Gastroenteritis is the main factor of infant morbidity and mortality, significantly contributing to malnutrition and growth retardation [1][2]. Diarrhoeal diseases cause 1.6 million deaths and constitute about 27% of all deaths among children under 5 years old per year [2]. Human Astroviruses, the third cause of viral gastroenteritis after rotavirus and calicivirus, are experiencing a recrudescence in all age groups, indicating an increasingly significant spread of these viruses [3]. They induce moderate or severe diarrhea, fever, loss of appetite, abdominal pain, nausea and vomiting [4]. Human Astroviruses are recognized as an endemic cause of acute gastroenteritis worldwide [5]. They are responsible for about 10% of sporadic diarrhea cases in children, with detection rates ranging from 2% to 9% in children with acute diarrhea. In low-income countries, prevalences of up to 26% have been reported [6]. Serological studies have shown that up to 90% of individuals in certain populations have antibodies against human Astroviruses [7]. Contamination can be of food, water, interhuman or sometimes zoonic origin [5].

Astroviruses are present worldwide, affecting populations of all ages and regions. They are considered one of the leading causes of viral gastroenteritis in infants and young children, particularly in developing countries where access to safe drinking water and sanitation may be limited. Studies from around the world have shown a wide range of prevalence, with prevalences ranging from 8.6% in Thailand to 4.3% in Australia and 3% in Iran [1]. In Brazil, Astroviruses were found in 33% of children under 5 years with diarrhea [8].

The epidemiology of Astroviruses in Africa is a crucial area of research due to the high prevalence of childhood gastroenteritis on the continent. Although specific data on the distribution of Astroviruses in Africa are still limited, several studies have highlighted their significant role in child morbidity. Studies conducted in different African countries reported a prevalence of 7% in South Africa [9], 7% in Nigeria [10], 6.3% in Gabon [11], 4% in Côte d’Ivoire [12].

The epidemiology of Astroviruses in Burkina Faso, as in many developing countries, is an area that requires special attention due to the significant impact of these viruses on child health. Although data specific to Burkina Faso are still somewhat limited, three studies (4.9% by Ouédraogo et al. (2016) [13], 6.3% by Badjo et al. (2024) [14] and 9% by Dakouo et al. (2024) [15]) provide valuable information on prevalence, the distribution and risk factors associated with Astrovirus infections in this West African country. However, in this country, the management of diarrhea of viral origin is mainly based on oral rehydration and monitoring for signs of severe dehydration. In addition, in the absence of commonly available diagnostic tests at primary health care centres, management often relies on empirical treatment without confirmation of the causative agent. This underscores the need to build diagnostic capacity to improve case management and guide public health interventions. Thus, the epidemiological data on Astroviruses in children in Burkina Faso require more updates despite the studies and publications already carried out. It is in this context that this study using molecular diagnostics to update the epidemiological profile of Astrovirus infections among children aged 0 to 5 years in Burkina Faso, takes place.

In our study, the frequency of Astrovirus infections (9.3%) was relatively higher than the results obtained, 4.9% by Ouédraogo et al. (2016) [13], 6.3% by Badjo et al. (2024) [14] and 9% by Dakouo et al. (2024) [15], in three previous studies carried out in Burkina Faso. We observe a gradual increase over time, which justifies addressing this issue from a public health perspective. This increase is explained by the deterioration of hygiene conditions in certain working-class districts of the city of Ouagadougou with the massive arrival of internally displaced persons. Indeed, astroviruses are considered one of the main causes of viral gastroenteritis in infants and young children, particularly in developing countries where access to safe drinking water and sanitation may be limited. The study by Meyer et al. (2015) [16] conducted in two African countries (Gambia and Kenya) found a prevalence of 9.9% among children with acute diarrhea. The study by Arowolo et al. (2020) [17] in Nigeria between 2015 and 2018 found a prevalence of 19.4%, with a peak at 41.4% in 2015. Gelaw et al. (2019) [18] in Ethiopia found a prevalence of 3.6% and Tsague et al. (2020) [19] in the Republic of Congo found a prevalence of 10.3%. In Burkina Faso, as in other sub-Saharan African countries, the incidence of viral gastroenteritis remains high due to environmental and socio-economic factors such as limited access to drinking water, poor sanitation and child malnutrition. Astrovirus transmission occurs mainly through the oro-fecal route, favored by water and food contamination; a parallel circulation between Rotavirus and Astrovirus with a dry season peak in tropical countries [20]. Furthermore, the prevalence of Astrovirus infection remains relatively low in developed countries. In Greece, a prevalence of 2.4% was observed over a six-year monitoring period [21] and only 0.97% in Italy between 2003 and 2013 [22]. The variability in the prevalence of the Astrovirus in different countries could be the effect of social and economic factors, geographical factors and hygiene and sanitation conditions. However, this prevalence may be underestimated due to the variability in detection techniques and seasonality of Astrovirus infections and the variability in prevalence depending on the season [19][22][23].

The average age of Astrovirus positive children in our study was 30 months with a predominance in infants (0 - 24 months). Ouédraogo et al. (2016) [13] and Badjo et al. (2024) [14] had found average ages of 14 months and 4.5 years, respectively. But, the study by Badjo et al. (2024) [14] included adults. In contrast, statistical analyses showed a high risk of viral infection in children under 5 years with a ratio of 3.9 and a confidence interval between 2.2 and 7.4 [14]. Both studies noted a high prevalence of Astrovirus in infants under two years old [13][14]. Meyer et al. (2015) [16] found a mean age of 17.4 months in Kenya and 16.4 months in the Gambia. In Nigeria, infants (0 - 24 months) were most affected by Astrovirus (44%) with a peak in children from 0 - 12 months (24%) [17]. In the Republic of Congo, the average age of children was 12 months with a high prevalence among children under 18 months [19]. The same observation was made in developed countries regarding the high prevalence of infection among children under 24 months [21]. The high prevalence of infection in infants could be explained by the fact that it is the period of growth and an immaturity of immunity of children at this time [24]. In addition, at this phase of life, children learn to walk and make all four paws with hands that are dirty during this period. They can easily get infected by putting their hand in the mouth without the parents’ knowledge.

The results of our study showed that Astrovirus infections were mainly associated with diarrhea, vomiting, abdominal pain, fever and bloating. Fever was present in 43% of positive cases and abdominal pain in 57% of cases. In Republic of Congo, Tsague et al. (2020) [19] had found symptoms such as fever (34%), vomiting (93%) and dehydration (93%). Other studies have shown that Astrovirus infections are often associated with less severe symptoms and faster recovery [24]. Only seven events limit the robustness of significance tests.

In conclusion, this study aimed to evaluate the frequency and clinical characteristics of Astrovirus infections in children aged 0 to 5 years who received consultation for diarrheal syndrome in Ouagadougou, Burkina Faso. Age was significantly associated with Astrovirus infections, children aged 0 to 24 months are the most affected. The prevalence of Astrovirus infections in children from 0 to 5 years was 9.3%. Abdominal pain, diarrhea, vomiting and fever were also significantly associated with Astrovirus infections. As a result of these results, a strengthening of the epidemiological surveillance of Astrovirus infections in children from 0 to 5 years is necessary. By carrying out the molecular diagnosis, this study made it possible to update the epidemiological information on Astrovirus infections in Ouagadougou in Burkina Faso. This information can reduce the impact of Astrovirus infections on child health in the country. In view of the importance of the pathology, an effective fight must be envisaged through the awareness of children’s parents on good hygiene practices to reduce the burden of this pathology.

This study was conducted in strict adherence to the ethical principles set out in the Declaration of Helsinki [25]. In addition, the research protocol has received approval from the Ethics Committee for Health Research (CERS) of Burkina Faso under the number 2024-07-223.

The authors thank the children’s parents for their collaboration and participation in this study. The work was carried out thanks to the financial support of the University of Saint Thomas d’Aquin (USTA) of Burkina Faso; the Pietro Annigoni Center for Biomolecular Research (CERBA) of Burkina Faso; the Hospital Saint Camille of Ouagadougou (HSCO) and the Paul VI Hospital of Burkina Faso.