Abstract
Diarrhoeal disease is still one of the most challenging issues for health in many countries across the Eastern Mediterranean region (EMR), with infectious diarrhoea being an important cause of morbidity and mortality, especially in children under five years of age. However, the understanding of the aetiological spectrum and the burden of enteric pathogens involved in diarrhoeal disease in the EMR is incomplete. Non-typhoidal Salmonella (NTS), the focus of this review, is one of the most frequently reported bacterial aetiologies in diarrhoeal disease in the EMR. Strains of NTS with resistance to antimicrobial drugs are increasingly reported in both developed and developing countries. In the EMR, it is now widely accepted that many such resistant strains are zoonotic in origin and acquire their resistance in the food-animal host before onward transmission to humans through the food chain. Here, we review epidemiological and microbiological aspects of diarrhoeal diseases among children in the EMR, with emphasis on the implication and burden of NTS. We collate evidence from studies across the EMR on the zoonotic exposure and antimicrobial resistance in NTS at the interface between human and foods of animal origin. This review adds to our understanding of the global epidemiology of Salmonella with emphasis on the current situation in the EMR.
Highlights
Worldwide, diarrhoeal diseases accounted for 8% of all deaths in children under five years of age in 2016, and this translates to over 1300 young children dying each day or approximately480,000 children a year [1]
The prevalence of enteropathogens in child diarrhoeal illnesses throughout the Eastern Mediterranean region (EMR) is difficult to precisely assess due to variations in geographical settings, a lack of harmonization in sampling approaches and study designs and varying laboratory techniques and methods used across different studies, even within the same country [24,25]
Clinical findings in these studies varied according to the aetiology of diarrhoea; abdominal pain, vomiting, fever and dehydration were seen in a majority of cases, and the highest incidence rates were commonly reported in the summer months
Summary
Diarrhoeal diseases accounted for 8% of all deaths in children under five years of age in 2016, and this translates to over 1300 young children dying each day or approximately. Across the 22 countries in the EMR, the highest rates of diarrhoea-attributed mortality among children younger than five years were reported in Somalia, Afghanistan, Djibouti, Iraq, Syria, Yemen, Sudan, Egypt and Tunisia [8,9]. Fund (UNICEF) in partnership with the Government of Iraq indicated that approximately 90% of children under the age of five years visited hospitals due to diarrhoea [12]. In this former survey, diarrhoea and acute respiratory infection accounted for 70% of childhood deaths, but the fatality rate due to diarrhoeal illnesses was higher than those caused by respiratory infection [12]
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