Nasopharyngeal carriage rate, antimicrobial susceptibility pattern, and associated risk factors of Streptococcus pneumoniae among children in Ethiopia: a systematic review and meta-analysis

Abstract

Background: Nasopharyngeal carriage of S. pneumoniae is a global health problem that has been associated with the emergence of severe disease and pathogen dissemination in the community. However, summary data on the carriage rate, antimicrobial susceptibility profile, and determinant factors is lacking.

Method: Articles were extensively searched in bibliographic databases and gray literature using entry terms or phrases. Studies meeting eligibility criteria were extracted in MS Excel and exported to STATA version 17 software for statistical analysis. A random-effects model was used to compute the pooled magnitude of the nasal carriage of S. pneumoniae and its multidrug resistance. The heterogeneity was quantified by using the I² value. Publication bias was assessed using a funnel plot and Egger's test. Sensitivity analysis was done to assess the impact of a single study on the pooled effect size.

Result: Of the 146 studies identified, 8 studies containing a total of 3223 children were selected for meta-analysis of the magnitude of the nasal carriage of S. pneumoniae and its multidrug resistance. The overall pooled prevalence of nasal carriage of S. pneumoniae and its MDR status in Ethiopian children was 32.77% (95%CI: 25.1, 40.44). and 31.22% (95%CI: 15.06, 46.84), respectively. The highest resistant pattern of S. pneumoniae was against tetracycline, which was 46.27% (95%CI: 37.75, 54.79), followed by 45.68% (95%CI: 34.43, 57.28) trimethoprim-sulfamethoxazole, while the least pooled prevalence was against chloramphenicol, which was 16.2% (95%CI: 9.44, 22.95). The pooled effect of age less than 5 years old (pooled OR = 1.97; 95% CI: 1.35, 2.88, P < 0.001), co-sleeping habit with others (pooled OR = 2.36; 95% CI: 1.77, 3.66; P < 0.001), sibling (pooled OR = 1.82; 95% CI: 1.14, 2.91, P = 0.01), history of hospitalization (pooled OR = 4.39; 95% CI: 1.86, 10.34, P = 0.001), and malnutrition (pooled OR = 2.18; 95% CI: 1.49, 3.19; P < 0.001) showed a statistical association with S. pneumoniae nasal carriage rate by using the random effect Sidik-Jonkman model.

Conclusion: The magnitude of the nasopharyngeal carriage rate and multi-drug resistance status of S. pneumoniae alarms the need for immediate interventions such as strengthening antimicrobial stewardship programs, undertaking national antimicrobial surveillance, one-health initiatives, and national immunization programs.

Keywords: S. pneumoniae; Antimicrobial resistance; Children; Ethiopia; Factors; Multi-drug resistance; Nasal carriage; Systematic review and meta-analysis.

Fig. 1

Flow diagram for selection process of eligible studies

Fig. 2

Forest plot showing pooled carriage rate of S. pneumoniae among children in Ethiopia

Fig. 3

Forest plot showing pooled carriage rate of S. pneumoniae among children in Ethiopia by region

Fig. 4

Forest plot showing pooled carriage rate of S. pneumoniae among children in Ethiopia by gender

Fig. 5

Forest plot showing pooled multi-drug resistance rate of S. pneumoniae

Fig. 6

Forest plot showing pooled multi-drug resistance rate of S. pneumoniae by ways of MDR classification

Fig. 7

Forest plot showing pooled multi-drug resistance rate of S. pneumoniae by region

Fig. 8

Funnel plot for assessing publication bias of S. pneumoniae nasal carriage rate