Bacterial and Protozoan Etiology of Acute Diarrhea among under-five Children in Nasarawa West, Nigeria

Abstract

Background: Diarrheal diseases continue to constitute challenges to public health globally, with children under five years in underdeveloped and developing countries being the most affected. Aim: The current study aimed to determine the pathogenic bacterial and protozoan agents associated with acute diarrhea among children under five years, alongside possible factors that contribute to the continuous predisposition of diarrheal diseases in the study area. Methodology: The study was a hospital-based cross-sectional study conducted from July 2024 to August 2025, which utilised 420 diarrheic stool samples of children aged 0-5 years. Demographics and clinical information about the children were obtained using a questionnaire. Diarrheic stools were analysed using standard microbiological methods. The Chi-square test, Fisher’s exact test, and Cochran-Armitage test were used to test independence and trends. Statistical significance was defined as P < 0.05, and 95% confidence intervals were reported where applicable. Descriptive statistics, such as percentages, were used to summarise the collected data. Results: Overall, 211(50.2%) of the samples were positive for bacterial and protozoan pathogens, with presumptive diarrheagenic Escherichia coli (DEC) being the predominant enteric bacteria isolated (27.4%). Enteric protozoa were detected in (18.9%) of cases, with Entamoeba histolytica (12.9%) and Giardia lamblia (4.3%) being the most prevalent. Furthermore, 13.6% of the cases were co-infection specifically with presumptive diarrheagenic Escherichia coli (DEC) and Entamoeba histolytica. The highest enteric pathogen infection rates were in the 25-36-month age group (86.1%) (P < 0.05). A greater number of males were infected (60.9%) compared to females (34.1%) (P < 0.05). Furthermore, fever, vomiting, diarrhea episodes, sources of drinking water, and sanitary practices were associated with the rate of infection (P < 0.05). Conclusion: The findings indicate the endemicity of pathogenic enteric bacteria and protozoa in the study area. The cases of co-infection suggest that the children are exposed to multiple sources of contamination. Although this study was a hospital-based design, the high correlation between open defecation and infection (74.6%) suggests that community-led total sanitation (CLTS) programs should be prioritised over general health education in Nasarawa West.