Enteric Pathogens Associated with Acute Gastroenteritis and Antibiotic Susceptibility Patterns among Children Under-Five Years in Nasarawa West, Nigeria

Abstract

Background: Acute gastroenteritis remains a leading cause of morbidity and mortality among children under five years, particularly in low- and middle-income countries where poor sanitation, unsafe water, and inadequate hygiene promote disease transmission. Objectives: This study investigated the bacterial, viral, fungal, and protozoal pathogens associated with acute gastroenteritis among children under 5 years of age in Nasarawa West, Nigeria, and evaluated their antibiotic susceptibility profile. Methods: A hospital-based cross-sectional study analysed 420 diarrheic stool samples collected from children aged 0–5 years attending five health facilities between July 2024 and August 2025. Demographic and clinical information were obtained using structured questionnaires. Stool samples were analysed using standard microbiological and biochemical methods. Data were analysed using Chi-square, Fisher’s exact, and Cochran–Armitage tests, with statistical significance set at P < 0.05. Results: Of the 420 samples analysed, 355 (84.5%) yielded diarrhoeagenic pathogens. Escherichia coli was the most prevalent bacterial pathogen (27.4%), followed by Salmonella typhi (2.4%) and Shigella species (1.7%). Among protozoa, Entamoeba histolytica (12.9%) predominated, while Candida albicans accounted for 14.3% of isolates. Rotavirus was the most common viral pathogen (15.2%). Coinfections involving E. coli, E. histolytica, and C. albicans occurred in 15.5% of cases (P < 0.05). Infection was significantly associated with age (25–36 months), and male sex (P < 0.05). Rotavirus infection was significantly lower among vaccinated children (3.2%) compared with unvaccinated children (20.4%) (P < 0.05). High resistance rates were observed against amoxicillin (84.3%), ceftriaxone (81.7%), ofloxacin (79.1%), gentamicin (76.5%), and ceftazidime (75.7%). Salmonella typhi and Shigella species showed extensive multidrug resistance, whereas imipenem demonstrated the highest susceptibility across isolates. Conclusion: Enteric pathogens and multidrug-resistant bacteria remain highly prevalent among children under five in Nasarawa West. Strengthening antimicrobial stewardship, improving diagnostic capacity, enhancing vaccination coverage, and implementing community-led sanitation interventions are critical to reducing diarrheal disease burden in the region.