Bacterial Pharyngitis, Antimicrobial Susceptibility, and Associated Factors among Children at comprehensive specialized hospitals, Northwest Ethiopia

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Compared to viral causes, it often presents more severely and can result in complications if untreated. However, data on its bacterial etiology, resistance patterns, and associated risk factors are limited in developing countries, including Ethiopia. Objective: To assess the prevalence, bacterial causes, antimicrobial susceptibility patterns, and risk factors of pharyngitis among children at comprehensive specialized hospitals, Northwest Ethiopia. Methods: A hospital-based cross-sectional study was conducted from June 1 to August 30, 2024, among 254 children aged ≤14 years. Throat swabs were collected and cultured following standard microbiological techniques. Bacterial identification was performed through colony morphology, Gram staining, and biochemical tests. Antimicrobial susceptibility was tested using the Kirby-Bauer disk diffusion method. Data were analyzed using SPSS version 27, and logistic regression identified significant risk factors (p ≤ 0.05). Results: The prevalence of culture-confirmed bacterial pharyngitis was 28.3% (95% CI: 22.5–33.9%). A total of 80 bacterial isolates were identified, predominantly Streptococcus pyogenes (35%), Staphylococcus aureus (32.5%), and Streptococcus pneumoniae (28.8%). High resistance was observed: S. pyogenes to ceftriaxone (64.3%) and chloramphenicol (53.6%); S. pneumoniae to penicillin (82.6%); and S. aureus to penicillin (80.8%) and tetracycline (57.7%). Overall, 41.3% of isolates exhibited multidrug resistance. Significant factors associated with bacterial pharyngitis included prior history of pharyngitis (AOR = 8.86), tonsillectomy (AOR = 5.65), contact with coughing individuals (AOR = 3.42), and weight loss (AOR = 2.58). Conclusion: Bacterial pharyngitis is prevalent among children in the study area, with a high burden of multidrug-resistant organisms. Routine use of culture and antibiotic susceptibility testing is essential to guide effective treatment and reduce resistance. Bacterial pharyngitis antimicrobial resistance children Ethiopia Figures Figure 1 Introduction Pharyngitis, an inflammation of the pharyngeal mucosa and tonsillar structures, is among the most common upper respiratory tract infections, particularly affecting children. Because of its close proximity to the salivary glands, oral cavity, and external environment, the human pharynx—a mucus-rich, aerated anatomical region—is constantly exposed to a variety of microbial agents (1, 2). A common cause of pediatric morbidity, bacterial pharyngitis is mostly caused by Streptococcus pyogenes (Group A Streptococcus, or GAS) and is frequently transmitted by direct contact with respiratory secretions or infected surfaces (3). The illness burden is also influenced by other bacterial infections, including Moraxella catarrhalis, Haemophilus influenzae, Staphylococcus aureus, and Streptococcus pneumoniae (4). Because of its high frequency and potential for major problems, particularly if left untreated, pharyngitis in children is a specific concern. These consequences include glomerulonephritis, rheumatic heart disease, otitis media, peritonsillar abscess, and even potentially fatal disorders including airway obstruction and septicemia (5, 6). Young age, overcrowding, seasonal fluctuations, exposure to environmental factors (such as smoke and dust), and a history of recurrent infections or contact with sick people are all factors that increase the risk of contracting the disease (7, 8). The rising incidence of antimicrobial resistance (AMR) among the bacterial pathogens that cause pharyngitis is a cause for increasing concern. Irrational antibiotic usage and self-medication have been the driving forces for resistance mechanisms, such as the creation of beta-lactamases, genetic mutation, and biofilm formation (9, 10). The AMR epidemic has been made worse in resource-constrained environments such as Ethiopia by inadequate diagnostic infrastructure, restricted access to microbiological testing, and inappropriate use of antibiotics (11, 12). There is a lack of local epidemiological data in Ethiopia, especially concerning the bacterial profile, patterns of antibiotic susceptibility, and related risk factors among pediatric populations, despite the clinical and public health importance of bacterial pharyngitis. Current and thorough information on the prevalence and microbiological characteristics of bacterial pharyngitis in children is lacking in northwest Ethiopia(13). In order to ascertain the frequency of bacterial pharyngitis, pinpoint the causing organisms, ascertain their patterns of antibiotic susceptibility, and investigate the risk factors linked to it, this study was conducted among pediatric patients who were seen at comprehensive specialized hospitals, Northwest Ethiopia. Materials and Methods Study Design and Setting A hospital-based cross-sectional study was conducted from June 1 to August 30, 2024, at two specialized hospitals located in Northwest Ethiopia: Felege Hiwot Specialized Hospital (FHSH) and Tibebe Ghion Specialized Teaching Hospital (TGSH). These tertiary-level institutions provide comprehensive inpatient and outpatient services to a wide catchment area across the Amhara Regional State and surrounding regions. Both FHSH and TGSH function as referral centers and are equipped with advanced diagnostic and therapeutic facilities. They serve as medical teaching and research hospitals affiliated with regional health science institutions. The hospitals include well-established pediatric departments, alongside other specialized units, and play a critical role in delivering healthcare services and clinical training in Northwest Ethiopia. Study Population The source population included all pediatric patients visiting FHSH and TGSH during the study period. The study population consisted of children under 14 years old presenting with signs and symptoms of pharyngitis. Inclusion Criteria · Children ≤14 years with clinical features of pharyngitis. · Patients or guardians willing to provide informed consent. Exclusion Criteria · Children who had received antibiotics within the past two weeks. · Children or guardians who declined participation. Variables · Dependent Variables: ü Presence of bacterial pharyngitis ü Antimicrobial susceptibility patterns · Independent Variables: ü Socio-demographic: Age, sex, parental education, residence ü Clinical: History of pharyngitis, contact with coughing patient ü Environmental: Exposure to wood smoke, overcrowding, school attendance ü Clinical Signs: Tonsillar swelling, exudate, fever >38°C, difficulty swallowing, lymph node enlargement, tonsillectomy status, vaccination history Operational Definition · Pediatric children: For this study, children aged 0–14 years. · Bacterial pharyngitis: Pharyngitis cases confirmed through positive bacterial culture. Sample Size Determination The sample size was calculated using a single population proportion formula, assuming: · 95% confidence level (Z = 1.96) · 5% margin of error (d) · Prevalence (p) = 21.3% (based on a prior study in Harar, Ethiopia) Single population proportion formula There were non-responsive patients; the final sample size was 254. Sampling Technique A convenience sampling technique was employed to recruit eligible participants from the pediatric outpatient and emergency departments. Data Collection A pre-tested, structured questionnaire was administered by trained clinical officers to collect demographic, environmental, and clinical information. The questionnaire was adapted from validated tools and pre-tested at Debre Tabor Comprehensive Specialized Hospital. The prepared questionnaires are attached in the supplementary file. Sample Collection and Transportation Throat swabs were collected aseptically using sterile cotton swabs by rotating across both tonsils and posterior pharyngeal wall. The swabs were placed in Amies transport medium and transported to the Bahir Dar University Microbiology Laboratory for processing within two hours of collection. Laboratory Investigation Culture and Identification: · Swabs were inoculated on 5% sheep blood agar, chocolate agar (with 5 µg/mL gentamicin), and MacConkey agar. · Plates were incubated at 37°C for 18–24 hours in 5% CO₂ candle jars. · Colonies were identified based on: o Hemolysis pattern: β-hemolysis (S. pyogenes, S. aureus), α-hemolysis (S. pneumoniae), non-hemolytic (M. catarrhalis) o Biochemical tests: catalase, coagulase, bacitracin, optochin, bile solubility, oxidase, indole, citrate, and TSI. o Gram staining was performed for bacterial characterization. Quality Control Strains: · S. aureus ATCC 25923 · S. pneumoniae ATCC 49619 · H. influenzae ATCC 49241 Antimicrobial Susceptibility Testing Antibiotic susceptibility was assessed using the Kirby-Bauer disk diffusion method on Mueller-Hinton Agar (MHA) and MHA supplemented with blood for fastidious organisms. Suspensions were adjusted to 0.5 McFarland standard before inoculation. Antibiotic discs used included: · Penicillin (10 IU) · Amoxicillin (10 µg) · Augmentin (10 µg) · Erythromycin (15 µg) · Ceftriaxone (30 µg) · Ciprofloxacin (5 µg) · Chloramphenicol (30 µg) · Gentamicin (15 µg) · Tetracycline (30 µg) The zone of inhibition was measured and interpreted according to CLSI 2023 guidelines. Data Quality Control · 5% of questionnaires were pre-tested for clarity and consistency. · Standard operating procedures (SOPs) were strictly followed. · Culture media were tested for sterility and performance. · Laboratory processes were validated using reference strains. · Daily temperature logs and equipment calibration were maintained. Data Analysis Data were entered into Epi Data version 4.6, cleaned, and exported to SPSS version 27 for statistical analysis. Descriptive statistics were computed. Associations were assessed using Chi-square and binary logistic regression. A p-value ≤ 0.05 was considered statistically significant. Ethical Considerations Ethical clearance was granted by the Institutional Review Board (IRB) of the College of Medicine and Health Sciences, Bahir Dar University (Ref: CMHS 1037/2024). Support letters were provided to the study hospitals. Written informed consent was obtained from parents or legal guardians. Data confidentiality and participant anonymity were strictly maintained throughout the study in accordance with the Declaration of Helsinki. RESULTS Socio-demographic features and prevalence of bacterial pharyngitis In this study, of the total study participants, 124 (48.8%) were males and 111 (43.7%) were rural living. The participants’ age range was up to 14 years; of which 98 (38.6%) were ≤ 5 years and 83 (32.7%) were 6–10 years (Table 1 ). Table 1 Socio-demographic characteristics of pediatric participants and prevalence of culture-confirmed bacterial pharyngitis in specialized hospitals, Northwest Ethiopia, 2024. Variables Bacterial culture results P value (χ2) Frequency Positive (%) Negative (%) Children age (Years) ≤ 5 98 26 (26.5%) 72 (73.5) 0.45 (χ2 = 0.55) 6–10 83 26 (31.3%) 57 (68.7%) 11–14 73 20 (27.4%) 53 (72.6%) Sex Male 124 44 (35.5%) 80 (64.5%) 0.014 (χ2 = 6.07) Female 130 28 (21.5%) 102 (78.5%) Residence Rural 111 39 (35.1%) 72 (64.9%) 0.035 (χ2 = 4.47) Urban 143 33 (23.1%) 110 (76.9%) Clinical profiles of children with bacterial pharyngitis The study reveals that children with bacterial pharyngitis exhibit various clinical symptoms, including increased body temperature in 175 (68.9%); weight loss in 136 (53.5%); and swollen lymph nodes in 156 (61.4%). The prevalence of culture-confirmed bacterial pharyngitis was 28.3% with a 95% confidence interval (95% CI, 22.5 to 33.9%) (Table 2 ). Table 2 Clinical characteristics of pediatric patients with culture-confirmed bacterial pharyngitis in specialized hospitals, Northwest Ethiopia, 2024. Variables Bacterial culture results P value and (χ2) Frequency (%) Positive (%) Negative (%) Weight loss Yes 136 (53.5) 54 (39.) 82 (60.3) 0.0001 (χ2 = 18.6) No 118 (46.5) 18 (15.) 100 (84.7) Tonsil structural Changes Yes 131 (51.6) 75 (57.3) 56 (42.7) 0.0001 (χ 2 = 54.01) No 123 (48.4) 16 ( 13 ) 107 (87) Type of Pharyngitis Acute 95 (37.4) 17 (17.9) 78 (82.1) 0.0001 (χ 2 = 14.8) Chronic 80 (31.5) 35 (43.8) 45 (56.2) Recurrent 79 (31.1) 20 (25.3) 59 (74.7) Body Temperature 37 79 (31.1) 17 (21.5) 62 (78.5) 0.105 (χ 2 = 2.6) ≥ 38 175 (68.9) 55 (31.4) 120 (68.6) White pharyngeal Exudate Yes 88 (34.6) 31 (35.2) 57 (64.8) 0.076 (χ2 = 3.2) No 166 (65.4) 41 (24.7) 125 (75.3) Swollen lymph Nodes Yes 156 (61.4) 50 (32.1) 106 (67.9) 0.098 (χ2 = 2.7) No 98 (38.6) 22 (22.4) 76 (77.6) Difficult to swallow food Yes 146 (57.5) 51 (34.9) 95 (65.1) 0.007 (χ2 = 7.3) No 108 (42.5) 21 (19.4) 87 (80.6) Factors Contributing to Bacterial Pharyngitis in Pediatric Patients The prevalence of culture-confirmed bacteria in children with pharyngitis includes a history of contact with patient 54 (43.5%), a history of previous pharyngitis 56 (42.7%), tonsillectomy 53 (41.1%), and 54 (40.5%) of incomplete or unimmunized; additionally, 50 (41.6%) of schooling, 47 (38.5%) of overcrowding live setup, and 44 (35.8%) of exposed dung/wood biofuel (Table 3 ). Table 3 Factors associated with bacterial pharyngitis and prevalence of culture-confirmed cases among pediatric patients in specialized hospitals, Northwest Ethiopia, 2024. Variables Bacterial culture results P value (χ2) Frequency (%) Positive F (%) Negative F (%) History of contact with cough patients Yes 124 (48.9) 54 (43.5) 70 (56.5) 0.0001 (χ2 = 27.6) No 130 (51.1) 18 (13.8) 112 (86.2) History of Pharyngitis Yes 131 (51.6) 56 (42.7) 75 (57.3) 0.001(x2 = 27.5) No 123 (48.4) 16 ( 13 ) 107 (87) Tonsillectomy Yes 129 (50.8) 53 (41.1) 19 (58.9) 0.0001 (χ2 = 27.6) No 125 (49.2) 76 (15.2) 106 (84.8) Immunization status Yes 129 (50.8) 18 (16.4) 107 (83.6) 0.0001 (χ2 = 23.5) No 125 (48.2) 54 (40.5) 75 (59.5) Attending school Yes 120 (47.2) 50 (41.6) 70 (58.3) 0.0001 (χ2 = 19.8) No 134 (52.8) 22 (16.4) 112 (83.6) Live overcrowded set up Yes 122 (48) 47 (38.5) 75 (61.5) 0.0005 (χ2 = 11.9) No 132 (52) 25 (18.9) 107 (81.1) Exposed dung/wood biofuel Yes 123 (48.4) 44 (35.8) 79 (64.2) 0.011 (χ2 = 6.5) No 131 (51.6) 28 (21.4) 103 (78.6) Distribution of bacteria isolates S. pyogenes 28 (35%) was the most frequently identified bacteria, followed by S. aureus 26 (32.5%), and S. pneumoniae 23 (28.8%) were found on throat swab samples. Mixed isolates were found: 5 (6.3%) S. pyogenes and S. aureus and 3 (3.8%) S. pneumoniae and K. pneumoniae (Fig. 1 ). Antibiotic resistance profile of cultured bacteria isolates Drug resistance was found against 45 (56.3%) of penicillin, 43 (53.8%) chloramphenicol, 42 (52.5%) gentamicin, 40 (50%) tetracycline, and 37 (46.3%) ceftriaxone. S. pyogenes , S. aureus , S. pneumoniae , and K. pneumoniae showed an overall antimicrobial resistance rate of 100 (39.7%), 117 (50%), 85 (41.1%), and 17 (62.9%), respectively. S. pyogenes showed a high resistance rate of 15 (53.6%) for chloramphenicol, 14 (50%) for gentamicin, and 18 (64.3%) for ceftriaxone. The resistance rates of S. pneumoniae isolates were 19 (82.6%) for penicillin, 12 (52.2%) for gentamycin, and 10 (43.5%) for tetracycline and chloramphenicol. Similarly, S. aureus isolates exhibited substantial resistance to penicillin 21 (80.8%), gentamycin 14 (53.8%), tetracycline 15 (57.7%), and chloramphenicol 61.5% (Table 4 ). Table 4 Antimicrobial susceptibility patterns of bacterial isolates from pediatric patients with bacterial pharyngitis in specialized hospitals, Northwest Ethiopia, 2024 Antibiotics test Percentage of bacterial isolates susceptible or resistant to, n (%) AUG AMX E TE C CIP GM CRO P Total N (%) S. pyogenes ( 28 ) S = N% 22 (78.6) 20(71.4) 16(57.1) 15 (54) 13(46.4) 16 (57.1) 14 (50) 10(35.7) 27(100%) R = N% 6 (21.4) 8 (28.6) 12(42.9) 13 (46) 15(53.6) 12 (42.9) 14 (50) 18(64.3) 0 98 (39.7) S. aureus ( 26 ) S = N% 19 (73.2) 18(69.2) 16(61.5) 11(42.3) 10(38.5) 11 (42.3) 12(46.2) 15(57.7) 5 (19.2) R = N% 7 (26.9) 8 (30.8) 10(38.5) 15(57.7) 16(61.5) 15 (57.7) 14(53.8) 11(42.3) 21(80.8) 117(50) S.pneumoniae ( 23 ) S = N% 16 (69.6) 14(60.9) 15(65.2) 13(56.5) 13(56.5) 20 (87) 11(47.8) 16(69.6) 4 (17.4) R = N% 7 (30.4) 9 (39.1) 8 (34.8) 10(43.5) 10 (43.5 3 ( 13 ) 12(52.2) 7 (30.4) 19 (82.6) 85(41,1) K.Pneumoniae ( 3) S = N% 1 (33.3) 0 1 (33.3) 1 (33.3) 1 (33.3) 3 (100) 1 (33.3) 2 (66.7) 0 R = N% 2 (66.7) 3 (100) 2 (66.7) 2 (66.7) 2 (66.7) 0 2 (66.7) 1 (33.3) 3 (100) 17(62.9) Total = 80 R = N% 22/80 (27.5) 28 ( 35 ) 32 ( 40 ) 40(50) 43(53.8) 30 (37.5) 42(52.5) 37(46.3) 45 (56.3) 319(39.8) CRO = Ceftriaxone AUG = Augmentin, AMX = Amoxicillin, E = Erythromycin, TE = Tetracycline, C = Chloramphenicol, CIP = Ciprofloxacin, GM = Gentamicin, p = penicillin, S = susceptible, R = resistance Profiles of MDR bacterial isolates The overall multidrug-resistance (MDR) rate of bacterial species was 33 (41.3%). The overall MDR of each bacterium, S. pyogenes , S. aureus , S. pneumoniae , and K. pneumoniae , was 9 (32.1%), 12 (46.2%), 10 (43.5%), and 2 (66.7%), respectively (Table 5 ). Table 5 Profiles of multidrug-resistant (MDR) bacterial isolates from pediatric patients with bacterial pharyngitis in specialized hospitals, Northwest Ethiopia, 2024. Antibiotics S. pyogenes ( 28 ) S.aureus ( 26 ) S. pneumoniae ( 23 ) K. pneumoniae ( 3 ) Total (80) R1 N (%) 15 (53.6%) 8 (30.8%) 5 (21.7%) 0 28 (35%) R2 N (%) 3 (10.7%) 6 (23.1%) 8 (34.7%) 1 (33.3%) 18 (22.5%) R3 N (%) 3 (10.7%) 2 (7.7%) 5 (21.7%) 0 10 (12.5%) R4 N (%) 4 (14.2%) 5 (19.2%) 4 (17.4%) 1 (33.3%) 14 (17.5%) R5 N % 2 (7%) 3 (11.5%) 1 (4.3%) 0 6 (7.5%) R6 N % 0 (0.0%) 2 (7.7%) 0 1 (33.3%) 3 (3.8%) Over all MDR N (%) 9 (32.1%) 12 (46.2%) 10 (43.5%) 2 (66.7%) 33 (41.3%) Factors associated with bacterial pharyngitis Bacterial pharyngitis was significantly associated with weight loss (AOR = 2.58, 95% CI: 1.1–6.05), chronicity (AOR = 2.93, 95% CI: 1.08–7.94), history of contact with patients (AOR = 3.42, 95% CI: 1.47–7.95), prior history of pharyngitis (AOR = 8.86, 95% CI: 3.37–23.29), tonsillectomy (AOR = 5.65, 95% CI: 2.37–13.46), immunization status (AOR = 4.22, 95% CI: 1.74–10.24), school attendance (AOR = 3.44, 95% CI: 1.44–8.2), and tonsillar structural changes (AOR = 2.53, 95% CI: 1.03–6.22). Children with weight loss were 2.5 times more likely to be culture-positive for bacterial pharyngitis compared to those without. Similarly, school attendees were three times more likely to test positive than non-attendees. A history of contact with symptomatic individuals increased the odds 3.4-fold, while a prior history of pharyngitis raised it nearly nine fold. Children with a history of tonsillectomy, unimmunized status, or tonsillar structural changes were 5.7, 4.2, and 2.5 times more likely, respectively, to have culture-confirmed bacterial pharyngitis (Table 6 ). Table 6 Bivariate and multivariable analysis of factors associated with bacterial pharyngitis among pediatric patients in specialized hospitals, Northwest Ethiopia, 2024. Variables COR (95%CI) P-value AOR (95%CI) P-value Sex Male 2 (1.15–3.49) 0.014 1.49 (0.65–3.38) 0.346 Female 1 1 Residence Rural 1.8 (1.04–3.13) 0.035 1.36 (0.60–3.08) 0.46 Urban 1 1 Weight loss Yes 3.7 (1.99–6.72) < 0.001 2.58 (1.1–6.05) 0.030 No 1 1 Tonsil structural Change Yes 5 (2.66–9.37) < 0.001 2.53 (1.03–6.22) 0.043 No 1 1 Type of Pharyngitis Acute 1 1 Chronic 3.6 (1.8–7.1) < 0.001 2.93 (1.08–7.94) 0.034 Recurrent 1.6 (0.75–3.22) 0.235 1.26 (0.43–3.69) 0.678 Body T° 37°C 1 1 ≥ 38°C 1.7 (0.89–3.1) 0.107 1.43 (0.55–3.73) 0.468 White pharyngeal exudate Yes 1.7 (0.95–2.91) 0.078 1.76 (0.76–4.08) 0.188 No 1 1 Swollen lymph nodes Yes 1.6 (0.91–2.92) 0.100 1.05 (0.45–2.44) 0.917 No 1 1 Difficult to swallow food Yes 2.2 (1.24–3.99) 0.007 1.64 (0.70–3.85) 0.253 No 1 1 History of Contact with patients Yes 4.8 (2.61–8.85) < 0.001 3.42 (1.47–7.95) 0.004 No 1 1 History pharyngitis Yes 5 (2.66–9.37) < 0.001 8.86 (3.37–23.29) 0.001 No 1 Tonsillectomy Yes 3.9 (2.13–7.09) < 0.001 5.65 (2.37–13.46) 0.001 No 1 1 Immunization status Yes 1 1 No 4.3 (2.34-8) < 0.001 4.22 (1.74–10.24) 0.001 Attending school Yes 3.6 (2-6.5) < 0.001 3.44 (1.44–8.2) 0.005 No 1 1 Live overcrowded setup Yes 2.7 (1.52–4.73) 0.001 1.82 (0.79–4.19) 0.161 No 1 1 Exposed wood biofuel Yes 2 (1.17–3.58) 0.012 1.37 (0.59–3.17) 0.462 No 1 1 DISCUSSION In this study, the prevalence of culture-confirmed bacterial pharyngitis among pediatric patients at specialized hospitals was 28.3% (95% CI: 22.5–33.9%). This finding is comparable to a study from Norway (27%) (14) , but higher than studies from Brazil (20.6%) (15, 16) and Jimma, Ethiopia (8.8%) (17). Conversely, it is lower than reports from Malaysia (43.4%) (18), Nigeria (83.3%) (4), Pakistan (78.1%) (19), Iraq (93.1%) (20), Somaliland (32.2%) (21), and Ethiopia (75.1%) (1). The observed differences may be due to variations in sample size, geographical and environmental factors, immunization coverage, diagnostic methods, the use of self-medication, and the emergence of antimicrobial resistance. Male children had a higher proportion of culture-confirmed bacterial pharyngitis, consistent with findings from Riyadh (22), Cairo (23), Iraq (24), Nigeria (4), and Ethiopia (25). This could be attributed to behavioral and social factors such as increased outdoor exposure and interaction, higher school attendance, and overcrowding, which increase the risk of transmission. Children from rural areas showed a higher prevalence of bacterial pharyngitis than urban dwellers, aligning with findings from Hawassa (25) and Bahir Dar, Ethiopia (26). Possible contributing factors include limited access to healthcare and immunization services, poor hygiene, overcrowded living and school environments, and the impacts of regional conflict on health infrastructure. Chronic pharyngitis was also associated with a higher bacterial isolation rate (43.8%), although slightly lower than the 57.7% reported in Somaliland (21). The discrepancy may be explained by differences in chronicity definitions, local bacterial strains, self-medication practices, and immunization status. Streptococcus pyogenes was the most frequently isolated pathogen (35%), which is lower than figures reported in Tanzania (40%) (27), Sudan (41.4%) (28), Somaliland (55%) (21), and Ethiopia (42.5%) (29), but higher than in Nigeria (11.6%) (30) and Kenya (13.7%) (31). Such variations may reflect differences in strain diversity, population density, antibiotic exposure, and diagnostic methods. Staphylococcus aureus accounted for 32.5% of isolates, similar to findings from Somaliland (29%) (21) and Bahir Dar (29%) (26), but higher than in Iraq (19.5%) (24) and Kenya (16.6%) (31), and lower than Brazil (63%) (32). Differences may be due to factors such as biofilm formation, antibiotic resistance, and tonsillar infections like tonsilloliths. Streptococcus pneumoniae was isolated in 28.8% of cases, higher than reported in Nigeria (8.5%) (33), Kenya (10.3%) (31), and Somaliland (7%) (21). This could be attributed to low immunization coverage, regional antimicrobial resistance patterns, or diagnostic variation. Klebsiella pneumoniae was identified in 3.8% of cases, consistent with findings from Somaliland (4%) (21) and Addis Ababa (4%) (34), but lower than Libya (43.3%) (15) and Kenya (20.6%) (31). Regional differences in pathogen prevalence, immunity levels, and healthcare access could explain these disparities. Regarding antimicrobial resistance, S. pyogenes showed high resistance to chloramphenicol (53.6%), gentamicin (50%), and ceftriaxone (64.3%). These rates are markedly higher than those reported in Gondar (5%, 9%, and 13%, respectively) (Tadesse et al., 2023) but lower than Cameroon (92%) (Ndip et al., 2008). Resistance mechanisms such as aminoglycoside-modifying enzymes and mutations in quinolone-resistance determining regions may be involved. S. aureus demonstrated high resistance to penicillin (80.8%), tetracycline (57.7%), gentamicin (53.8%), and chloramphenicol (61.5%), comparable to findings from Bahir Dar (84.1%) (26), but higher than in Gondar (65%) (35) and Somaliland (38%) (21). These patterns likely reflect overuse of antibiotics, poor prescribing practices, and resistance gene acquisition. S. pneumoniae showed resistance to penicillin (82.6%) and gentamicin (52.2%), rates exceeding those from Germany (43%) (36), the USA (38.9%) (37), and China (56% and 21%, respectively) (38). These findings underscore the consequences of limited vaccination, over-the-counter antibiotic access, and diagnostic gaps. Antimicrobial resistance patterns showed alarmingly high resistance rates, particularly to penicillin, which reached 80.8% across isolates. S. pyogenes demonstrated high resistance to chloramphenicol (53.6%), gentamicin (50%), and ceftriaxone (64.3%), while S. aureus showed resistance to penicillin (80.8%), tetracycline (57.7%), gentamicin (53.8%), and chloramphenicol (61.5%). These findings highlight the increasing burden of multidrug-resistant organisms (41.3% MDR overall), likely driven by antibiotic overuse, self-medication, and limited diagnostic testing. Several factors were significantly associated with culture-confirmed bacterial pharyngitis: incomplete or no immunization, prior history of pharyngitis, contact with coughing individuals, and history of tonsillectomy, chronic pharyngitis, school attendance, and visible tonsillar structural changes. These associations are consistent with findings from studies in India, Riyadh, Nigeria, Somaliland, and various Ethiopian regions (7, 39) (21) (40), (25). Limitations of the study This investigation gave invaluable knowledge about the bacterial etiology and resistance patterns of pediatric pharyngitis. However, it had certain limitations. Notably, it did not investigate viral or fungal causes of pharyngitis. Additionally, we did not utilize molecular diagnosis. CONCLUSION The most common causal agents were Staphylococcus pyogenes, Staphylococcus aureus , and Streptococcus pneumoniae . These pathogens exhibited high resistance to commonly used antibiotics, particularly penicillin, with a notable presence of multidrug resistance, underscoring the need for improved antimicrobial stewardship. Significant associations were observed with incomplete vaccination, prior pharyngitis, and contact with symptomatic individuals, tonsillectomy, school attendance, and tonsillar abnormalities. Abbreviations AMR Antimicrobial Resistance AST Antimicrobial sensitivity testing CDC Centre for Disease Control CLSI Clinical Laboratory Standards Institution FHSH Felege Hiwot Specialized Hospital MAC MacConkey Agar MDR Multidrug Resistant SOPs Standared Oprative Procuder TGSH Tibebe Ghion Specialised Hospital WHO World Health Organization Declarations Clinical trial number Not applicable. Ethical approval and consent to participate This study titled "Bacterial Pharyngitis, Antimicrobial Susceptibility, and Associated Factors among Children at Comprehensive Specialized Hospitals, Northwest Ethiopia" will be conducted in full compliance with national and international ethical research standards, including the Declaration of Helsinki. Ethical clearance was obtained from the Institutional Review Board (IRB) of Bahir Dar University. Written informed consent was obtained from the parents or legal guardians of all participating children. For children aged 7 years and above, we also obtained verbal or written assent using age-appropriate language. Throat swab sample collection was performed using sterile techniques by trained personnel to minimize discomfort or risk of infection. Participation in this study was entirely voluntary. Computing interest The author declare that they have no computing interest. Funding Not available Data availability The data sets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request. Author contributions Kefiyalew Mihrete: designed this study, collected and analyzed data, interpreted results, and drafted the manuscript; Addisu Melake: participated in data management and analyzed data; Bayeh Aberaand Tewachew Awoke participated in the design, data collection, and analysis, interpretation of the results, supervising the overall work of this study, review and approval of the manuscript; Tadese Sisay: prepared the manuscript, data analysis and data collection. All authors read the manuscript and approve it for submission. Author details 1Department of Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia 2Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia 3Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia. ACKNOWLEDGMENTS The authors would like to thank Bahir Dar University, College of Medicine and Health Sciences, Department of Medical laboratory Science for the opportunity to conduct this study. Our sincere gratitude also goes to the Amhara Public Health Institute, TGTH, and FHCSH microbiology laboratory staff and pediatricians for their cooperation and support with sample access, laboratory materials, kind assistance and study participants. References Wondimu M, Simbo T, Chaka T, Lemi H, Bedada W. Oropharyngeal Pathogenic Bacteria: Carriage, Antimicrobial Susceptibility Pattern and Associated Risk Factors among Febrile Patients. Int J Pharm Sci Dev Res. 2022;8(1):006-12. Sykes EA, Wu V, Beyea MM, Simpson MT, Beyea JA. Pharyngitis: Approach to diagnosis and treatment. Canadian Family Physician. 2020;66(4):251-7. Bayu D, Mekonnen A, Mohammed J, Bodena D. Magnitude of streptococcus pneumoniae among under-five children with symptom of acute respiratory infection at Hiwot Fana specialized University Hospital, Harar, Ethiopia: associated risk factors and antibacterial susceptibility patterns. Risk management and healthcare policy. 2020:2919-25. Garba B, Muhammad A, Mohammed F, Onazi S, Ahmad M, Yusuf T. Antibiogram of pharyngeal isolates of children with pharyngotonsillitis in a specialist hospital in GUSAU, North-western Nigeria. group. 2017;1(2):4. Welp AL, Bomberger JM. Bacterial community interactions during chronic respiratory disease. 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Infection and Drug Resistance. 2023;16(null):1637-48. Gjelstad S, Dalen I, Lindbæk M. GPs’ antibiotic prescription patterns for respiratory tract infections–still room for improvement. Scandinavian journal of primary health care. 2009;27(4):208-15. El-sherif AM. Prevalence of tonsillitis among sore throat patients attending OPD Department at Zawia Central Hospital, Libya. Libyan Journal of Medical Research. 2022;16(2):166-76. Bazilio J. Prevalence and Bacteriology of Tonsillitis among Patients Attending Otorhinolaryngology Services at Muhimbili National Hospital Dar Es Salaam, Tanzania: Muhimbili University of Health and Allied Sciences; 2017. Fenta F, Aklilu A, Tsalla T, Woldemariam M, Manilal A. Prevalence and antimicrobial susceptibility profile of Group A Streptococcus pyogenes among school-aged children with pharyngitis in Arba Minch, southern Ethiopia. 2022. Wang Q, Du J, Jie C, Ouyang H, Luo R, Li W. Bacteriology and antibiotic sensitivity of tonsillar diseases in Chinese children. European Archives of Oto-Rhino-Laryngology. 2017;274:3153-9. AMIN F, Hassan N, Bashir K, KHAN A, Bibi H, Irshad M, et al. Antimicrobial susceptibility profile of various bacteria isolated from respiratory tract infection. Bulletin of Biological and Allied Sciences Research. 2023;2023(1):48-. Bunyan IA, Naji SS, Aljodoa HH. Isolation and Identification of Some Bacterial Strains Isolated from Throat Infections in Hilla Province, Iraq. Indian Journal of Public Health. 2019;10(6):785. Darod HH, Melese A, Kibret M, Mulu W. Throat Swab Culture Positivity and Antibiotic Resistance Profiles in Children 2–5 Years of Age Suspected of Bacterial Tonsillitis at Hargeisa Group of Hospitals, Somaliland: A Cross-Sectional Study. International Journal of Microbiology. 2023;2023:6474952. Bukhari HQ, Madloul MH, Alorinan BI, Albarrak NK, Alotaibi WH, El-Sayed S. Prevalence study of acute tonsillitis among pediatrics age groups. International Journal of Medical Reviews and Case Reports. 2019;3(1):1. Nabat ZN, ALateef BA, Hussain IM. Bacteriological and immunological study of patients with tonsillitis in Hila City. Iraqi journal of biotechnology. 2019;18(2). Al-Tameemi K, Hraishawi R, Aaiz FL. Isolation, identification and evaluation of resistance of bacterial isolates from patients with tonsillitis. Ann Trop Med Public Health. 2020;23:10. Anja A, Beyene G, S/Mariam Z, Daka D. Asymptomatic pharyngeal carriage rate of Streptococcus pyogenes, its associated factors and antibiotic susceptibility pattern among school children in Hawassa town, southern Ethiopia. BMC Research Notes. 2019;12(1):564. Mulu W, Yizengaw E, Alemu M, Mekonnen D, Hailu D, Ketemaw K, et al. Pharyngeal colonization and drug resistance profiles of Morraxella catarrrhalis, Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae among HIV infected children attending ART Clinic of Felegehiwot Referral Hospital, Ethiopia. PLoS One. 2018;13(5):e0196722. Abraham ZS, Bazilio J, Kahinga AA, Manyahi J, Ntunaguzi D, Massawe ER. Prevalence and bacteriology of tonsillitis among patients attending otorhinolaryngology Department at Muhimbili National Hospital, Dar es Salaam-Tanzania. Medical journal of Zambia. 2019;46(1):33-40. Ahmed EB, Groun EAA, Almugadam BS, Ahmed YMA, Mudawe AMN, Babiker NA, et al. Epidemiological Aspects and Antibiotics Susceptibility Patterns of Streptococcus pyogenes Isolated from Subjects with Tonsillitis, Sudan. Sudan Journal of Medical Sciences. 2023;18(1):6-24. Zelelie TZ, Mekonnen YT. Bacterial profile and antimicrobial resistance patterns in patients with upper respiratory tract infections In Debre Berhan referral hospital, Ethiopia. Egyptian Journal of Ear, Nose, Throat and Allied Sciences. 2019;20(1):9-15. Abd El Galil1ab SY, Abd El Gawad1cd S, El Ateeq2a E. Isolation and identification of microorganisms causing tonsillitis among children of Hail region. 2014. Miriti DM, Muthini JM, Nyamache AK. Study of bacterial respiratory infections and antimicrobial susceptibility profile among antibiotics naive outpatients visiting Meru teaching and referral hospital, Meru County, Kenya in 2018. BMC microbiology. 2023;23(1):172. Katkowska M, Garbacz K, Kopala W, Schubert J, Bania J. Genetic diversity and antimicrobial resistance of Staphylococcus aureus from recurrent tonsillitis in children. Apmis. 2020;128(3):211-9. Cavalcanti VP, Camargo LAd, Moura FS, Melo Fernandes EJd, Lamaro-Cardoso J, Braga CAdSB, et al. Staphylococcus aureus in tonsils of patients with recurrent tonsillitis: prevalence, susceptibility profile, and genotypic characterization. Brazilian Journal of Infectious Diseases. 2019;23:8-14. DEBEBE S, Admassu D. MAGNITUDE, DRUG SUSCEPTIBILITY PATTERN AND ASSOCIATED FACTORS OF BACTERIAL ISOLATES AMONG ACUTE TONSILLITIS PATIENTS VISITING PUBLIC HOSPITAL, HARAR EASTERN ETHIOPIA: Haramaya University; 2020. Tadesse M, Hailu Y, Biset S, Ferede G, Gelaw B. Prevalence, Antibiotic Susceptibility Profile and Associated Factors of Group A Streptococcal pharyngitis Among Pediatric Patients with Acute Pharyngitis in Gondar, Northwest Ethiopia. Infect Drug Resist. 2023;16:1637-48. Felmingham D, Farrell DJ, Reinert RR, Morrissey I. Antibacterial resistance among children with community-acquired respiratory tract infections (PROTEKT 1999–2000). Journal of Infection. 2004;48(1):39-55. Doern GV, Brown SD. Antimicrobial susceptibility among community-acquired respiratory tract pathogens in the USA: data from PROTEKT US 2000–01. Journal of Infection. 2004;48(1):56-65. Wang LM, Qiao XL, Ai L, Zhai JJ, Wang XX. Isolation of antimicrobial resistant bacteria in upper respiratory tract infections of patients. 3 Biotech. 2016;6(2):166. Islam F, Sarma R, Debroy A, Kar S, Pal R. Profiling acute respiratory tract infections in children from Assam, India. Journal of global infectious diseases. 2013;5(1):8-14. Gebrerufael GG, Hagos BT. Prevalence and predictors of acute respiratory infection among children under-five years in Tigray regional state, northern Ethiopia: a cross sectional study. BMC Infectious Diseases. 2023;23(1):743. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7276190","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":509850594,"identity":"7adae7c2-d678-4aa7-98a6-2377ecc1ef98","order_by":0,"name":"Kefiyalew Mihrete","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7klEQVRIiWNgGAWjYDACHgaGDwwMFgwM7M0HgFwJGWK0MM4AqgQyjiWAtPCQoEXCxwBqKwGg23P4YDNPjYScwQ2ez69u1FjwMLAfProBnxazs22JzTzHJIwNbvdus845BnQYT1raDbxazvOYP+Zhk0jcdufsNuMcNqAWCR4zAlr4Pzbz/JOo33Yj55lxzj9itJztYWzmbZNIMLuRw/w4t40YLWeOGTbO7ZMw3H/mmBlzbp8EDxtBv5xJftjw5puNvGR78+PPOd/q5PjZDx/DqwUEmKBxwSYBJgkpBwHGHxCa+QMxqkfBKBgFo2DkAQALvUrn/S84BwAAAABJRU5ErkJggg==","orcid":"","institution":"College of Health Sciences, Debre Tabor University","correspondingAuthor":true,"prefix":"","firstName":"Kefiyalew","middleName":"","lastName":"Mihrete","suffix":""},{"id":509850595,"identity":"9efeda5d-2a8c-4ac3-81dd-7e7143128e19","order_by":1,"name":"Tewachew Awoke","email":"","orcid":"","institution":"College of Medicine and Health Sciences, Bahir Dar University","correspondingAuthor":false,"prefix":"","firstName":"Tewachew","middleName":"","lastName":"Awoke","suffix":""},{"id":509850596,"identity":"f24dc170-736d-4778-87a4-38c5d25802ff","order_by":2,"name":"Addisu Melake","email":"","orcid":"","institution":"College of Health Sciences, Debre Tabor University","correspondingAuthor":false,"prefix":"","firstName":"Addisu","middleName":"","lastName":"Melake","suffix":""},{"id":509850597,"identity":"52d79e2e-3f0d-49e7-a58d-edac48ed0a75","order_by":3,"name":"Tadese Sisay","email":"","orcid":"","institution":"College of Health Sciences, Debre Tabor University","correspondingAuthor":false,"prefix":"","firstName":"Tadese","middleName":"","lastName":"Sisay","suffix":""},{"id":509850598,"identity":"bce75fca-1dfd-4d06-9033-c4abe05a2978","order_by":4,"name":"Bayeh Abera","email":"","orcid":"","institution":"College of Medicine and Health Sciences, Bahir Dar University","correspondingAuthor":false,"prefix":"","firstName":"Bayeh","middleName":"","lastName":"Abera","suffix":""}],"badges":[],"createdAt":"2025-08-02 07:08:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7276190/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7276190/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12879-025-12427-8","type":"published","date":"2026-01-03T15:57:38+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":90879920,"identity":"dd405e15-6229-42e5-9878-dfd40e27ac41","added_by":"auto","created_at":"2025-09-09 09:37:39","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":10513,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of bacterial isolates from pediatric patients with pharyngitis in specialized hospitals, Northwest Ethiopia, 2024.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7276190/v1/517b8bd2182abdd5903bf43f.png"},{"id":99545383,"identity":"51b4518b-6d28-4dfd-90bf-b15e990acdcd","added_by":"auto","created_at":"2026-01-05 16:06:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1391571,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7276190/v1/1f2ea4a6-7f4a-4098-b5f8-6776145a71f9.pdf"},{"id":90879922,"identity":"e6b0d6ac-7f0a-4ce1-8601-9a5597f6851e","added_by":"auto","created_at":"2025-09-09 09:37:40","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":27346,"visible":true,"origin":"","legend":"","description":"","filename":"AnnexII.docx","url":"https://assets-eu.researchsquare.com/files/rs-7276190/v1/e22daf007900181f15deae3c.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Bacterial Pharyngitis, Antimicrobial Susceptibility, and Associated Factors among Children at comprehensive specialized hospitals, Northwest Ethiopia","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePharyngitis, an inflammation of the pharyngeal mucosa and tonsillar structures, is among the most common upper respiratory tract infections, particularly affecting children. Because of its close proximity to the salivary glands, oral cavity, and external environment, the human pharynx\u0026mdash;a mucus-rich, aerated anatomical region\u0026mdash;is constantly exposed to a variety of microbial agents (1, 2). A common cause of pediatric morbidity, bacterial pharyngitis is mostly caused by Streptococcus pyogenes (Group A Streptococcus, or GAS) and is frequently transmitted by direct contact with respiratory secretions or infected surfaces (3). The illness burden is also influenced by other bacterial infections, including Moraxella catarrhalis, Haemophilus influenzae, Staphylococcus aureus, and Streptococcus pneumoniae (4).\u003c/p\u003e\n\u003cp\u003eBecause of its high frequency and potential for major problems, particularly if left untreated, pharyngitis in children is a specific concern. These consequences include glomerulonephritis, rheumatic heart disease, otitis media, peritonsillar abscess, and even potentially fatal disorders including airway obstruction and septicemia (5, 6). Young age, overcrowding, seasonal fluctuations, exposure to environmental factors (such as smoke and dust), and a history of recurrent infections or contact with sick people are all factors that increase the risk of contracting the disease (7, 8).\u003c/p\u003e\n\u003cp\u003eThe rising incidence of antimicrobial resistance (AMR) among the bacterial pathogens that cause pharyngitis is a cause for increasing concern. Irrational antibiotic usage and self-medication have been the driving forces for resistance mechanisms, such as the creation of beta-lactamases, genetic mutation, and biofilm formation (9, 10). The AMR epidemic has been made worse in resource-constrained environments such as Ethiopia by inadequate diagnostic infrastructure, restricted access to microbiological testing, and inappropriate use of antibiotics (11, 12).\u003c/p\u003e\n\u003cp\u003eThere is a lack of local epidemiological data in Ethiopia, especially concerning the bacterial profile, patterns of antibiotic susceptibility, and related risk factors among pediatric populations, despite the clinical and public health importance of bacterial pharyngitis. Current and thorough information on the prevalence and microbiological characteristics of bacterial pharyngitis in children is lacking in northwest Ethiopia(13). In order to ascertain the frequency of bacterial pharyngitis, pinpoint the causing organisms, ascertain their patterns of antibiotic susceptibility, and investigate the risk factors linked to it, this study was conducted among pediatric patients who were seen at comprehensive specialized hospitals, Northwest Ethiopia. \u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA hospital-based cross-sectional study was conducted from June 1 to August 30, 2024, at two specialized hospitals located in Northwest Ethiopia: Felege Hiwot Specialized Hospital (FHSH) and Tibebe Ghion Specialized Teaching Hospital (TGSH). These tertiary-level institutions provide comprehensive inpatient and outpatient services to a wide catchment area across the Amhara Regional State and surrounding regions.\u003c/p\u003e\n\u003cp\u003eBoth FHSH and TGSH function as referral centers and are equipped with advanced diagnostic and therapeutic facilities. They serve as medical teaching and research hospitals affiliated with regional health science institutions. The hospitals include well-established pediatric departments, alongside other specialized units, and play a critical role in delivering healthcare services and clinical training in Northwest Ethiopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe source population included all pediatric patients visiting FHSH and TGSH during the study period. The study population consisted of children under 14 years old presenting with signs and symptoms of pharyngitis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026middot; Children \u0026le;14 years with clinical features of pharyngitis.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Patients or guardians willing to provide informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026middot; Children who had received antibiotics within the past two weeks.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Children or guardians who declined participation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eDependent Variables:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026uuml; Presence of bacterial pharyngitis\u003c/p\u003e\n\u003cp\u003e\u0026uuml; Antimicrobial susceptibility patterns\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eIndependent Variables:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026uuml; Socio-demographic: Age, sex, parental education, residence\u003c/p\u003e\n\u003cp\u003e\u0026uuml; Clinical: History of pharyngitis, contact with coughing patient\u003c/p\u003e\n\u003cp\u003e\u0026uuml; Environmental: Exposure to wood smoke, overcrowding, school attendance\u003c/p\u003e\n\u003cp\u003e\u0026uuml; Clinical Signs: Tonsillar swelling, exudate, fever \u0026gt;38\u0026deg;C, difficulty swallowing, lymph node enlargement, tonsillectomy status, vaccination history\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOperational Definition\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003ePediatric children:\u003c/strong\u003e For this study, children aged 0\u0026ndash;14 years.\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eBacterial pharyngitis:\u003c/strong\u003e Pharyngitis cases confirmed through positive bacterial culture.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size Determination\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size was calculated using a single population proportion formula, assuming:\u003c/p\u003e\n\u003cp\u003e\u0026middot; 95% confidence level (Z = 1.96)\u003c/p\u003e\n\u003cp\u003e\u0026middot; 5% margin of error (d)\u003c/p\u003e\n\u003cp\u003e\u0026middot; Prevalence (p) = 21.3% (based on a prior study in Harar, Ethiopia)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Single population proportion formula\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cimg 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Jrnu3zauepY2otuLcdQzEb2ctYcMpNt0nW5p7e/fvwCAT58+1Wk7OzsIw7D+3DVcsMkZ9Lpb3LW0DRnIemNMo+yrWgRk9fZxHDtn38MaEmiTJAlOT08BAL9//67nV3z+/BllWTq7w8uy1Ek1V/7t7e3WdY/VVQYs1utftvz7nuzXte+qqjCZTJb2+1xj2fP5vP61hb20XW8Rx3FjyMAeepOfre7v79e/9lnFSw4ZjEaj+lyljNJOXfrqg4iez1oBwXQ6xWw2w2QyWbpxsyxzvih2dnaWfq61tbUFqElnv379wsHBQf356urKOe8gyzLs7+8vHV+Tl1efwWCw9JDWi6scURQhjmOYFV9OXaReu4KsP3/+NOrHliRJ57ZtfN/H/f29Tq61BV19db+urjL4vt8516JL1/kNBgPc3t7q5GcTBIFzfkSfr1+/4uzsTCdjOp1iPB63ts8uw+FwqY3r5TkCo+Pj40bgYk8wtG26fRHRalYOCKqqwvHxMeI4dj6Azs7OnDeyfEO1DQYD+L5fP5DlhXh3dwd0zNCWb0r6W5KeCFeWZe836k2wjzubzRrrxHQ6dQZKQibf6TqyVVWF8/Nz5zcr6Umx696uc+ktcF2bb9++4ezsrPFtUOr+/PwcZVk2rsXl5SXSNK0/b0Icxzg7O6vr6OrqClj8nYWiKPDt27elv7PQ1j60rvP7+vUrxuNxo/dnOp1u7JuxLVv8DQ5dlrYg2jYcDuH7PqIoWppAC6sNvmRwsy6ZTJmmaePeHY1GmM1m9TWoqgrj8Rjfv3+3tiaiF6PHENq0jeXK0jXu1zaWa2+f53k9vhzH8dLYp2ssUvLa+sbaN0XGaO1y2PUgY8a6fKKt/MLed9scgFxNjLNJXaJjXoJR+aDGhfU56jkK9jb2Zxk/12n6WMLOK/VoX3997SeOCaP6s5RVH9M+P71N27Wwyydj3PJZxsHt/ZSLv5shn4XOly4mgdpprvukbR6IfU/adfS///u/jX3qe+kp9Dm45lHIObjmNmh6gmpXWyWi5+WZTfR59yiKAicnJ0tDB88hCAJcXl4+S5cnERHRe/UiAQEW3YbHx8cbGXNv43keJpOJc0iDiIiI2r1YQIDFGGGSJGv//wxWEQQBbm5unGPlRERE1O1FAwIiIiJ6nVb+lQERERG9XwwIiIiIiAEBERERMSAgIiIiBgREREQEBgREREQEBgREREQEBgREREQEBgREREQEBgREREQEBgREREQEBgREREQEBgREREQEBgREREQEBgREREQEBgREREQEBgREREQEBgREREQEBgREREQEBgREREQEBgREREQEBgREREQEBgREREQEBgREREQEBgREREQEBgRERESEpwQEQRDA87ylJUkSnfVJ9P5lybJMZ321ptMpPM9DVVV61YsqiqKuvyAI9GrasCiK6vqeTqd6dUNVVfA8D0VR6FWkBEHwJu5//ZxKkuTR912WZfA8TycvSZKkN588j1Zpb237s58lbW17nXPNsmyprmT/fc9Nuyxd+b2W95NdH/pc9ed3zzzBZDIxAExZlo3PYRjqrE+Spqmxiyqf4zhu5KN2ZVnWdSj/nkwmOhttSBzHJk3T+t++7+ssNbkeAEye53o1WXzfNwDqun2t5HpuopzyvOt7XEuernxSf/LM7tK1P2mreZ479xfH8VJamzAMG8/yOI7rz3JvtO2rLMvG+yYMw6X88l6C452R53kjLQzDxv7k+B/lvly+0mvQAYFpuSBPpQMCYzXs12idm+GlpGm68UCN2q3yEHmPD56yLJceutpT26Hv+xt50fZ5ajmxoYDAtDwDXbry+b7fGZi6uPangwCoLxeTyWTlLxtpmjbaiysAsAMETR9HttfpZnH+ej/6OT2ZTJbqSPb5ETx6yKDNwcEBAODv37961UYdHh4Ci67W16QoCozHY538n7u7u9NJ9ExWaZNZlmE+n+vkN8/VJWubTqeYzWY6+dXpO4+3JssylGX5Im3u9vYWR0dHOnlJVVU4OzvD9+/f67Q/f/7A930MBoM6bX9/Hzc3N/Vnmz6Ovd0qdP77+3tcXFw00gaDAdI0fXdtwmXjAYG8eLa2tvSq1nkHsqxT4fLQlQsq44qyLxkbs8ei9HhQkiSIoqgxhqTHJlfZXsaKgyDA3t4eAMD3fURRBLSM/+lxK3ssT9bBmkMh+2rTtT/P8zAejzGbzeD11LO9D51PxrllsccO29bJZ6lXqSv7fFzXLssyBEFQ17+URZ+nsMfg7bF7mx5rtOtIl79vbNVuy/a5ZFkG3/cBAHt7e/AcY5pJkuDs7AxlWcJztLlVy6/3a2s7HztNrpHUsX0ernxYlC1JksZ1kPVBEGA2m2E8HjeOKbIsw/HxMeAYz22rzy52Pem6aCu/ZrcvKU8URY375X/+53/qfel6tK+dXef6mmKxX31u9nnrbexnz1P9+PEDcRw3jqevz6qGwyGw+NIn+9jd3QUW5zgajRr52/z8+RNhGDZeyre3t865B2VZ6qROUp51SDvRQQYAfP78+VV+0ds43WWwDj1kIF1JT+1q03S3lRxXun9k+ECfju5qkuEMWSfbSB45jnTbrrq93c2ru9Nc43+6W8o+rj3eJdvIPtu6k7v2J+I47r0u9jbSTSbnr7u07WvStc44unjtsriunV1nuivSvh7xYmxeji+LlANWl62+LrKtWZTfrj/drjXf9xvlgmrzuj5c0jRtHNM+B7v8cpw8zxvH0HVs6zsf3U1rFvsX9n7ttiftH1a7sOvROMaDNSmLra8+NWkzUmb7vjQd5ddya/xYl0vfL65rardrvV6uj6yXMtr7lLZrby/1oI8v9d7H1S5k32EY1sfTddbGtT+jxuWlzGma1udvPx/b7iNXW9HnbRzXpstkMmk8a2y+Y8hA2G1bH1+gpR29J6vVcgv98gLQeDhsiv2CaLto+qUjN4FujLBuUlfjk0bz2O31i8c4bir9ADRqMou+AfTDRuvbn2kpqy11zDGwXyRxxzhe1zrjuDa6LHq9cbwwjbpp7aUsS2cd2fsNw3DpGMLVvtAyDjlxjDHql46rLJo+P9c2dvntB6y9uI7Rdz6lChjKsqz347qnoV5s9rXW56HXa7ptr1Kfmm4vUneTxdi1LrtdflvXcXQbXeX66PPWx7XvSTm2XtqePXJN+7jyuZ5Jdp11ce3PpSzL+lzleMbRPmz6OhpHvRtHm+nSdizTExAIXwWbtlXq663byJBBWZZYBBedY1RPHTKQYxhjcH19rVc3tM1h8H2/czxduqseu/0qXN1fg8Ggs+66bGJ/rnP69OkTsKgL3SVr61q3SfP5HHmeN9qBMWZpHNClqy7u7u6QpunSfl1dh/f39zqpHh57eHjQqzamqipMJpOlMkr3ra3vfAaDAYIgqLtIf/78We/n/v4ecRwvbXt6eto4xqZsoj7t679O+YfDIcIwrId2+p4/Xda9Bx4eHhCG4VI5R6NR67Nnk1a5Z9aRJEldx79//66HzT5//oyyLFeun/39/aV79f7+vt5flyiKlrZd11O3f+s2EhCsaj6fL90A+mbYtD9//ugk7Ozs6KTafD5vrF93+1Xd3t7qJOfY2ao2sb+2yV5bW1sYDAatN3XXuk0KggC/f//WySsJgsAZ9GBxPX/9+qWTW7U94CSAeg6DwcB5jV1WOZ+TkxOcn5/rZGxvb7dO4HouT61P2XZ3d3ft8l9fX8MYgziOMR6Pl8bx1+E6hzafPn1qvd/EpgIDCfZcz7JV67hLkiSPena77snd3d2l9nB3d4dv37418mlJkjjb82P4vu+cA4cN1ddr9qIBwUuS6P/4+LhuXEVRoCzLxreF2WxWr59Op/X6Vbfv0vZwSdMU4/G4MdlpPB4/ukFvYn8y09ee9HR1dYU4jjEYDPD161fMZrPGOU2nUxRF0blOyI1fVVU9YUtPsOpzcnKCs7Ozxn6zLFvpQXxycrJUR7Ltly9flspfFIVzMppce/mVC6zJUa5v66toaye2r1+/LpVf17FY5XyOjo5QliWiKMKXL1+W0u1vy1VVrVRGW1VVzvqzZVn26Pq0A54kSep2uk75i6Ko841GI8RxrLMA6vpIr4U8K87OzpBlGU5OTjCbzepzlv/Kem04HDYmHoskSep1JycndfqPHz+AJ/yhnMlkUk/oxOKc+up4FUVRYH9/v9HjIL0CsHoLXD0SBwcHS/fuYDBAHMf4559/AOtXW13P3CRJsL+/3zgXXa+ryrIMh4eHS+WV++yp9fXq6TGEVclYiz329RzsY6BlLLCrHHrc2SbjVfa52ONspmN7O12PW0n6ZDHBxbW9TpcxK52ux0TbxrD0dvYYmJ3etQ8ZV5RF16Ue97TXd62zz0HG8WSc0LVNrMbLbfo808VEJjtN15nsV6fbbUnvQ49jam15dfl02xD28XS59Oe28uvrY1vlfFzjtcbRDuQc7PtE5grY+Yx1/m3nbe+7rY26yqTZZdHPhLbya/liUqHruHZdCztvvJhMaR/bvvaSV9bbzwv7OHY57WPpdbK/LvqZrO9zu3y6jqV8tr795Wqiq80+ln6mCtdcCWHXl2vug7R9/XyWpeveRss11dvZUsdE3PfIM/82vA8pSRJUVdU7H4GIiDYvyzLc3d09asjhJXmeh7Isl3oO3pt3O2RARESvmwwFPLaL/7lVi78tkef5uw8GAODD9hBEUVRP6vF9/8PPLiUi+q9Mp1Pc3993zhX4L3ieh4/0ivywAQERERH9Hw4ZEBEREQMCIiIiYkBAREREDAiIiIgIDAiIiIgIDAiIiIgIDAiIiIgIDAiIiIgIDAiIiIgIDAiIiIgIDAiIiIgIDAiIiIgIDAiIiIgIDAiIiIgIDAiIiIgIDAiIiIgIDAiIiIgIDAiIiIgIDAiIiIgIDAiIiIgIDAiIiIgIDAiIiIgIDAiIiIgIDAiIiIgIDAiIiIgImw4IkiRBEAQ6+dGCIIDnefA8D9PpVK+uFUVR5/M8D1VV6Swbsenza5NlWX0uSZLo1e9SEASN6xZFUes17aubJElQFEX92fO8xnoiInIwGxLHsQFgfN/Xq55kMpn07leOHcexXvXmTCYTE4Zh/W8ApixLne3dKMvSADB5ntdpeZ6byWTSyCfCMDRpmhpjjAGwlG8ymSyluY5BRERNG+shGI1GiONYJ29EHMcoy9LZS1BVFW5ubuD7vl71Jl1eXuLg4AAAcHR0BGMMBoOBzvYmZFnW+Kbucnh4iDzPMRwO67SrqyscHR018onZbIbt7W0AQBiGuL29rddVVYXb29ulbQeDAcqyxN7eXiOdiIj+z8YCgue0v7+PMAxxfn6uV+Hnz5+4uLjQyW/WfD7XSW9SVVU4OzvTyQ1ZliEIgkYwUBQFxuNx55BAm3/++Qej0UgnA4ugIE3TtfdJRPRRPDkgkLHevrF1PSaslyiK9CYNJycnKMty6Rvn2dnZ0jdCOOYV2PufTqfwPK8eq5d1kq4XOWYURY39JEmCKIoax8qyrF7vkiRJY99C9lGWJc7OzuB1zJvQ5RSyDzkvuSZBEDTmJcj52GmeGqeXl7WUt+1Fam8vZSmKou6x2dvba20bP378wMnJSSNta2sLxhgYY+rAwC5XGIa4v78HFr0F+/v7wKK8X79+rfO5fP78GePxWCcTERGeOIcgDMN63F7GabvG+h/DHhP2fb8eX5d1cnzf9xtzCHzfr8ea8zyvx5BlXB5AvV7nMcaYNE0b4/dhGBoA9fFl3oKdJtu0ieO4UUbZp80ut4t9zmaxT9/36/JDzaXwfb9Ot6Vp2qhLOZ+yLOvzgGOM3hbHcWMfdp32jdv3rRdhGDaOIdvZ55nneX1c+/q6yr7KMYmIPqL2t1cPeQHZ5OW0SXZAIA97eaD7vl+/sHVAIOwXhGwnaa58wvXC0i8n/ULU+7DJ/vQEQajApC8gkCBCL2VZ1tdEH8O1T31uRtVhmqYrX0v7Jb1qQNBWVk3208W+7nLMtv2jJVAgIvroHj1k8PDwoJM6PXXIAItJdgBwcXGBoigQBEHrhDvpVr+9vUVZlnr1Etm3dNP/+fMHABrj20/x9+9fnQQA8H0fd3d3OrnVfD5Hnud1t7osbfXg0vazTP3Tvz5VVcHzPBweHsIY8ywTOweDQed+kyTB9+/fgcVQBRbDDnLd5DoSEVG3RwcEYtUXyPX19dJLzF6ur6/1Jk5pmmI2m+Hk5MQ5yRCLMh0fHyPP89ZJZi6TyQTHx8fwPK/eftNcL6idnR2d1CoIAvz+/VsnP4prP+sEFoeHh0jT9FETIbe2toCOQElUVdU6B2E6nWJ/f3+tMgPAp0+fdBIR0Yf36IBAvlHbk83G4zHKsmx9gG/C6elp/e++b+/Si+F6CWtVVeHy8rIRpPTtfx3D4RBhGOL4+LgOooqiQFmWjXPqc3JygrOzs8bkyizLVg7MsHjpx3Hc2E9VVZjNZvW37VVJ70ZVVa09Ma6JlvLNv6+n6fDwsDWo0z8xlOv19+/f+rx2d3fr9ZK2yetKRPRu6DGEddhjx1hM8lp13HkV9oQ4e79pmi7NK7CXsiwbk/7sf9v7lLzGGtPWixzXHruXuQR2Hnsinr1fTc8BEK7jt+1DH0vqw06TsXs7Tc+xsOvFPp5Ob2Mf019M+LSPI3Wt5y8IPbHROOqnrQ7aymXXo54rkKbpUh0QEdG/PPPvw/XDq6oKf/78WfoJI79VPq8gCHB5efki9estfta57hADEdFH8Oghg/fm8PBQJwGLCYwv8bL6qObzOfb29lr/5sImyOTHPM8ZDBARtWAPwUJVVc7Z7PxG+TKiKMJoNHqWuvY8D2zmRETdGBAQERERhwyIiIiIAQERERExICAiIiIwICAiIiIwICAiIiIwICAiIiIwICAiIiIwICAiIiIwICAiIiIwICAiIiIwICAiIiIwICAiIiIwICAiIiIwICAiIiIwICAiIiIwICAiIiIwICAiIiIwICAiIiIwICAiIiIwICAiIiIwICAiIiIwICAiIiIwICAiIiIwICAiIiIwIFgWBAE8z0MURXoVERHRu8WAwJJlGW5ubmCMwXw+x3Q61VmIiIjepTcTEERRhCAIdLJTFEXwPA+e5yHLMr26lmVZna+qKpyenmIwGAAALi4ucH9/38hfFAU8z2uk2WRfq/QuJEnSm386ncLzPBRFoVc1zjFJEr0aWKG8WJTDDnyqquqtN03K6XneSkGU5O3K33a9pXyy2HUTRZGzrjbNrjP73PvqWtj5u+o5SZLWa+t1XHchbUTqcdXyia7jv5Zrbusqr9B1IPtsuweF3Et6sa+fbgtVVa20/XQ67S33OvSx7HIIXVbdDrvW0TtmXrmyLA0AA8D4vq9XLwnD0MRxXH8GYNI0beSR9K7Tn0wmZjKZGGOMSdO0zuv7vsnz3AAweZ7X+e3PaZqaMAzrdVqapvW+5fx0/jAM6zLaxzHGmDiO6zTZXvZnViyvrLPrRrZrqzOXyWTSuC6+7zfKotl55Xh2/r7r7dper1+17I9h7z/P80ZbC8Nw6Tpqvu83tmmrL7lmdl6zqG+pH71OyLa6LFK3uh1oUsbJZGLSNDVxHDfq/TVe867yGqtOyrKs0+y6WOWe1cIwrLfX95h8Fn3bp2m6VObHKMuycR7yHLHP2yyeIW1WbaP0/rS/EV8Z102uyYPFJg9Qm+thqekbRh5EcoPpF7DeX9eDV99croeccTxkhL65wzBceuB0ldcszk9vI7BGQKAfFvplYcvzfKns+uEjXNdbbyvXW6f7iyBo03Sd6eN2nbtpeSHrfdrpoQpubW31Jm3GtU/Tco+4+L5fLzr/a73mbeU1izZtb7PuPetKt8vqeqHbx+zb3iz24aqXdej7XOpLXy9XecyabZTenzczZLCKP3/+6CTs7u4Ci240LLoVfd/H9fW1yvl/sizD9+/fG2l3d3cAgNls1kgHgF+/fuHg4KCRFoYhfv/+3UgTR0dHjc/b29uNz31kWEPM53Ocnp420rrKWxQFxuPx0jbrqqoKZVnWdYxFfZdl6eymHA6HS2V3dRG30dv+/fsXcRwvpV9eXuLk5KSR9lSuOtPHvb+/x8XFRSPNJvl1u9DX39X+VnVycoI4jluv7WAwQJqmvV3UZVnWi+21XvO28mJxz+tt1r1nh8Nh4/N0OsXh4WH9eXt721kHcsy+7QHg9PQUNzc3rUMiq9DPFl1PAHB+fo69vT14jiGkVdsovU9PCgiiKKrHU2W8qWt8UI+f2UvfGN46um6o8XiMb9++NY5t38QyXjYYDOp/Z1mG8XiMsizh+z7yPMfx8XF9nNls5rxh5KW8ijAMddJKoijCzc1NI62vvFdXV4jjuLHNY0gA5nro/P37Vye12t/f10m9qqrCxcUFRqORXoXhcIiyLJ3tQI+duhb9UMcKdSbtXj+QtTRNcXZ2hul0iul0ip2dncY2UmZXnfYpigJlWWJnZ6c+F9fL9/PnzxiPxzq5FgQB4jhGmqZI0xRxHNf7eY3XvKu8WNzzX79+bWzz1Hv28vKysc+joyP4vg/f94HFfekKToTeXhweHuLq6konL82jcC1tz15YX4wA1BOn4ziG55gj0NdG6R3TXQarsse4pZvL1eW3KavuG2o4wO52l3/b66Wb0SyOIedkn5eQ7TXdJWcccxm6hGG41AVqOoYMjBp3dR3fdJTX7xlnR0eXs801HOPqcmxTqvFOW9f1luEQWVxcwyhP0VVn9r3Qdj42aWeu9mGndbUhV7e71IuUU66Fzmd6usdFHMdL277ma+4qr9wD+v6C457pqm+trZxSvr66aNu+a/jlMSaLeRVt5Hrq+ulqo/R+PbqH4Pr6GmEYIo7jOmLf2dnR2V5cWZaYzWZ11Ly3twcsvjU+PDwAi7KLy8vL+tvkaDTCYl4FjDFL30SGwyH+vec3Zzqd4uDgwPmNq8tgMIAxBnmeA4tuQK2tvGVZOr8dvbQkSZbqeBWnp6f1NxxYvTraqt/2VtFVZ9fX1zDGwPd9zGYzZ8+E7ebmBnmeYzweN3rGnjJUgMX5hmFYDxfI8EBbb4DcD21Go9Gjrk+X57zmrvLKOa57f3VxdfdLuvRQ7O3ttX5jb9tedPUsrOv8/Lx1+AiLno0wDJeGW9vaKL1vjw4I1vVSQwbyopTF932kaaqz1ba2tnTS2sIwXPqJ4nw+7w2QqqrC7e1t5w3bZzgcYjKZ6OSN09dvOp3W3ZB2F7t0G/fVa5ZlOD8/f9KDejQarT3U8tghg1XM53OdtCQIAlxeXtbB2mw2q8fzf/z4Ad/363LMZjOMx+MnlaktiHmst3jNXR57z6Klu78oivrlOxqNMJlMGsN0Ntf2fR4zZBBF0UptUs+l6Gqj9L69WEAg36Lalq5Jfo8l3yLkhasnGNr6HmZdDg4O8OvXr0ZaWZb48uVLI007PDxc+kbzGJ8+fXKOFbfxfX/pYdhHX7+joyMMBgP4vt/4dvHw8IAwDDsf+vLg0hOtHmMwGLS+9FwP96Ojo6W2pxdX2VetM9/3W9uSjPHb6yeTST0HZD6fN8ohPXBtZdL29/edk0hlXFv79OmTTur12q+5JueoA6rH3rNYzD/Q53F1ddW4B+Wbt56ch5btba7rpb/ouBZ7nD9JEmevocuvX78az8auNkrvnB5DWIcec3P99GZTusYXXfyWnx/pMrrGHR/DHjdcZZ+6bGVZLm3TNYfA5q/5M7u+8mHFOQTGMebZV97JZLJ07DRNl7ZZ5Xrned6ap68c6+qrM7Piz8b0uGzXfvX9ZXPNITCObXzHb8jb5pas6rVe8zZt5Vv3njUt5yLp+jj6s+RzbS9WLUeXePE3GWxt8zbSNF2619dpo/S+PPqpIC9cLCZSxWpC3ibZ+9U3mW9NCrQn2ulGbrPLuqmGbh9b33wyISpf/CZbn48s9sQeXZ92Obu2W0XbC0EearKs+uC1J3zpB5F9ffTEMFl0fen1cr11+fR24jEvjT6uOtPXSLc516Q+ff272p9+uRurHPai2femvh5mxcClz2u75l3aXmir3rO20PpjQpo+V1e+ru3NI4J7LbQmuNqLtE1dn7rNmjXbKL0vnvn3ZqQPJkkS7OzsPGn+wmsVRRFOTk42/lOp91JnnuehLMvOLv735i2c83Q6xeXl5bMMnxKtggHBBxZFEQaDwUbmMbwWQRDg27dvz/bSfst1VlVV/Xcpusaw36PXfu5ZluHHjx8rTQIkei5vOiDwHH9pi6jLJpp7lmXY3t7eeA/Ec+P98q9NtIFNarsur62c9P696YCAiIiINuPFfnZIRERErxcDAiIiImJAQERERAwIiIiIiAEBERERgQEBERERgQEBERERgQEBERERgQEBERERgQEBERERgQEBERERgQEBERERgQEBERERgQEBERERgQEBERERgQEBERERgQEBERERgQEBERERgQEBERERgQEBERERgQEBERERgQEBERERgQEBERERgQEBERERgQHB21QUBTzPg+d5mE6nejUREdHaGBC8QVdXVzDGIM9zHB8f69VERERrY0CwIs/zlj57nocoihrpbfryR1FU5/E8D1VVYTqdIkkSnRWj0QgAMBwOEYYhqqrSWeiDmk6na/Ue9eXvW2+3Wdf6qqoaedraPxH99xgQ9JDu+bIs6zTP85DnOYwxODg46H3I9eUvigInJycwxtTLYDDA0dERdnZ2EARBI782GAx0En1A0+kU5+fndRs6Pz93vqRFX/6+9UEQ1OvSNMXx8fHS8f75559Gu76+vm6sJ6JXxFAnAKYsy/pzmqYmDMOlPHmeN9LEKvnjOG6s19I0debJ89xMJhOdTB+U7/uN9jCZTIzv+408tr78XevzPG/cF2aR326nZVmaNE0beYjo9WIPQYckSRDHceMb+K9fv3BwcNDIF4Yhfv/+3UgTffmLosB4PIbnec7hAQA4PT3Fzc0NiqJopF9dXeHo6KiRRh9TVVUoyxK7u7t12u7uLsqydA4p9eXvWz8cDpd6pnRP1j///IOzszN4nrfUdono9WFA0GE8HuPr16+NtNlshu3t7UYaANzd3ekkYIX8W1tbdXeqBAauB/jh4SGurq7qz0EQ4Pv37wCALMusnPQR/fnzB2gZPvr7969O6s3ft77N/v5+/e/v37/DGIPJZIK9vb2loTIiel0YELSQbzRbW1t61UbZD1xjDMIwdPYU7O/v4+bmBljMSSjLEr7vw/M8fP78WWcnelESxNo9VtK2j46OUJYlZrPZ0hwDIno9GBC0eHh4AFq+IT2n0WiE2WymkwGgnthoT9IyxmA4HOqsRC8qSZL61y8ug8EAaZri9vZWryKiV4IBwZrCMMT9/X0jbT6fY2dnp5Em1s0/GAzg+75OJuokY/32cJN07bt6ufry9623ZVmG8/Pz3uCZPVlErxsDghafPn0C1AMRAA4ODvDr169GWlmW+PLlSyNNrJu/qqqlyVmCgQK1kUBSxv6x6OUKw9D5ou7L37deyBDAKr1Uv3//bswxIKJXRv/sgP6P/nmgKz2OY+dPAm3r5Pd9f+nnXGaF7Yj0zwbb2q/oy7/Ket0m0zR1HjPP86Wf3xLR68KAoEPbS7gsSwPAAFh6yKVpuvTg7MofhmG9DupvHth833c+aIls0v4ALP2NCt/3l/4uQVf+rvV2ur1I+7bbvJ1ORK+XZ/6N/KmFzOh3dbu+lOl0isvLS/6VNyIiejacQ9BDft73X/1hFZmwxWCAiIieEwOCHoPBAMYYnJyc6FXPbjqd4u7uDvP5XK8iIiLaKA4ZEBEREXsIiIiIiAEBERERMSAgIiIiMCAgIiIiMCAgIiIiMCAgIiIiMCAgIiIiMCAgIiIiMCAgIiIiMCAgIiIiMCAgIiIiMCAgIiIiMCAgIiIiMCAgIiIiAPj/UmmqzF/KAb0AAAAASUVORK5CYII=\"\u003e\u003c/p\u003e\n\u003cp\u003eThere were non-responsive patients; the final sample size was 254.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling Technique\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA convenience sampling technique was employed to recruit eligible participants from the pediatric outpatient and emergency departments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA pre-tested, structured questionnaire was administered by trained clinical officers to collect demographic, environmental, and clinical information. The questionnaire was adapted from validated tools and pre-tested at Debre Tabor Comprehensive Specialized Hospital. The prepared questionnaires are attached in the supplementary file.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Collection and Transportation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThroat swabs were collected aseptically using sterile cotton swabs by rotating across both tonsils and posterior pharyngeal wall. The swabs were placed in Amies transport medium and transported to the Bahir Dar University Microbiology Laboratory for processing within two hours of collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLaboratory Investigation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCulture and Identification:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026middot; Swabs were inoculated on 5% sheep blood agar, chocolate agar (with 5 \u0026micro;g/mL gentamicin), and MacConkey agar.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Plates were incubated at 37\u0026deg;C for 18\u0026ndash;24 hours in 5% CO₂ candle jars.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Colonies were identified based on:\u003c/p\u003e\n\u003cp\u003eo Hemolysis pattern: \u0026beta;-hemolysis (S. pyogenes, S. aureus), \u0026alpha;-hemolysis (S. pneumoniae), non-hemolytic (M. catarrhalis)\u003c/p\u003e\n\u003cp\u003eo Biochemical tests: catalase, coagulase, bacitracin, optochin, bile solubility, oxidase, indole, citrate, and TSI.\u003c/p\u003e\n\u003cp\u003eo Gram staining was performed for bacterial characterization.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuality Control Strains:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cem\u003eS. aureus\u003c/em\u003e ATCC 25923\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cem\u003eS. pneumoniae\u003c/em\u003e ATCC 49619\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cem\u003eH. influenzae\u003c/em\u003e ATCC 49241\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAntimicrobial Susceptibility Testing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAntibiotic susceptibility was assessed using the Kirby-Bauer disk diffusion method on Mueller-Hinton Agar (MHA) and MHA supplemented with blood for fastidious organisms. Suspensions were adjusted to 0.5 McFarland standard before inoculation. Antibiotic discs used included:\u003c/p\u003e\n\u003cp\u003e\u0026middot; Penicillin (10 IU)\u003c/p\u003e\n\u003cp\u003e\u0026middot; Amoxicillin (10 \u0026micro;g)\u003c/p\u003e\n\u003cp\u003e\u0026middot; Augmentin (10 \u0026micro;g)\u003c/p\u003e\n\u003cp\u003e\u0026middot; Erythromycin (15 \u0026micro;g)\u003c/p\u003e\n\u003cp\u003e\u0026middot; Ceftriaxone (30 \u0026micro;g)\u003c/p\u003e\n\u003cp\u003e\u0026middot; Ciprofloxacin (5 \u0026micro;g)\u003c/p\u003e\n\u003cp\u003e\u0026middot; Chloramphenicol (30 \u0026micro;g)\u003c/p\u003e\n\u003cp\u003e\u0026middot; Gentamicin (15 \u0026micro;g)\u003c/p\u003e\n\u003cp\u003e\u0026middot; Tetracycline (30 \u0026micro;g)\u003c/p\u003e\n\u003cp\u003eThe zone of inhibition was measured and interpreted according to CLSI 2023 guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Quality Control\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026middot; 5% of questionnaires were pre-tested for clarity and consistency.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Standard operating procedures (SOPs) were strictly followed.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Culture media were tested for sterility and performance.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Laboratory processes were validated using reference strains.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Daily temperature logs and equipment calibration were maintained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were entered into Epi Data version 4.6, cleaned, and exported to SPSS version 27 for statistical analysis. Descriptive statistics were computed. Associations were assessed using Chi-square and binary logistic regression. A p-value \u0026le; 0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical clearance was granted by the Institutional Review Board (IRB) of the College of Medicine and Health Sciences, Bahir Dar University (Ref: CMHS 1037/2024). Support letters were provided to the study hospitals. Written informed consent was obtained from parents or legal guardians. Data confidentiality and participant anonymity were strictly maintained throughout the study in accordance with the Declaration of Helsinki.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003e\u003cb\u003eSocio-demographic features and prevalence of bacterial pharyngitis\u003c/b\u003e\u003c/h2\u003e\u003cp\u003eIn this study, of the total study participants, 124 (48.8%) were males and 111 (43.7%) were rural living. The participants\u0026rsquo; age range was up to 14 years; of which 98 (38.6%) were \u0026le;\u0026thinsp;5 years and 83 (32.7%) were 6\u0026ndash;10 years (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSocio-demographic characteristics of pediatric participants and prevalence of culture-confirmed bacterial pharyngitis in specialized hospitals, Northwest Ethiopia, 2024.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003eBacterial culture results\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP value (χ2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePositive (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNegative (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eChildren age (Years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26 (26.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e72 (73.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.45 (χ2\u0026thinsp;=\u0026thinsp;0.55)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u0026ndash;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26 (31.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e57 (68.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11\u0026ndash;14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20 (27.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e53 (72.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44 (35.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e80 (64.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e0.014\u003c/b\u003e (χ2\u0026thinsp;=\u0026thinsp;6.07)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28 (21.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e102 (78.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eResidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39 (35.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e72 (64.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.035 (χ2\u0026thinsp;=\u0026thinsp;4.47)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e143\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33 (23.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e110 (76.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\u003ch2\u003eClinical profiles of children with bacterial pharyngitis\u003c/h2\u003e\u003cp\u003eThe study reveals that children with bacterial pharyngitis exhibit various clinical symptoms, including increased body temperature in 175 (68.9%); weight loss in 136 (53.5%); and swollen lymph nodes in 156 (61.4%). The prevalence of culture-confirmed bacterial pharyngitis was 28.3% with a 95% confidence interval (95% CI, 22.5 to 33.9%) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eClinical characteristics of pediatric patients with culture-confirmed bacterial pharyngitis in specialized hospitals, Northwest Ethiopia, 2024.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003eBacterial culture results\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP value and (χ2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePositive (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNegative (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eWeight loss\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e136 (53.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e54 (39.)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e82 (60.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e0.0001\u003c/b\u003e (χ2\u0026thinsp;=\u0026thinsp;18.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e118 (46.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18 (15.)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e100 (84.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTonsil structural Changes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e131 (51.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e75 (57.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e56 (42.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e0.0001\u003c/b\u003e (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;54.01)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e123 (48.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16 (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e107 (87)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eType of Pharyngitis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAcute\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95 (37.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17 (17.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e78 (82.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003e0.0001\u003c/b\u003e (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;14.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChronic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e80 (31.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35 (43.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e45 (56.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRecurrent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e79 (31.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20 (25.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e59 (74.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eBody Temperature\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e79 (31.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17 (21.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e62 (78.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.105 (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;2.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e175 (68.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e55 (31.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e120 (68.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eWhite pharyngeal Exudate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e88 (34.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31 (35.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e57 (64.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.076 (χ2\u0026thinsp;=\u0026thinsp;3.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e166 (65.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41 (24.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e125 (75.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSwollen lymph Nodes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e156 (61.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e50 (32.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e106 (67.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.098 (χ2\u0026thinsp;=\u0026thinsp;2.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e98 (38.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22 (22.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e76 (77.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eDifficult to swallow food\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e146 (57.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e51 (34.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e95 (65.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.007 (χ2\u0026thinsp;=\u0026thinsp;7.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e108 (42.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21 (19.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e87 (80.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec26\" class=\"Section3\"\u003e\u003ch2\u003eFactors Contributing to Bacterial Pharyngitis in Pediatric Patients\u003c/h2\u003e\u003cp\u003eThe prevalence of culture-confirmed bacteria in children with pharyngitis includes a history of contact with patient 54 (43.5%), a history of previous pharyngitis 56 (42.7%), tonsillectomy 53 (41.1%), and 54 (40.5%) of incomplete or unimmunized; additionally, 50 (41.6%) of schooling, 47 (38.5%) of overcrowding live setup, and 44 (35.8%) of exposed dung/wood biofuel (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFactors associated with bacterial pharyngitis and prevalence of culture-confirmed cases among pediatric patients in specialized hospitals, Northwest Ethiopia, 2024.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003eBacterial culture results\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP value (χ2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePositive F (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNegative F (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eHistory of contact with cough patients\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e124 (48.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e54 (43.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e70 (56.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e0.0001\u003c/b\u003e (χ2\u0026thinsp;=\u0026thinsp;27.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e130 (51.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18 (13.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e112 (86.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eHistory of Pharyngitis\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e131 (51.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e56 (42.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e75 (57.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.001(x2\u0026thinsp;=\u0026thinsp;27.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e123 (48.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16 (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e107 (87)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eTonsillectomy\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e129 (50.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e53 (41.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19 (58.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e0.0001\u003c/b\u003e (χ2\u0026thinsp;=\u0026thinsp;27.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e125 (49.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e76 (15.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e106 (84.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eImmunization status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e129 (50.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18 (16.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e107 (83.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e0.0001\u003c/b\u003e (χ2\u0026thinsp;=\u0026thinsp;23.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e125 (48.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e54 (40.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e75 (59.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eAttending school\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e120 (47.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e50 (41.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e70 (58.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.0001 (χ2\u0026thinsp;=\u0026thinsp;19.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e134 (52.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22 (16.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e112 (83.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eLive overcrowded set up\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e122 (48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47 (38.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e75 (61.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.0005 (χ2\u0026thinsp;=\u0026thinsp;11.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e132 (52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25 (18.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e107 (81.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eExposed dung/wood biofuel\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e123 (48.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44 (35.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e79 (64.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.011 (χ2\u0026thinsp;=\u0026thinsp;6.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e131 (51.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28 (21.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e103 (78.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec27\" class=\"Section3\"\u003e\u003ch2\u003eDistribution of bacteria isolates\u003c/h2\u003e\u003cp\u003e\u003cem\u003eS. pyogenes\u003c/em\u003e 28 (35%) was the most frequently identified bacteria, followed by \u003cem\u003eS. aureus\u003c/em\u003e 26 (32.5%), and \u003cem\u003eS. pneumoniae\u003c/em\u003e 23 (28.8%) were found on throat swab samples. Mixed isolates were found: 5 (6.3%) \u003cem\u003eS. pyogenes and S. aureus\u003c/em\u003e and 3 (3.8%) \u003cem\u003eS. pneumoniae and K. pneumoniae\u003c/em\u003e (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec28\" class=\"Section2\"\u003e\u003ch2\u003eAntibiotic resistance profile of cultured bacteria isolates\u003c/h2\u003e\u003cp\u003eDrug resistance was found against 45 (56.3%) of penicillin, 43 (53.8%) chloramphenicol, 42 (52.5%) gentamicin, 40 (50%) tetracycline, and 37 (46.3%) ceftriaxone. \u003cem\u003eS. pyogenes\u003c/em\u003e, \u003cem\u003eS. aureus\u003c/em\u003e, \u003cem\u003eS. pneumoniae\u003c/em\u003e, and \u003cem\u003eK. pneumoniae\u003c/em\u003e showed an overall antimicrobial resistance rate of 100 (39.7%), 117 (50%), 85 (41.1%), and 17 (62.9%), respectively. \u003cem\u003eS. pyogenes\u003c/em\u003e showed a high resistance rate of 15 (53.6%) for chloramphenicol, 14 (50%) for gentamicin, and 18 (64.3%) for ceftriaxone. The resistance rates of \u003cem\u003eS. pneumoniae\u003c/em\u003e isolates were 19 (82.6%) for penicillin, 12 (52.2%) for gentamycin, and 10 (43.5%) for tetracycline and chloramphenicol. Similarly, \u003cem\u003eS. aureus\u003c/em\u003e isolates exhibited substantial resistance to penicillin 21 (80.8%), gentamycin 14 (53.8%), tetracycline 15 (57.7%), and chloramphenicol 61.5% (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAntimicrobial susceptibility patterns of bacterial isolates from pediatric patients with bacterial pharyngitis in specialized hospitals, Northwest Ethiopia, 2024\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"12\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u003cp\u003eAntibiotics test\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"10\" nameend=\"c12\" namest=\"c3\"\u003e\u003cp\u003ePercentage of bacterial isolates susceptible or resistant to, n (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAUG\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAMX\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eTE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eC\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCIP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eGM\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eCRO\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003eTotal N (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003eS. pyogenes\u003c/em\u003e (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eS\u0026thinsp;=\u0026thinsp;N%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e22 (78.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20(71.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16(57.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e15 (54)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e13(46.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e16 (57.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e14 (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e10(35.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e27(100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR\u0026thinsp;=\u0026thinsp;N%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6 (21.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (28.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12(42.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e13 (46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e15(53.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e12 (42.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e14 (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e18(64.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e98 (39.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003eS. aureus\u003c/em\u003e(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eS\u0026thinsp;=\u0026thinsp;N%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19 (73.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18(69.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16(61.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e11(42.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e10(38.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e11 (42.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e12(46.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e15(57.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e5 (19.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR\u0026thinsp;=\u0026thinsp;N%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7 (26.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (30.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10(38.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e15(57.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e16(61.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e15 (57.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e14(53.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e11(42.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e21(80.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e117(50)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003eS.pneumoniae\u003c/em\u003e (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eS\u0026thinsp;=\u0026thinsp;N%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16 (69.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14(60.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15(65.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e13(56.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e13(56.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e20 (87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e11(47.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e16(69.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e4 (17.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR\u0026thinsp;=\u0026thinsp;N%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7 (30.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9 (39.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8 (34.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10(43.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e10 (43.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3 (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e12(52.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e7 (30.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e19 (82.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e85(41,1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003eK.Pneumoniae\u003c/em\u003e ( 3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eS\u0026thinsp;=\u0026thinsp;N%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e2 (66.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR\u0026thinsp;=\u0026thinsp;N%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2 (66.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (66.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2 (66.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e2 (66.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2 (66.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e1 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e3 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e17(62.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u0026thinsp;=\u0026thinsp;80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR\u0026thinsp;=\u0026thinsp;N%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e22/80 (27.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28 (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e32 (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e40(50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e43(53.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e30 (37.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e42(52.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e37(46.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e45 (56.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e319(39.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"12\"\u003eCRO\u0026thinsp;=\u0026thinsp;Ceftriaxone AUG\u0026thinsp;=\u0026thinsp;Augmentin, AMX\u0026thinsp;=\u0026thinsp;Amoxicillin, E\u0026thinsp;=\u0026thinsp;Erythromycin, TE\u0026thinsp;=\u0026thinsp;Tetracycline, C\u0026thinsp;=\u0026thinsp;Chloramphenicol, CIP\u0026thinsp;=\u0026thinsp;Ciprofloxacin, GM\u0026thinsp;=\u0026thinsp;Gentamicin, p\u0026thinsp;=\u0026thinsp;penicillin, S\u0026thinsp;=\u0026thinsp;susceptible, R\u0026thinsp;=\u0026thinsp;resistance\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec29\" class=\"Section2\"\u003e\u003ch2\u003eProfiles of MDR bacterial isolates\u003c/h2\u003e\u003cp\u003eThe overall multidrug-resistance (MDR) rate of bacterial species was 33 (41.3%). The overall MDR of each bacterium, \u003cem\u003eS. pyogenes\u003c/em\u003e, \u003cem\u003eS. aureus\u003c/em\u003e, \u003cem\u003eS. pneumoniae\u003c/em\u003e, and \u003cem\u003eK. pneumoniae\u003c/em\u003e, was 9 (32.1%), 12 (46.2%), 10 (43.5%), and 2 (66.7%), respectively (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eProfiles of multidrug-resistant (MDR) bacterial isolates from pediatric patients with bacterial pharyngitis in specialized hospitals, Northwest Ethiopia, 2024.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAntibiotics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eS. pyogenes\u003c/em\u003e (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eS.aureus\u003c/em\u003e (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eS. pneumoniae\u003c/em\u003e (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eK. pneumoniae\u003c/em\u003e (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eTotal (80)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eR1 N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 (53.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8 (30.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (21.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e28 (35%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eR2 N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (10.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6 (23.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (34.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (33.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e18 (22.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eR3 N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (10.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2 (7.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (21.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10 (12.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eR4 N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (14.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5 (19.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (17.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (33.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14 (17.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eR5 N %\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3 (11.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (4.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6 (7.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eR6 N %\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2 (7.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (33.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3 (3.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOver all MDR N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (32.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12 (46.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10 (43.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (66.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e33 (41.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eFactors associated with bacterial pharyngitis\u003c/h3\u003e\n\u003cp\u003eBacterial pharyngitis was significantly associated with weight loss (AOR\u0026thinsp;=\u0026thinsp;2.58, 95% CI: 1.1\u0026ndash;6.05), chronicity (AOR\u0026thinsp;=\u0026thinsp;2.93, 95% CI: 1.08\u0026ndash;7.94), history of contact with patients (AOR\u0026thinsp;=\u0026thinsp;3.42, 95% CI: 1.47\u0026ndash;7.95), prior history of pharyngitis (AOR\u0026thinsp;=\u0026thinsp;8.86, 95% CI: 3.37\u0026ndash;23.29), tonsillectomy (AOR\u0026thinsp;=\u0026thinsp;5.65, 95% CI: 2.37\u0026ndash;13.46), immunization status (AOR\u0026thinsp;=\u0026thinsp;4.22, 95% CI: 1.74\u0026ndash;10.24), school attendance (AOR\u0026thinsp;=\u0026thinsp;3.44, 95% CI: 1.44\u0026ndash;8.2), and tonsillar structural changes (AOR\u0026thinsp;=\u0026thinsp;2.53, 95% CI: 1.03\u0026ndash;6.22).\u003c/p\u003e\u003cp\u003eChildren with weight loss were 2.5 times more likely to be culture-positive for bacterial pharyngitis compared to those without. Similarly, school attendees were three times more likely to test positive than non-attendees. A history of contact with symptomatic individuals increased the odds 3.4-fold, while a prior history of pharyngitis raised it nearly nine fold. Children with a history of tonsillectomy, unimmunized status, or tonsillar structural changes were 5.7, 4.2, and 2.5 times more likely, respectively, to have culture-confirmed bacterial pharyngitis (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBivariate and multivariable analysis of factors associated with bacterial pharyngitis among pediatric patients in specialized hospitals, Northwest Ethiopia, 2024.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCOR (95%CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAOR (95%CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (1.15\u0026ndash;3.49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.49 (0.65\u0026ndash;3.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.346\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eResidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.8 (1.04\u0026ndash;3.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.035\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.36 (0.60\u0026ndash;3.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.46\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eWeight loss\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.7 (1.99\u0026ndash;6.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.58 (1.1\u0026ndash;6.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.030\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTonsil structural Change\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (2.66\u0026ndash;9.37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.53 (1.03\u0026ndash;6.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.043\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eType of Pharyngitis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAcute\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChronic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.6 (1.8\u0026ndash;7.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.93 (1.08\u0026ndash;7.94)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.034\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRecurrent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.6 (0.75\u0026ndash;3.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.235\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.26 (0.43\u0026ndash;3.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.678\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eBody T\u0026deg;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37\u0026deg;C\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;38\u0026deg;C\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.7 (0.89\u0026ndash;3.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.43 (0.55\u0026ndash;3.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.468\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eWhite pharyngeal exudate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.7 (0.95\u0026ndash;2.91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.078\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.76 (0.76\u0026ndash;4.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.188\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSwollen lymph nodes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.6 (0.91\u0026ndash;2.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.05 (0.45\u0026ndash;2.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.917\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eDifficult to swallow food\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.2 (1.24\u0026ndash;3.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.007\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.64 (0.70\u0026ndash;3.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.253\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eHistory of Contact with patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.8 (2.61\u0026ndash;8.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.42 (1.47\u0026ndash;7.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eHistory pharyngitis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (2.66\u0026ndash;9.37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8.86 (3.37\u0026ndash;23.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTonsillectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.9 (2.13\u0026ndash;7.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.65 (2.37\u0026ndash;13.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eImmunization status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.3 (2.34-8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.22 (1.74\u0026ndash;10.24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAttending school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.6 (2-6.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.44 (1.44\u0026ndash;8.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eLive overcrowded setup\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.7 (1.52\u0026ndash;4.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.82 (0.79\u0026ndash;4.19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.161\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eExposed wood biofuel\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (1.17\u0026ndash;3.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.37 (0.59\u0026ndash;3.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.462\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this study, the prevalence of culture-confirmed bacterial pharyngitis among pediatric patients at specialized hospitals was 28.3% (95% CI: 22.5\u0026ndash;33.9%). This finding is comparable to a study from Norway (27%) (14) , but higher than studies from Brazil (20.6%) (15, 16) and Jimma, Ethiopia (8.8%) (17). Conversely, it is lower than reports from Malaysia (43.4%) (18), Nigeria (83.3%) (4), Pakistan (78.1%) (19), Iraq (93.1%) (20), Somaliland (32.2%) (21), and Ethiopia (75.1%) (1). The observed differences may be due to variations in sample size, geographical and environmental factors, immunization coverage, diagnostic methods, the use of self-medication, and the emergence of antimicrobial resistance.\u003c/p\u003e\n\u003cp\u003eMale children had a higher proportion of culture-confirmed bacterial pharyngitis, consistent with findings from Riyadh (22), Cairo (23), Iraq (24), Nigeria (4), and Ethiopia (25). This could be attributed to behavioral and social factors such as increased outdoor exposure and interaction, higher school attendance, and overcrowding, which increase the risk of transmission.\u003c/p\u003e\n\u003cp\u003eChildren from rural areas showed a higher prevalence of bacterial pharyngitis than urban dwellers, aligning with findings from Hawassa (25) and Bahir Dar, Ethiopia (26). Possible contributing factors include limited access to healthcare and immunization services, poor hygiene, overcrowded living and school environments, and the impacts of regional conflict on health infrastructure.\u003c/p\u003e\n\u003cp\u003eChronic pharyngitis was also associated with a higher bacterial isolation rate (43.8%), although slightly lower than the 57.7% reported in Somaliland (21). The discrepancy may be explained by differences in chronicity definitions, local bacterial strains, self-medication practices, and immunization status.\u003c/p\u003e\n\u003cp\u003eStreptococcus pyogenes was the most frequently isolated pathogen (35%), which is lower than figures reported in Tanzania (40%) (27), Sudan (41.4%) (28), Somaliland (55%) (21), and Ethiopia (42.5%) (29), but higher than in Nigeria (11.6%) (30) and Kenya (13.7%) (31). Such variations may reflect differences in strain diversity, population density, antibiotic exposure, and diagnostic methods.\u003c/p\u003e\n\u003cp\u003eStaphylococcus aureus accounted for 32.5% of isolates, similar to findings from Somaliland (29%) (21) and Bahir Dar (29%) (26), but higher than in Iraq (19.5%) (24) and Kenya (16.6%) (31), and lower than Brazil (63%) (32). Differences may be due to factors such as biofilm formation, antibiotic resistance, and tonsillar infections like tonsilloliths.\u003c/p\u003e\n\u003cp\u003eStreptococcus pneumoniae was isolated in 28.8% of cases, higher than reported in Nigeria (8.5%) (33), Kenya (10.3%) (31), and Somaliland (7%) (21). This could be attributed to low immunization coverage, regional antimicrobial resistance patterns, or diagnostic variation.\u003c/p\u003e\n\u003cp\u003eKlebsiella pneumoniae was identified in 3.8% of cases, consistent with findings from Somaliland (4%) (21) and Addis Ababa (4%) (34), but lower than Libya (43.3%) (15) and Kenya (20.6%) (31). Regional differences in pathogen prevalence, immunity levels, and healthcare access could explain these disparities.\u003c/p\u003e\n\u003cp\u003eRegarding antimicrobial resistance, S. pyogenes showed high resistance to chloramphenicol (53.6%), gentamicin (50%), and ceftriaxone (64.3%). These rates are markedly higher than those reported in Gondar (5%, 9%, and 13%, respectively) (Tadesse et al., 2023) but lower than Cameroon (92%) (Ndip et al., 2008). Resistance mechanisms such as aminoglycoside-modifying enzymes and mutations in quinolone-resistance determining regions may be involved.\u003c/p\u003e\n\u003cp\u003eS. aureus demonstrated high resistance to penicillin (80.8%), tetracycline (57.7%), gentamicin (53.8%), and chloramphenicol (61.5%), comparable to findings from Bahir Dar (84.1%) (26), but higher than in Gondar (65%) (35) and Somaliland (38%) (21). These patterns likely reflect overuse of antibiotics, poor prescribing practices, and resistance gene acquisition.\u003c/p\u003e\n\u003cp\u003eS. pneumoniae showed resistance to penicillin (82.6%) and gentamicin (52.2%), rates exceeding those from Germany (43%) (36), the USA (38.9%) (37), and China (56% and 21%, respectively) (38). These findings underscore the consequences of limited vaccination, over-the-counter antibiotic access, and diagnostic gaps.\u003c/p\u003e\n\u003cp\u003eAntimicrobial resistance patterns showed alarmingly high resistance rates, particularly to penicillin, which reached 80.8% across isolates. \u003cem\u003eS. pyogenes\u003c/em\u003e demonstrated high resistance to chloramphenicol (53.6%), gentamicin (50%), and ceftriaxone (64.3%), while \u003cem\u003eS. aureus\u003c/em\u003e showed resistance to penicillin (80.8%), tetracycline (57.7%), gentamicin (53.8%), and chloramphenicol (61.5%). These findings highlight the increasing burden of multidrug-resistant organisms (41.3% MDR overall), likely driven by antibiotic overuse, self-medication, and limited diagnostic testing.\u003c/p\u003e\n\u003cp\u003eSeveral factors were significantly associated with culture-confirmed bacterial pharyngitis: incomplete or no immunization, prior history of pharyngitis, contact with coughing individuals, and history of tonsillectomy, chronic pharyngitis, school attendance, and visible tonsillar structural changes. These associations are consistent with findings from studies in India, Riyadh, Nigeria, Somaliland, and various Ethiopian regions (7, 39) (21) (40), (25). \u003c/p\u003e\n\u003cp id=\"_Toc193288352\"\u003eLimitations of the study\u003c/p\u003e\n\u003cp\u003eThis investigation gave invaluable knowledge about the bacterial etiology and resistance patterns of pediatric pharyngitis. However, it had certain limitations. Notably, it did not investigate viral or fungal causes of pharyngitis. Additionally, we did not utilize molecular diagnosis.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe most common causal agents were \u003cem\u003eStaphylococcus pyogenes, Staphylococcus aureus\u003c/em\u003e, and \u003cem\u003eStreptococcus pneumoniae\u003c/em\u003e. These pathogens exhibited high resistance to commonly used antibiotics, particularly penicillin, with a notable presence of multidrug resistance, underscoring the need for improved antimicrobial stewardship. Significant associations were observed with incomplete vaccination, prior pharyngitis, and contact with symptomatic individuals, tonsillectomy, school attendance, and tonsillar abnormalities.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAMR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAntimicrobial Resistance\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAST\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAntimicrobial sensitivity testing\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCDC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCentre for Disease Control\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCLSI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eClinical Laboratory Standards Institution\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eFHSH\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eFelege Hiwot Specialized Hospital\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMAC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMacConkey Agar\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMDR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMultidrug Resistant\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSOPs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStandared Oprative Procuder\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eTGSH\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eTibebe Ghion Specialised Hospital\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWorld Health Organization\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study titled \"Bacterial Pharyngitis, Antimicrobial Susceptibility, and Associated Factors among Children at Comprehensive Specialized Hospitals, Northwest Ethiopia\" will be conducted in full compliance with national and international ethical research standards, including the Declaration of Helsinki. Ethical clearance was obtained from the Institutional Review Board (IRB) of Bahir Dar University. Written informed consent was obtained from the parents or legal guardians of all participating children. For children aged 7 years and above, we also obtained verbal or written assent using age-appropriate language. Throat swab sample collection was performed using sterile techniques by trained personnel to minimize discomfort or risk of infection. Participation in this study was entirely voluntary.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComputing interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author declare that they have no computing interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot available\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data sets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKefiyalew Mihrete: designed this study, collected and analyzed data, interpreted results, and drafted the manuscript; Addisu Melake: participated in data management and analyzed data; Bayeh Aberaand Tewachew Awoke participated in the design, data collection, and analysis, interpretation of the results, supervising the overall work of this study, review and approval of the manuscript;\u0026nbsp;Tadese Sisay: \u0026nbsp; prepared the manuscript, data analysis and data collection. All authors read the manuscript and approve it for submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1Department of Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia\u003c/p\u003e\n\u003cp\u003e2Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia\u003c/p\u003e\n\u003cp\u003e3Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eACKNOWLEDGMENTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank Bahir Dar University, College of Medicine and Health Sciences, Department of Medical laboratory Science for the opportunity to conduct this study. Our sincere gratitude also goes to the Amhara Public Health Institute, TGTH, and FHCSH microbiology laboratory staff and pediatricians for their cooperation and support with sample access, laboratory materials, kind assistance and study participants.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWondimu M, Simbo T, Chaka T, Lemi H, Bedada W. Oropharyngeal Pathogenic Bacteria: Carriage, Antimicrobial Susceptibility Pattern and Associated Risk Factors among Febrile Patients. Int J Pharm Sci Dev Res. 2022;8(1):006-12.\u003c/li\u003e\n\u003cli\u003eSykes EA, Wu V, Beyea MM, Simpson MT, Beyea JA. Pharyngitis: Approach to diagnosis and treatment. Canadian Family Physician. 2020;66(4):251-7.\u003c/li\u003e\n\u003cli\u003eBayu D, Mekonnen A, Mohammed J, Bodena D. 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Bulletin of Biological and Allied Sciences Research. 2023;2023(1):48-.\u003c/li\u003e\n\u003cli\u003eBunyan IA, Naji SS, Aljodoa HH. Isolation and Identification of Some Bacterial Strains Isolated from Throat Infections in Hilla Province, Iraq. Indian Journal of Public Health. 2019;10(6):785.\u003c/li\u003e\n\u003cli\u003eDarod HH, Melese A, Kibret M, Mulu W. Throat Swab Culture Positivity and Antibiotic Resistance Profiles in Children 2\u0026ndash;5 Years of Age Suspected of Bacterial Tonsillitis at Hargeisa Group of Hospitals, Somaliland: A Cross-Sectional Study. International Journal of Microbiology. 2023;2023:6474952.\u003c/li\u003e\n\u003cli\u003eBukhari HQ, Madloul MH, Alorinan BI, Albarrak NK, Alotaibi WH, El-Sayed S. Prevalence study of acute tonsillitis among pediatrics age groups. International Journal of Medical Reviews and Case Reports. 2019;3(1):1.\u003c/li\u003e\n\u003cli\u003eNabat ZN, ALateef BA, Hussain IM. Bacteriological and immunological study of patients with tonsillitis in Hila City. Iraqi journal of biotechnology. 2019;18(2).\u003c/li\u003e\n\u003cli\u003eAl-Tameemi K, Hraishawi R, Aaiz FL. Isolation, identification and evaluation of resistance of bacterial isolates from patients with tonsillitis. Ann Trop Med Public Health. 2020;23:10.\u003c/li\u003e\n\u003cli\u003eAnja A, Beyene G, S/Mariam Z, Daka D. Asymptomatic pharyngeal carriage rate of Streptococcus pyogenes, its associated factors and antibiotic susceptibility pattern among school children in Hawassa town, southern Ethiopia. BMC Research Notes. 2019;12(1):564.\u003c/li\u003e\n\u003cli\u003eMulu W, Yizengaw E, Alemu M, Mekonnen D, Hailu D, Ketemaw K, et al. Pharyngeal colonization and drug resistance profiles of Morraxella catarrrhalis, Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae among HIV infected children attending ART Clinic of Felegehiwot Referral Hospital, Ethiopia. PLoS One. 2018;13(5):e0196722.\u003c/li\u003e\n\u003cli\u003eAbraham ZS, Bazilio J, Kahinga AA, Manyahi J, Ntunaguzi D, Massawe ER. Prevalence and bacteriology of tonsillitis among patients attending otorhinolaryngology Department at Muhimbili National Hospital, Dar es Salaam-Tanzania. Medical journal of Zambia. 2019;46(1):33-40.\u003c/li\u003e\n\u003cli\u003eAhmed EB, Groun EAA, Almugadam BS, Ahmed YMA, Mudawe AMN, Babiker NA, et al. Epidemiological Aspects and Antibiotics Susceptibility Patterns of Streptococcus pyogenes Isolated from Subjects with Tonsillitis, Sudan. Sudan Journal of Medical Sciences. 2023;18(1):6-24.\u003c/li\u003e\n\u003cli\u003eZelelie TZ, Mekonnen YT. Bacterial profile and antimicrobial resistance patterns in patients with upper respiratory tract infections In Debre Berhan referral hospital, Ethiopia. Egyptian Journal of Ear, Nose, Throat and Allied Sciences. 2019;20(1):9-15.\u003c/li\u003e\n\u003cli\u003eAbd El Galil1ab SY, Abd El Gawad1cd S, El Ateeq2a E. Isolation and identification of microorganisms causing tonsillitis among children of Hail region. 2014.\u003c/li\u003e\n\u003cli\u003eMiriti DM, Muthini JM, Nyamache AK. Study of bacterial respiratory infections and antimicrobial susceptibility profile among antibiotics naive outpatients visiting Meru teaching and referral hospital, Meru County, Kenya in 2018. BMC microbiology. 2023;23(1):172.\u003c/li\u003e\n\u003cli\u003eKatkowska M, Garbacz K, Kopala W, Schubert J, Bania J. Genetic diversity and antimicrobial resistance of Staphylococcus aureus from recurrent tonsillitis in children. Apmis. 2020;128(3):211-9.\u003c/li\u003e\n\u003cli\u003eCavalcanti VP, Camargo LAd, Moura FS, Melo Fernandes EJd, Lamaro-Cardoso J, Braga CAdSB, et al. Staphylococcus aureus in tonsils of patients with recurrent tonsillitis: prevalence, susceptibility profile, and genotypic characterization. Brazilian Journal of Infectious Diseases. 2019;23:8-14.\u003c/li\u003e\n\u003cli\u003eDEBEBE S, Admassu D. MAGNITUDE, DRUG SUSCEPTIBILITY PATTERN AND ASSOCIATED FACTORS OF BACTERIAL ISOLATES AMONG ACUTE TONSILLITIS PATIENTS VISITING PUBLIC HOSPITAL, HARAR EASTERN ETHIOPIA: Haramaya University; 2020.\u003c/li\u003e\n\u003cli\u003eTadesse M, Hailu Y, Biset S, Ferede G, Gelaw B. Prevalence, Antibiotic Susceptibility Profile and Associated Factors of Group A Streptococcal pharyngitis Among Pediatric Patients with Acute Pharyngitis in Gondar, Northwest Ethiopia. Infect Drug Resist. 2023;16:1637-48.\u003c/li\u003e\n\u003cli\u003eFelmingham D, Farrell DJ, Reinert RR, Morrissey I. Antibacterial resistance among children with community-acquired respiratory tract infections (PROTEKT 1999\u0026ndash;2000). Journal of Infection. 2004;48(1):39-55.\u003c/li\u003e\n\u003cli\u003eDoern GV, Brown SD. Antimicrobial susceptibility among community-acquired respiratory tract pathogens in the USA: data from PROTEKT US 2000\u0026ndash;01. Journal of Infection. 2004;48(1):56-65.\u003c/li\u003e\n\u003cli\u003eWang LM, Qiao XL, Ai L, Zhai JJ, Wang XX. Isolation of antimicrobial resistant bacteria in upper respiratory tract infections of patients. 3 Biotech. 2016;6(2):166.\u003c/li\u003e\n\u003cli\u003eIslam F, Sarma R, Debroy A, Kar S, Pal R. Profiling acute respiratory tract infections in children from Assam, India. Journal of global infectious diseases. 2013;5(1):8-14.\u003c/li\u003e\n\u003cli\u003eGebrerufael GG, Hagos BT. Prevalence and predictors of acute respiratory infection among children under-five years in Tigray regional state, northern Ethiopia: a cross sectional study. BMC Infectious Diseases. 2023;23(1):743.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Bacterial pharyngitis, antimicrobial resistance, children, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-7276190/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7276190/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003e\u003cbr\u003e\nBacterial pharyngitis is a common childhood infection involving inflammation of the pharynx and tonsils. Compared to viral causes, it often presents more severely and can result in complications if untreated. However, data on its bacterial etiology, resistance patterns, and associated risk factors are limited in developing countries, including Ethiopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003e\u003cbr\u003e\nTo assess the prevalence, bacterial causes, antimicrobial susceptibility patterns, and risk factors of pharyngitis among children at comprehensive specialized hospitals, Northwest Ethiopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003e\u003cbr\u003e\nA hospital-based cross-sectional study was conducted from June 1 to August 30, 2024, among 254 children aged ≤14 years. Throat swabs were collected and cultured following standard microbiological techniques. Bacterial identification was performed through colony morphology, Gram staining, and biochemical tests. Antimicrobial susceptibility was tested using the Kirby-Bauer disk diffusion method. Data were analyzed using SPSS version 27, and logistic regression identified significant risk factors (p ≤ 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003e\u003cbr\u003e\nThe prevalence of culture-confirmed bacterial pharyngitis was 28.3% (95% CI: 22.5–33.9%). A total of 80 bacterial isolates were identified, predominantly \u003cem\u003eStreptococcus pyogenes\u003c/em\u003e (35%), \u003cem\u003eStaphylococcus aureus\u003c/em\u003e (32.5%), and \u003cem\u003eStreptococcus pneumoniae\u003c/em\u003e (28.8%). High resistance was observed: \u003cem\u003eS. pyogenes\u003c/em\u003e to ceftriaxone (64.3%) and chloramphenicol (53.6%); \u003cem\u003eS. pneumoniae\u003c/em\u003e to penicillin (82.6%); and \u003cem\u003eS. aureus\u003c/em\u003e to penicillin (80.8%) and tetracycline (57.7%). Overall, 41.3% of isolates exhibited multidrug resistance. Significant factors associated with bacterial pharyngitis included prior history of pharyngitis (AOR = 8.86), tonsillectomy (AOR = 5.65), contact with coughing individuals (AOR = 3.42), and weight loss (AOR = 2.58).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003e\u003cbr\u003e\nBacterial pharyngitis is prevalent among children in the study area, with a high burden of multidrug-resistant organisms. Routine use of culture and antibiotic susceptibility testing is essential to guide effective treatment and reduce resistance.\u003c/p\u003e","manuscriptTitle":"Bacterial Pharyngitis, Antimicrobial Susceptibility, and Associated Factors among Children at comprehensive specialized hospitals, Northwest Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-09 09:37:35","doi":"10.21203/rs.3.rs-7276190/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-11T14:30:11+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-15T14:22:02+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-14T14:04:06+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-14T03:02:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"33788270196539775302750202968966223222","date":"2025-09-06T13:01:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-06T09:03:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"126455812064888462231704993361368917692","date":"2025-09-05T19:09:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"75442825299236251873024766980546852396","date":"2025-09-05T13:25:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"147712927467018737927272453470054876773","date":"2025-09-05T12:11:53+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-03T18:10:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"287240095254141690895718638269016074956","date":"2025-08-29T11:58:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"135191614657064336618272179774441293897","date":"2025-08-29T10:45:41+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-29T10:31:04+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-28T06:24:15+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-08T04:19:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-07T19:52:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2025-08-07T19:49:52+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7ef8add5-b07c-4cfc-b8ff-0d9ab160bdcd","owner":[],"postedDate":"September 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-05T16:02:23+00:00","versionOfRecord":{"articleIdentity":"rs-7276190","link":"https://doi.org/10.1186/s12879-025-12427-8","journal":{"identity":"bmc-infectious-diseases","isVorOnly":false,"title":"BMC Infectious Diseases"},"publishedOn":"2026-01-03 15:57:38","publishedOnDateReadable":"January 3rd, 2026"},"versionCreatedAt":"2025-09-09 09:37:35","video":"","vorDoi":"10.1186/s12879-025-12427-8","vorDoiUrl":"https://doi.org/10.1186/s12879-025-12427-8","workflowStages":[]},"version":"v1","identity":"rs-7276190","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7276190","identity":"rs-7276190","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}