Bacterial diarrhea is a serious public health concern, especially in children under five. Early exposure to a wide range of enteric bacterial infections causes children in underdeveloped countries to suffer from many episodes of diarrheal illness.

Bacterial diarrhea is a serious public health concern, especially in children under five. Early exposure to a wide range of enteric bacterial infections causes children in underdeveloped countries to suffer from many episodes of diarrheal illness. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Bacterial diarrhea is a serious public health concern, especially in children under five. Early exposure to a wide range of enteric bacterial infections causes children in underdeveloped countries to suffer from many episodes of diarrheal illness. Mr. Seyoum Dechasa Gemechu, Dr. Seifu Gizaw Fayisa, Mr. Abdi Negash, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8704393/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Diarrheal diseases are a common disease worldwide associated with high morbidity and mortality rates in children under the age of five especially in developing countries. Enteric bacterial are most common causative agents of diarrhea and become a challenges to prevent and treat diarrhea due to emergency of antimicrobial resistant. Objective: The aims of this study was to isolate and determine prevalence and antimicrobial susceptibility patterns of Escherichia coli , Salmonella , and Shigella species among under five years age diarrheal children attending Mettu Karl Comprehensive Specialized Hospital, Southwest Ethiopia June to August, 2023 Methods: A cross-sectional study was conducted from June to August 2023 on 382 at Mettu Karl Comprehensive Specialized Hospital, Southwest Ethiopia. A structured questionnaire were used to collect data from children under five who had diarrhea. Data collection was done using convenience sample technique. Each collected sample was inoculated onto Selenite F broth and MacConkey agar. Antimicrobial susceptibility testing was performed using the Kirby Bauer disk method on Muller Hinton agar. Socio-demographic, clinical, and laboratory results data were entered in EpiData v4.6.0.6 and analyzed using SPSS version 25. Descriptive summaries, frequency, tables, and graphs were used to describe the study variables. Results: From the 382 children screened, bacteria were isolated from 44 (11.52%). This included; 19(5.0%) Escherichia coli , 14(3.66%) Salmonella species, and 11 (2.9%) Shigella . The highest resistance among bacteria was observed against Ampicillin (89.5%), cotrimoxazole (73.7%), and cefazolin (57.1%). Almost all of E.coli, Salmonella, and Shigella were susceptible to imipenem, cefepime, and cefotaxime. Of the total 44 isolates, 20(45.5%) showed multidrug resistance. Conclusion and Recommendation: This study indicates that E. coli, Salmonella , and Shigella were isolated pathogenic bacteria. The identified bacteria were susceptible to Imipenem, cefepime, and cefotaxime. The highest prevalence of antimicrobial resistance was observed for ampicillin followed by cotrimoxazole and cefazolin. Also, isolated bacteria showed resistance to ceftriaxone, ceftazidime, azithromycin, and ciprofloxacin and multiple antimicrobial resistances were high among those bacteria. It is better to use potent antimicrobials like Imipenem, Cefepime, and Cefotaxime for the treatment of bacterial-caused diarrhea. Diarrhea Escherichia coli Salmonella and Shigella Antimicrobial Susceptibility Figures Figure 1 Figure 2 Background Diarrhea is a condition of having three or more loose or liquid bowel movement per day. Human diarrheal diseases have been recognized since the beginning of civilization and remain one of the most prevalent public health problems of today. The most significant modes of transmission is believed to be fecal–oral spread by ingestion of contaminated food or water which is frequently facilitated easily by unsanitary and hygienic situations( 1 ). Diarrheal diseases are caused by a lack of access to good health care, a lack of appropriate diagnostics method, poor health facilities, unsanitary water sources and/or a lack of effective treatment strategies ( 2 ). According to World Health Organization (2013), diarrhea could be classified into four types, based on clinical symptoms to less than five years children. They are watery diarrhea which defined as a sudden onset of frequent, watery, loose stools without visible blood, lasting less than two weeks. Dysentery is a diarrhea containing blood and mucus in feces. Persistent diarrhea is defined as diarrhea episodes of presumed infectious etiology that have an unusually for longer than 14 days, but less than 1 month. Chronic diarrhea is recurrent or long-lasting due to mainly noninfectious causes. Each of them reflecting different pathogenesis ( 3 ). Watery stools, frequent bowel movements, vomiting, nausea, fever, gas, dry mouth, blood in the stools, decreased urine production, loss of appetite, and dehydration are some of the clinical signs of diarrhea ( 4 ). Both infectious and non-infectious can causes diarrhea ( 5 ). Bacterial pathogens, viruses, and parasites can all lead to infectious diarrhea( 6 ). Bacterial infections are most common causative agents of diarrhea ( 7 ). Global estimates show that among all diarrheal causes, the prevalence of specific types of bacterial diarrhea is 10% to 25% for E. coli , 10% for Shigella , 3% for Salmonella , and 3 to 6% for Campylobacter ( 8 ). Children in developing nations experience multiple episodes of diarrheal disease due to early exposure to a broad spectrum of enteric bacterial infections. The most common bacterial infections vary with the child's age and time, showing both seasonal as well as geographical variation. Every child's experience is unique, but the most frequently identified bacterial in young children are Salmonella strains, entero-hemorrhagic E. coli, Shigella spp., Clostridium difficile , Campylobacter jejuni , and Yersinia enterocolitica . Other less common causes of diarrhea but clinically significant bacterial infections include Aeromonas hydrophila , Campylobacter upsaliensis, Vibrio spp ( 7 , 9 ). Parasites that causes diarrhea include Giardia lamblia, Entamoeba histolytica, Cyclospora cayetanensis, Cryptosporidium, Ascaris lumbricoides, Trichuris trichiura , and Hymnolepis nana. and viruses such as Adenovirus, Norwalk Virus and Rotavirus which cause diarrhea in children under five ( 10 ). The emergence of multidrug-resistant bacteria has significantly impeded the use of antimicrobials to treat infectious diarrhea ( 11 ). There have been reports of high rates of resistance to widely used and readily available antimicrobials such as ampicillin, tetracycline, trimethoprim-sulfamethoxazole (cotrimoxazole), and chloramphenicol ( 5 , 12 ). In addition, the development of antimicrobial resistance (AMR) and multidrug resistance (MDR) has changed the antimicrobial susceptibility pattern of Salmonella spp., Shigella spp., and E. coli gradually ( 13 ). When necessary, antimicrobials should only be used to treat diarrhea caused by infectious agents such as bacteria after culture and susceptibility testing have been performed ( 14 ). However, antimicrobial susceptibility tests (ASTs) are not usually performed before antimicrobials are prescribed; therefore, empirical treatment is usually considered. Because of this, the prevalence of antimicrobial-resistant bacteria has increased ( 15 ). This may be partially explained by the scarcity of ASTs and the increased turnaround time for test results ( 12 ). So the future of treatment by antimicrobial is being challenged by infections from resistant organisms, which are affecting treatment costs, treatment outcomes, disease duration and disease spread ( 16 ). Therefore, this study was aimed to fill the gap that stated above by assessing the prevalence and antimicrobial susceptibility patterns of Escherichia coli , Salmonella , and Shigella species among under five years age diarrheal children attending Mettu Karl Comprehensive Specialized Hospital, Southwest Ethiopia June to August, 2023. Materials and Methods Study Area, Study Design and Period Hospital-based, cross-sectional study was carried out to determine prevalence and antimicrobial susceptibility patterns of Escherichia coli , Salmonella , and Shigella species among under five years age diarrheal children attending Mettu Karl Comprehensive Specialized Hospital (MKCSH) from June to August 2023. MKCSH Hospital is a specialty hospital founded in 1964 and named after Dr. Karlheinz Boom, the founder and chairman of Mesnchem für Mesnchem (MFM), a German-born Non-Governmental Organization (NGO), who renovated and expanded the hospital in February 2001. The hospital provides services to a catchment area of ​​more than 2 million people come from Ilubabor Zone, Gambella Region, Southwestern Population Region of Ethiopia and South Sudan Country. Based on the Central Statistical Agency (CSA) projection for 2022, the town has a total population of 59,706, of which 29,569 are male and 30,137 female. Sample Size Determination The sample size was calculated based on a single population proportion formula by taking the prevalence of enteric bacteria in under-five children with diarrhea from a previous study done at Debre Berhan town of 46% (53) at a 95% confidence interval and 5% margin of error. Where: n = sample size Zα/2 = 95% level of confidence (1.96). P = diarrhea prevalence from previous study = 46%. q = 1-p. d = margin of error (0.05) \(\:n=\frac{{\left(Z\frac{\alpha\:}{2}\right)}^{2}\:P(1-P)}{{d}^{2}}\) \(\:n\:=\frac{{\left(1.96\right)}^{2}x0.46x0.54}{{\left(0.05\right)}^{2}}=\:\:\:\:\:\:\:\:\:\:382\) Thus, the totals of 382 children with diarrhea were included in the study Data and sample collection Two days of training was provided by the principal investigator for two BSc. Nurse, two BSc. Laboratory technologists and one supervisors on data collection tools and collection techniques, how to approach the interviews, and maintaining the privacy and confidentiality of respondents prior to the actual data collection period. The data was collected using a structured questionnaire. The questionnaire was translated into the local language Afan Orormo and translated back into English to check its consistency. Prior to data collection, 5% of the sample was pre-tested on Bedele general hospital that is not included in the actual sample. All information on the questionnaire was filled in by the data collector. After the data collection, the questionnaires were cleaned daily by the supervisors and principal investigator and checked for completeness. Children's socio-demographic variables include age and gender, as well as guardian/parent variables such as education level, family size, and residence. Hygiene and sanitation-related variables like source of drinking water, feeding practice of children, utilization of latrines, hand washing of parents/gardians, clinical data including duration of diarrhea, fever, vomiting, bloody diarrhea, mucoid diarrhea, watery diarrhea, the immunization status of the child, and breastfeeding were collected. Fresh stool specimens were collected from each study participants by trained BSc. Nurses for bacteriological analysis. The specimens were coded with patients ID and information and transported using Cary-Blair transport media to MKCSH bacteriology laboratory at 2-8 0 C. Identification of Bacterial Isolates Isolation and characterization of parasites were examined by preparing a slide using normal saline 0.85% to observe the ova, cysts, and trophozoite stage of the parasites present in the stool at Mettu Karl Coprehensive Specialized Hospital laboratory before inoculated on culture medaia. For bacteriological isolation, each stool sample directly cultured onto Selenite F broth (SFB) and MacConkey agar media. Approximately 1 g of each sample inoculated into 10 ml of SFB. The tubes and plates were incubated for 24 hours at 37 0 C. From enrichment Selenite F broth subculture onto Xylose-Lysine Deoxycholate (XLD) agar then the plates incubated at 37°C for 18 to 24 hrs. The suspected bacteria were identified by colony morphology and biochemical characteristics. On MacConkey agar suspected enteric bacteria appeared as transparent or colorless colonies. Salmonella spp. appeared on XLD agar as red colonies with black center owing to H 2 S production. Shigella spp . colonies identified on XLD agar the colonies appeared as transparent red. On MacConkey agar suspected enteric bacteria appeared as transparent or colorless colonies. E.coli on MacConkey agar showed transparent colorless colonies. Unfortunately, there was no growth of bacteria on alkaline peptone water. The colonies of each representative isolate was then characterized using standard bacteriological methods. Please see laboratory work flow below (Fig. 1 ). Biochemical Tests Biochemical media were used for the identification of bacterial isolates. The identification were done based on the pattern of biochemical reactions using a standard bacterial identification system. All the suspected isolates were examined biochemically using Nutrient Broth, Simmons Citrate Agar, Klingler Iron Agar (KIA), Sulfide-Indole-Motility (SIM), Urea Broth Base, and Kovac’s Reagent to identify bacteria. Among the tests used to identify enteric bacteria are: pigment production, motility, urease, citrate, hydrogen sulfide utilization, oxidase, indole, lysine, and sugar fermentation. Bacterial isolates were categorized based on culture outcomes and biochemical tests. Please see laboratory work flow below (Fig. 1 ). Antimicrobial Susceptibility Testing Antimicrobial susceptibility patterns was determined by the Kirby Bauer disk method. Three to five pure colonies from agar plate isolates were suspended in the normal saline solution and mixed well to adjust at 0.5 McFarland standards. The 0.5 McFarland turbidity standard was prepared by mixing 0.5 mL barium chloride dehydrate (1.175%) with 99.5mL sulfuric acid (1%). A sterile cotton swab is used to evenly spread bacterial inoculum on a sterile petri dish of Mueller Hinton Agar. 12 disk on 150mm plate and 6 on 100mm plate with up to 24mm apart each other. Each disc must be pressed down to ensure complete contact with the agar surface. The plates was incubate for 16-18hrs at 37 o C, which was done according to the guideline. Commonly prescribed Antimicrobials like ampicillin (10µg), amoxicillin-clavulanic acid (20/10µg), cefazolin (30µg), cefotaxime (30µg), ceftazidime (30µg), cefepime (30µg), imipenem (10µg), ciprofloxacin (5µg), co-trimoxazoale (trimethoprim-sulfamethoxazole,(1.25/23.75µg), gentamicin (15µg), azithromycin (15µg) were used to test against bacteria. According to the size of the zone of inhibition, the organisms were classified as susceptible, intermediate, or resistant to each Antimicrobial using the CLSI 31th edition, 2021 interpretation guideline ( 35 ). Please see laboratory work flow below (Fig. 1 ). undefined Data Quality Assurance The data quality control measures of the study was maintained throughout the whole process of data collection and laboratory work. For laboratory analysis, the pre-analytical, analytical, and post-analytical stages of quality assurance and standard operating procedures (SOPs) of testing laboratory was followed. Stool samples were collected by trained healthcare personnel using sterile stool containers that are labeled with participant identification numbers and transported to the Microbiology Laboratory at the MKCSH immediately. The collected samples were registered in the logbook to avoid re-sampling. Before using culture medium, the expiration date was checked. Two plates of prepared culture media from the test batch were taken and placed into the incubator set at 37°C for 24 hours. After required incubation, the plates were checked for any growth. If there is any growth, contamination has occurred in the prepared batch and all the batch is not used. The sample was analyzed at MKCSH. The test was performed by a well-trained and experienced laboratory technologist. The collected sample were tasted once for bacterial culture and for intestinal parasites. A known strain of the American Type Culture Collection (ATCC) of Escherichia coli 25922 and Pseudomonas aeruginosa ATCC 27853 control were used as the zone of inhibition for these organisms is known in accordance with the CLSI 31th edition (2021) ( 35 ). The results were recorded with an identification number on the laboratory result form and logbook. The laboratory results were given to the physician immediately for medical treatments, and parents and guardians were informed. All bacterial isolates were stored at refrigerator until the end of this research project for any kind of checkup & future use. Statistical Analysis and Interpretation Following data collection, it was reviewed for completeness and consistency. EpiData v4.6.0.6 version software was used for data entry and exported to the statistical package for social science (SPSS) 25version for analysis. Finally, descriptive summaries, frequency, tables, and graphs were used to describe the study variables. Results Socio-Demographic Characteristic of the Study Participants In this study, a total of 382 under-five children with diarrhea disease were included. Out of 382 childrens, 178(46.6%) were male and 204 (53.4%) were female; with male to female ratio of 1:1.2. The age ranges from 4–60 months with mean of 32.64 (SD ± 14.39) months, while majority of participants (213 (55.8%)) lived in urban areas and (294(77%)) had family size 3–4 persons. It was found that among the respondents, 35(9.2%) parents/guardians were not able to read and write and less than three-fourths of parents or guardians 104(27.2%) had completed college and above. Almost half 170 (44.5%) of the guardians had a monthly income of 1,001-3000 birr (Table 1 ). Table 1 Distribution of Escherichia coli , Salmonella , and Shigella among study participants with respect to sociodemographic variables at Mettu Karl Comprehensive Specialized Hospital Southwest Oromia, Ethiopia from June to August, 2023 Variables Frequency Percentage Escherichia coli Salmonella spp Shigella spp Age categories (in month) 0–6 15 3.9 7–12 23 6.0 1 13–24 89 23.3 9 5 2 25–36 101 26.4 3 2 3 37–48 97 25.4 3 3 2 49–60 57 14.9 4 3 4 Gender Male 178 46.6 8 6 6 Female 204 53.4 11 8 5 Residence Urban 213 55.8 14 9 7 Rural 169 44.2 5 5 4 Educational status of parents or guardians Can’t read and write 57 14.9 5 2 5 Primary school 101 26.4 6 5 3 Secondary School 119 31.2 5 6 2 College and above 105 27.5 3 1 1 Family size 1–2 2 0.5 3–4 294 77.0 5 5 7 5–6 86 22.5 14 9 4 Average monthly income 5,000 57 14.9 4 4 2 Clinical Characteristics of Respondents The clinical complaints of the diarrheal children indicated that, out of 382 diarrheal children, 128(33.5%) had fever and 80(20.9%) had vomiting. With regard to consistency of stools, 243(63.6%) had watery diarrhea. Almost all (372(97.4%) of children were vaccinated. The study also revealed that the duration of diarrhea ranged from 1–6 days with a mean of 2.030 days with 265 (69.4%) had three days of duration. One hundred ninty five (51%) of chidren had stool frequency greater than 5 per days and 192(50.2%) children were breastfeeding for 1–2 years (Table 2 ). Table 2 Distribution of Escherichia coli , Salmonella , and Shigella among diarrheal children with respect to clinical variables at Mettu Karl Comprehensive Specialized Hospital Southwest Oromia, Ethiopia from June to August, 2023 Variables Frequency Percentage Escherichia coli Salmonella spp Shigella spp Fever Yes 128 33.5 5 10 9 No 254 66.5 14 4 2 Duration of diarrhea 1 day 54 14.1 3 0 1 2 days 64 16.8 4 3 3 3 days 162 42.4 6 5 2 4 days 102 26.7 6 6 5 Stool Frequency (per day) 1–2 per day 8 2.1 1 2 0 3–4 per day 177 46.3 8 5 4 > 5 per day 197 51.6 10 7 7 Type of diarrhea Watery diarrhea 243 63.6 6 5 2 Mucoid diarrhea 116 30.4 8 2 3 Bloody diarrhea 23 6.0 5 7 6 Vomiting Yes 80 20.9 3 8 3 No 302 79.1 16 6 8 Dehydration No 380 99.5 19 14 11 Mild 2 0.5 0 0 0 Weaning Age 1 year breast feeding 66 17.3 1 1–2 years breast feed 222 58.1 15 10 9 > 2 breast feed 94 24.6 4 3 2 Immunization He/she take an age appropriate vaccine 45 11.7 0 1 0 Complete vaccine 327 85.6 18 13 9 Incomplete vaccine 10 2.6 1 0 2 This study indicated that around half of the respondents 169 (44.9%) used pipe water as sources of drinking. Almost all parents/guardians used traditional pit latrines (340(89%)) but only 28(7.3%) had hand washing facilities near their latrines. The study also revealed that the majority of parents/guardians (327(88.2%)) washed their hands before and after cooking food and more than half of parents/guardians (255(66.8%)) used bottles for feeding their children. (Table 3 ). Table 3 Distribution of Escherichia coli , Salmonella , and Shigella among diarrheal children with respect to behavioral characteristics at Mettu Karl Comprehensive Specialized Hospital Southwest Oromia, Ethiopia from June to August, 2023 Variables Frequency Percentage Escherichia coli Salmonella spp Shigella spp Source of drinking water Pipe water 228 59.7 5 3 2 Spring/protected 96 25.1 5 2 0 Well water 23 6.0 2 4 3 River water 35 9.2 7 5 6 Utilization of latrine Yes 365 95.5 16 12 7 No 17 4.5 3 2 4 Type of latrine Traditional pit latrine 340 89.0 17 14 10 Ventilated improved latrine 25 6.5 2 0 1 Hand washing Facility near the latrine Yes 28 7.3 1 2 0 No 337 88.2 18 12 11 At what time did you wash your hand Before and After cooking food 327 85.6 6 7 3 Before feeding child 227 59.4 6 5 4 After Toilet 222 58.1 7 2 4 Material used for feed child Bottle 255 66.8 14 10 4 Cup with spoon 118 30.9 5 3 7 Glass Tube 9 2.4 0 1 0 Isolation of Enteric Bacterial From the total 382 stool specimens, isolated enteric bacteria were Escherichia coli, Salmonella and Shigella species. The positive rate of enteric bacteria identified from this research were 44(11.52%). There is no other species of bacteria is isolated in this study from a total of 382 stool samples processed. From the positive stool sample 43(97.7%) had single infection of bacterial pathogen whereas 1(2.3%) had protozoan parasite and bacterial infection. Out of 44(11.52%) isolated bacteria, E.coli was detected in 19(5.0%), Salmonella species was detected in 14(3.7%) of study participants and Shigella species was detected in 11(2.9%) of target children. About half of detected E.coli and Salmonella cases were in the age group between 13 and 24 months whereas Shigella species were detected in almost all age groups equally. In this study, protozoan parasites were identified of which 6 (1.6%) Giardia lamblia and 2(0.5%) Entamoeba histolytica/dispar (Fig. 2 ). Antimicrobial Resistance Pattern The antimicrobial susceptibility pattern for isolated bacteria to was determined by the disk diffusion method by following the recommendations of the CLSI 31 2021(67). Resistance to Ampicillin was 89.5%, 85.7%, and 72.7% for E.coli, Salmonella species, and Shigella species respectively. Resistance to co-trimoxazoale was 73.7% for E.coli , 72.75% for Shigella spps and 54.5% for Salmonella spp isolates. Resistance to ceftriaxone was 64.3% for Salmonella , 47.4% for E. coli spps, and 45.5% for Shigella . From 19 isolates of E.coli species, most of them have shown sensitivity for imipenem (94.7%), cefepime and cefotaxime (89.5%), and azithromycin (73.7%). From 14 isolates of Salmonella species, 100% sensitivity has shown for imipenem and cefepime whereas three-fourths of them were susceptible for azithromycin, cefotaxime, augmentin, cotrimoxazole, ciprofloxacin. From 11 isolates of Shigella species, 100% sensitivity has shown for imipenem, 81.8% for azithromycin, and 72.7% for cefotaxime, and ciprofloxacin and more than half shows sensitivity for augmentin, Cefepime, ceftriaxone. Almost all E.coli, Salmonella , and Shigella were susceptible to imipenem, cefepime, cefotaxime (Table 4 ). Table 4 Antimicrobial susceptibility pattern of Escherichia coli , Salmonella , and Shigella identified from under five age children at Mettu Karl Comprehensive Specialized Hospital Southwest Oromia, Ethiopia from June to August, 2023 Antimicrobial discs E.coli n = 19(5.0%) Salmonella spp n = 14(3.7%) Shigella spp n = 11(2.9%) S I R S I R S I R AMP(10µg) 2(10.5) 0(0.0) 17(89.5) 1(7.1) 1(7.1) 12(85.7) 2(18.2) 1(9.1) 8(72.7) AUG (210/0µg) 13(68.4) 3(15.8) 3(15.8) 9(64.3) 1(7.1) 4(28.6) 8(72.7) 1(9.1) 3(27.3) GN (10µg) 15(78.9) 0 (0.0) 4(21.1) - - - - - - TMP-SXT (1.25/23.75µg) 4(21.1) 1(5.3) 14(73.7) 6 (42.9) 0(0.0) 8(57.1) 2(18.2) 1(9.1) 8(72.7) IPM(10µg) 18(94.7) 0(0.) 1(5.3) 14(100) 0(0.0) 0(0.0) 11(100) 0(0.0) 0(0.0) FEP(30 µg) 17(89.5) 0(0.0) 2(10.5) 14(100) 0(0.0) 0(0.0) 9 (81.8) 1(9.1) 1(1.9) AZT(30 µg) 14(73.7) 1(5.3) 4(21.1) 12(85.7) 0(0.0) 2(14.3) 7(63.6) 0(0.0) 4(36.4) CRO(30 µg) 7(36.8) 3(15.8) 9(47.4) 3(21.4) 2(14.3) 9(64.3) 6(54.5) 0(0.0) 5(45.5) CIP(5 µg) 11(57.9) 1(5.3) 7(36.8) 11(78.6) 0(0.0) 3(21.4) 8(72.7) 1(9.1) 2(18.2) CZ (30µg) 7(36.8) 1(5.3) 11(57.9) 5(35.7) 1(7.1) 8(57.1) 5(45.5) 0(0.0) 6(54.5) CTX (30µg) 17(89.5) 0(0.0) 2(10.5) 9(64.3) 0(0.0) 5(35.7) 8(72.7) 0(0.0) 3(27.3) CAZ (30µg) 9(47.4) 2(10.5) 8(42.1) 7(50.0) 5(35.7) 2(14.3) 4(36.4) 4(36.4) 3(27.3) Key S-Susceptibility I- Intermediate, R-Resistance, TMP- SXT-trimethoprim sulphamethoxazole, AMP-Ampicillin, AUG-Augmentin, IPM-imipenem, CAZ-ceftazidime, CTX-Cefotaxime, CZ-cefazolin, FEP-Cefepime, AZT-Azithromycin, CRO-Ceftriaxone, CIP-Ciprofloxacin. Multi-Drug Resistant Isolates From total 44 isolates, 20(45.5%) of them were showed multidrug resistance. Out of that, 10(52.6%) of E.coli isolate were multidrug resistant, 6(31.5%) of them resistance to 3 antimicrobials and 4(21.1%) of them resistance to 4 antimicrobials. Regarding, Salmonella isolate, 5(35.7%) of the isolates showed multidrug resistant, 4(28.6%) of them showing resistance to 3 antimicrobials and 1(7.1%) to 4 antimicrobial. Also, Shigella isolates showed multidrug resistance for 5 (45.5%) of which 4 (36.4%) of the isolates showed resistant to 4 antimicrobials and the remaining 1(9.1%) were resistant to 4 antimicrobials. But 3 (15.8%) E.coli , 3(21.4%) Salmonella and 2(18.2%) of Shigella were susceptible to all tested antimicrobial (Table 5 ). Table 5 Resistance Antibiogram of Escherichia coli , Salmonella , and Shigella species of under five chidren at Mettu Karl Comprehensive Specialized Hospital Southwest Oromia, Ethiopia from June to August, 2023 Number of antimicrobial resistance Resistance antibiogram Resistance isolates n (%) E coli spp (n = 19) Salmonella ( n = 14 ) Shigella ( n = 11 ) RO None 3 (15.8) 3(21.4) 2(18.2) R1 Amp 2 (10.5) 1(7.1) 1(9.1) AUG - - - SXT 1(5.3) 1(7.1) - R2 Amp, AUG - 1(7.1) - Amp, SXT 3 (15.8) 2(14.3) 2(18.2) Amp ,CIP 1(7.1) 1(9.1) R3 Amp, AUG,SXT - Amp, SXT,CRO 2(10.5) 2(14.3) 1(9.1) Amp, SXT,GN 3(15.8) - - Amp, SXT,CZ 1(5.3) 2(14.3) 3(27.3) R4 Amp ,AUG,SXT,CRO 1(7.1) 1(9.1) Amp ,SXT,CIP,GEN 4(21.1) - - R5 AUG,CIP,SXT,CRO,AZT, - - - Key : Amp-Ampicillin, ,SXT-Cotrimoxazole, AUG- Agumentin, AZT- azithromycin, GEN-Gentamycin, CRO-ceftriaxone, CIP-Ciprofloxacillin, RO-none resistance, R1-resistance for one antimicrobial, R2-resistance for two antimicrobial, R3-resistance for three antimicrobial, R4-resistance for four antimicrobial, R6- resistance for six antimicrobial Discussion The overall prevalence of E.coli, Salmonella , and Shigella obtained in the current study was 44 (11.52%). Current study is comparable with study conducted in Bahir Dar with prevalence of enteric bacteria 13.1%, and in Jimma, southwest Ethiopia which counts 8.4% ( 24 , 34 ) but lower than previous findings from Hawassa Town, South Ethiopia which counted 22.5%, Nigeria 68.5%, and Kenya 46.0% ( 21 , 23 , 27 ). This might be partly due to true difference of the bacterial infection in the area and also seasonal variations. According to this study's results, children between 13 to 24 months old are more susceptible to diarrhea diseases and enteropathogenic bacteria as demonstrated in (Table 2 ). Studies done at Hawassa, Nigeria and Gambella agree with this finding that children ages between 13 to 24 months old are more susceptible to diarrhea diseases ( 21 , 27 , 29 ). This is probably because of youngsters at this age attempt to masticate everything’s with their mouths and also more likely to play in soil where they may come into contact with faeces. In current study, 19(5.0%) of children were found to be infected with E.coli , 14(3.7%) were infected with Salmonella species and 11(2.9%) with Shigella species. The prevalence of Salmonella and Shigella in the current study is comparable with previously reported in 2014 in Ambo town, Ethiopia which was 3.8% ( 30 ). Prevalence of E.coli 19 (5.0%). The finding of this study was comparable with previous reports with studies done at Bahir Dar with prevalence of 6.1% ( 24 ). On the other hand, it was found to be higher than similar study conducted in Bangladesh with prevalence of 1.45% ( 17 ). But lower than studies done at South Africa with prevalence of 13.9% ( 22 ), at Tehran, Iran 16% ( 19 ), at Hawassa 22.2% ( 27 ), Addis Ababa with prevalence of 24.1% ( 26 ), Kenya 36.4% ( 23 ), at Ghana 49.1% ( 20 ), at Pakistan with prevalence 60% ( 18 ), at Debra Berhan 62.7% ( 25 ),and at Nigeria with prevalence of 62.8% ( 21 ). The prevalence of Salmonella in this study was 14(3.7%). The finding of the current study was comparable with previous reports at Pakistan with prevalence of 3% ( 18 ), at Bahir Dar 3.1% ( 24 ), at Addis Ababa 3.95% ( 26 ), 21,22), at Gambella 2.3%( 29 ), at Kenya 2.4%( 23 ), at Hawassa 2.5% ( 27 ), at Bangladesh with prevalence of 4.34% ( 17 ) but higher than studies done at Ambo with prevalence of 1.3% ( 30 ), at South Africa and Abuja, Nigeria with prevalence of 1.7%. The current study is lower than a study conducted at Debra Berhan 6.7%( 25 ), at Arba Minch ( 28 ), Ghana ( 20 ), and Iran ( 19 ) with prevalence of 12.6%, 23.9% and 42% respectively. The variability of isolation of Salmonella may be attributable to the difference in study areas and period, because the features of the disease vary from place to place and time to time community awareness about personal and environmental hygiene and socioeconomic elements. The prevalence of Shigella in current study was found to be 11(2.9%). This was comparable with study done at Ambo which was 2.5% ( 30 ), at Kenya with prevalence of 3.2% ( 23 ), at Debra Berhan and Bahir Dar with prevalence 4.0% ( 24 , 25 ), at Bangladesh 4.34% ( 17 ). Contrarily, the prevalence Shigella in the current study is lower as compared to studies done at Arba Minch 4.8%, Abuja, Nigeria and South Africa 5.5%, Gambella 6% ( 21 , 22 , 28 , 29 ). Also lower than the study conducted at Hawassa 7%, at Addis Ababa 9.1%, at Ghana 10.2%, and at Tehran, Iran 40% ( 19 , 20 , 26 , 27 ). The lower prevalence of E.coli , Salmonella , and Shigella could be due to different factors including, variation of socio-demographic and behavioral characteristics, methods used in isolation of pathogens, and the presence of other enteric bacterial causing diarrhea. Among parasitic infections, Giardia lamblia and Entamoeba identified in this study were 6(1.6%) and 2(0.5%) respectively. The study is comparable to the study in Ambo with a prevalence of Giardia lamblia (3.3%), followed by Entamoeba at (2.1%) ( 30 ) but it is lower than the study conducted in Gambella with Giardia lamblia 28(50.9%), E. histolytica/dispar 13(23.6%). This may be because of their nature for easily transmitting in the community and accessibility as well as utilization of latrine ( 29 ). The resistance of enteric pathogens to currently used antimicrobial agents has increased all over the world as a result of the widespread use of antimicrobials. There are reports from Arba Minch, Gambella and Jimma on multiple antimicrobial resistances among strains of pathogenic E.coli , Salmonella , and Shigella species in Ethiopia ( 28 , 29 , 34 ). All E.coli , Salmonella and Shigella species isolates from current study displayed resistance to one or more antimicrobials including Ampicillin, Cotrimoxazole, and Cefazolin. Among the isolates there were no resistances for Imipenem, Cefepime and except 2(10.5%) a few resistances for Cefotaxime which comparable with studies done at Debre Berhan, Addis Ababa and Ambo Town ( 25 , 26 , 30 ). The highest prevalence antimicrobial resistance of E.coli spps against Ampicillin (89.5%) observed was comparable with the study done at Addis Ababa which counts 83.6% ( 26 ), at Pakistan (93.5%) ( 18 ), at Korea resistance was 78% ( 31 ), at South Africa (98%) ( 32 ). It is higher than a study done in Kenya which counts 55.2% ( 23 ).This may be show Ampicillin resistance strain is widespread in study area. Antimicrobial resistance of E.coli spp in the current study against cotrimoxazole was (73.7%) which comparable with a study done at Bangladesh which counts 80%( 17 ). The current study is higher than study conducted in Kenya with cotrimoxazole resistance rate 61.4% ( 23 ), in Addis Ababa which counts 62.3%( 26 ) but lower than study done at South Africa, with Cotrimoxazole resistance (96%) ( 32 ). E.coli was susceptible for Imipenem 94.7%, cefepime and cefotaxime 89.5%, augumentin 68.4%, azithromycin 73.7%, ciprofloxacin 57.9% and ceftazidime 47.4%. This is comparable with study done in Pakistan, Korea, South Africa Kenya and Addis Ababa ( 18 , 23 , 26 , 31 , 32 ). This may be due to the different laboratory techniques used for susceptibility test. In current study resistance of Salmonella species to ampicillin, Ceftriaxone and cotrimoxazole was 85.7%, 64.3%, and 57.1% respectively. Accordingly, a high level of Salmonella resistance was observed for ampicillin (85.7%) which is comparable with a study done in Kenya which counts 77.8% ( 23 ), in Mekelle which counts 89.5% ( 33 ), but lower than study done at Ambo 100%( 30 ) and higher than study conducted in Iran 50% ( 19 ). Level of resistance for cotrimoxazole was 64.3% which is a relatively similar pattern of resistance reported from study done at Mekelle 57.9% ( 33 ), Ambo 66.7% ( 30 ) but higher than study done in Bangladesh 40%(45). In contrarily to this, study done at Kenya showed that cotrimoxazole was 100% susceptible for Salmonella species ( 23 ). In the current study Salmonella was 100% susceptible for imipenem, cefepime, 85.7% susceptible for azithromycin, 78.6% susceptible for ciprofloxacin which is comparable study done at Bangladesh, Pakistan, Jimma, Ambo and Addis Ababa ( 17 ),( 30 ),( 34 ),( 18 ),( 26 ).However, augumentin, ceftazidime, cefotaxime, cefazolin was shown more than one-fourths of resistance for Salmonella species. The highest prevalence Antimicrobial resistance of Shigella spp against Ampicillin was (72.7%) This was comparable with the study done on Shigella isolates in Ambo which counts 83.3% ( 30 ) The current study was lower than study in Mekelle which counts 88.9% ( 33 ), in Tehran, Iran which counts 92% ( 19 ), in Jimma which counts 100% ( 34 ). This study was higher than a study done in Kenya which counts 28.6% ( 23 ). Antimicrobial resistance of Shigella spps against cotrimoxazole was (72.7%) which lower than a study done in Tehran, Iran (93.0%) ( 19 ), in Jimma and Bangladesh 100% ( 17 , 34 ). The study was higher than study done in Kenya 47.6% ( 23 ), in Ambo which counts 50% resistance for cotrimoxazole ( 30 ), in Mekelle 55.6% ( 33 ). Among the Shigella species 100% susceptible for Imipenem, 81.8% susceptible for cefepime and more than three-fourths (72.7%) were susceptible cefotaxime, ciprofloxacin, ceftriaxone, augumentin and azithromycin which is comparable to studies conducted in Ambo, Jimma, and Kenya.( 23 , 30 , 34 ). The difference may be due to susceptibility methods used. Conclusion and Recommendation The overall prevalence of enteric bacterial isolates in this study was 11.52%. This study indicates that E.coli, Salmonella, and Shigella species are among the most pathogenic bacteria identified in children with diarrhea under five years old examined in the study area. These isolated bacteria were susceptible to Imipenem, cefepime, and cefotaxime. But those bacteria were showed the highest resistance for ampicillin followed by cotrimoxazole and cefazolin indicating that no longer potent in the treatments of E.coli, Salmonella, and Shigella among children with diarrhea aged fewer than five years old diagnosed in the study area. Though still at low levels, the major concern from this finding is the emerging resistance of enteric pathogens that were observed for ceftriaxone, ceftazidime, azithromycin, and ciprofloxacin. Multiple antimicrobial resistances were high among the isolated bacteria. From total of 44 isolated bacteria, 20(45.5%) of them were showed multidrug resistance. Abbreviations AMR Antimicrobial Resistance AST Antimicrobial Susceptibility Tests CLSI Clinical And Laboratory Standards Institute DAEC Diffuse Adhering Escherichia coli EAEC Enteroaggregative Escherichia coli EPEC Enteropathogenic Escherichia coli ETEC Enterotoxigenic Escherichia coli LMIC Low and Middle-Income Countries MAC MacConkey agar MDR Multi-Drug Resistance OPD Outpatient Department SFB Selenite F broth SOP Standard Operating Procedures Spp Species WHO World Health Organization XLD Xylose Lysine Deoxycholate Declarations Acknowledgments First of all, I would like to express my heartfelt thanks to the almighty God for allowing me to accomplish this thesis. I would like to express my sincere and heartfelt gratitude to: Salale University, College of Health Sciences, Departments of Medical Laboratory Sciences and Oromia Health Bureau for sponsoring me. My deep gratitude goes to Mettu Karl Comprehensive Specialized Hospital laboratory for supporting me and providing laboratory reagents, materials and staff of hospital for their co-operation during laboratory work. I would like to express my gratitude to Ethiopian Public Health Institute for providing me a known control strain. I would like to acknowledge Pediatrics Wards of the hospital, for providing necessary clinical data and all nurses for their help during data collection period. I would also like to acknowledge all study participants and their parents for their cooperation Finally, I would also like to express my heartfelt thanks to all individuals who directly or indirectly contributed to the work of this thesis. Ethical Approval and consents of Study paticipants Ethical clearance was obtained from the Ethical Review Committee (ERC) of Salale University College of Health Sciences with Ref. N o . SLU-IRB/28/23. Permission letters was obtained from the Chief Executive Officer of MKCSH Hospital with Ref. N o . MD/2874/015.All selected study participants signed the informed assent form. Parents/guardians of study participants were also informed about the purpose of the study, the importance of their participation, and their right to withdraw at any time. The privacy and confidentiality of the information given by each respondent was maintained, and name was not recorded. Culture results and antimicrobial susceptibility results were communicated to the hospital clinician as soon as the results had ready. Author contributions; - SD. Had a substantial contribution from conception to the acquisition of data. All the authors had a great contribution to study design, analysis, and interpretation of the findings. SD and AA were involved in laboratory analysis. All drafted the manuscript. All authors revised the paper carefully for important intellectual contents. All authors read and approved the final manuscript. Funding: - Oromia Health Bureau funded partially. But does not have a role in study design, data collection and analysis, interpretation, or preparation of the manuscript. Data availability:- All relevant data are within this paper. Competing interests : - There is no competing interests. Author details: - 1. Seyoum Dechasa Gemechu: - Ambo University, Clinical Microbiology Diagnostic Department, P.O. Box 19, Ambo/Town, Ethiopia 2. Dr. Seifu Gizaw Fayisa and Mr. Abdi Negash: - Salale University College of Health Sciences, Department of Medical Laboratory Sciences, P.O. Box 245, Fitche, Ethiopia 3 . Mr. Abate Abdisa Eticha: - Tulu Bolo General Hospital, laboratory of Department P.O. Box 197, Tullu Bollo, Ethiopia References World Health Organization. Diarrhea disease. WHO. 2017; Khalil IA, Troeger C, Blacker BF, Rao PC, Brown A, Atherly DE et al. Morbidity and mortality due to shigella and enterotoxigenic Escherichia coli diarrhea: The Global Burden of Disease Study 1990–2016. Lancet Infect Dis. 2018;18(11):1229–40. World Health Organization. Diarrheal disease fact Sheet. WHO. 2013;No. 330. Nemeth V, Zulfiqar H PN. Diarrhea - StatPearls. NCBI Bookshelf StatPearls. 2019;1–10. Barr W SA. Acute Diarrhea in Adults.In American Family Physician. 2014;89(3). Lanata CF, Fischer-Walker CL, Olascoaga AC, Torres CX, Aryee MJ, Black RE. Global Causes of Diarrheal Disease Mortality in Children <5 Years of Age: A Systematic Review. PLoS One. 2013;8(9). Black R LC. Epidemiology of diarrheal disease in developing countries. In: Infections of the Gastrointestinal Tract, editor. Blaser MJ, Smith PD, Ravdin JI, et al (Eds),. 2nd ed. Philadelphia: Lippincott Williams and Wilkins; 2002. 11–29. Notario R, Borda N, Gambande T, Sutich E. Species and serovars of enteropathogenic agents associated with acute diarrheal disease in Rosario, Argentina. Vol. 38, Revista do Instituto de Medicina Tropical de Sao Paulo. 1996. 5–7. Chiriac PC, Duceac L-D, Manole A, Poroch V, Delcea F, Stafie L, et al. Acute Bacterial Gastroenteritis as a Healthcare-Associated Infection in Pediatrics. Curr Heal Sci J. 2017;43(3):275–81. Gustavo V, Batthyány L, Bianco MN, Pérez W, Pardo L, Algorta G, et al. Enteropathogens Associated with Acute Diarrhea in Children from Households with High Socioeconomic Level in Uruguay. Int J Microbiol. 2015;2015:8. World Health Organization. Antimicrobial resistance: global report on surveillance. WHO. 2014; Breurec S, Reynaud Y, Frank T, Farra A, Costilhes G, Weill FX LHS. Serotype distribution and antimicrobial resistance of human Salmonella enterica in Bangui, Central African Republic, from 2004 to 2013. PLoS Negl Trop Dis. 2019;13(12):7917. Raza S, Tamrakar R, Bhatt C JS. Antimicrobial susceptibility patterns of Salmonella typhi and Salmonella paratyphi A in a tertiary care hospital. J Nepal Health Res Counc. 2012;10(22). Kasanga M, Mudenda S, Siyanga M, Chileshe M, Mwiikisa MJ, Kasanga M et al. Antimicrobial susceptibility patterns of bacteria that commonly cause bacteremia at a tertiary hospital in Zambia. Future Microbiology. 2020;15(18):1735–45. Sjolund-Karlsson M, Joyce K, Blickenstaff K, Ball T, Haro J, Medalla FM, Fedorka-Cray P, Zhao S, Crump JA WJ. Antimicrobial susceptibility to azithromycin among Salmonella enterica isolates from the United States. Antimicrobial agents and chemotherapy. 2011;55(9):3985–9. O’Neill J. Antimicrobial resistance: Tackling a crisis for the health and wealth of nations. 2014;1–2. Uddin MS, Rahman M, Faruk O, Talukder A, Hoq I, Das S, et al. Bacterial gastroenteritis in children below five years of age : a cross ‑ sectional study focused on etiology and drug resistance of Escherichia coli O157 , Salmonella spp ., and Shigella spp . Bull Natl Res Cent. 2021;45:138. Quraishi F, Shaheen S, Memon Z, Fatima G. Culture and Sensitivity Patterns of Various Antibiotics Used for the Treatment of Pediatric Infectious Diarrhea in Children under 5 Years of Age: A Tertiary Care Experience from Karachi. Int J Clin Med. 2018;09(09):684–96. Mahmoudi S, Pourakbari B, Moradzadeh M, Eshaghi H, Ramezani A, Haghi Ashtiani MT, et al. Prevalence and antimicrobial susceptibility of Salmonella and Shigella spp. among children with gastroenteritis in an Iranian referral hospital. Microb Pathog. 2017;109:45–8. Afum T, Asandem DA, Asare P, Asante-Poku A, Mensah GI, Musah AB et al. Diarrhea-Causing Bacteria and Their Antibiotic Resistance Patterns Among Diarrhea Patients From Ghana. Front Microbiol. 2022;13.894319. Cajetan IC, Nnennaya IR, Casmir AA, Florence IN. Enteric bacteria pathogens associated with diarrhoea of children in the federal capital territory Abuja, Nigeria. N Y Sci J. 2009;62–9. Ledwaba S.E., Kabue J.P., Barnard T.G. TAN and PN. Enteric Pathogen Co-Infections in the Pediatric Population from rural Communities in the Vhembe District, South Africa. South African J Child Heal. 2018;12:170 – 174. Kilongosi Webale M, Wanjala C, Guyah B, Shaviya N, Munyekenye GO, Lokamar Nyanga P et al. Epidemiological patterns and antimicrobial resistance of bacterial diarrhea among children in Nairobi city,Kenya. astroenterol Hepatol Bed Bench. 2020;12(3):238–46. Balew M, Kibret M. Prevalence of enteric bacterial pathogens in diarrheic under-five children and their association with the nutritional status in Bahir Dar Zuria District, Northwest Ethiopia. BMC Nutr. 2023;9(1):1–9. Tizazu Z, Zelelie TZ, Gebreyes DS, Tesema A, Craddock HA, Gishen NZ. Enteropathogens in Under-Five Children with Diarrhea in Health Facilities of Debre Berhan Town , North Shoa , Ethiopia. Ethiop J Heal Sci. 2019;29(2):203. Mamuye Y, Metaferia G, Birhanu A, Desta K FS. Isolation and Antibiotic Susceptibility Patterns of Shigella and Salmonella among Under 5 Children with Acute Diarrhoea: A Cross-Sectional Study at Selected Public Health Facilities in Addis Ababa, Ethiopia. Clin Microbiol. 2015;4:186. Mulatu G, Beyene G ZA. Prevalence of Shigella, Salmonella and Cmpylobacter species and their susceptibility patters among under five children with diarrhea in Hawassa town, South Ethiopia. Ethiop J Heal Sci. 2014;24(2):101–18. Ameya G, Tsalla T, Getu F, Getu E. Antimicrobial susceptibility pattern , and associated factors of Salmonella and Shigella infections among under five children in Arba Minch , South Ethiopia. Ann Clin Microbiol Antimicrob. 2018;17(1):1–7. Mekonnen GK, Mengistie B, Sahilu G, Kloos H, Mulat W. Etiologies of diarrhea and drug susceptibility patterns of bacterial isolates among under-five year children in refugee camps in Gambella Region , Ethiopia : a case control study. BMC Infect Dis. 2019;19:1008. Tosisa W, Mihret A, Ararsa A, Eguale T, Abebe T. Prevalence and antimicrobial susceptibility of Salmonella and Shigella species isolated from diarrheic children in Ambo town. BMC Pediatr. 2020;20:91. Cho SH, Lim YS, Park MS, Kim SH, Kang YH. Prevalence of antibiotic resistance in Escherichia coli fecal isolates from healthy persons and patients with diarrhea. Osong Public Heal Res Perspect. 2011;2(1):41–5. Omolajaiye SA, Afolabi KO, Iweriebor BC. Pathotyping and Antibiotic Resistance Profiling of Escherichia coli Isolates from Children with Acute Diarrhea in Amatole Gebreegziabher G, Asrat D, W/Amanuel Y, Hagos T. Isolation and Antimicrobial Susceptibility Profile of Shigella and Salmonella Species from Children with Acute Diarrhoea in Mekelle Hospital and Semen Health Center, Ethiopia. Ethiop J Health Sci. 2018;28(2):197–206. Beyene, G. and Tasew H. Prevalence of intestinal parasite, Shigella and Salmonella species among diarrheal children in Jimma health center, Jimma southwest Ethiopia: a cross sectional study. Ann Clin Microbiol Antimicrob. 2014;13(1):1–10. Clinical and laboratory standard Institute. M100 Performance Standards for Antimicrobial Susceptability Testing. Vol. 31th editi. 2021. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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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-8704393","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":584337325,"identity":"d730294b-84be-41cd-aa3c-499ed77f7956","order_by":0,"name":"Mr. Seyoum Dechasa Gemechu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3klEQVRIiWNgGAWjYLCCBwzMdvzsDUCWgQWRWhIYmJMlew6AtEgQr4Vxw40EEJMILfIzcgwfJFRYMzPcfH51w48CCQb+9u4EvFoMbuQYGyScSedjnJ1TdrMH6DCJM2c34NcikWMmkdh2mJlZOiftBg9Qi4FELn4tQIeZ/wBqYWyTPJN28w8xWhhu5JgxgLT0SLAfu02ULQZnnhVLAP2SLMGTw3ZbxkCCh6Bf5NuTN374UGFtZ3/8+LObb/7YyPG39xJwGAOHAZTBA2bwEFAOAuwP0BmjYBSMglEwClABAEjBR1SHxPBvAAAAAElFTkSuQmCC","orcid":"","institution":"Ambo University","correspondingAuthor":true,"prefix":"Mr.","firstName":"Seyoum","middleName":"Dechasa","lastName":"Gemechu","suffix":""},{"id":584337326,"identity":"9c38d0a3-64f2-461a-8b9a-f7143c99627f","order_by":1,"name":"Dr. Seifu Gizaw Fayisa","email":"","orcid":"","institution":"Salale University College of Health Science","correspondingAuthor":false,"prefix":"Dr.","firstName":"Seifu","middleName":"Gizaw","lastName":"Fayisa","suffix":""},{"id":584337329,"identity":"31756057-8cb5-439d-871d-d171cafc901c","order_by":2,"name":"Mr. Abdi Negash","email":"","orcid":"","institution":"Salale University College of Health Science","correspondingAuthor":false,"prefix":"Mr.","firstName":"Abdi","middleName":"","lastName":"Negash","suffix":""},{"id":584337331,"identity":"0fb68ba6-e72c-46cc-8f4b-42a35a66a463","order_by":3,"name":"Mr. Abate Abdisa Eticha","email":"","orcid":"","institution":"Tulu Bolo General Hospital","correspondingAuthor":false,"prefix":"Mr.","firstName":"Abate","middleName":"Abdisa","lastName":"Eticha","suffix":""}],"badges":[],"createdAt":"2026-01-27 00:38:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8704393/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8704393/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101792289,"identity":"044e9d17-86e0-4c3a-9aa3-e836641ca075","added_by":"auto","created_at":"2026-02-03 16:11:41","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":56153,"visible":true,"origin":"","legend":"\u003cp\u003eThe isolation and identification of \u003cem\u003eEscherichia coli, Salmonella, \u003c/em\u003eand\u003cem\u003eShigella \u003c/em\u003efrom under five children at Mettu Karl Comprehensive Specialized hospital, Southwest Oromia, Ethiopia, 2023.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8704393/v1/4e20075cac9235c798c83e8e.png"},{"id":101792020,"identity":"617c4e6f-32e4-4f64-9879-53d43dc7cf31","added_by":"auto","created_at":"2026-02-03 16:11:22","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":38199,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of entero-pathogens isolated from under-five children with a compliant of diarrhea at Mettu Karl Comprehensive Specialized Hospital Southwest Oromia, Ethiopia from June to August, 2023\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8704393/v1/7b78218dfeb1da6908a63dff.png"},{"id":103398127,"identity":"21b87312-7861-4dbb-a93a-28ed4049b39a","added_by":"auto","created_at":"2026-02-25 08:58:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1467965,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8704393/v1/381ad439-e3bb-46e1-9ff5-aa9c68d63efe.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Bacterial diarrhea is a serious public health concern, especially in children under five. Early exposure to a wide range of enteric bacterial infections causes children in underdeveloped countries to suffer from many episodes of diarrheal illness.","fulltext":[{"header":"Background","content":"\u003cp\u003eDiarrhea is a condition of having three or more loose or liquid bowel movement per day. Human diarrheal diseases have been recognized since the beginning of civilization and remain one of the most prevalent public health problems of today. The most significant modes of transmission is believed to be fecal\u0026ndash;oral spread by ingestion of contaminated food or water which is frequently facilitated easily by unsanitary and hygienic situations(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Diarrheal diseases are caused by a lack of access to good health care, a lack of appropriate diagnostics method, poor health facilities, unsanitary water sources and/or a lack of effective treatment strategies (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccording to World Health Organization (2013), diarrhea could be classified into four types, based on clinical symptoms to less than five years children. They are watery diarrhea which defined as a sudden onset of frequent, watery, loose stools without visible blood, lasting less than two weeks. Dysentery is a diarrhea containing blood and mucus in feces. Persistent diarrhea is defined as diarrhea episodes of presumed infectious etiology that have an unusually for longer than 14 days, but less than 1 month. Chronic diarrhea is recurrent or long-lasting due to mainly noninfectious causes. Each of them reflecting different pathogenesis (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Watery stools, frequent bowel movements, vomiting, nausea, fever, gas, dry mouth, blood in the stools, decreased urine production, loss of appetite, and dehydration are some of the clinical signs of diarrhea (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBoth infectious and non-infectious can causes diarrhea (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Bacterial pathogens, viruses, and parasites can all lead to infectious diarrhea(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Bacterial infections are most common causative agents of diarrhea (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Global estimates show that among all diarrheal causes, the prevalence of specific types of bacterial diarrhea is 10% to 25% for \u003cem\u003eE. coli\u003c/em\u003e, 10% for \u003cem\u003eShigella\u003c/em\u003e, 3% for \u003cem\u003eSalmonella\u003c/em\u003e, and 3 to 6% for \u003cem\u003eCampylobacter\u003c/em\u003e (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eChildren in developing nations experience multiple episodes of diarrheal disease due to early exposure to a broad spectrum of enteric bacterial infections. The most common bacterial infections vary with the child's age and time, showing both seasonal as well as geographical variation. Every child's experience is unique, but the most frequently identified bacterial in young children are \u003cem\u003eSalmonella\u003c/em\u003e strains, entero-hemorrhagic \u003cem\u003eE. coli, Shigella\u003c/em\u003e spp., \u003cem\u003eClostridium difficile\u003c/em\u003e, \u003cem\u003eCampylobacter jejuni\u003c/em\u003e, and \u003cem\u003eYersinia enterocolitica\u003c/em\u003e. Other less common causes of diarrhea but clinically significant bacterial infections include \u003cem\u003eAeromonas hydrophila\u003c/em\u003e, \u003cem\u003eCampylobacter upsaliensis, Vibrio\u003c/em\u003e spp (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Parasites that causes diarrhea include \u003cem\u003eGiardia lamblia, Entamoeba histolytica, Cyclospora cayetanensis, Cryptosporidium, Ascaris lumbricoides, Trichuris trichiura\u003c/em\u003e, and \u003cem\u003eHymnolepis nana.\u003c/em\u003eand viruses such as Adenovirus, Norwalk Virus and Rotavirus which cause diarrhea in children under five (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe emergence of multidrug-resistant bacteria has significantly impeded the use of antimicrobials to treat infectious diarrhea (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). There have been reports of high rates of resistance to widely used and readily available antimicrobials such as ampicillin, tetracycline, trimethoprim-sulfamethoxazole (cotrimoxazole), and chloramphenicol (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). In addition, the development of antimicrobial resistance (AMR) and multidrug resistance (MDR) has changed the antimicrobial susceptibility pattern of \u003cem\u003eSalmonella\u003c/em\u003e spp., \u003cem\u003eShigella\u003c/em\u003e spp., and \u003cem\u003eE. coli\u003c/em\u003e gradually (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). When necessary, antimicrobials should only be used to treat diarrhea caused by infectious agents such as bacteria after culture and susceptibility testing have been performed (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). However, antimicrobial susceptibility tests (ASTs) are not usually performed before antimicrobials are prescribed; therefore, empirical treatment is usually considered. Because of this, the prevalence of antimicrobial-resistant bacteria has increased (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). This may be partially explained by the scarcity of ASTs and the increased turnaround time for test results (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). So the future of treatment by antimicrobial is being challenged by infections from resistant organisms, which are affecting treatment costs, treatment outcomes, disease duration and disease spread (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Therefore, this study was aimed to fill the gap that stated above by assessing the prevalence and antimicrobial susceptibility patterns of \u003cem\u003eEscherichia coli\u003c/em\u003e, \u003cem\u003eSalmonella\u003c/em\u003e, and \u003cem\u003eShigella\u003c/em\u003e species among under five years age diarrheal children attending Mettu Karl Comprehensive Specialized Hospital, Southwest Ethiopia June to August, 2023.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Area, Study Design and Period\u003c/h2\u003e \u003cp\u003eHospital-based, cross-sectional study was carried out to determine prevalence and antimicrobial susceptibility patterns of \u003cem\u003eEscherichia coli\u003c/em\u003e, \u003cem\u003eSalmonella\u003c/em\u003e, and \u003cem\u003eShigella\u003c/em\u003e species among under five years age diarrheal children attending Mettu Karl Comprehensive Specialized Hospital (MKCSH) from June to August 2023. MKCSH Hospital is a specialty hospital founded in 1964 and named after Dr. Karlheinz Boom, the founder and chairman of Mesnchem f\u0026uuml;r Mesnchem (MFM), a German-born Non-Governmental Organization (NGO), who renovated and expanded the hospital in February 2001.\u003c/p\u003e \u003cp\u003eThe hospital provides services to a catchment area of ​​more than 2\u0026nbsp;million people come from Ilubabor Zone, Gambella Region, Southwestern Population Region of Ethiopia and South Sudan Country. Based on the Central Statistical Agency (CSA) projection for 2022, the town has a total population of 59,706, of which 29,569 are male and 30,137 female.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSample Size Determination\u003c/h3\u003e\n\u003cp\u003eThe sample size was calculated based on a single population proportion formula by taking the prevalence of enteric bacteria in under-five children with diarrhea from a previous study done at Debre Berhan town of 46% (53) at a 95% confidence interval and 5% margin of error.\u003c/p\u003e \u003cp\u003eWhere: n\u0026thinsp;=\u0026thinsp;sample size\u003c/p\u003e \u003cp\u003eZα/2\u0026thinsp;=\u0026thinsp;95% level of confidence (1.96).\u003c/p\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;diarrhea prevalence from previous study\u0026thinsp;=\u0026thinsp;46%.\u003c/p\u003e \u003cp\u003eq\u0026thinsp;=\u0026thinsp;1-p.\u003c/p\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;margin of error (0.05)\u003c/p\u003e\n\u003ch3\u003e \u003c/h3\u003e\n\u003cdiv class=\"Heading\"\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:n=\\frac{{\\left(Z\\frac{\\alpha\\:}{2}\\right)}^{2}\\:P(1-P)}{{d}^{2}}\\)\u003c/span\u003e\u003c/span\u003e \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:n\\:=\\frac{{\\left(1.96\\right)}^{2}x0.46x0.54}{{\\left(0.05\\right)}^{2}}=\\:\\:\\:\\:\\:\\:\\:\\:\\:\\:382\\)\u003c/span\u003e\u003c/span\u003e\u003c/div\u003e \u003cp\u003eThus, the totals of \u003cb\u003e382\u003c/b\u003e children with diarrhea were included in the study\u003c/p\u003e\n\u003ch3\u003eData and sample collection\u003c/h3\u003e\n\u003cp\u003eTwo days of training was provided by the principal investigator for two BSc. Nurse, two BSc. Laboratory technologists and one supervisors on data collection tools and collection techniques, how to approach the interviews, and maintaining the privacy and confidentiality of respondents prior to the actual data collection period. The data was collected using a structured questionnaire. The questionnaire was translated into the local language Afan Orormo and translated back into English to check its consistency. Prior to data collection, 5% of the sample was pre-tested on Bedele general hospital that is not included in the actual sample. All information on the questionnaire was filled in by the data collector. After the data collection, the questionnaires were cleaned daily by the supervisors and principal investigator and checked for completeness.\u003c/p\u003e \u003cp\u003eChildren's socio-demographic variables include age and gender, as well as guardian/parent variables such as education level, family size, and residence. Hygiene and sanitation-related variables like source of drinking water, feeding practice of children, utilization of latrines, hand washing of parents/gardians, clinical data including duration of diarrhea, fever, vomiting, bloody diarrhea, mucoid diarrhea, watery diarrhea, the immunization status of the child, and breastfeeding were collected.\u003c/p\u003e \u003cp\u003eFresh stool specimens were collected from each study participants by trained BSc. Nurses for bacteriological analysis. The specimens were coded with patients ID and information and transported using Cary-Blair transport media to MKCSH bacteriology laboratory at 2-8\u003csup\u003e0\u003c/sup\u003eC.\u003c/p\u003e\n\u003ch3\u003eIdentification of Bacterial Isolates\u003c/h3\u003e\n\u003cp\u003eIsolation and characterization of parasites were examined by preparing a slide using normal saline 0.85% to observe the ova, cysts, and trophozoite stage of the parasites present in the stool at Mettu Karl Coprehensive Specialized Hospital laboratory before inoculated on culture medaia. For bacteriological isolation, each stool sample directly cultured onto Selenite F broth (SFB) and MacConkey agar media. Approximately 1 g of each sample inoculated into 10 ml of SFB. The tubes and plates were incubated for 24 hours at 37\u003csup\u003e0\u003c/sup\u003eC. From enrichment Selenite F broth subculture onto Xylose-Lysine Deoxycholate (XLD) agar then the plates incubated at 37\u0026deg;C for 18 to 24 hrs. The suspected bacteria were identified by colony morphology and biochemical characteristics. On MacConkey agar suspected enteric bacteria appeared as transparent or colorless colonies. \u003cem\u003eSalmonella spp.\u003c/em\u003e appeared on XLD agar as red colonies with black center owing to H\u003csub\u003e2\u003c/sub\u003eS production. \u003cem\u003eShigella spp\u003c/em\u003e. colonies identified on XLD agar the colonies appeared as transparent red. On MacConkey agar suspected enteric bacteria appeared as transparent or colorless colonies. \u003cem\u003eE.coli\u003c/em\u003e on MacConkey agar showed transparent colorless colonies. Unfortunately, there was no growth of bacteria on alkaline peptone water. The colonies of each representative isolate was then characterized using standard bacteriological methods. Please see laboratory work flow below (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eBiochemical Tests\u003c/h2\u003e \u003cp\u003eBiochemical media were used for the identification of bacterial isolates. The identification were done based on the pattern of biochemical reactions using a standard bacterial identification system. All the suspected isolates were examined biochemically using Nutrient Broth, Simmons Citrate Agar, Klingler Iron Agar (KIA), Sulfide-Indole-Motility (SIM), Urea Broth Base, and Kovac\u0026rsquo;s Reagent to identify bacteria. Among the tests used to identify enteric bacteria are: pigment production, motility, urease, citrate, hydrogen sulfide utilization, oxidase, indole, lysine, and sugar fermentation. Bacterial isolates were categorized based on culture outcomes and biochemical tests. Please see laboratory work flow below (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAntimicrobial Susceptibility Testing\u003c/h3\u003e\n\u003cp\u003eAntimicrobial susceptibility patterns was determined by the Kirby Bauer disk method. Three to five pure colonies from agar plate isolates were suspended in the normal saline solution and mixed well to adjust at 0.5 McFarland standards. The 0.5 McFarland turbidity standard was prepared by mixing 0.5 mL barium chloride dehydrate (1.175%) with 99.5mL sulfuric acid (1%). A sterile cotton swab is used to evenly spread bacterial inoculum on a sterile petri dish of Mueller Hinton Agar. 12 disk on 150mm plate and 6 on 100mm plate with up to 24mm apart each other. Each disc must be pressed down to ensure complete contact with the agar surface. The plates was incubate for 16-18hrs at 37\u003csup\u003eo\u003c/sup\u003eC, which was done according to the guideline. Commonly prescribed Antimicrobials like ampicillin (10\u0026micro;g), amoxicillin-clavulanic acid (20/10\u0026micro;g), cefazolin (30\u0026micro;g), cefotaxime (30\u0026micro;g), ceftazidime (30\u0026micro;g), cefepime (30\u0026micro;g), imipenem (10\u0026micro;g), ciprofloxacin (5\u0026micro;g), co-trimoxazoale (trimethoprim-sulfamethoxazole,(1.25/23.75\u0026micro;g), gentamicin (15\u0026micro;g), azithromycin (15\u0026micro;g) were used to test against bacteria. According to the size of the zone of inhibition, the organisms were classified as susceptible, intermediate, or resistant to each Antimicrobial using the CLSI 31th edition, 2021 interpretation guideline (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Please see laboratory work flow below (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eundefined\u003c/h3\u003e\n\u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eData Quality Assurance\u003c/h2\u003e \u003cp\u003eThe data quality control measures of the study was maintained throughout the whole process of data collection and laboratory work. For laboratory analysis, the pre-analytical, analytical, and post-analytical stages of quality assurance and standard operating procedures (SOPs) of testing laboratory was followed.\u003c/p\u003e \u003cp\u003eStool samples were collected by trained healthcare personnel using sterile stool containers that are labeled with participant identification numbers and transported to the Microbiology Laboratory at the MKCSH immediately. The collected samples were registered in the logbook to avoid re-sampling. Before using culture medium, the expiration date was checked. Two plates of prepared culture media from the test batch were taken and placed into the incubator set at 37\u0026deg;C for 24 hours. After required incubation, the plates were checked for any growth. If there is any growth, contamination has occurred in the prepared batch and all the batch is not used.\u003c/p\u003e \u003cp\u003eThe sample was analyzed at MKCSH. The test was performed by a well-trained and experienced laboratory technologist. The collected sample were tasted once for bacterial culture and for intestinal parasites. A known strain of the American Type Culture Collection (ATCC) of \u003cem\u003eEscherichia coli\u003c/em\u003e 25922 and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e ATCC 27853 control were used as the zone of inhibition for these organisms is known in accordance with the CLSI 31th edition (2021) (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe results were recorded with an identification number on the laboratory result form and logbook. The laboratory results were given to the physician immediately for medical treatments, and parents and guardians were informed. All bacterial isolates were stored at refrigerator until the end of this research project for any kind of checkup \u0026amp; future use.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis and Interpretation\u003c/h2\u003e \u003cp\u003eFollowing data collection, it was reviewed for completeness and consistency. EpiData v4.6.0.6 version software was used for data entry and exported to the statistical package for social science (SPSS) 25version for analysis. Finally, descriptive summaries, frequency, tables, and graphs were used to describe the study variables.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eSocio-Demographic Characteristic of the Study Participants\u003c/h2\u003e \u003cp\u003eIn this study, a total of 382 under-five children with diarrhea disease were included. Out of 382 childrens, 178(46.6%) were male and 204 (53.4%) were female; with male to female ratio of 1:1.2. The age ranges from 4\u0026ndash;60 months with mean of 32.64 (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;14.39) months, while majority of participants (213 (55.8%)) lived in urban areas and (294(77%)) had family size 3\u0026ndash;4 persons. It was found that among the respondents, 35(9.2%) parents/guardians were not able to read and write and less than three-fourths of parents or guardians 104(27.2%) had completed college and above. Almost half 170 (44.5%) of the guardians had a monthly income of 1,001-3000 birr (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\u003eDistribution of \u003cem\u003eEscherichia coli\u003c/em\u003e, \u003cem\u003eSalmonella\u003c/em\u003e, and \u003cem\u003eShigella\u003c/em\u003e among study participants with respect to sociodemographic variables at Mettu Karl Comprehensive Specialized Hospital Southwest Oromia, Ethiopia from June to August, 2023\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\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\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eEscherichia coli\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eSalmonella\u003c/em\u003e spp\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eShigella\u003c/em\u003e spp\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eAge categories\u003c/p\u003e \u003cp\u003e(in month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u0026ndash;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37\u0026ndash;48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e6\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=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5\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\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e55.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducational status of parents\u003c/p\u003e \u003cp\u003eor guardians\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCan\u0026rsquo;t read and write\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCollege and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eFamily size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e294\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e77.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u0026ndash;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eAverage monthly\u003c/p\u003e \u003cp\u003eincome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1001-3,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,001\u0026ndash;5,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2\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=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eClinical Characteristics of Respondents\u003c/h2\u003e \u003cp\u003eThe clinical complaints of the diarrheal children indicated that, out of 382 diarrheal children, 128(33.5%) had fever and 80(20.9%) had vomiting. With regard to consistency of stools, 243(63.6%) had watery diarrhea. Almost all (372(97.4%) of children were vaccinated. The study also revealed that the duration of diarrhea ranged from 1\u0026ndash;6 days with a mean of 2.030 days with 265 (69.4%) had three days of duration. One hundred ninty five (51%) of chidren had stool frequency greater than 5 per days and 192(50.2%) children were breastfeeding for 1\u0026ndash;2 years (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\u003eDistribution of \u003cem\u003eEscherichia coli\u003c/em\u003e, \u003cem\u003eSalmonella\u003c/em\u003e, and \u003cem\u003eShigella\u003c/em\u003e among diarrheal children with respect to clinical variables at Mettu Karl Comprehensive Specialized Hospital Southwest Oromia, Ethiopia from June to August, 2023\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\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\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eEscherichia coli\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eSalmonella\u003c/em\u003e spp\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eShigella\u003c/em\u003e spp\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\u003eFever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e9\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=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e254\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eDuration of diarrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eStool Frequency (per day)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;2 per day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026ndash;4 per day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 per day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e197\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eType of diarrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWatery diarrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e63.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMucoid diarrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBloody diarrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVomiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3\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=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e302\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e79.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDehydration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e380\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e99.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eWeaning Age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 year breast feeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;2 years breast feed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e222\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e58.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;2 breast feed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eImmunization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHe/she take an age appropriate vaccine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eComplete vaccine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e327\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e85.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncomplete vaccine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThis study indicated that around half of the respondents 169 (44.9%) used pipe water as sources of drinking. Almost all parents/guardians used traditional pit latrines (340(89%)) but only 28(7.3%) had hand washing facilities near their latrines. The study also revealed that the majority of parents/guardians (327(88.2%)) washed their hands before and after cooking food and more than half of parents/guardians (255(66.8%)) used bottles for feeding their children. (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\u003eDistribution of \u003cem\u003eEscherichia coli\u003c/em\u003e, \u003cem\u003eSalmonella\u003c/em\u003e, and \u003cem\u003eShigella\u003c/em\u003e among diarrheal children with respect to behavioral characteristics at Mettu Karl Comprehensive Specialized Hospital Southwest Oromia, Ethiopia from June to August, 2023\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\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\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eEscherichia coli\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eSalmonella\u003c/em\u003e spp\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eShigella\u003c/em\u003e spp\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eSource of\u003c/p\u003e \u003cp\u003edrinking water\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePipe water\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpring/protected\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWell water\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRiver water\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eUtilization of latrine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e365\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e95.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e7\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=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eType of latrine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTraditional pit latrine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e89.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVentilated improved latrine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHand washing Facility near the latrine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\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=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e337\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e88.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAt what time did you wash your hand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore and After cooking food\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e327\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e85.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore feeding child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter Toilet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e222\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e58.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMaterial used for feed child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBottle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e255\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCup with spoon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGlass Tube\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\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=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eIsolation of Enteric Bacterial\u003c/h2\u003e \u003cp\u003eFrom the total 382 stool specimens, isolated enteric bacteria were \u003cem\u003eEscherichia coli, Salmonella\u003c/em\u003e and \u003cem\u003eShigella\u003c/em\u003e species. The positive rate of enteric bacteria identified from this research were 44(11.52%). There is no other species of bacteria is isolated in this study from a total of 382 stool samples processed. From the positive stool sample 43(97.7%) had single infection of bacterial pathogen whereas 1(2.3%) had protozoan parasite and bacterial infection.\u003c/p\u003e \u003cp\u003eOut of 44(11.52%) isolated bacteria, \u003cem\u003eE.coli\u003c/em\u003e was detected in 19(5.0%), \u003cem\u003eSalmonella\u003c/em\u003e species was detected in 14(3.7%) of study participants and \u003cem\u003eShigella\u003c/em\u003e species was detected in 11(2.9%) of target children. About half of detected \u003cem\u003eE.coli\u003c/em\u003e and \u003cem\u003eSalmonella\u003c/em\u003e cases were in the age group between 13 and 24 months whereas \u003cem\u003eShigella\u003c/em\u003e species were detected in almost all age groups equally. In this study, protozoan parasites were identified of which 6 (1.6%) \u003cem\u003eGiardia lamblia\u003c/em\u003e and 2(0.5%) \u003cem\u003eEntamoeba histolytica/dispar\u003c/em\u003e (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eAntimicrobial Resistance Pattern\u003c/h2\u003e \u003cp\u003eThe antimicrobial susceptibility pattern for isolated bacteria to was determined by the disk diffusion method by following the recommendations of the CLSI 31 2021(67). Resistance to Ampicillin was 89.5%, 85.7%, and 72.7% for \u003cem\u003eE.coli, Salmonella\u003c/em\u003e species, and \u003cem\u003eShigella\u003c/em\u003e species respectively. Resistance to co-trimoxazoale was 73.7% for \u003cem\u003eE.coli\u003c/em\u003e, 72.75% for \u003cem\u003eShigella\u003c/em\u003e spps and 54.5% for \u003cem\u003eSalmonella\u003c/em\u003e spp isolates. Resistance to ceftriaxone was 64.3% for \u003cem\u003eSalmonella\u003c/em\u003e, 47.4% for \u003cem\u003eE. coli\u003c/em\u003e spps, and 45.5% for \u003cem\u003eShigella\u003c/em\u003e. From 19 isolates of \u003cem\u003eE.coli\u003c/em\u003e species, most of them have shown sensitivity for imipenem (94.7%), cefepime and cefotaxime (89.5%), and azithromycin (73.7%). From 14 isolates of \u003cem\u003eSalmonella\u003c/em\u003e species, 100% sensitivity has shown for imipenem and cefepime whereas three-fourths of them were susceptible for azithromycin, cefotaxime, augmentin, cotrimoxazole, ciprofloxacin. From 11 isolates of \u003cem\u003eShigella\u003c/em\u003e species, 100% sensitivity has shown for imipenem, 81.8% for azithromycin, and 72.7% for cefotaxime, and ciprofloxacin and more than half shows sensitivity for augmentin, Cefepime, ceftriaxone. Almost all \u003cem\u003eE.coli, Salmonella\u003c/em\u003e, and \u003cem\u003eShigella\u003c/em\u003e were susceptible to imipenem, cefepime, cefotaxime (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 pattern of \u003cem\u003eEscherichia coli\u003c/em\u003e, \u003cem\u003eSalmonella\u003c/em\u003e, and \u003cem\u003eShigella\u003c/em\u003e identified from under five age children at Mettu Karl Comprehensive Specialized Hospital Southwest Oromia, Ethiopia from June to August, 2023\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" 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=\"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=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" 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=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAntimicrobial discs\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eE.coli\u003c/em\u003e\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;19(5.0%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cem\u003eSalmonella\u003c/em\u003e spp\u003c/p\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;14(3.7%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e\u003cem\u003eShigella\u003c/em\u003e spp\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;11(2.9%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eR\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAMP(10\u0026micro;g)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2(10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17(89.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12(85.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2(18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1(9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e8(72.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAUG (210/0\u0026micro;g)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13(68.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3(15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3(15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9(64.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4(28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8(72.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1(9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3(27.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGN (10\u0026micro;g)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15(78.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4(21.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTMP-SXT (1.25/23.75\u0026micro;g)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4(21.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14(73.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8(57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2(18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1(9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e8(72.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIPM(10\u0026micro;g)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18(94.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0(0.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1(5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFEP(30 \u0026micro;g)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17(89.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2(10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9 (81.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1(9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1(1.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAZT(30 \u0026micro;g)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14(73.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4(21.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12(85.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2(14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7(63.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4(36.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRO(30 \u0026micro;g)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7(36.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3(15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9(47.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3(21.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2(14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9(64.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6(54.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e5(45.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCIP(5 \u0026micro;g)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11(57.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7(36.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11(78.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3(21.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8(72.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1(9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2(18.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCZ (30\u0026micro;g)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7(36.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11(57.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5(35.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8(57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5(45.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e6(54.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCTX (30\u0026micro;g)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17(89.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2(10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9(64.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5(35.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8(72.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3(27.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCAZ (30\u0026micro;g)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9(47.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8(42.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5(35.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2(14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4(36.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4(36.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3(27.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eKey\u003c/b\u003e S-Susceptibility I- Intermediate, R-Resistance, TMP- SXT-trimethoprim sulphamethoxazole, AMP-Ampicillin, AUG-Augmentin, IPM-imipenem, CAZ-ceftazidime, CTX-Cefotaxime, CZ-cefazolin, FEP-Cefepime, AZT-Azithromycin, CRO-Ceftriaxone, CIP-Ciprofloxacin.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eMulti-Drug Resistant Isolates\u003c/h2\u003e \u003cp\u003eFrom total 44 isolates, 20(45.5%) of them were showed multidrug resistance. Out of that, 10(52.6%) of \u003cem\u003eE.coli\u003c/em\u003e isolate were multidrug resistant, 6(31.5%) of them resistance to 3 antimicrobials and 4(21.1%) of them resistance to 4 antimicrobials. Regarding, \u003cem\u003eSalmonella\u003c/em\u003e isolate, 5(35.7%) of the isolates showed multidrug resistant, 4(28.6%) of them showing resistance to 3 antimicrobials and 1(7.1%) to 4 antimicrobial. Also, \u003cem\u003eShigella\u003c/em\u003e isolates showed multidrug resistance for 5 (45.5%) of which 4 (36.4%) of the isolates showed resistant to 4 antimicrobials and the remaining 1(9.1%) were resistant to 4 antimicrobials. But 3 (15.8%) \u003cem\u003eE.coli\u003c/em\u003e, 3(21.4%) \u003cem\u003eSalmonella\u003c/em\u003e and 2(18.2%) of \u003cem\u003eShigella\u003c/em\u003e were susceptible to all tested antimicrobial (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\u003eResistance Antibiogram of \u003cem\u003eEscherichia coli\u003c/em\u003e, \u003cem\u003eSalmonella\u003c/em\u003e, and \u003cem\u003eShigella\u003c/em\u003e species of under five chidren at Mettu Karl Comprehensive Specialized Hospital Southwest Oromia, Ethiopia from June to August, 2023\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNumber of antimicrobial resistance\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eResistance antibiogram\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eResistance isolates n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eE coli\u003c/em\u003e spp (n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSalmonella\u003c/p\u003e \u003cp\u003e( n\u0026thinsp;=\u0026thinsp;14 )\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eShigella\u003c/p\u003e \u003cp\u003e( n\u0026thinsp;=\u0026thinsp;11 )\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(21.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2(18.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eR1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAmp\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(9.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAUG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSXT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eR2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAmp, AUG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAmp, SXT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2(18.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAmp ,CIP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(9.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eR3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAmp, AUG,SXT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAmp, SXT,CRO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(9.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAmp, SXT,GN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAmp, SXT,CZ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3(27.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eR4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAmp ,AUG,SXT,CRO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(9.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAmp ,SXT,CIP,GEN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(21.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAUG,CIP,SXT,CRO,AZT,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003eKey\u003c/b\u003e: Amp-Ampicillin, ,SXT-Cotrimoxazole, AUG- Agumentin, AZT- azithromycin, GEN-Gentamycin, CRO-ceftriaxone, CIP-Ciprofloxacillin, RO-none resistance, R1-resistance for one antimicrobial, R2-resistance for two antimicrobial, R3-resistance for three antimicrobial, R4-resistance for four antimicrobial, R6- resistance for six antimicrobial\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe overall prevalence of \u003cem\u003eE.coli, Salmonella\u003c/em\u003e, and \u003cem\u003eShigella\u003c/em\u003e obtained in the current study was 44 (11.52%). Current study is comparable with study conducted in Bahir Dar with prevalence of enteric bacteria 13.1%, and in Jimma, southwest Ethiopia which counts 8.4% (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e) but lower than previous findings from Hawassa Town, South Ethiopia which counted 22.5%, Nigeria 68.5%, and Kenya 46.0% (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). This might be partly due to true difference of the bacterial infection in the area and also seasonal variations.\u003c/p\u003e \u003cp\u003eAccording to this study's results, children between 13 to 24 months old are more susceptible to diarrhea diseases and enteropathogenic bacteria as demonstrated in (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Studies done at Hawassa, Nigeria and Gambella agree with this finding that children ages between 13 to 24 months old are more susceptible to diarrhea diseases (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). This is probably because of youngsters at this age attempt to masticate everything\u0026rsquo;s with their mouths and also more likely to play in soil where they may come into contact with faeces.\u003c/p\u003e \u003cp\u003eIn current study, 19(5.0%) of children were found to be infected with \u003cem\u003eE.coli\u003c/em\u003e, 14(3.7%) were infected with \u003cem\u003eSalmonella\u003c/em\u003e species and 11(2.9%) with \u003cem\u003eShigella\u003c/em\u003e species. The prevalence of \u003cem\u003eSalmonella\u003c/em\u003e and \u003cem\u003eShigella\u003c/em\u003e in the current study is comparable with previously reported in 2014 in Ambo town, Ethiopia which was 3.8% (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePrevalence of \u003cem\u003eE.coli\u003c/em\u003e 19 (5.0%). The finding of this study was comparable with previous reports with studies done at Bahir Dar with prevalence of 6.1% (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). On the other hand, it was found to be higher than similar study conducted in Bangladesh with prevalence of 1.45% (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). But lower than studies done at South Africa with prevalence of 13.9% (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), at Tehran, Iran 16% (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), at Hawassa 22.2% (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e), Addis Ababa with prevalence of 24.1% (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), Kenya 36.4% (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), at Ghana 49.1% (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), at Pakistan with prevalence 60% (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), at Debra Berhan 62.7% (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e),and at Nigeria with prevalence of 62.8% (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe prevalence of \u003cem\u003eSalmonella\u003c/em\u003e in this study was 14(3.7%). The finding of the current study was comparable with previous reports at Pakistan with prevalence of 3% (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), at Bahir Dar 3.1% (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), at Addis Ababa 3.95% (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), 21,22), at Gambella 2.3%(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e), at Kenya 2.4%(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), at Hawassa 2.5% (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e), at Bangladesh with prevalence of 4.34% (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) but higher than studies done at Ambo with prevalence of 1.3% (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), at South Africa and Abuja, Nigeria with prevalence of 1.7%. The current study is lower than a study conducted at Debra Berhan 6.7%(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), at Arba Minch (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), Ghana (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), and Iran (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) with prevalence of 12.6%, 23.9% and 42% respectively. The variability of isolation of \u003cem\u003eSalmonella\u003c/em\u003e may be attributable to the difference in study areas and period, because the features of the disease vary from place to place and time to time community awareness about personal and environmental hygiene and socioeconomic elements.\u003c/p\u003e \u003cp\u003eThe prevalence of \u003cem\u003eShigella\u003c/em\u003e in current study was found to be 11(2.9%). This was comparable with study done at Ambo which was 2.5% (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), at Kenya with prevalence of 3.2% (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), at Debra Berhan and Bahir Dar with prevalence 4.0% (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), at Bangladesh 4.34% (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Contrarily, the prevalence \u003cem\u003eShigella\u003c/em\u003e in the current study is lower as compared to studies done at Arba Minch 4.8%, Abuja, Nigeria and South Africa 5.5%, Gambella 6% (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Also lower than the study conducted at Hawassa 7%, at Addis Ababa 9.1%, at Ghana 10.2%, and at Tehran, Iran 40% (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). The lower prevalence of \u003cem\u003eE.coli\u003c/em\u003e, \u003cem\u003eSalmonella\u003c/em\u003e, and \u003cem\u003eShigella\u003c/em\u003e could be due to different factors including, variation of socio-demographic and behavioral characteristics, methods used in isolation of pathogens, and the presence of other enteric bacterial causing diarrhea.\u003c/p\u003e \u003cp\u003eAmong parasitic infections, \u003cem\u003eGiardia lamblia\u003c/em\u003e and \u003cem\u003eEntamoeba\u003c/em\u003e identified in this study were 6(1.6%) and 2(0.5%) respectively. The study is comparable to the study in Ambo with a prevalence of \u003cem\u003eGiardia lamblia\u003c/em\u003e (3.3%), followed by \u003cem\u003eEntamoeba\u003c/em\u003e at (2.1%) (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) but it is lower than the study conducted in Gambella with \u003cem\u003eGiardia lamblia\u003c/em\u003e 28(50.9%), \u003cem\u003eE. histolytica/dispar\u003c/em\u003e 13(23.6%). This may be because of their nature for easily transmitting in the community and accessibility as well as utilization of latrine (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe resistance of enteric pathogens to currently used antimicrobial agents has increased all over the world as a result of the widespread use of antimicrobials. There are reports from Arba Minch, Gambella and Jimma on multiple antimicrobial resistances among strains of pathogenic \u003cem\u003eE.coli\u003c/em\u003e, \u003cem\u003eSalmonella\u003c/em\u003e, and \u003cem\u003eShigella\u003c/em\u003e species in Ethiopia (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAll \u003cem\u003eE.coli\u003c/em\u003e, \u003cem\u003eSalmonella\u003c/em\u003e and \u003cem\u003eShigella\u003c/em\u003e species isolates from current study displayed resistance to one or more antimicrobials including Ampicillin, Cotrimoxazole, and Cefazolin. Among the isolates there were no resistances for Imipenem, Cefepime and except 2(10.5%) a few resistances for Cefotaxime which comparable with studies done at Debre Berhan, Addis Ababa and Ambo Town (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe highest prevalence antimicrobial resistance of \u003cem\u003eE.coli\u003c/em\u003e spps against Ampicillin (89.5%) observed was comparable with the study done at Addis Ababa which counts 83.6% (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), at Pakistan (93.5%) (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), at Korea resistance was 78% (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), at South Africa (98%) (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). It is higher than a study done in Kenya which counts 55.2% (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).This may be show Ampicillin resistance strain is widespread in study area.\u003c/p\u003e \u003cp\u003eAntimicrobial resistance of \u003cem\u003eE.coli\u003c/em\u003e spp in the current study against cotrimoxazole was (73.7%) which comparable with a study done at Bangladesh which counts 80%(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The current study is higher than study conducted in Kenya with cotrimoxazole resistance rate 61.4% (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), in Addis Ababa which counts 62.3%(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) but lower than study done at South Africa, with Cotrimoxazole resistance (96%) (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). \u003cem\u003eE.coli\u003c/em\u003e was susceptible for Imipenem 94.7%, cefepime and cefotaxime 89.5%, augumentin 68.4%, azithromycin 73.7%, ciprofloxacin 57.9% and ceftazidime 47.4%. This is comparable with study done in Pakistan, Korea, South Africa Kenya and Addis Ababa (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). This may be due to the different laboratory techniques used for susceptibility test.\u003c/p\u003e \u003cp\u003eIn current study resistance of \u003cem\u003eSalmonella\u003c/em\u003e species to ampicillin, Ceftriaxone and cotrimoxazole was 85.7%, 64.3%, and 57.1% respectively. Accordingly, a high level of \u003cem\u003eSalmonella\u003c/em\u003e resistance was observed for ampicillin (85.7%) which is comparable with a study done in Kenya which counts 77.8% (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), in Mekelle which counts 89.5% (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), but lower than study done at Ambo 100%(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) and higher than study conducted in Iran 50% (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Level of resistance for cotrimoxazole was 64.3% which is a relatively similar pattern of resistance reported from study done at Mekelle 57.9% (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), Ambo 66.7% (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) but higher than study done in Bangladesh 40%(45). In contrarily to this, study done at Kenya showed that cotrimoxazole was 100% susceptible for \u003cem\u003eSalmonella\u003c/em\u003e species (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). In the current study \u003cem\u003eSalmonella\u003c/em\u003e was 100% susceptible for imipenem, cefepime, 85.7% susceptible for azithromycin, 78.6% susceptible for ciprofloxacin which is comparable study done at Bangladesh, Pakistan, Jimma, Ambo and Addis Ababa (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e),(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e),(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e),(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e),(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).However, augumentin, ceftazidime, cefotaxime, cefazolin was shown more than one-fourths of resistance for \u003cem\u003eSalmonella\u003c/em\u003e species.\u003c/p\u003e \u003cp\u003eThe highest prevalence Antimicrobial resistance of \u003cem\u003eShigella\u003c/em\u003e spp against Ampicillin was (72.7%) This was comparable with the study done on \u003cem\u003eShigella\u003c/em\u003e isolates in Ambo which counts 83.3% (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) The current study was lower than study in Mekelle which counts 88.9% (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), in Tehran, Iran which counts 92% (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), in Jimma which counts 100% (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). This study was higher than a study done in Kenya which counts 28.6% (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Antimicrobial resistance of \u003cem\u003eShigella\u003c/em\u003e spps against cotrimoxazole was (72.7%) which lower than a study done in Tehran, Iran (93.0%) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), in Jimma and Bangladesh 100% (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). The study was higher than study done in Kenya 47.6% (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), in Ambo which counts 50% resistance for cotrimoxazole (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), in Mekelle 55.6% (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Among the \u003cem\u003eShigella\u003c/em\u003e species 100% susceptible for Imipenem, 81.8% susceptible for cefepime and more than three-fourths (72.7%) were susceptible cefotaxime, ciprofloxacin, ceftriaxone, augumentin and azithromycin which is comparable to studies conducted in Ambo, Jimma, and Kenya.(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). The difference may be due to susceptibility methods used.\u003c/p\u003e"},{"header":"Conclusion and Recommendation ","content":"\u003cp\u003eThe overall prevalence of enteric bacterial isolates in this study was 11.52%. This study indicates that \u003cem\u003eE.coli, Salmonella,\u0026nbsp;\u003c/em\u003eand \u003cem\u003eShigella\u003c/em\u003e species are among the most pathogenic bacteria identified in children with diarrhea under five years old examined in the study area. These isolated bacteria were susceptible to Imipenem, cefepime, and cefotaxime. But those bacteria were showed the highest resistance for ampicillin followed by cotrimoxazole and cefazolin indicating that no longer potent in the treatments of \u003cem\u003eE.coli, Salmonella,\u0026nbsp;\u003c/em\u003eand \u003cem\u003eShigella\u003c/em\u003e among children with diarrhea aged fewer than five years old diagnosed in the study area. Though still at low levels, the major concern from this finding is the emerging resistance of enteric pathogens that were observed for ceftriaxone, ceftazidime, azithromycin, and ciprofloxacin. Multiple antimicrobial resistances were high among the isolated bacteria. From total of 44 isolated bacteria, 20(45.5%) of them were showed multidrug resistance.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eAMR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 406px;\"\u003e\n \u003cp\u003eAntimicrobial Resistance\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eAST\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 406px;\"\u003e\n \u003cp\u003eAntimicrobial\u003cem\u003e\u0026nbsp;\u003c/em\u003eSusceptibility Tests\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eCLSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 406px;\"\u003e\n \u003cp\u003eClinical And Laboratory Standards Institute\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eDAEC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 406px;\"\u003e\n \u003cp\u003eDiffuse Adhering \u0026nbsp;\u003cem\u003eEscherichia coli\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eEAEC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 406px;\"\u003e\n \u003cp\u003eEnteroaggregative \u003cem\u003eEscherichia\u003c/em\u003e \u003cem\u003ecoli\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eEPEC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 406px;\"\u003e\n \u003cp\u003eEnteropathogenic \u003cem\u003eEscherichia coli\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eETEC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 406px;\"\u003e\n \u003cp\u003eEnterotoxigenic \u003cem\u003eEscherichia\u003c/em\u003e \u003cem\u003ecoli \u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eLMIC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 406px;\"\u003e\n \u003cp\u003eLow and Middle-Income Countries\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;MAC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 406px;\"\u003e\n \u003cp\u003eMacConkey agar\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMDR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 406px;\"\u003e\n \u003cp\u003e\u0026nbsp;Multi-Drug Resistance\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eOPD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 406px;\"\u003e\n \u003cp\u003eOutpatient Department\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eSFB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 406px;\"\u003e\n \u003cp\u003eSelenite F broth\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eSOP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 406px;\"\u003e\n \u003cp\u003eStandard Operating Procedures\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eSpp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 406px;\"\u003e\n \u003cp\u003eSpecies\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eWHO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 406px;\"\u003e\n \u003cp\u003eWorld Health Organization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eXLD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 406px;\"\u003e\n \u003cp\u003eXylose Lysine Deoxycholate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFirst of all, I would like to express my heartfelt thanks to the almighty God for allowing me to accomplish this thesis.\u003c/p\u003e\n\u003cp\u003eI would like to express my sincere and heartfelt gratitude to:\u003c/p\u003e\n\u003cp\u003eSalale University, College of Health Sciences, Departments of Medical Laboratory Sciences and Oromia Health Bureau for sponsoring me.\u003c/p\u003e\n\u003cp\u003eMy deep gratitude goes to Mettu Karl Comprehensive Specialized Hospital laboratory for supporting me and providing laboratory reagents, materials and staff of hospital for their co-operation during laboratory work.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;I would like to express my gratitude to Ethiopian Public Health Institute for providing me a known control strain.\u003c/p\u003e\n\u003cp\u003eI would like to acknowledge Pediatrics Wards of the hospital, for providing necessary clinical data and all nurses for their help during data collection period.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eI would also like to acknowledge all study participants and their parents for their cooperation\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFinally, I would also like to express my heartfelt thanks to all individuals who directly or indirectly contributed to the work of this thesis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval and consents of Study paticipants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical clearance was obtained from the Ethical Review Committee (ERC) of Salale University College of Health Sciences with Ref. N\u003cu\u003eo\u003c/u\u003e. SLU-IRB/28/23. Permission letters was obtained from the Chief Executive Officer of MKCSH Hospital with Ref. N\u003cu\u003eo\u003c/u\u003e. MD/2874/015.All selected study participants signed the informed assent form. Parents/guardians of study participants were also informed about the purpose of the study, the importance of their participation, and their right to withdraw at any time. The privacy and confidentiality of the information given by each respondent was maintained, and name was not recorded. Culture results and antimicrobial susceptibility results were communicated to the hospital clinician as soon as the results had ready.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions; - SD.\u003c/strong\u003e Had a substantial contribution from conception to the acquisition of data. All the authors had a great contribution to study design, analysis, and interpretation of the findings. \u003cstrong\u003eSD and AA\u0026nbsp;\u003c/strong\u003ewere involved in laboratory analysis. All drafted the manuscript. All authors revised the paper carefully for important intellectual contents. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding: -\u003c/strong\u003e Oromia Health Bureau funded partially. But does not have a role in study design, data collection and analysis, interpretation, or preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:- \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;All relevant data are within this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e: - There is no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details: - \u0026nbsp;1.\u0026nbsp;\u003c/strong\u003e Seyoum Dechasa Gemechu: - Ambo University, Clinical Microbiology \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Diagnostic Department, P.O. Box 19, Ambo/Town, Ethiopia\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003cstrong\u003e2.\u003c/strong\u003e\u0026nbsp; Dr. Seifu Gizaw Fayisa and Mr. Abdi Negash: - Salale University College of \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Health Sciences, Department of Medical Laboratory Sciences, P.O. Box 245,\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Fitche, Ethiopia\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;3\u003c/strong\u003e. \u0026nbsp; Mr. Abate Abdisa Eticha: - Tulu Bolo General Hospital, laboratory of\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Department P.O. Box 197, Tullu Bollo, Ethiopia\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. Diarrhea disease. WHO. 2017; \u003c/li\u003e\n\u003cli\u003eKhalil IA, Troeger C, Blacker BF, Rao PC, Brown A, Atherly DE et al. Morbidity and mortality due to shigella and enterotoxigenic Escherichia coli diarrhea: The Global Burden of Disease Study 1990\u0026ndash;2016. Lancet Infect Dis. 2018;18(11):1229\u0026ndash;40. \u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Diarrheal disease fact Sheet. WHO. 2013;No. 330. \u003c/li\u003e\n\u003cli\u003eNemeth V, Zulfiqar H PN. Diarrhea - StatPearls. NCBI Bookshelf StatPearls. 2019;1\u0026ndash;10. \u003c/li\u003e\n\u003cli\u003eBarr W SA. Acute Diarrhea in Adults.In American Family Physician. 2014;89(3). \u003c/li\u003e\n\u003cli\u003eLanata CF, Fischer-Walker CL, Olascoaga AC, Torres CX, Aryee MJ, Black RE. Global Causes of Diarrheal Disease Mortality in Children \u0026lt;5 Years of Age: A Systematic Review. PLoS One. 2013;8(9). \u003c/li\u003e\n\u003cli\u003eBlack R LC. Epidemiology of diarrheal disease in developing countries. In: Infections of the Gastrointestinal Tract, editor. Blaser MJ, Smith PD, Ravdin JI, et al (Eds),. 2nd ed. Philadelphia: Lippincott Williams and Wilkins; 2002. 11\u0026ndash;29. \u003c/li\u003e\n\u003cli\u003eNotario R, Borda N, Gambande T, Sutich E. Species and serovars of enteropathogenic agents associated with acute diarrheal disease in Rosario, Argentina. Vol. 38, Revista do Instituto de Medicina Tropical de Sao Paulo. 1996. 5\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eChiriac PC, Duceac L-D, Manole A, Poroch V, Delcea F, Stafie L, et al. Acute Bacterial Gastroenteritis as a Healthcare-Associated Infection in Pediatrics. Curr Heal Sci J. 2017;43(3):275\u0026ndash;81. \u003c/li\u003e\n\u003cli\u003eGustavo V, Batthy\u0026aacute;ny L, Bianco MN, P\u0026eacute;rez W, Pardo L, Algorta G, et al. Enteropathogens Associated with Acute Diarrhea in Children from Households with High Socioeconomic Level in Uruguay. Int J Microbiol. 2015;2015:8. \u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Antimicrobial resistance: global report on surveillance. WHO. 2014; \u003c/li\u003e\n\u003cli\u003eBreurec S, Reynaud Y, Frank T, Farra A, Costilhes G, Weill FX LHS. Serotype distribution and antimicrobial resistance of human Salmonella enterica in Bangui, Central African Republic, from 2004 to 2013. PLoS Negl Trop Dis. 2019;13(12):7917. \u003c/li\u003e\n\u003cli\u003eRaza S, Tamrakar R, Bhatt C JS. Antimicrobial susceptibility patterns of Salmonella typhi and Salmonella paratyphi A in a tertiary care hospital. J Nepal Health Res Counc. 2012;10(22). \u003c/li\u003e\n\u003cli\u003eKasanga M, Mudenda S, Siyanga M, Chileshe M, Mwiikisa MJ, Kasanga M et al. Antimicrobial susceptibility patterns of bacteria that commonly cause bacteremia at a tertiary hospital in Zambia. Future Microbiology. 2020;15(18):1735\u0026ndash;45. \u003c/li\u003e\n\u003cli\u003eSjolund-Karlsson M, Joyce K, Blickenstaff K, Ball T, Haro J, Medalla FM, Fedorka-Cray P, Zhao S, Crump JA WJ. Antimicrobial susceptibility to azithromycin among Salmonella enterica isolates from the United States. Antimicrobial agents and chemotherapy. 2011;55(9):3985\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eO\u0026rsquo;Neill J. Antimicrobial resistance: Tackling a crisis for the health and wealth of nations. 2014;1\u0026ndash;2. \u003c/li\u003e\n\u003cli\u003eUddin MS, Rahman M, Faruk O, Talukder A, Hoq I, Das S, et al. Bacterial gastroenteritis in children below five years of age : a cross ‑ sectional study focused on etiology and drug resistance of Escherichia coli O157 , Salmonella spp ., and Shigella spp . Bull Natl Res Cent. 2021;45:138. \u003c/li\u003e\n\u003cli\u003eQuraishi F, Shaheen S, Memon Z, Fatima G. Culture and Sensitivity Patterns of Various Antibiotics Used for the Treatment of Pediatric Infectious Diarrhea in Children under 5 Years of Age: A Tertiary Care Experience from Karachi. Int J Clin Med. 2018;09(09):684\u0026ndash;96. \u003c/li\u003e\n\u003cli\u003eMahmoudi S, Pourakbari B, Moradzadeh M, Eshaghi H, Ramezani A, Haghi Ashtiani MT, et al. Prevalence and antimicrobial susceptibility of Salmonella and Shigella spp. among children with gastroenteritis in an Iranian referral hospital. Microb Pathog. 2017;109:45\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eAfum T, Asandem DA, Asare P, Asante-Poku A, Mensah GI, Musah AB et al. Diarrhea-Causing Bacteria and Their Antibiotic Resistance Patterns Among Diarrhea Patients From Ghana. Front Microbiol. 2022;13.894319. \u003c/li\u003e\n\u003cli\u003eCajetan IC, Nnennaya IR, Casmir AA, Florence IN. Enteric bacteria pathogens associated with diarrhoea of children in the federal capital territory Abuja, Nigeria. N Y Sci J. 2009;62\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eLedwaba S.E., Kabue J.P., Barnard T.G. TAN and PN. Enteric Pathogen Co-Infections in the Pediatric Population from rural Communities in the Vhembe District, South Africa. South African J Child Heal. 2018;12:170 \u0026ndash; 174. \u003c/li\u003e\n\u003cli\u003eKilongosi Webale M, Wanjala C, Guyah B, Shaviya N, Munyekenye GO, Lokamar Nyanga P et al. Epidemiological patterns and antimicrobial resistance of bacterial diarrhea among children in Nairobi city,Kenya. astroenterol Hepatol Bed Bench. 2020;12(3):238\u0026ndash;46. \u003c/li\u003e\n\u003cli\u003eBalew M, Kibret M. Prevalence of enteric bacterial pathogens in diarrheic under-five children and their association with the nutritional status in Bahir Dar Zuria District, Northwest Ethiopia. BMC Nutr. 2023;9(1):1\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eTizazu Z, Zelelie TZ, Gebreyes DS, Tesema A, Craddock HA, Gishen NZ. Enteropathogens in Under-Five Children with Diarrhea in Health Facilities of Debre Berhan Town , North Shoa , Ethiopia. Ethiop J Heal Sci. 2019;29(2):203. \u003c/li\u003e\n\u003cli\u003eMamuye Y, Metaferia G, Birhanu A, Desta K FS. Isolation and Antibiotic Susceptibility Patterns of Shigella and Salmonella among Under 5 Children with Acute Diarrhoea: A Cross-Sectional Study at Selected Public Health Facilities in Addis Ababa, Ethiopia. Clin Microbiol. 2015;4:186. \u003c/li\u003e\n\u003cli\u003eMulatu G, Beyene G ZA. Prevalence of Shigella, Salmonella and Cmpylobacter species and their susceptibility patters among under five children with diarrhea in Hawassa town, South Ethiopia. Ethiop J Heal Sci. 2014;24(2):101\u0026ndash;18. \u003c/li\u003e\n\u003cli\u003eAmeya G, Tsalla T, Getu F, Getu E. Antimicrobial susceptibility pattern , and associated factors of Salmonella and Shigella infections among under five children in Arba Minch , South Ethiopia. Ann Clin Microbiol Antimicrob. 2018;17(1):1\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eMekonnen GK, Mengistie B, Sahilu G, Kloos H, Mulat W. Etiologies of diarrhea and drug susceptibility patterns of bacterial isolates among under-five year children in refugee camps in Gambella Region , Ethiopia : a case control study. BMC Infect Dis. 2019;19:1008. \u003c/li\u003e\n\u003cli\u003eTosisa W, Mihret A, Ararsa A, Eguale T, Abebe T. Prevalence and antimicrobial susceptibility of Salmonella and Shigella species isolated from diarrheic children in Ambo town. BMC Pediatr. 2020;20:91.\u003c/li\u003e\n\u003cli\u003eCho SH, Lim YS, Park MS, Kim SH, Kang YH. Prevalence of antibiotic resistance in Escherichia coli fecal isolates from healthy persons and patients with diarrhea. Osong Public Heal Res Perspect. 2011;2(1):41\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eOmolajaiye SA, Afolabi KO, Iweriebor BC. Pathotyping and Antibiotic Resistance Profiling of Escherichia coli Isolates from Children with Acute Diarrhea in Amatole \u003c/li\u003e\n\u003cli\u003eGebreegziabher G, Asrat D, W/Amanuel Y, Hagos T. Isolation and Antimicrobial Susceptibility Profile of Shigella and Salmonella Species from Children with Acute Diarrhoea in Mekelle Hospital and Semen Health Center, Ethiopia. Ethiop J Health Sci. 2018;28(2):197\u0026ndash;206. \u003c/li\u003e\n\u003cli\u003eBeyene, G. and Tasew H. Prevalence of intestinal parasite, Shigella and Salmonella species among diarrheal children in Jimma health center, Jimma southwest Ethiopia: a cross sectional study. Ann Clin Microbiol Antimicrob. 2014;13(1):1\u0026ndash;10. \u003c/li\u003e\n\u003cli\u003eClinical and laboratory standard Institute. M100 Performance Standards for Antimicrobial Susceptability Testing. Vol. 31th editi. 2021. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Diarrhea, Escherichia coli, Salmonella, and Shigella, Antimicrobial Susceptibility","lastPublishedDoi":"10.21203/rs.3.rs-8704393/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8704393/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Diarrheal diseases are a common disease worldwide associated with high morbidity and mortality rates in children under the age of five especially in developing countries. Enteric bacterial are most common causative agents of diarrhea and become a challenges to prevent and treat diarrhea due to emergency of antimicrobial resistant.\u003c/p\u003e\n\u003cp\u003eObjective: The aims of this study was to isolate and determine prevalence and antimicrobial susceptibility patterns of \u003cem\u003eEscherichia coli\u003c/em\u003e, \u003cem\u003eSalmonella\u003c/em\u003e, and \u0026nbsp;\u003cem\u003eShigella\u003c/em\u003especies among under five years age diarrheal children attending Mettu Karl Comprehensive Specialized Hospital, Southwest Ethiopia June to August, 2023\u003c/p\u003e\n\u003cp\u003eMethods: \u0026nbsp;A cross-sectional study was conducted from June to August 2023 on 382 at Mettu Karl Comprehensive Specialized Hospital, Southwest Ethiopia. A structured questionnaire were used to collect data from children under five who had diarrhea. Data collection was done using convenience sample technique. Each collected sample was inoculated onto Selenite F broth and MacConkey agar. Antimicrobial susceptibility testing was performed using the Kirby Bauer disk method on Muller Hinton agar. Socio-demographic, clinical, and laboratory results data were entered in EpiData v4.6.0.6 and analyzed using SPSS version 25. Descriptive summaries, frequency, tables, and graphs were used to describe the study variables.\u003c/p\u003e\n\u003cp\u003eResults: From the 382 children screened, bacteria were isolated from 44 (11.52%). This included; 19(5.0%) \u003cem\u003eEscherichia coli\u003c/em\u003e, 14(3.66%) \u003cem\u003eSalmonella\u003c/em\u003e species, and 11 (2.9%) \u003cem\u003eShigella\u003c/em\u003e. The highest resistance among bacteria was observed against Ampicillin (89.5%), cotrimoxazole (73.7%), and cefazolin (57.1%). Almost all of \u003cem\u003eE.coli, Salmonella, \u003c/em\u003eand \u003cem\u003eShigella \u003c/em\u003ewere susceptible to imipenem, cefepime, and cefotaxime. Of the total 44 isolates, 20(45.5%) showed multidrug resistance.\u003c/p\u003e\n\u003cp\u003eConclusion and Recommendation: This study indicates that \u003cem\u003eE. coli, Salmonella\u003c/em\u003e, and \u003cem\u003eShigella \u003c/em\u003ewere isolated pathogenic bacteria. The identified bacteria were susceptible to Imipenem, cefepime, and cefotaxime. The highest prevalence of antimicrobial resistance was observed for ampicillin followed by cotrimoxazole and cefazolin. Also, isolated bacteria showed resistance to ceftriaxone, ceftazidime, azithromycin, and ciprofloxacin and multiple antimicrobial resistances were high among those bacteria. It is better to use potent antimicrobials like Imipenem, Cefepime, and Cefotaxime for the treatment of bacterial-caused diarrhea.\u003c/p\u003e","manuscriptTitle":"Bacterial diarrhea is a serious public health concern, especially in children under five. Early exposure to a wide range of enteric bacterial infections causes children in underdeveloped countries to suffer from many episodes of diarrheal illness.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-03 16:09:10","doi":"10.21203/rs.3.rs-8704393/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a12fc15c-07ee-4c4e-8ccc-211cf7a7756a","owner":[],"postedDate":"February 3rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-25T08:57:44+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-03 16:09:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8704393","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8704393","identity":"rs-8704393","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}