Insight into the Stunting vis a vis Salmonella and Shigella Species among Children of Pakistan

Research Article

J Bacteriol Mycol. 2021; 8(3): 1172.

Insight into the Stunting vis a vis Salmonella and Shigella Species among Children of Pakistan

Batool M¹, Noreen Z¹, Krishin J² and Bokhari H¹*

1Department of Biosciences, COMSATS University, Islamabad 44000, Pakistan

2Department of Pediatrics, Pakistan Institute of Medical Sciences (PIMS) Islamabad 44000, Pakistan

*Corresponding author: Habib Bokhari, Department of Biosciences, COMSATS University Islamabad, 44000, Islamabad, Pakistan

Received: April 15, 2021; Accepted: May 15, 2021; Published: May 22, 2021


Pakistan is one of the leading countries where the high childhood mortality (under the age of 5 years) as well as is a country where >33% of children are underweight and 38% show stunted growth. The current study investigated the presence or absence of Salmonella and Shigella sp. in stunted children under five years of age from the lower socioeconomic background of Pakistan. Besides, the antibiotics susceptibility patterns were studied along with the sociodemographic and clinical information demographic factors using a questionnaire. The stool samples from stunted children have processed following standard bacteriological protocols and presumptive colonies of Salmonella and Shigella species were identified and sub-cultured on selective media and confirmed by using the standard biochemical test as well as molecular tests. Antibiotics susceptibility of the isolates to 10 antibiotics was tested using disk diffusion assay. The results suggested that 10.5% and 5.7% of the stool samples were positive for Salmonella and Shigella sp. respectively. Moreover, the antibiotics susceptibility test results of the isolates showed that Salmonella sp., were showing higher resistance to amoxicillin whereas Shigella sp. were more resistant to gentamycin. All Salmonella and Shigella isolates were resistant to Rifampicin and 80% of isolates of both were susceptible to ciprofloxacin and cefotaxime. The study suggested that environmental enteric dysfunction (EED), is widespread among malnourished children and may result in stunted growth. The contributory factors such as unsafe farming practices or close association to poultry or livestock animals and prevailing sanitation & hygiene conditions are the potential source of entero-pathogens.

Keywords: Salmonella sp.; Shigella sp.; Antibiotic susceptibility; Stunted growth; Gut diarrheagenic pathogens


WHO: World Health Organization; SD: Standard Deviations; Height-for-Age: HAZ; XLD agar: Xylose Lysine; DA: Deoxycholate Agar; SS agar: Salmonella Shigella agar; EED: Environmental Enteric Dysfunction; PCR: Polymerase Chain Reaction; IEVRP: International Enteric Vaccines Research Program; AOR: Adjusted Odds Ratio; CI: Confidence Interval; PCM: Protein-calorie Malnutrition


Almost 3.5 million children die annually, due to maternal and childhood undernutrition [1]. Malnutrition encompasses both overnutrition (overweight & obesity) and under-nutrition (underweight, stunting & wasting). Moreover, it is the key problem with detrimental impacts on normal survival, development and economic productivity of individuals and societies at large [2]. Nearly 1.1 billion populations from developing countries have no access to safe drinking water, consequently, they develop enteric infections and besides, due to extreme poverty, most vulnerable children population, in particular, suffer from undernutrition/malnutrition and malabsorption of nutrients and low immunity levels which lead to enhanced susceptibility to infections. This malicious cycle of stunting starts from in utero during the pregnancy and it prevails for several generations resulting in low Body Mass Index (BMI) and IQ of a newly born and continues in early childhood [3]. Various studies have found a correlation between diarrheal pathogens and malnutrition in children with a cumulative 50 per cent of annual deaths of children under five years of age [4]. The most prevalent form of undernutrition is stunting; which results from failure to receive adequate nutrition over an extended period [6].

According to World Health Organization (WHO), wasting, underweight and stunting can be defined as Z-scores more than -2 (>- 2) standard deviation of weight for height, weight for age and height for age respectively [7]. Moreover, children with height for age below Three Standard Deviations (-3SD), considered severely stunted, from the median of the reference population [8]. According to World Health Organization (WHO), stunting or lower linear growth have several short as well as long term consequences. The short term consequences of stunting among children are morbidity and mortality due to infections such as pneumonia and diarrhoea. Moreover, stunting can significantly affect the development of the brain in the fetus or newborn, poor cognitive and educational outcomes in later childhood as well as in adolescence [9]. Pakistan is among the countries, with the highest rates of stunting globally [10]. According to the Demographic and Public Health survey of Pakistan, conducted in 2019, 38 per cent of Pakistani children who are under five have stunted growth [11]. The determinants of childhood undernutrition can be grouped into; primary factors and secondary factors. The primary factors are the inherent factors (child’s age and gender), whereas the secondary factors are distal factors which include the socioeconomic status of children, next are the intermediate factors i.e. environmental and maternal factors and the proximate factors such as child feeding, personal hygiene and health status [12]. Children from underprivileged backgrounds have a higher burden of mortality from diarrhoea in developing countries, whereas the annual mortality rate is 1.5-5.1 million [13]. Pakistan is a large livestock raising country [14] and poultry farming has become a common household business and women from the low-income group in rural and urban areas are heavily involved in domestic farming and hence the risk of frequent exposure of vulnerable children population at a very early age to enteropathogens including E. coli, Campylobacter sp., and Shigella sp. which correlate with stunted growth and subsequent life-long physical and cognitive impairments The abundance of such pathogenic bacteria of animal origin interferes with the normal functioning of the gut or small intestine [15], which inhibits the absorption of nutrients, consequently leading to either frequent episodes of diarrhoea while long term asymptomatic association/carriage may lead to stunting [16]. Moreover, the presence of antibiotics resistance among these enteropathogens affects the recovery process. However, their asymptomatic association with the gut of a child with stunted growth has not been systematically investigated and the present study has investigated the occurrence or persistence of Shigella sp. and Salmonella sp. in stunted Pakistani children [17] (Figure 1).