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Papers by Moses Ngari

This is a replication dataset for the submitted manuscript "Inpatient and post-discharge mor... more This is a replication dataset for the submitted manuscript "Inpatient and post-discharge mortality among children 5-12 years old in rural Kenya." The data was used in a secondary analysis of children aged 5 to 12 years admitted at Kilifi County hospital from January 2007 to December 2016 and linked with Kilifi Health and Demographic Surveillance System (KHDSS) to obtain their vital status one year after hospital discharge. The objective of the study was to describe types of illness leading to admission to hospital and mortality during inpatient and one-year post-discharge periods among children admitted at Kilifi County Hospital, Kenya. The data package contains the following files: Data files a) Over5years_multipleadmissions.dta This file contains clinical, athropometric, CBC, blood CSF culture at the time of hospital admission (at KCH) for children aged 5 to 12 years from 2007 to 2016. b) over5years_khdss.dta This file contains Vital status in the community following hos...

Background: Animal African trypanosomosis (AAT) is a veterinary disease caused by trypanosomes tr... more Background: Animal African trypanosomosis (AAT) is a veterinary disease caused by trypanosomes transmitted cyclically by tsetse flies. AAT causes huge agricultural losses in sub-Saharan Africa. Both tsetse flies and trypanosomosis (T&T) are endemic in the study area inhabited by smallholder livestock farmers at the livestock-wildlife interface around Arabuko-Sokoke Forest Reserve (ASFR) in Kilifi County on the Kenyan coast. We assessed farmers' knowledge, perceptions and control practices towards T&T. Methods: A cross-sectional study was conducted during November and December 2017 to collect data from 404 randomly selected cattlerearing households using a structured questionnaire. Descriptive statistics were used to determine farmers' knowledge, perceptions, and control practices towards T&T. Demographic factors associated with knowledge of T&T were assessed using a logistic regression model. Results: Participants consisted of 53% female, 77% married, 30% elderly (>55 years), and the majority (81%) had attained primary education or below. Most small-scale farmers (98%) knew the tsetse fly by its local name, and 76% could describe the morphology of the adult tsetse fly by size in comparison to the housefly's (Musca Open Peer Review Approval Status AWAITING PEER REVIEW Any reports and responses or comments on the article can be found at the end of the article.

EBioMedicine, May 1, 2022

Summary Background While fluid flows in a steady state from plasma, through interstitium, and int... more Summary Background While fluid flows in a steady state from plasma, through interstitium, and into the lymph compartment, altered fluid distribution and oedema can result from abnormal Starling's forces, increased endothelial permeability or impaired lymphatic drainage. The mechanism of oedema formation, especially the primary role of hypoalbuminaemia, remains controversial. Here, we explored the roles of albumin and albumin-independent mechanisms in oedema formation among children with severe malnutrition (SM). Methods We performed secondary analysis of data obtained from two independent clinical trials in Malawi and Kenya (NCT02246296 and NCT00934492). We then used an unconventional strategy of comparing children with kwashiorkor and marasmus by matching (discovery cohort, n = 144) and normalising (validation cohort, n = 98, 2 time points) for serum albumin. Untargeted proteomics was used in the discovery cohort to determine plausible albumin-independent mechanisms associated with oedema, which was validated using enzyme-linked immunosorbent assay and multiplex assays in the validation cohort. Findings We demonstrated that low serum albumin is necessary but not sufficient to develop oedema in SM. We further found that markers of extracellular matrix (ECM) degradation rather than markers of EG degradation distinguished oedematous and non-oedematous children with SM. Interpretation Our results show that oedema formation has both albumin-dependent and independent mechanisms. ECM integrity appears to have a greater role in oedema formation than EG shedding in SM. Funding Research Foundation Flanders (FWO), Thrasher Foundation (15122 and 9403), VLIR-UOS-Ghent University Global Minds Fund, Bill & Melinda Gates Foundation (OPP1131320), MRC/DfID/Wellcome Trust Global Health Trials Scheme (MR/M007367/1), Canadian Institutes of Health Research (156307), Wellcome Trust (WT083579MA).

PLOS global public health, Jun 27, 2023

Diarrhea continues to be a leading cause of death for children under-five. Amongst children treat... more Diarrhea continues to be a leading cause of death for children under-five. Amongst children treated for acute diarrhea, mortality risk remains elevated during and after acute medical management. Identification of those at highest risk would enable better targeting of interventions, but available prognostic tools lack validation. We used clinical and demographic data from the Global Enteric Multicenter Study (GEMS) to build clinical prognostic models (CPMs) to predict death (in-treatment, after discharge, or either) in children aged �59 months presenting with moderate-to-severe diarrhea (MSD), in Africa and Asia. We screened variables using random forests, and assessed predictive performance with random forest regression and logistic regression using repeated cross-validation. We used data from the Kilifi Health and Demographic Surveillance System (KHDSS) and Kilifi County Hospital (KCH) in Kenya to externally validate our GEMS-derived CPM. Of 8060 MSD cases, 43 (0.5%) children died in treatment and 122 (1.5% of remaining) died after discharge. MUAC at presentation, respiratory rate, age, temperature, number of days with diarrhea at presentation, number of people living in household, number of children <60 months old living in household, and how much the child had been offered to drink since diarrhea started were predictive of death both in treatment and after discharge. Using a parsimonious 2-variable prediction model, we achieved an area under the ROC curve (AUC) of 0.84 (95% CI: 0.82, 0.86) in the derivation dataset, and an AUC = 0.74 (95% CI 0.71, 0.77) in the external dataset. Our findings suggest it is possible to identify children most likely to die after PLOS GLOBAL PUBLIC HEALTH

The Lancet Global Health, Sep 1, 2018

BMJ Open, 2023

Objectives To describe admission trends and estimate inpatient and post-discharge mortality and i... more Objectives To describe admission trends and estimate inpatient and post-discharge mortality and its associated exposures, among young infants (YI) admitted to a county hospital in Kenya. Design Retrospective cohort study. Setting Secondary level hospital. Participants YI aged less than 60 days admitted to hospital from January 2009 to December 2019: 12 271 admissions in 11 877 individuals. YI who were resident within a Kilifi Health and Demographic Surveillance System (KHDSS): n=3625 with 4421 admissions were followed-up for 1 year after discharge. Primary and secondary outcome measures Inpatient and 1-year post-discharge mortality, the latter in KHDSS residents. Results Of 12 271 YI admissions, 4421 (36%) were KHDSS-resident. Neonatal sepsis, preterm complications and birth asphyxia accounted for 83% of the admissions. The proportion of YI among under-5s admissions increased from 19% in 2009 to 34% in 2019 (P trend =0.02). Inpatient case fatality was 16%, with 66% of the deaths occurring within 48 hours of admission. The introduction of free maternity care in 2013 was not associated with a change in admissions or inpatient mortality among YI. During 1-year post-discharge, 208/3625 (5.7%) YI died, 64.3 (95% CI 56.2 to 73.7) per 1000 infant-years. 49% of the post-discharge deaths occurred within 1 month of discharge, and 49% of post-discharge deaths occurred at home. Both inpatient and post-discharge deaths were associated with low admission weight. Inpatient mortality was associated with clinical signs of disease severity, while postdischarge mortality was associated with the length of hospitalisation, leaving against advice and referral to a specialised hospital. Conclusions YIs accounted for an increasing proportion of paediatric admissions and their overall mortality remains high. Post-discharge mortality accounts for a lower proportion of deaths but mortality rate is higher than among children aged 2-59 months. Services to address post-discharge mortality are needed and should focus on infants at higher risk.

medRxiv (Cold Spring Harbor Laboratory), Feb 10, 2023

doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by pee... more doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.

Journal of Medical Entomology, Jun 13, 2020

Culicine mosquitoes are vectors of human disease-causing pathogens like filarial worms and severa... more Culicine mosquitoes are vectors of human disease-causing pathogens like filarial worms and several arthropod-borne viruses (arboviruses). Currently, there has been an increase in emerging and re-emerging vector-borne diseases along coastal Kenya, which has been of major concern in public health. This study aimed at determining culicine mosquito species abundance, diversity and their host feeding preferences in Taita-Taveta County, Coastal Kenya. Entomological sampling was done during the long-wet season (March and May) and long dry season (June to October) 2016−2018. Mosquito sampling was done using CDC light traps and Backpack aspiration for indoor and outdoor environments. All culicine mosquitoes collected were identified morphologically and categorized according to their physiological status. Blood fed culicine mosquitoes were tested for bloodmeal sources using ELISA. In total, 3,278 culicine mosquitoes were collected, of which 738 (22.5 %) were found indoors and 2,540, (77.5 %) outdoors. The mosquitoes consisted of 18 species belonging to four genera: Aedes (7), Culex (8), Mansonia (2), and Coquillettidia (1). Overall, there was high mosquito species diversity (H) in outdoors (H = 2.4339) than in indoors (H =2.2523), whereas even distribution (EH) was higher in indoors (EH = 0.9064) than outdoors (EH = 0.8266). Majorly the bloodmeals identified were from multiple host sources with (51.6%), single hosts (41.3%), and unidentified (7.2%). This study has demonstrated a high diversity of culicine mosquitoes with relaxed feeding tendencies. These mosquitoes are contributing to mosquito biting nuisance and the likelihood of exposure of populations to diseases of public health.

BMC Public Health, Dec 1, 2015

Background: Maternal mortality has declined by 43 % globally between 1990 and 2013, a reduction t... more Background: Maternal mortality has declined by 43 % globally between 1990 and 2013, a reduction that was insufficient to achieve the 75 % reduction target by millennium development goal (MDG) five. Kenya recorded a decline of 18 % from 490 deaths in 1990 to 400 deaths per 100,000 live births in 2013. Delivering at home, is associated with higher risk of maternal deaths, therefore reducing number of home deliveries is important to improve maternal health. In this study, we aimed at establishing the proportion of home deliveries and evaluating factors associated with home deliveries in Kilifi County. Methods: The study was conducted among mothers seeking immunization services in selected health facilities within Kilifi County using Semi-structured questionnaires administered through face to face oral interviews to collect both quantitative and qualitative data. Six Focus Group Discussion (FGD) and ten in-depth interviews (IDIs) were used to collect qualitative data. A random sample of 379 mothers was sufficient to answer the study question. Log-binomial regression model was used to identify factors associated with childbirth at home. Results: A total of 103 (26 %) mothers delivered at home. From the univariate analysis, both mother and the partners old age, being in a polygamy marriage, being a mother of at least two children and staying ≥5 Kms radius from the nearest health facility were associated with higher risk of delivering at home (crude P < 0.05). Both mother and partner's higher education level were associated with a protective effect on the risk of delivering at home (RR < 1.0 and P < 0.05). In multivariate regression model, only long distance (≥10Kms) from the nearest health facility was associated with higher risk of delivering at home (adjusted RR 3.86, 95 % CI 2.13 to 7.02). Conclusion: From this population, the major reason why mothers still deliver at home is the long distance from nearest health facility. To reduce maternal mortality, access to health facility by pregnant mothers need to be improved.

Wellcome open research, Jan 4, 2021

Background: Far less is known about the reasons for hospitalization or mortality during and after... more Background: Far less is known about the reasons for hospitalization or mortality during and after hospitalization among school-aged children than among under-fives in low-and middle-income countries. This study aimed to describe common types of illness causing hospitalisation; inpatient mortality and post-discharge mortality among school-age children at Kilifi County Hospital (KCH), Kenya. Methods: A retrospective cohort study of children 5−12 years old admitted at KCH, 2007 to 2016, and resident within the Kilifi Health Demographic Surveillance System (KHDSS). Children discharged alive were followed up for one year by quarterly census. Outcomes were inpatient and one-year post-discharge mortality. Results: We included 3,907 admissions among 3,196 children with a median age of 7 years 8 months (IQR 74−116 months). Severe anaemia (792, 20%), malaria (749, 19%), sickle cell disease (408, 10%), trauma (408, 10%), and severe pneumonia (340, 8.7%) were the commonest reasons for admission. Comorbidities included 623 (16%) with severe wasting, 386 (10%) with severe stunting, 90 (2.3%) with oedematous malnutrition and 194 (5.0%) with HIV infection. 132 (3.4%) children died during hospitalisation. Inpatient death was associated with signs of disease severity, age, bacteraemia, HIV infection and severe stunting. After discharge, 89/2,997 (3.0%) children died within one year during 2,853 child-years observed (31.2 deaths [95%CI, 25.3−38.4] per 1,000 child-years). 63/89 (71%) of post-discharge

Archives of Disease in Childhood, Aug 20, 2020

Background Detection of meningitis is essential to optimise the duration and choice of antimicrob... more Background Detection of meningitis is essential to optimise the duration and choice of antimicrobial agents to limit mortality and sequelae. In low and middleincome countries most health facilities lack laboratory capacity and rely on clinical features to empirically treat meningitis. Objective We conducted a diagnostic validation study to investigate the performance of clinical features (fever, convulsions, irritability, bulging fontanel and temperature ≥39°C) and WHO-recommended signs (drowsiness, lethargy, unconsciousness, convulsions, bulging fontanel, irritability or a high-pitched cry) in discriminating meningitis in young infants. Design Retrospective cohort study. Setting Kilifi County Hospital. Patients Infants aged <60 days hospitalised between 2012 and 2016. Main outcome measure Definite meningitis defined as positive cerebrospinal fluid (CSF) culture, microscopy or antigen test, or leucocytes ≥0.05 x 10∧9/L. Results Of 4809 infants aged <60 days included, 81 (1.7%) had definite meningitis. WHO-recommended signs had sensitivity of 58% (95% CI 47% to 69%) and specificity of 57% (95% CI 56% to 59%) for definite meningitis. Addition of history of fever improved sensitivity to 89% (95% CI 80% to 95%) but reduced specificity to 26% (95% CI 25% to 27%). Presence of ≥1 of 5 previously identified signs had sensitivity of 79% (95% CI 69% to 87%) and specificity of 51% (95% CI 50% to 53%). Conclusions Despite a lower prevalence of definite meningitis, the performance of previously identified signs at admission in predicting meningitis was unchanged. Presence of history of fever improves the sensitivity of WHO-recommended signs but loses specificity. Careful evaluation, repeated assessment and capacity for lumbar puncture and CSF microscopy to exclude meningitis in most young infants with potential signs are essential to management in this age group.

International Breastfeeding Journal, Apr 26, 2016

Background: Exclusive breastfeeding for the first 6 months of life is currently recommended by th... more Background: Exclusive breastfeeding for the first 6 months of life is currently recommended by the World Health Organization, but mixed feeding earlier than this commonly occurs in rural coastal Kenya. Mothers may receive conflicting advice on breastfeeding from various sources including health workers, relatives and community members. We aimed to find out how first-time mothers learn to breastfeed, who advises them on infant feeding and what advice they obtain in case of any breastfeeding problems. Methods: To identify advisers, a questionnaire on socio-demographic status, place of delivery, household members, education and help received on breastfeeding, breastfeeding problems, name of advisers and their relationship to the mothers was administered to 50 new first-time mothers in Jaribuni, Kilifi (population approximately 18,000). Summary statistics were obtained using frequencies, medians and interquartile ranges (IQR). Focus group discussions (FGDs) were held amongst 4 groups of mothers who had answered questionnaires; 4 groups of their named advisers; and 1 group of community health workers in order to explore breastfeeding practices, problems and advice given. FGDs were analysed by thematic framework analysis. Results: First-time mothers were young (median age 18, IQR 17-21, range 14-26 years) and 42 % were single. Living in extended families was the norm and married women lived with their husband's family. All had a female family member or neighbour helping with childcare in the perinatal period. The main advisers on breastfeeding were their mother or older female members of their husband's family. Married first-time mothers felt obliged to follow their mother-in-law's advice to maintain good relationships and show respect within the household. Breastfeeding problems were reported by 80 % of respondents. Nipple pain (56 %) was the most reported problem, then breast engorgement (48 %) and insufficient milk supply (38 %). Most problems were treated at home without consultation with health workers. Concerns were raised about co-sleeping, breastfeeding whilst lying down, and insufficient milk supply. Advisers would like more information on breastfeeding in order to help mothers. Conclusions: Interventions to increase knowledge of, and facilitate optimal breastfeeding practices in first-time mothers should include those family members who advise and assist with childcare around the time of delivery.

Scientific Reports, Jul 21, 2021

The World Health Organization (WHO) criteria for diagnosing and treating Tuberculosis (TB) includ... more The World Health Organization (WHO) criteria for diagnosing and treating Tuberculosis (TB) includes clinical signs, therefore not requiring bacteriological laboratory confirmation. In resource-limited settings, including Kenya, this empirical TB treatment is routine practice however limited data exist on patient clinical outcomes when comparing the method of diagnosis. We evaluated TB treatment outcomes comparing clinically diagnosed and bacteriologically confirmed TB, 6 months after starting treatment of TB in a rural county in Kenya. Our analysis compared patients with a clinical versus a bacteriologically confirmed TB diagnosis. In this retrospective analysis, we included all adults (≥ 18 years) starting treatment of TB and followed up for 6 months, within the County TB surveillance database from 2012 to 2018. Patients included from both public and private facilities. The TB treatment outcomes assessed included treatment success, treatment failure, death, defaulted and transferred out. We used survival regression models to assess effect of type of diagnosis on TB treatment outcome defining time at risk from date of starting treatment to experiencing one of the treatment outcomes or completing 6-months of treatment. A total of 12,856 patients; median age 37 [IQR 28 − 50] years were included. 7639 (59%) were male while 11,339 (88%) were pulmonary TB cases. Overall, 11,633 (90%) were given first-line TB treatment and 3791 (29%) were HIV infected. 6472 (50%) of the patients were clinically diagnosed of whom 4521/6472 (70%) had a negative sputum/ GeneXpert test. During the study 5565 person-years (PYs) observed, treatment success was 82% and 83% amongst clinically and bacteriologically diagnosed patients (P = 0.05). There were no significant differences in defaulting (P = 0.70) or transfer out (P = 0.19) between clinically and bacteriologically diagnosed patients. Mortality was significantly higher among clinically diagnosed patients: 639 (9.9%) deaths compared to 285 (4.5%) amongst the bacteriologically diagnosed patients; aHR 5.16 (95%CI 2.17 − 12.3) P < 0.001. Our study suggests survival during empirical TB treatment is significantly lower compared to patients with laboratory evidence, irrespective of HIV status and age. To improve TB treatment outcomes amongst clinically diagnosed patients, we recommend systematic screening for comorbidities, prompt diagnosis and management of other infections. Abbreviations aHR Adjusted hazards ratio AIC Akaike information criterion AIDS Acquired immunodeficiency syndrome ARVs Antiretroviral BCG Bacillus Calmette-Guérin BMI Body mass index CD4 Cluster of differentiation 4 CHR Crude hazards ratio CXR Chest radiograph EPTB Extra pulmonary tuberculosis HIV Human immunodeficiency virus

BMJ Global Health, Feb 1, 2017

BMC Medical Research Methodology, Mar 7, 2018

Background: We use the example of the Gojjam Lymphoedema Best Practice Trial (GoLBeT), a pragmati... more Background: We use the example of the Gojjam Lymphoedema Best Practice Trial (GoLBeT), a pragmatic trial in a remote rural setting in northern Ethiopia, to extract lessons relevant to other investigators balancing the demands of practicality and community acceptability with internal and external validity in clinical trials. Methods: We explain in detail the preparation for the trial, its setting in northern Ethiopia, the identification and selection of patients (inclusion and exclusion criterion, identifying and screening of patients at home, enrollment of patients at the health centres and health posts), and randomisation. Results: We describe the challenges met, together with strategies employed to overcome them. Conclusions: Examples given in the previous section are contextualised and general principles extracted where possible. We conclude that it is possible to conduct a trial that balances approaches that support internal validity (e.g. careful design of proformas, accurate case identification, control over data quality and high retention rates) with those that favour generalisability (e.g. 'real world' setting and low rates of exclusion). Strategies, such as Rapid Ethical Assessment, that increase researchers' understanding of the study setting and inclusion of hard-to-reach participants are likely to have resource and time implications, but are vital in achieving an appropriate balance. Trial registration: ISRCTN67805210, registered 24/01/2013.

International Journal of Infectious Diseases, Dec 1, 2020

Background: Bacterial meningitis is associated with significant mortality and sequelae in young i... more Background: Bacterial meningitis is associated with significant mortality and sequelae in young infants, yet most health facilities in developing countries lack adequate laboratory capacity, relying only on clinical features to treat meningitis. We investigated whether clinical features and WHO-recommended signs derived prior to introduction of conjugate vaccines still discriminate meningitis in young infants aged <60 days. Methods & Materials: We conducted a diagnostic performance validation study of clinical features (bulging fontanel, convulsions, axillary temperature ≥39 • C, agitation, history of fever or WHOrecommended signs) on a cohort of 5591 infants aged <60 days admitted to Kilifi County Hospital between January 2012 and December 2016. 782 infants died before lumbar puncture (LP) and were excluded as we could not ascertain their meningitis status. Definite meningitis was defined by cerebrospinal fluid (CSF) results as: (1) positive culture; (2) positive microscopy; (3) positive antigen test; or (4) CSF leucocytes ≥50/L. Results: 81/4809 admissions (1.7%) had definite meningitis (3 [3.7%] S. pneumoniae or H. influenzae) and 126 (2.6%) had possible meningitis. WHO-recommended signs had low sensitivity: 58% (95% CI: 47-69%), and specificity 57% (95% CI: 56-59%). Addition of history of fever improved sensitivity to 89% (95% CI: 80-95) but reduced specificity to 26% (95% CI: 25-27), resulting in 77 rather than 98 LPs needed to identify each case of meningitis. Presence of 31 of five previously identified signs detected 79% (95% CI: 69-87) infants with specificity of 51% (95%: 50-53), and 50 LPs would need to be performed to identify each case of confirmed meningitis. Conclusion: The observed prevalence of confirmed meningitis in infants aged <60 days was lower than in previous studies at this site. However, there was no evidence that the performance of previously identified admission signs in predicting meningitis assessed by area under the ROC curve has markedly changed. Careful evaluation, repeated assessment and building the capacity for LP and CSF microscopy to exclude meningitis in the majority of infants with suggestive signs are essential to management in this age group.

BMC Medicine, Jun 4, 2021

Background: Diagnosing bacterial meningitis is essential to optimise the type and duration of ant... more Background: Diagnosing bacterial meningitis is essential to optimise the type and duration of antimicrobial therapy to limit mortality and sequelae. In sub-Saharan Africa, many public hospitals lack laboratory capacity, relying on clinical features to empirically treat or not treat meningitis. We investigated whether clinical features of bacterial meningitis identified prior to the introduction of conjugate vaccines still discriminate meningitis in children aged ≥60 days. Methods: We conducted a retrospective cohort study to validate seven clinical features identified in 2002 (KCH-2002): bulging fontanel, neck stiffness, cyanosis, seizures outside the febrile convulsion age range, focal seizures, impaired consciousness, or fever without malaria parasitaemia and Integrated Management of Childhood Illness (IMCI) signs: neck stiffness, lethargy, impaired consciousness or seizures, and assessed at admission in discriminating bacterial meningitis after the introduction of conjugate vaccines. Children aged ≥60 days hospitalised between 2012 and 2016 at Kilifi County Hospital were included in this analysis. Meningitis was defined as positive cerebrospinal fluid (CSF) culture, organism observed on CSF microscopy, positive CSF antigen test, leukocytes ≥50/ μL, or CSF to blood glucose ratio <0.1. Results: Among 12,837 admissions, 98 (0.8%) had meningitis. The presence of KCH-2002 signs had a sensitivity of 86% (95% CI 77-92) and specificity of 38% (95% CI 37-38). Exclusion of 'fever without malaria parasitaemia' reduced sensitivity to 58% (95% CI 48-68) and increased specificity to 80% (95% CI 79-80). IMCI signs had a sensitivity of 80% (95% CI 70-87) and specificity of 62% (95% CI 61-63). Conclusions: A lower prevalence of bacterial meningitis and less typical signs than in 2002 meant the lower performance of KCH-2002 signs. Clinicians and policymakers should be aware of the number of lumbar punctures (LPs) or empirical treatments needed for each case of meningitis. Establishing basic capacity for CSF analysis is essential to exclude bacterial meningitis in children with potential signs.

medRxiv (Cold Spring Harbor Laboratory), Apr 29, 2022

Background: Kenya introduced Rotarix ® (GlaxoSmithKline Biologicals, Rixensart, Belgium) vaccinat... more Background: Kenya introduced Rotarix ® (GlaxoSmithKline Biologicals, Rixensart, Belgium) vaccination into its national immunization programme beginning July 2014. The impact of this vaccination program on the local epidemiology of various known enteropathogens is not fully understood. Methods: We used a custom TaqMan Array Card (TAC) to screen for 28 different enteropathogens in 718 stools from children aged less than 13 years admitted to Kilifi County Hospital, coastal Kenya, following presentation with diarrhea in 2013 (before vaccine introduction) and in 2016-2018 (after vaccine introduction). Pathogen positivity rate differences between pre-and post-Rotarix ® vaccination introduction were examined using both univariate and multivariable logistic regression models. Results: In 665 specimens (92.6%), one or more enteropathogen was detected, while in 323 specimens (48.6%) three or more enteropathogens were detected. The top six detected enteropathogens were: enteroaggregative Escherichia coli (EAggEC; 42.1%), enteropathogenic Escherichia coli (EPEC; 30.2%), enterovirus (26.9%), rotavirus group A (RVA; 24.8%), parechovirus (16.6%) and norovirus GI/GII (14.4%). Post-rotavirus vaccine introduction, there was a significant increase in the proportion of samples testing positive for EAggEC (35.7% vs. 45.3%, p = 0.014), cytomegalovirus (4.2% vs. 9.9%, p = 0.008), Vibrio cholerae (0.0% vs. 2.3%, p = 0.019), Strongyloides species (0.8% vs. 3.6%, p = 0.048) and Dientamoeba fragilis (2.1% vs. 7.8%, p = 0.004). Although not reaching statistical significance, the positivity rate of adenovirus 40/41 (5.8% vs. 7.3%, p = 0.444), norovirus GI/GII (11.2% vs. 15.9%, p = 0.089), Shigella species (8.7% vs. 13.0%, p = 0.092) and Cryptosporidium spp. (11.6% vs. 14.7%, p = 0.261) appeared to increase post-vaccine introduction. Conversely, the positivity rate of sapovirus decreased significantly post-vaccine introduction (7.8% vs. 4.0%, p = 0.030) while that of RVA appeared not to change (27.4% vs. 23.5%, p = 0.253). More enteropathogen coinfections were detected per child post-vaccine introduction compared to before (mean: 2.7 vs. 2.3; p = 0.0025). Conclusions: In this rural Coastal Kenya setting, childhood enteropathogen infection burden was high both pre-and post-rotavirus vaccination introduction. Children who had diarrheal admissions post-vaccination showed an increase