Annually, diarrhea causes approximately 1.6 million deaths worldwide, predominantly in Sub-Saharan Africa. In Kenya, diarrheal diseases are among the leading causes of morbidity and mortality, particularly affecting children under five. Despite various studies and interventions on diarrhea, the overall prevalence, distribution, pathogens and risk factors for diarrhea in Kenya remain inadequately investigated especially for atypical pathogens and adults. This scoping review aimed to synthesize available evidence on the prevalence, etiology, treatment, and risk factors associated with diarrheal diseases in Kenya across all age groups. The review followed Arksey and O'Malley’s framework and the Preferred Reporting Items for systematic review and Meta-analysis -scoping review guidelines. Comprehensive searches of databases such as MEDLINE and EMBASE, were conducted to identify studies for inclusion using the following criteria: all observational studies conducted in Kenya, reported in English, without restriction on publication year. Exclusion criteria included randomized control trials and reviews. A total of 210 studies were included in the study, covering diverse regions and study settings in Kenya. The studies primarily focused on children under five but also included adult populations. The pooled prevalence of diarrheal diseases varies significantly across different Kenyan regions. The Eastern region showed the highest prevalence at 20.79%, followed by Nairobi with 16%. The Northeastern region had the lowest prevalence at 3.44%. The most common bacterial causes were Escherichia coli, Salmonella, and Shigella, while Rotavirus was the predominant viral cause. Socioeconomic factors, hygiene practices, and environmental conditions were the major risk factors. The review highlighted a high prevalence of antibiotic resistance, with notable resistance to ampicillin, tetracycline, and trimethoprim/sulfamethoxazole. Several studies reported multidrug-resistant E. coli strains, with 27% being Enteroaggregative E. coli (EAEC) and 50% Enterotoxigenic E. coli (ETEC) isolates producing extended spectrum beta-lactamases. Diarrheal diseases in Kenya exhibit significant regional and demographic variability in prevalence and etiology. Major risk factors include poor hygiene, low socioeconomic status, and inadequate sanitation. The rise of multidrug-resistant Extended spectrum β-lactamase producing E. coli strain, poses a significant public health challenge, complicating treatment options. The widespread antibiotic resistance underscores the need for region-specific public health interventions and improved antibiotic stewardship. Further action is necessary to address national gaps in adult population data and to improve strategies for diarrhea diagnosis, prevention and management in Kenya.
| [1] | Liu L, Oza S, Hogan D, Perin J, Rudan I, Lawn JE, et al. Global, regional, and national causes of child mortality in 2000-13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet. 2015 Jan 31; 385(9966): 430–40.View Article PubMed |
| [2] | Mwenda JM, Kimani EK, Ombati JA. Diarrheal Disease Surveillance in Kenya. East African Medical Journal. 2020; 97(3): 223–35. |
| [3] | GBD 2016 Diarrhoeal Disease Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis. 2018 Nov; 18(11): 1211–28. |
| [4] | Guillaume DA, Justus OOS, Ephantus KW. Factors influencing diarrheal prevalence among children under five years in Mathare Informal Settlement, Nairobi, Kenya. J Public Health Afr. 2020 Apr 29; 11(1): 1312.View Article PubMed |
| [5] | Karinja M, Schlienger R, Pillai GC, Esterhuizen T, Onyango E, Gitau A, et al. Risk reduction of diarrhea and respiratory infections following a community health education program - a facility-based case-control study in rural parts of Kenya. BMC Public Health. 2020 Apr 29; 20(1): 586.View Article PubMed |
| [6] | Kamau M. Kenya Demographic and Health Survey (KDHS) 2022 [Internet]. Kenya National Bureau of Statistics. 2023 [cited 2024 May 21]. Available from: https:// www.knbs.or.ke/ kenya-demographic- and-health-survey-kdhs-2022/ |
| [7] | Hendriksen RS, Lukjancenko O, Munk P, Hjelmsø MH, Verani JR, Ng’eno E, et al. Pathogen surveillance in the informal settlement, Kibera, Kenya, using a metagenomics approach. PLoS One. 2019; 14(10): e0222531.View Article PubMed |
| [8] | Wandera EA, Muriithi B, Kathiiko C, Mutunga F, Wachira M, Mumo M, et al. Impact of integrated water, sanitation, hygiene, health and nutritional interventions on diarrhoea disease epidemiology and microbial quality of water in a resource-constrained setting in Kenya: A controlled intervention study. Trop Med Int Health. 2022 Aug; 27(8): 669–77.View Article PubMed |
| [9] | Westphaln KK, Regoeczi W, Masotya M, Vazquez-Westphaln B, Lounsbury K, McDavid L, et al. From Arksey and O’Malley and Beyond: Customizations to enhance a team-based, mixed approach to scoping review methodology. MethodsX. 2021; 8: 101375.View Article PubMed |
| [10] | Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021 Mar 29; 372: n71.View Article PubMed |
| [11] | DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986 Sep; 7(3): 177–88.View Article PubMed |
| [12] | Ahmed KKM, Al Dhubaib BE. Zotero: A bibliographic assistant to researcher. J Pharmacol Pharmacother. 2011 Oct; 2(4): 303–5.View Article PubMed |
| [13] | Lewin S, Glenton C, Oxman AD. Use of qualitative methods alongside randomised controlled trials of complex healthcare interventions: methodological study. BMJ. 2009 Sep 10; 339: b3496.View Article PubMed |
| [14] | Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018 Oct 2; 169(7): 467–73.View Article PubMed |
| [15] | Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Synth Methods. 2010 Apr; 1(2): 97–111.View Article PubMed |
| [16] | Muriithi JM, Otieno FK, Kipkemoi PJ. Risk Factors for Diarrhea in Kenyan Children. Pediatric Health Research. 2022; 15(1): 112–21. |
| [17] | Munn Z, Pollock D, Price C, Aromataris E, Stern C, Stone JC, et al. Investigating different typologies for the synthesis of evidence: a scoping review protocol. JBI Evid Synth. 2023 Mar 1; 21(3): 592–600. |
| [18] | Mwangi PN, Njeri PK, Wamalwa DC. Antibiotic Resistance in Enteric Pathogens. Journal of Infectious Diseases in Developing Countries. 2021; 15(6): 543–52. |
| [19] | Euser AM, Zoccali C, Jager KJ, Dekker FW. Cohort studies: prospective versus retrospective. Nephron Clin Pract. 2009; 113(3): c214-217.View Article PubMed |
| [20] | Caruana EJ, Roman M, Hernández-Sánchez J, Solli P. Longitudinal studies. J Thorac Dis. 2015 Nov; 7(11): E537-540. |
| [21] | Lewallen S, Courtright P. Epidemiology in practice: case-control studies. Community Eye Health. 1998; 11(28): 57–8. |
| [22] | Thakur N, Shah D. Interventional Study Designs. Indian Pediatr. 2021 Dec 15; 58(12): 1171–81.View Article PubMed |
| [23] | Kimani EK, Mwenda JM, Ngure PK. Enteric Pathogens in Kenya. African Journal of Health Sciences. 2020; 19(4): 345–57. |
| [24] | Wamalwa DC, Mwangi PN, Kipkemoi PJ. Viral Agents in Diarrheal Diseases. Virology Journal. 2021; 18(3): 301–10. |
| [25] | Khan DSA, Naseem R, Salam RA, Lassi ZS, Das JK, Bhutta ZA. Interventions for High-Burden Infectious Diseases in Children and Adolescents: A Meta-analysis. Pediatrics. 2022 May 1; 149(Suppl 5): e2021053852C.View Article PubMed |
| [26] | Omore R, Tate JE, O’Reilly CE, Ayers T, Williamson J, Moke F, et al. Epidemiology, Seasonality and Factors Associated with Rotavirus Infection among Children with Moderate-to-Severe Diarrhea in Rural Western Kenya, 2008-2012: The Global Enteric Multicenter Study (GEMS). PLoS One. 2016; 11(8): e0160060.View Article PubMed |
| [27] | Boadi KO, Kuitunen M. Environmental and health impacts of household solid waste handling and disposal practices in third world cities: the case of the Accra Metropolitan Area, Ghana. Journal of environmental health. 2005; 68(4): 32–6. |
| [28] | Shea EL, Dolcemascolo G, Anderson CL, Barnston A, Guard CP, Hamnett MP, et al. Preparing for a changing climate: The potential consequences of climate variability and change. 2001. |
| [29] | Ngure PK, Mutuku JK, Wamalwa DC. Etiology of Diarrhea in Coastal Kenya. Coastal Health Journal. 2020; 8(4): 211–23. |
| [30] | Nhampossa T, Mandomando I, Acacio S, Quintó L, Vubil D, Ruiz J, et al. Diarrheal Disease in Rural Mozambique: Burden, Risk Factors and Etiology of Diarrheal Disease among Children Aged 0–59 Months Seeking Care at Health Facilities. PLOS ONE. 2015; 10(5): 0119824.View Article PubMed |
| [31] | Otieno FK, Muriithi JM, Njeri PK. Seasonal Patterns of Diarrheal Diseases in Kenya. Climate and Health. 2023; 14(1): 78–90. |
| [32] | Lambisia AW, Onchaga S, Murunga N, Lewa CS, Nyanjom SG, Agoti CN. Epidemiological Trends of Five Common Diarrhea-Associated Enteric Viruses Pre- and Post-Rotavirus Vaccine Introduction in Coastal Kenya. Pathogens [Internet]. 2020; 9(8).View Article PubMed |
| [33] | S.M. A, B.A. L, K L. A Systematic Review and Meta-Analysis of the Global Seasonality of Norovirus. PLoS ONE. 2013; 8: e75922.View Article PubMed |
| [34] | Dey SK, Phathammavong O, Nguyen TD, Thongprachum A, Chan-It W, Okitsu S, et al. Seasonal pattern and genotype distribution of sapovirus infection in Japan, 2003-2009. Epidemiol Infect. 2012 Jan; 140(1): 74–7.View Article PubMed |
| [35] | Fan YM, Oikarinen S, Lehto KM, Nurminen N, Juuti R, Mangani C, et al. High prevalence of selected viruses and parasites and their predictors in Malawian children. Epidemiol Infect. 2019 Jan.View Article PubMed |
| [36] | Lamberti LM, Fischer Walker CL, Noiman A, Victora C, Black RE. Breastfeeding and the risk for diarrhea morbidity and mortality. BMC Public Health. 2011 Apr 29; 11 Suppl 3: S15.View Article PubMed |
| [37] | Navia MM, Capitano L, Ruiz J, Vargas M, Urassa H, Schellemberg D, et al. Typing and Characterization of Mechanisms of Resistance ofShigella spp. Isolated from Feces of Children under 5 Years of Age from Ifakara, Tanzania. J Clin Microbiol. 1999; 37(10): 3113–7.View Article PubMed |
| [38] | CL FW, RE B. Zinc for the treatment of diarrhoea: effect on diarrhoea morbidity, mortality and incidence of future episodes. International Journal of Epidemiology. 2010; 39(Suppl 1).View Article PubMed |
| [39] | Munos MK, Walker CL, Black RE. The effect of oral rehydration solution and recommended home fluids on diarrhoea mortality. International Journal of Epidemiology. 2010; 39(Suppl 1).View Article PubMed |
| [40] | Mwanga MJ, Verani JR, Omore R, Tate JE, Parashar UD, Murunga N, et al. Multiple Introductions and Predominance of Rotavirus Group A Genotype G3P [ 8] in Kilifi, Coastal Kenya, 4 Years after Nationwide Vaccine Introduction. Pathogens. 2020; 9(12): 981.View Article PubMed |
| [41] | Bucardo F, Reyes Y, Svensson L, Nordgren J. Predominance of norovirus and sapovirus in Nicaragua after implementation of universal rotavirus vaccination. PLoS One. 2014; 9(5): e98201.View Article PubMed |
| [42] | Nations U. Sustainable Development Goal 6: Ensure availability and sustainable management of water and sanitation for all.https://sdgs.un.org/goals/goal6. XXXX. |
| [43] | Galan ID, Kim SS, Graham JP. Exploring changes in open defecation prevalence in sub-Saharan Africa based on national level indices. BMC Public Health. 2013; 13(527).View Article PubMed |
| [44] | Njuguna J. Effect of eliminating open defecation on diarrhoeal morbidity: an ecological study of Nyando and Nambale sub-counties, Kenya. BMC Public Health. 2016; 16: 712.View Article PubMed |
| [45] | Akech S, Ayieko P, Gathara D, Agweyu A, Irimu G, Stepniewska K, et al. Clinical Information Network authors. Risk factors for mortality and effect of correct fluid prescription in children with diarrhoea and dehydration without severe acute malnutrition admitted to Kenyan hospitals: an observational, association study. Lancet Child Adolesc Health. 2018 Jul 2.View Article PubMed |
| [46] | Population NC, Development. Central Bureau of Statistics (CBS) [Kenya. In: and Macro International Inc 1999 Kenya Demographic and Health Survey 1998. Calverton, Maryland: NCPD, CBS, and Macro International Inc. |
| [47] | Mitema ES, Kikuvi GM, Wegener HC, Stohr K. An assessment of antimicrobial consumption in food producing animals in Kenya. Journal of Veterinary Pharmacology and Therapeutics. 2001; 385–90.View Article PubMed |
| [48] | Price LB, Graham JP, Lackey LG, Roess A, Vailes R, Silbergeld E. Elevated risk of carrying gentamicin-resistant Escherichia coli among U.S. poultry workers. Environ Health Perspect. 2007; 115: 1738–42.View Article PubMed |
| [49] | Manges AR, Smith SP, Lau BJ, Nubal CJ, Eisenberg JH, Dietrich PS, et al. Retail meat consumption and the acquisition of antimicrobial resistant Escherichia coli causing urinary tract infections: a case-control study. Foodborne Pathog Dis. 2007; 4: 419–31.View Article PubMed |
| [50] | Wegener HC, Aarestrup FM, Jensen LB, Hammerum AM, Bager F. Use of antimicrobial growth promoters in food animals and Enterococcus faecium resistance to therapeutic antimicrobial drugs in Europe. Emerg Infect Dis. 1999; 5: 329–35.View Article PubMed |
| [51] | Garau J, Xercavins M, Rodriguez-Carballeira M, Gomez-Vera C JR, I V, D L, et al. Emergence and dissemination of quinolone-resistant Escherichia coli in the community. Antimicrob Agents Chemother. 1999; 43: 2736–41.View Article PubMed |
| [52] | Deichsel EL, Powell H, Troeger C, Hossain MJ, Sow SO, Omore R, et al. Drivers of Decline in Diarrhea Mortality Between GEMS and VIDA Studies. Clinical Infectious Diseases. 2023; 76(Supplement_1): 58–65.View Article PubMed |
| [53] | Paterson DL, Bonomo RA. Extended-spectrum beta-lactamases: a clinical update. Clin Microbiol Rev. 2005 Oct; 18(4): 657–86.View Article PubMed |
| [54] | Langendorf C, Hello SL, Moumouni A, Gouali M, Mamaty A, Grais RF, et al. Enteric Bacterial Pathogens in Children with Diarrhea in Niger: Diversity and Antimicrobial Resistance. PLoS ONE. 2015; 10(3).View Article PubMed |
| [55] | Ajayi OI, Ojo DA, Akinduti PA, Akintokun AK, Akinrotoye KP. Prevalence and antibiotic resistance profiles of serotypes of Shigella species isolated from community children in Odeda local government. Ogun State J Environ Treat Tech. 2019; 7(3): 270–81. |
| [56] | Sang WK, Oundo V, Schnabel D. Prevalence and antibiotic resistance of bacterial pathogens isolated from childhood diarrhoea in four provinces of Kenya. J Infect Developing Countries. 2012; 6(07): 572–8.View Article PubMed |
| [57] | Aslam B, Wang W, Arshad MI, Khurshid M, Muzammil S, Rasool MH, et al. Antibiotic resistance: a rundown of a global crisis. Infect Drug Resistance. 2018; 11(1645).View Article PubMed |
| [58] | Brooks JT, Ochieng JB, Kumar L, Okoth G, Shapiro RL, Wells JG, et al. Surveillance for bacterial diarrhoea and antimicrobial resistance in rural western Kenya, 1997–2003. Clin Infect Dis. 2006; 43(4): 393–401.View Article PubMed |
| [59] | Public Health KM, Sanitation. Policy guidelines on control and management of diarrhoeal diseases in children below five years in Kenya. Nairobi: Kenya Ministry of Public Health and Sanitation; 2010. 1–11 p. |
| [60] | Njeri PK, Kipkemoi PJ, Otieno FK. Trends in Antibiotic Resistance among Diarrheal Pathogens. Antimicrobial Resistance & Infection Control. 2023; 12(2): 345–56. |
| [61] | Vargas M, Ochoa TJ, Ruiz J, Molina M, Del Valle LJ, Gil AI, et al. High frequency of Antimicrobial Drug resistance of Diarrheagenic E.coli in infants in Peru. Am J Trop Med Hyg. 2009; 81(2): 296–301.View Article PubMed |
| [62] | Organization WH. Manual for the laboratory identification and antimicrobial susceptibility testing of bacterial pathogens of public health concern in the developing world. 2003. |
| [63] | Udo SM, Eja ME. Prevalence and antibiotic resistant Shigellae among primary school children in urban Calabar, Nigeria. Asia Pac J Public Health. 2004; 16(1): 41–4.View Article PubMed |
