High Burden of Shigellosis Among Hospitalized Children under five in Ndola, Zambia: Evidence from molecular-based surveillance
- 1Arthur Davison Children's Hospital
Abstract
Background Shigella spp. is a leading cause of moderate-to-severe diarrhea and diarrheal mortality in children under five (CU5), globally. Traditional culture-based techniques consistently underestimates its prevalence, particularly in high-burden regions of sub-Saharan Africa. We aimed to generate population-relevant estimates of shigellosis among hospitalized children under five (CU5) in Ndola, Zambia, using a sensitive molecular diagnostic approach. Methods A prospective, hospital-based surveillance study was conducted at Arthur Davison Childrens Hospital (ADCH) from May 2020 to November 2021. All CU5 admitted with acute diarrhea ([≥]2 watery stools/day) were eligible. From enrolled children, sociodemographic and clinical data were collected, and stool samples were obtained where possible. Primary detection of Shigella spp./enteroinvasive E. coli (EIEC) was performed using loop-mediated isothermal amplification (LAMP) targeting the conserved ipaH gene. Operational shigellosis case-definition: A child with diarrhea (2 or more watery stools/day) and a stool sample positive for the ipaH gene by LAMP. Prevalence of shigellosis was calculated among children with LAMP-tested samples and weighted to account for all admissions. The incidence of hospitalization was estimated using the district CU5 population denominators. Results Among 1,685 enrolled children, 950 provided stool samples. LAMP detected ipaH in 186 samples (19.6%;95% CI: 17.1-22.5). The weighted prevalence among all admissions was 19.5% (95% CI: 17.5-21.5) corresponding to 329 cases. The incidence of shigellosis hospitalization was 2.4 (95% CI: 2.2-2.7) per 1,000 person-years. The burden exhibited a distinct age distribution, peaking in children aged 12-23 months, preceded by an evident rise in the number of cases between 6 and 12 months of age. Shigellosis was associated with bloody diarrhea, increased stool frequency, and fever. Pre-admission antibiotic or other medication use was reported in 33% of cases. Conclusions Shigellosis accounts for a substantial proportion of severe diarrhea requiring hospitalization in Ndola, Zambia. Findings support improved diagnostics, antimicrobial stewardship, and prioritization of Shigella vaccines.
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BibTeX
@misc{miti2026high,
title = {{High Burden of Shigellosis Among Hospitalized Children under five in Ndola, Zambia: Evidence from molecular-based surveillance}},
author = {S. Miti and S. Siziya and R. Chilengi and C. Zulu and N. M. Kalaba and M. C. Niyongabo and C. Manda and L. Chisapi and M. Chakopo and R. Moono and M. Nachamba and I. Chilumba and B. Nduna and L. Msimuko and D. N. Thole and G. Chongwe and L. Mukubuta and A. M. Dombola and M. Inambao and G. Sofya and I. Ilubala and M. Chibuye and M. Simuyandi and C. C. Chisenga and D. Cohen},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.29.26366813},
url = {https://www.medrxiv.org/content/10.64898/2026.10.29.26366813v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - High Burden of Shigellosis Among Hospitalized Children under five in Ndola, Zambia: Evidence from molecular-based surveillance
AU - S. Miti
AU - S. Siziya
AU - R. Chilengi
AU - C. Zulu
AU - N. M. Kalaba
AU - M. C. Niyongabo
AU - C. Manda
AU - L. Chisapi
AU - M. Chakopo
AU - R. Moono
AU - M. Nachamba
AU - I. Chilumba
AU - B. Nduna
AU - L. Msimuko
AU - D. N. Thole
AU - G. Chongwe
AU - L. Mukubuta
AU - A. M. Dombola
AU - M. Inambao
AU - G. Sofya
AU - I. Ilubala
AU - M. Chibuye
AU - M. Simuyandi
AU - C. C. Chisenga
AU - D. Cohen
PY - 2026
DA - 2026/10/29
PB - medRxiv
DO - 10.64898/2026.10.29.26366813
UR - https://www.medrxiv.org/content/10.64898/2026.10.29.26366813v1
AB - Background Shigella spp. is a leading cause of moderate-to-severe diarrhea and diarrheal mortality in children under five (CU5), globally. Traditional culture-based techniques consistently underestimates its prevalence, particularly in high-burden regions of sub-Saharan Africa. We aimed to generate population-relevant estimates of shigellosis among hospitalized children under five (CU5) in Ndola, Zambia, using a sensitive molecular diagnostic approach. Methods A prospective, hospital-based surveillance study was conducted at Arthur Davison Childrens Hospital (ADCH) from May 2020 to November 2021. All CU5 admitted with acute diarrhea ([≥]2 watery stools/day) were eligible. From enrolled children, sociodemographic and clinical data were collected, and stool samples were obtained where possible. Primary detection of Shigella spp./enteroinvasive E. coli (EIEC) was performed using loop-mediated isothermal amplification (LAMP) targeting the conserved ipaH gene. Operational shigellosis case-definition: A child with diarrhea (2 or more watery stools/day) and a stool sample positive for the ipaH gene by LAMP. Prevalence of shigellosis was calculated among children with LAMP-tested samples and weighted to account for all admissions. The incidence of hospitalization was estimated using the district CU5 population denominators. Results Among 1,685 enrolled children, 950 provided stool samples. LAMP detected ipaH in 186 samples (19.6%;95% CI: 17.1-22.5). The weighted prevalence among all admissions was 19.5% (95% CI: 17.5-21.5) corresponding to 329 cases. The incidence of shigellosis hospitalization was 2.4 (95% CI: 2.2-2.7) per 1,000 person-years. The burden exhibited a distinct age distribution, peaking in children aged 12-23 months, preceded by an evident rise in the number of cases between 6 and 12 months of age. Shigellosis was associated with bloody diarrhea, increased stool frequency, and fever. Pre-admission antibiotic or other medication use was reported in 33% of cases. Conclusions Shigellosis accounts for a substantial proportion of severe diarrhea requiring hospitalization in Ndola, Zambia. Findings support improved diagnostics, antimicrobial stewardship, and prioritization of Shigella vaccines.
ER -