TY - JOUR
T1 - Epidemiology and Risk Factors for Cryptosporidiosis in Children from 8 Low-income Sites
T2 - Results from the MAL-ED Study
AU - Korpe, Poonum S.
AU - Valencia, Cristian
AU - Haque, Rashidul
AU - Mahfuz, Mustafa
AU - McGrath, Monica
AU - Houpt, Eric
AU - Kosek, Margaret
AU - McCormick, Benjamin J.J.
AU - Penataro Yori, Pablo
AU - Babji, Sudhir
AU - Kang, Gagandeep
AU - Lang, Dennis
AU - Gottlieb, Michael
AU - Samie, Amidou
AU - Bessong, Pascal
AU - Faruque, A. S.G.
AU - Mduma, Esto
AU - Nshama, Rosemary
AU - Havt, Alexandre
AU - Lima, Ila F.N.
AU - Lima, Aldo A.M.
AU - Bodhidatta, Ladaporn
AU - Shreshtha, Ashish
AU - Petri, William A.
AU - Ahmed, Tahmeed
AU - Duggal, Priya
N1 - Funding Information:
The MAL-ED study is carried out as a collaborative project supported by the Bill &Melinda Gates Foundation, the Foundation for the National Institutes of Health (NIH), and the NIH Fogarty International Center. This work was also supported by the National Institute of Allergy and Infectious Diseases of the NIH (grant numbers K23 AI108790 to P. K. and R01 AI043596 to W. A. P.) and by the Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases Discovery Program (to P. D.).
Publisher Copyright:
© 2018 The Author(s).
PY - 2018/11/13
Y1 - 2018/11/13
N2 - Background Cryptosporidium species are enteric protozoa that cause significant morbidity and mortality in children worldwide. We characterized the epidemiology of Cryptosporidium in children from 8 resource-limited sites in Africa, Asia, and South America. Methods Children were enrolled within 17 days of birth and followed twice weekly for 24 months. Diarrheal and monthly surveillance stool samples were tested for Cryptosporidium by enzyme-linked immunosorbent assay. Socioeconomic data were collected by survey, and anthropometry was measured monthly. Results Sixty-five percent (962/1486) of children had a Cryptosporidium infection and 54% (802/1486) had at least 1 Cryptosporidium-associated diarrheal episode. Cryptosporidium diarrhea was more likely to be associated with dehydration (16.5% vs 8.3%, P <.01). Rates of Cryptosporidium diarrhea were highest in the Peru (10.9%) and Pakistan (9.2%) sites. In multivariable regression analysis, overcrowding at home was a significant risk factor for infection in the Bangladesh site (odds ratio, 2.3 [95% confidence interval {CI}, 1.2-4.6]). Multiple linear regression demonstrated a decreased length-for-age z score at 24 months in Cryptosporidium-positive children in the India (β =-.26 [95% CI,-.51 to-.01]) and Bangladesh (β =-.20 [95% CI,-.44 to.05]) sites. Conclusions This multicountry cohort study confirmed the association of Cryptosporidium infection with stunting in 2 South Asian sites, highlighting the significance of cryptosporidiosis as a risk factor for poor growth. We observed that the rate, age of onset, and number of repeat infections varied per site; future interventions should be targeted per region to maximize success.
AB - Background Cryptosporidium species are enteric protozoa that cause significant morbidity and mortality in children worldwide. We characterized the epidemiology of Cryptosporidium in children from 8 resource-limited sites in Africa, Asia, and South America. Methods Children were enrolled within 17 days of birth and followed twice weekly for 24 months. Diarrheal and monthly surveillance stool samples were tested for Cryptosporidium by enzyme-linked immunosorbent assay. Socioeconomic data were collected by survey, and anthropometry was measured monthly. Results Sixty-five percent (962/1486) of children had a Cryptosporidium infection and 54% (802/1486) had at least 1 Cryptosporidium-associated diarrheal episode. Cryptosporidium diarrhea was more likely to be associated with dehydration (16.5% vs 8.3%, P <.01). Rates of Cryptosporidium diarrhea were highest in the Peru (10.9%) and Pakistan (9.2%) sites. In multivariable regression analysis, overcrowding at home was a significant risk factor for infection in the Bangladesh site (odds ratio, 2.3 [95% confidence interval {CI}, 1.2-4.6]). Multiple linear regression demonstrated a decreased length-for-age z score at 24 months in Cryptosporidium-positive children in the India (β =-.26 [95% CI,-.51 to-.01]) and Bangladesh (β =-.20 [95% CI,-.44 to.05]) sites. Conclusions This multicountry cohort study confirmed the association of Cryptosporidium infection with stunting in 2 South Asian sites, highlighting the significance of cryptosporidiosis as a risk factor for poor growth. We observed that the rate, age of onset, and number of repeat infections varied per site; future interventions should be targeted per region to maximize success.
KW - Cryptosporidium species
KW - MAL-ED
KW - diarrhea
KW - malnutrition
KW - stunting
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U2 - 10.1093/cid/ciy355
DO - 10.1093/cid/ciy355
M3 - Article
C2 - 29701852
AN - SCOPUS:85053224112
SN - 1058-4838
VL - 67
SP - 1660
EP - 1669
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 11
ER -