A comparison of risk factors for cryptosporidiosis and non-cryptosporidiosis diarrhoea: A case-case-control study in Ethiopian children

Abstract

Background Cryptosporidiosis is a major cause of diarrhoea in young children in low-and-middle-income countries. New interventions should be informed by evidence pertaining to risk factors and their relative importance. Inconsistencies in the literature may to some extent be explained by choice of methodology, furthermore, most previous risk factor studies compared cryptosporidiosis cases to diarrhoea cases of other aetiologies rather than with controls without diarrhoea. Methodology/Principal findings We investigated a broad set of factors in under-2-year-olds presenting with diarrhoea to a hospital and a health center in southwestern Ethiopia. We applied quantitative cut-offs to distinguish between cryptosporidiosis and incidental Cryptosporidium infection or carriage, a hierarchical causal framework to minimize confounding and overadjustment, and a case-case-control design, to describe risk factors for both cryptosporidiosis and non-cryptosporidiosis diarrhoea. Moderate and severe acute malnutrition were strongly associated with both cryptosporidiosis and non-cryptosporidiosis diarrhoea. Previous healthcare attendance and low maternal education were only associated with cryptosporidiosis, whereas unsafe child stool disposal, prematurity and early cessation of exclusive breastfeeding were significantly associated with non-cryptosporidiosis diarrhoea only. By estimation of population attributable fractions, socioeconomic factors—specifically low maternal education—and public tap water use, were apparently more important risk factors for cryptosporidiosis than for non-cryptosporidiosis diarrhoea. Conclusions/Significance Nutritional management of moderate acute malnutrition may be an effective intervention against cryptosporidiosis, particularly if combined with targeted therapy for cryptosporidiosis which, again, may mitigate nutritional insult. Focused caregiver education in healthcare settings and follow-up of children with acute malnutrition may prevent or improve outcomes of future episodes of cryptosporidiosis.

Protozoan Infections Acquired from Food or Drinking Water: An Update

“…The same was confirmed by the MAL-ED (Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project) project reported that for eight countries of Africa, Asia, and South America [121], while in industrialized nations it occurred more frequently over the age of 2 years, probably for delayed exposure and better hygienic conditions [112]. According to a case-control study carried out in South West Ethiopia, diarrhea caused by Cryptosporidium in children younger than two years was associated with public tap water use and, as diarrhea from other causes, it was strongly associated with malnutrition [122].…”

Food and Drinking Water as Sources of Pathogenic Protozoans: An Update

“…The Global Burden of Disease Study (GBD) in 2016 listed Cryptosporidium as the fifth leading cause of diarrhea in children younger than five years, accounting for more than 57,000 deaths and more than 12.9 million disability-adjusted life years (DALYs) considering growth impairment and increased risk of subsequent infectious diseases [113]. In southwest Ethiopia, diarrhea caused by Cryptosporidium in children younger than two years was strongly associated with malnutrition [118].…”

Point of care diagnostics for Cryptosporidium: new and emerging technologies

“…The parasite is transmitted upon the ingestion of oocysts via contaminated food or drink, or through direct contact with faeces of infected persons or animals and also via inhalation [2]. Although asymptomatic infections can occur, cryptosporidiosis is a major and frequently underestimated cause of childhood diarrhoea in both low and high-income countries [1][2][3][4] with malnutrition a major risk factor [5].…”