Fredrick Ogumbo^1,, Latifah Benta¹, Brian Kimutai¹, Joseph Mugah¹, Eddy Johnson¹, Vanessa Onyonyi^{1, 2}, Caroline Dande¹, Lillian Musila^{1, 2}, Steve Wandiga¹

Annually, diarrhea causes approximately 1.6 million deaths worldwide, predominantly in Sub-Saharan Africa. In Kenya, diarrheal diseases are among the leading causes of morbidity and mortality, particularly affecting children under five. Despite various studies and interventions on diarrhea, the overall prevalence, distribution, pathogens and risk factors for diarrhea in Kenya remain inadequately investigated especially for atypical pathogens and adults. This scoping review aimed to synthesize available evidence on the prevalence, etiology, treatment, and risk factors associated with diarrheal diseases in Kenya across all age groups. The review followed Arksey and O'Malley’s framework and the Preferred Reporting Items for systematic review and Meta-analysis -scoping review guidelines. Comprehensive searches of databases such as MEDLINE and EMBASE, were conducted to identify studies for inclusion using the following criteria: all observational studies conducted in Kenya, reported in English, without restriction on publication year. Exclusion criteria included randomized control trials and reviews. A total of 210 studies were included in the study, covering diverse regions and study settings in Kenya. The studies primarily focused on children under five but also included adult populations. The pooled prevalence of diarrheal diseases varies significantly across different Kenyan regions. The Eastern region showed the highest prevalence at 20.79%, followed by Nairobi with 16%. The Northeastern region had the lowest prevalence at 3.44%. The most common bacterial causes were Escherichia coli, Salmonella, and Shigella, while Rotavirus was the predominant viral cause. Socioeconomic factors, hygiene practices, and environmental conditions were the major risk factors. The review highlighted a high prevalence of antibiotic resistance, with notable resistance to ampicillin, tetracycline, and trimethoprim/sulfamethoxazole. Several studies reported multidrug-resistant E. coli strains, with 27% being Enteroaggregative E. coli (EAEC) and 50% Enterotoxigenic E. coli (ETEC) isolates producing extended spectrum beta-lactamases. Diarrheal diseases in Kenya exhibit significant regional and demographic variability in prevalence and etiology. Major risk factors include poor hygiene, low socioeconomic status, and inadequate sanitation. The rise of multidrug-resistant Extended spectrum β-lactamase producing E. coli strain, poses a significant public health challenge, complicating treatment options. The widespread antibiotic resistance underscores the need for region-specific public health interventions and improved antibiotic stewardship. Further action is necessary to address national gaps in adult population data and to improve strategies for diarrhea diagnosis, prevention and management in Kenya.

Antimicrobial resistance, Diarrhea, Etiology, Prevalence, Risk factors, Treatment