- Research
- Open access
- Published:
An estimation of global Aeromonas infection prevalence in children with diarrhoea: a systematic review and meta-analysis
BMC Pediatrics volume 23, Article number: 254 (2023)
Abstract
Objectives
Diarrhoea is the most commonly related disease caused by Aeromonas. To improve knowledge on prevalence, this systematic review and meta-analysis was performed to evaluate the global prevalence of Aeromonas in children with diarrhoea worldwide.
Methods
We systematically searched PubMed, Google scholar, Wiley Online Library, ScienceDirect, and Web of sciences to identify all cross-sectional published papers between 2000 and 10 July 2022. After initial scrutinizing, 31 papers reporting the prevalence of Aeromonas in children with diarrhoea were found to be adequate for meta-analysis. The statistical study was accompanied by using random effects models.
Results
A total of 5660 identified papers, 31 cross-sectional studies encompassing 38,663 participants were included in the meta-analysis. The pooled prevalence of Aeromonas in children with diarrhoea worldwide was 4.2% (95% CI 3.1–5.6%). In the subgroup analysis, the highest prevalence was seen among children in Upper middle-income countries with pooled prevalence of 5.1% (95% CI 2.8–9.2%). The prevalence of Aeromonas in children with diarrhoea was higher in countries with populations of over 100 million people (9.4%; 95% CI 5.6–15.3%), and water and sanitation quality score of less than 25% (8.8%; 95% CI 5.2–14.4%). Additionally, Cumulative Forest Plot showed a decreasing trend in the prevalence of Aeromonas infection in children with diarrhoea over time (P = 0.0001).
Conclusion
The results of this study showed a better comprehension of Aeromonas prevalence in children with diarrhoea on a global scale. As well as our findings showed that much work is still required to decline the burden of bacterial diarrhoea in countries with high populations, low-level income, and unsanitary water.
Introduction
Diarrhoeal diseases remain a serious worldwide problem among young children. In 2016, diarrhoea was the fifth main cause of fatality among children younger than 5 years, approximately 27% of diarrhoeal deaths occurred among children [1]. Some causes of diarrhoea involve infection by bacteria, viruses, parasites, and other non-infectious causes [2]. Bacteria are responsible for 20–40% of diarrhoea diseases, and various bacterial pathogens have been mostly attributed to diarrhoea episodes, including Escherichia coli, Campylobacter jejuni, Salmonella spp., Yersinia enterocolitica, Vibrio cholerae, Plesiomonas spp, and Aeromonas spp [3]. The rank of Aeromonas vary from first [4] to fifth [5] among enteropathogenic bacteria that cause diarrhoea. Childhood diarrhoea is most often caused by Aeromonas species [6] and in bacteremia disseminated from gastrointestinal tract have mortality rates of 30–70% [7]. Diarrhoea is the common manifestation of Aeromonas infection. Aeromonas has also been related to a variety of extraintestinal presentations. [8]. Aeromonas-associated diarrhoeal is defined as the leading cause of mortality with 1.0 cases per 100,000 [1]. Symptoms of Aeromonas related diarrhoea are quietly changeable, consistency of stool varied from watery to loose to bloody; and diarrhoea is either self-limited, tolerable to one week, or elongated up to two weeks, or become chronic with more than one month period [4, 9]. It is noteworthy that 2,195 children die due to diarrhoea every day, more than malaria, AIDS, and measles combined worldwide [10]. Several investigations have been conducted in many parts of the world at several times to record the prevalence of Aeromonas genus. Anyway, briefed prevalence information of this bacterial disease in diarrhoea children worldwide is needed. Accordingly, the existing study is the first of its kind to specify the pooled prevalence of Aeromons in diarrhoea children on a global scale.
Methods
Search strategy
This systematic review and meta-analysis followed PRISMA guidelines (http://www.prisma-statement.org/). A comprehensive literature search was carried out to estimate the prevalence of Aeromonas in children with diarrhoea. Papers were identified using a literature search in five English-language databases (PubMed, Google scholar, Wiley Online Library, ScienceDirect, and Web of sciences) between 2000 and 10 July 2022 using the following keywords: “Aeromonas” “Children” “diarrhoea” alone or in combination with “OR” and/or “AND” operators. Published studies with focused on the epidemiology were selected. All records were imported in Endnote version X8 (Clarivate Analytics, Philadelphia, PA, USA). The limits of language and study group were English and children respectively.
Eligibility criteria
We skimmed titles and abstracts of studies based on determined inclusion and exclusion criteria. The following five inclusion criteria were selected in the current systematic review and meta-analysis: (A) original available full text research papers; (B) studies design been cross-sectional; (C) All papers related to the prevalence of Aeromonas in children with diarrhoea; (D) literatures published in the English language; and (E) Published papers between 2000 and 10 July 2022 were considered. The exclusion criteria were empirical investigations, review papers, clinical trials, letters to the editor, case report articles, unpublished studies, confusing studies, meeting abstracts, congress, case control, cohort studies, and short communication articles.
Data extraction
The data extraction was carried out by 2 members of the research team (HS and SGK) independently from included studies using a pretested format prepared in Microsoft Excel. Following a careful study of fulltext papers, information such as the name of first author, country, year of publication, patients, sample size, type of sample, type of study, prevalence of Aeromonas, and positive samples were exteracted. Any disagreements between the two research team members were resolved by discussion and meeting with a third research team member (AA).
Quality assessment
The Newcastle–Ottawa scale was used for assessing the quality of included articles [11]. A score with a most of 10 points was given to each paper according to subject selection (0–5 points), comparability of subjects (0–2 points), and outcome (0–3 points). A total score of 0–4, 5–6, 7–8, and 9–10 points was addressed Unsatisfactory Studies, Satisfactory Studies, Good Studies, and Very Good Studies, respectively [12].
Data synthesis and statistical analysis
All statistical analysis were carried out using Comprehensive Meta-Analysis (version 3) software. The original papers were explained using forest plot, tables, and figures. Whereof there was heterogeneity among surveys, random effect model was used to evaluate the pooled prevalence. The pooled prevalence of Aeromonas in children with diarrhoea did report globally and was estimated with 95% confidence intervals (CIs). Sub-group analysis included country income level, population, and water and sanitation quality score. The possibility of publication bias was studied using Egger’s regression test and Begg’s test. A meta-regression analysis was carried out to assess the effect of the year of publication on prevalence. Cochrane’s Q test and heterogeneity index (I2 statistics) were used to calculate the amount of heterogeneity among included papers, with I2 values of 25%, 50%, and 75% known as low, moderate, and high heterogeneity, respectively [13]. A P value < 0.05 was considered statistically significant.
Results
Details of prevalence publications
Through online database search, we returned a total of 5660 papers. Review papers on the prevalence of Aeromonas in children with diarrhoea were removed. After the primary check of the titles of eligible papers, related articles to the prevalence of Aeromonas were selected, while irrelevant papers were excluded from the study. Finally, thirty one papers were included in the meta-analysis (Fig. 1) [6, 14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43].
Meta-analysis of Aeromonas prevalence in diarrhoea children
Current survey covered four continents: Europe, Asia, Africa, and South America. No related published papers were found for North, Central America, and Australia. The number of papers included in the meta-analysis was 31, including 38,663 samples, from 2000 to 2022. The principal specifications and outcomes of the included studies are presented in Table 1. Included studies showed high heterogeneity (I2 = 95.27%; p < 0.0001), which is indicative to use random effects model. The pooled prevalence by the random-effects model was 4.2% (95% CI 3.1–5.6%) (Fig. 2). Subgroup analysis showed that regions with populations of over 100 million people had the highest prevalence of Aeromonas (9.4%; 95% CI 5.6–15.3%) (Fig. 3). In addition, the infection was more prevalent in Upper middle-income regions 5.1% (95% CI 2.8–9.2%) (Fig. 4), and regions with water and sanitation quality score of less than 25% (8.8%; 95% CI 5.2–14.4%) (Fig. 5). Our results identify evidence of decreasing Aeromonas infection in children with diarrhoea within the approximately more than two decades covered by reported studies (Fig. 6).
Quality assessment
Evaluation of study quality displayed that, among 31 studies, 12 had a total score of 0–4 points (Unsatisfactory Studies), 12 had a total score of 5–6 points (Satisfactory Studies), and 6 had a total score points 7–8 (Good Studies). 1 included study was considered Very Good Studies (Table 2).
Publication bias
As indicated by funnel plot (Fig. 7) asymmetry, no significant publication bias was observed in our study using Eggers regression intercept test (P = 0.98) and Begg and Mazumdar rank correlation (P = 0.13) (Fig. 8a, b). Meta-regression analysis revealed that there was no significant heterogeneity between studies regarding the year of publication (P = 0.08) (Fig. 9).
Discussion
Enteric bacteria related diarrhoea maintains to be a main cause of morbidity and mortality among children [44]. Troeger et al. [1], Aeromonas-associated diarrhoeal is known as the leading cause of mortality with 1.0 cases per 100,000 which indicates that children are more sensitive to Aeromonas infection. In humans, Aeromonas is a cause of extra-intestinal and intestinal diseases, particularly in immunocompromised patients, including urinary tract infections, septicemia, wound infections, necrotizing fasciitis, and hepatobiliary tract infections [8]. Clinical symptoms of Aeromonas infection include chronic watery diarrhoea to severe dysentery [45]. Rehydration therapy is sufficient intervention in most children cases of gastroenteritis and watery diarrhoea caused by Aeromonas. Antibiotics are used for only unresponsive and sever cases of Aeromonas gastroenteritis or extraintestinal infections [46]. Correct detection of the genus Aeromonas in laboratory is still a great challenge. Many studies have been conducted with the goal of making detection applied and reproducible, thus increasing the reliability of findings [47]. The current systematic review presents the first published summary of the global prevalence of Aeromonas infection in children with diarrhoea. Based on 31 cross-sectional articles published during the past 22 years, we evaluated the overall prevalence of Aeromonas infection in children with diarrhoea worldwide to be 4.2% (95% CI 3.1–5.6%) using a random effect model. Global prevalence of Aeromonas and its huge burden in some countries such as South Africa, India, and Kenya made Aeromonas reportable disease especially in children with diarrhoea [37, 38, 40]. Prevalence for different studies that met the inclusion criteria of the current review differed largely from 0.002% to 30.5% [21, 35]. Differences in the prevalence of Aeromonas infection in children with diarrhoea reflected possible differences associated with geographic factors in various parts of the world [48, 49], water and sanitation quality, income level, and population densities [50, 51]. In the present study the greatest and lowest prevalence of Aeromonas infection in children with diarrhoea was in India (30.5%) [21] and Denmark (0.002%) [35]. The pooled prevalence here totally agrees with other investigations of Aeromonas infection in children with diarrhoea, including NASEEM Q N DUBAI (4.1%), and Oliver Waithaka Mbuthia (4.3%) [25, 52]. Furthermore, the pooled prevalence we obtained is approximately in line with the findings of both W S Lee (4.0%) and Saba Talib Hashim (4.0%) [16, 27]. Subgroups analysis based on population, income level, and water and sanitation quality score also was evaluated. Findings show prevalence of Aeromonas in children with diarrhoea being documented from 17 countries that have the higher prevalence in upper middle-income countries 5.1% (95% CI 2.8–9.2%), regions with populations of over 100 million people (9.4%; 95% CI 5.6–15.3%), and water and sanitation quality score of less than 25% (8.8%; 95% CI 5.2–14.4%). The present subgroups analysis confirmed the findings that the high prevalence rate of diarrhoea diseases among children would happen in areas with large population densities, poor water and sanitation facilities [50], and low-income and middle-income countries [51]. Based on the importance of quality assessment section in meta-analysis getting high-quality studies is crucial in providing reliable and useful results to provide a deeper understanding of research topic. Accordingly, some suggestions for high-quality studies are mentioned as follows:
-
1.
High-quality research is anchored on a good study question.
-
2.
High-quality research follows a systematic, relevant study methodology.
-
3.
High-quality research acknowledges previous studies.
-
4.
High-quality research uses appropriate, empirical data and correct data analysis methods.
-
5.
High-quality research is representative and generalizable.
-
6.
High-quality research has external validity.
-
7.
High-quality research is replicable and transparent.
Strengths and limitations
This was the first systematic review and meta-analysis to obtain a global prevalence of Aeromonas infection in children with diarrhoea. The comprehensive literature search, duplicated data elicitation, precise methodology, and quality assessment by two autonomous reviewers, obvious exclusion and inclusion criteria, and the lack of publication bias are strengths of this meta-analysis. Nevertheless, there are some limitations that goes back to the nature of the surveys that are as follow: Firstly, most of the investigations included in this meta-analysis did not report information about the virulence genes and antibiotic resistance pattern clearly and consistently; therefore, we were unable to evaluate the effect of these momentous factors. Secondly, the age of patients was not provided clearly in most included studies. Third, in many studies, information about children's gender was not given.
Conclusion
We did provide a systematic review and meta-analysis of Aeromonas infection in children with diarrhoea to get a better comprehension of the global dispensation of this infectious disease. Although diarrhoeal disease fatality has reduced remarkably in the last three decades, lots of work is still required to speed up the decline in the burden of bacterial diarrhoeal diseases in deprived children in terms of safe and healthy water and sanitation, and appropriate health care.
Availability of data and materials
All of the data generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
References
Troeger C, Blacker BF, Khalil IA, Rao PC, Cao S, Zimsen SR, et al. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis. 2018;18(11):1211–28.
Abrami L, Fivaz M, Decroly E, Seidah NG, Jean F, Thomas G, et al. The pore-forming toxin proaerolysin is activated by furin. J Biol Chem. 1998;273(49):32656–61.
Guerra IM, Fadanelli R, Figueiró M, Schreiner F, Delamare APL, Wollheim C, et al. Aeromonas associated diarrhoeal disease in south Brazil: prevalence, virulence factors and antimicrobial resistance. Braz J Microbiol. 2007;38:638–43.
Moyer NP. Clinical significance of Aeromonas species isolated from patients with diarrhea. J Clin Microbiol. 1987;25(11):2044–8.
Albert MJ, Faruque A, Faruque S, Sack R, Mahalanabis D. Case-control study of enteropathogens associated with childhood diarrhea in Dhaka, Bangladesh. J Clin Microbiol. 1999;37(11):3458–64.
Sadeghi H, Heidarzadeh S, Naghavi M, Rozeh ME, Afshar D. Molecular detection of Aeromonas and its virulence genes in hospitalized children with diarrhea in northwest of Iran. Human Gene. 2022;33:201030.
Horneman AJ. Aeromonas. Manual Clin Microbiol. 2015:752–61.
Janda JM, Abbott SL. The genus Aeromonas: taxonomy, pathogenicity, and infection. Clin Microbiol Rev. 2010;23(1):35–73.
Agger WA, McCormick J, Gurwith MJ. Clinical and microbiological features of Aeromonas hydrophila-associated diarrhea. J Clin Microbiol. 1985;21(6):909–13.
Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet. 2012;379(9832):2151–61.
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5.
Quek TT, Tam WW, Tran BX, Zhang M, Zhang Z, Ho CS, et al. The global prevalence of anxiety among medical students: a meta-analysis. Int J Environ Res Public Health. 2019;16(15):2735.
Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.
Khan A, Faruque A, Hossain M. Isolation of Vibrio cholerae from neonates admitted to an urban diarrhoeal diseases hospital in Bangladesh. Ann Trop Paediatr. 2005;25(3):179–82.
Khan A, Hossain M, Khan A, Chisti M, Chowdhury F, Faruque A, et al. Bacterial enteropathogens of neonates admitted to an urban diarrhoeal hospital in Bangladesh. J Trop Pediatr. 2009;55(2):122–4.
Lee W, Puthucheary S. Bacterial enteropathogens isolated in childhood diarrhoea in Kuala Lumpur–the changing trend. Med J Malaysia. 2002;57(1):24–30.
Maltezou H, Zafiropoulou A, Mavrikou M, Bozavoutoglou E, Liapi G, Foustoukou M, et al. Acute diarrhoea in children treated in an outpatient setting in Athens, Greece. J Infect. 2001;43(2):122–7.
Manikandan C, Amsath A. Antimicrobial resistance of enteric pathogens isolated from children with acute diarrhoea in Pattukkottai, Tamil Nadu, India. Int J Pure Appl Zool. 2013;1(2):139–45.
Onori M, Coltella L, Mancinelli L, Argentieri M, Menichella D, Villani A, et al. Evaluation of a multiplex PCR assay for simultaneous detection of bacterial and viral enteropathogens in stool samples of paediatric patients. Diagn Microbiol Infect Dis. 2014;79(2):149–54.
Rather M, Willayat M, Wani S, Munshi Z, Hussain S. A multiplex PCR for detection of enterotoxin genes in Aeromonas species isolated from foods of animal origin and human diarrhoeal samples. J Appl Microbiol. 2014;117(6):1721–9.
Subashkumar R, Thayumanavan T, Vivekanandhan G, Lakshmanaperumalsamy P. Etiology of children’s diarrhoea in Southern India: associated pathogens and usual isolates. Afr J Microbiol Res. 2012;6(11):2808–15.
Vera CG, Ventura MG, del Castillo AG, Aurrecoechea BD, Olcina MJE, Rubio AM, et al. Acute bacterial gastroenteritis: 729 cases recruited by a Primary Care national network. An Pediatr (Barc). 2017;87(3):128–34.
Abbasi E, Khansari-Nejad B, Abtahi H, Akbari M, Ghaznavi-Rad E. Low Prevalence of Aeromonas hydrophilain Infectious Diarrhea Samples of Pediatric Patients in Arak, Iran. Rep Biochem Mol Biol. 2016;5(1):15–9.
Ali MB, Ghenghesh KS, Aissa RB, Abuhelfaia A, Dufani M. Etiology of childhood diarrhea in Zliten, Libya. Saudi Med J. 2005;26(11):1759–65.
Dubai NQN, Al-Thahab AA. Isolation of outer membrane protein of Aeromonas hydrophila recoverd from children with diarrhea. Int J Humanit Arts Med Sci. 2013;1(2):15–22.
Essers B, Burnens AP, Lanfranchini FM, Somaruga SG, von Vigier RO, Schaad UB, et al. Acute community-acquired diarrhea requiring hospital admission in Swiss children. Clin Infect Dis. 2000;31(1):192–6.
Hashim ST, Nema MM. Study of some virulence factors of Aeromonas Spp. isolated from stool samples of children with diarrhea. Iraqi J Vet Med. 2018;42(1):23–7.
Juan H-J, Tang R-B, Wu T-C, Yu K-W. Isolation of Aeromonas hydrophila in children with diarrhea. J Microbiol Immunol Infect. 2000;33(2):115–7.
Kazemi S, Alikhani MY, Arabestani MR, Sedighi I, Rastyani S, Farhadi KH. Prevalence of Aeromonas hydrophila and Yersinia enterocolitica in children with acute diarrhea attending health centers in Hamadan. Avicenna J Clin Med. 2016;22(4):338–45.
Maraki S, Ladomenou F, Samonis G, Galanakis E. Long-term trends in the epidemiology and resistance of childhood bacterial enteropathogens in Crete. Eur J Clin Microbiol Infect Dis. 2012;31(8):1889–94.
Mbuthia OW, Mathenge SG, Oyaro MO, Ng’ayo MO. Etiology and pathogenicity of bacterial isolates: a cross sectional study among diarrheal children below five years in central regions of Kenya. Pan Afr Med J. 2018;31:88.
Meiyanti, Salim OC, Surjawidjaja JE, Lesmana M. Isolation and antibiotic sensitivity of Aeromonas from children with diarrhea. Univ Med. 2010;29(1):14–20.
Mota MI, Gadea MP, Gonzalez S, Gonzalez G, Pardo L, Sirok A, et al. Bacterial pathogens associated with bloody diarrhea in Uruguayan children. Rev Argent Microbiol. 2010;42(2):114–7.
Obi CL, Potgieter N, Bessong PO, Igumbor EO, Green E. Prevalence of pathogenic bacteria and rotaviruses in stools of patients presenting with diarrhoea from rural communities in Venda, South Africa. S Afr J Sci. 2003;99(11–12):589–92.
Prere MF, Bacrie SC, Baron O, Fayet O. Bacterial ae tiology of diarrhoea in young children: high prevalence of enteropathogenic Escherichia coli (EPEC) not belonging to the classical EPEC serogroups. Pathol Biol (Paris). 2006;54(10):600–2.
Ali TS, Dhahi SJ, Khalaf SH. Study of exotoxin production ability of Aeromonas species isolated from children diarrhea in Mosul. Rafidain J Sci. 2005;16(12):159–70.
Samie A, Guerrant RL, Barrett L, Bessong PO, Igumbor EO, Obi CL. Prevalence of intestinal parasitic and bacterial pathogens in diarrhoeal and non-diarroeal human stools from Vhembe District, South Africa. J Health Popul Nutr. 2009;27(6):739–45.
Shah M, Kathiiko C, Wada A, Odoyo E, Bundi M, Miringu G, et al. Prevalence, seasonal variation, and antibiotic resistance pattern of enteric bacterial pathogens among hospitalized diarrheic children in suburban regions of central Kenya. Trop Med Health. 2016;44:39.
Soltan Dallal MM, Mazaheri Nezhad Fard R, Kavan Talkhabi M, Aghaiyan L, Salehipour Z. Prevalence, virulence and antimicrobial resistance patterns of Aeromonas spp. isolated from children with diarrhea. Germs. 2016;6(3):91–6.
Subashkumar R, Thayumanavan T, Vivekanandhan G, Lakshmanaperumalsamy P. Occurrence of Aeromonas hydrophila in acute gasteroenteritis among children. Indian J Med Res. 2006;123(1):61–6.
Urbina D, Arzuza O, Young G, Parra E, Castro R, Puello M. Rotavirus type A and other enteric pathogens in stool samples from children with acute diarrhea on the Colombian northern coast. Int Microbiol. 2003;6(1):27–32.
Verma S, Venkatesh V, Kumar R, Kashyap S, Kumar M, Maurya AK, et al. Etiological agents of diarrhea in hospitalized pediatric patients with special emphasis on diarrheagenic Escherichia coli in North India. J Lab Phys. 2019;11(1):68–74.
Webale MK, Wanjala C, Guyah B, Shaviya N, Munyekenye GO, Nyanga PL, et al. Epidemiological patterns and antimicrobial resistance of bacterial diarrhea among children in Nairobi City, Kenya. Gastroenterol Hepatol Bed Bench. 2020;13(3):238–46.
Webale MK, Wanjala C, Guyah B, Shaviya N, Munyekenye GO, Nyanga PL, et al. Epidemiological patterns and antimicrobial resistance of bacterial diarrhea among children in Nairobi City, Kenya. Gastroenterol Hepatol Bed Bench. 2020;13(3):238.
Puthucheary SD, Puah SM, Chua KH. Molecular characterization of clinical isolates of Aeromonas species from Malaysia. PLoS one. 2012;7(2):e30205.
Igbinosa IH, Igumbor EU, Aghdasi F, Tom M, Okoh AI. Emerging Aeromonas species infections and their significance in public health. ScientificWorldJournal. 2012;2012:625023.
Pessoa RBG, de Oliveira WF, Marques DSC, dos Santos Correia MT, de Carvalho EVMM, Coelho LCBB. The genus Aeromonas: a general approach. Microb Pathog. 2019;130:81–94.
Hu M, Wang N, Pan Z, Lu C, Liu Y. Identity and virulence properties of Aeromonas isolates from diseased fish, healthy controls and water environment in China. Lett Appl Microbiol. 2012;55(3):224–33.
Ljungh A, Popoff M, Wadstrom T. Aeromonas hydrophila in acute diarrheal disease: detection of enterotoxin and biotyping of strains. J Clin Microbiol. 1977;6(2):96–100.
Hartley DM, Morris JG Jr, Smith DL. Hyperinfectivity: a critical element in the ability of V. cholerae to cause epidemics? PLoS Med. 2006;3(1):e7.
Walker CLF, Rudan I, Liu L, Nair H, Theodoratou E, Bhutta ZA, et al. Global burden of childhood pneumonia and diarrhoea. Lancet. 2013;381(9875):1405–16.
Mbuthia OW, Mathenge SG, Oyaro MO, Ng’ayo MO. Etiology and pathogenicity of bacterial isolates: a cross sectional study among diarrheal children below five years in central regions of Kenya. Pan Afr Med J. 2018;31(1):e7.
Acknowledgements
We sincerely thank staff members of the Medical Microbiology Research Center, Qazvin University of Medical Sciences, Qazvin, Iran and Clinical Research Development Unit, Kowsar Hospital, Qazvin University of Medical Sciences, Qazvin, Iran.
Funding
This research was funded by the Deputy of Research and Technology, Qazvin University of Medical Sciences, Qazvin, Iran, grant number 401000199.
Author information
Authors and Affiliations
Contributions
S.G.K and H.S: Performed the literature review and research, Conceptualization, Methodology, Supervision, Project administration, Writing- Reviewing and Editing, Methodology, Investigation, Studies analysis, Data Curation, and Writing Original draft preparation. A.A: Statistical analysis, Validation, and performed the literature review and research. M.V and M.R.M: Validation, Methodology and Reviewing. The author(s) read and approved the final manuscript.
Corresponding author
Ethics declarations
Ethics approval and consent to participate
The study was approved by the Ethics Committee of the Medical Microbiology Research Center, Qazvin University of Medical Sciences, Qazvin, Iran with approval number IR.QUMS.REC.1401.167.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
About this article
Cite this article
Sadeghi, H., Alizadeh, A., Vafaie, M. et al. An estimation of global Aeromonas infection prevalence in children with diarrhoea: a systematic review and meta-analysis. BMC Pediatr 23, 254 (2023). https://doi.org/10.1186/s12887-023-04081-3
Received:
Accepted:
Published:
DOI: https://doi.org/10.1186/s12887-023-04081-3