70.3%) and the least prevalent was shiga bacillus (5/37, 13.5%) (t = 15.187; p = 0.0001). There was 100% resistance to ampicillin, trimethoprim-sulfamethoxazole, and tetracycline among the Shigella serogroups isolated. Except for S. dysenteriae type 1, which remained susceptible to ciprofloxacin, 19.2% (5/26) of S. flexneri and 50% (3/6) of S. sonnei isolates showed resistance. Forty per cent of the Shiga bacillus were ceftriaxone (CRO) nonsusceptible. Shigella sonnei had the highest CRO resistance (66.7%, 4/6) and the least resistant was S. flexneri (38.5%, 10/26). All the serogroups were susceptible to azithromycin. MDR phenotype AMP/SXT/TE (37/37, 100%) was the most dominant, and the least prevalent was AMP/SXT/TE/CIP/CRO (8.1%, 3/37). There was no significant association of shigellosis among children aged five years and below with the risk factors investigated in Banadir Hospital. This study showed high shigellosis prevalence, and S. flexneri and Shiga bacillus as the most and least prevalent serogroup, respectively, among children (≤ 5 years) in Banadir Hospital. CIP and CRO resistant Shigella, including MDR strains, have emerged among children (≤ 5 years) in Mogadishu, Somalia. Therefore, prevention and control interventions are urgently required to mitigate MDR Shigella associated infections in Banadir Hospital and the surrounding regions.