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Epidemiology and Risk Factors for Cryptosporidiosis in Children From 8 Low-income Sites: Results From the MAL-ED Study.

Korpe, Poonum S; Valencia, Cristian; Haque, Rashidul; Mahfuz, Mustafa; McGrath, Monica; Houpt, Eric; Kosek, Margaret; McCormick, Benjamin J J; Penataro Yori, Pablo; Babji, Sudhir; Kang, Gagandeep; Lang, Dennis; Gottlieb, Michael; Samie, Amidou; Bessong, Pascal; Faruque, A S G; Mduma, Esto; Nshama, Rosemary; Havt, Alexandre; Lima, Ila F N; Lima, Aldo A M; Bodhidatta, Ladaporn; Shreshtha, Ashish; Petri, William A; Ahmed, Tahmeed; Duggal, Priya.
Clin Infect Dis; 67(11): 1660-1669, 2018 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-29701852

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 (ß = -.26 [95% CI, -.51 to -.01]) and Bangladesh (ß = -.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.
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