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

Poonum S. Korpe; Cristian Valencia; Rashidul Haque; Mustafa Mahfuz; Monica McGrath; Eric Houpt; Margaret Kosek; Benjamin J.J. McCormick; Pablo Penataro Yori; Sudhir Babji; Gagandeep Kang; Dennis Lang; Michael Gottlieb; Amidou Samie; Pascal Bessong; A. S.G. Faruque; Esto Mduma; Rosemary Nshama; Alexandre Havt; Ila F.N. Lima; Aldo A.M. Lima; Ladaporn Bodhidatta; Ashish Shreshtha; William A. Petri; Tahmeed Ahmed; Priya Duggal

doi:10.1093/cid/ciy355

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

Poonum S. Korpe^* (Corresponding Author), Cristian Valencia, Rashidul Haque, Mustafa Mahfuz, Monica McGrath, Eric Houpt, Margaret Kosek, Benjamin J.J. McCormick, Pablo Penataro Yori, Sudhir Babji, Gagandeep Kang, Dennis Lang, Michael Gottlieb, Amidou Samie, Pascal Bessong, A. S.G. Faruque, Esto Mduma, Rosemary Nshama, Alexandre Havt, Ila F.N. LimaAldo A.M. Lima, Ladaporn Bodhidatta, Ashish Shreshtha, William A. Petri, Tahmeed Ahmed, Priya Duggal

^*Corresponding author for this work

The Rowett Institute of Nutrition and Health

Research output: Contribution to journal › Article › peer-review

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Abstract

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.

Original language	English
Pages (from-to)	1660-1669
Number of pages	10
Journal	Clinical Infectious Diseases
Volume	67
Issue number	11
Early online date	26 Apr 2018
DOIs	https://doi.org/10.1093/cid/ciy355
Publication status	Published - 1 Dec 2018

Bibliographical note

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 AI087910 to P. K. and K23 AI087910 to W. A. P.) and by the Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases Discovery Program (to P. D.).

Data Availability Statement

Supplementary materials are available at Clinical Infectious Diseases online.
Consisting of data provided by the authors to benefit the reader, the posted materials are not copyedited and are the sole responsibility of the authors, so questions or comments should be addressed to the corresponding author.

Keywords

Cryptosporidium species
diarrhea
MAL-ED
malnutrition
stunting

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Korpe, P. S., Valencia, C., Haque, R., Mahfuz, M., McGrath, M., Houpt, E., Kosek, M., McCormick, B. J. J., Penataro Yori, P., Babji, S., Kang, G., Lang, D., Gottlieb, M., Samie, A., Bessong, P., Faruque, A. S. G., Mduma, E., Nshama, R., Havt, A., ... Duggal, P. (2018). Epidemiology and Risk Factors for Cryptosporidiosis in Children from 8 Low-income Sites: Results from the MAL-ED Study. Clinical Infectious Diseases, 67(11), 1660-1669. https://doi.org/10.1093/cid/ciy355

Korpe, PS, Valencia, C, Haque, R, Mahfuz, M, McGrath, M, Houpt, E, Kosek, M, McCormick, BJJ, Penataro Yori, P, Babji, S, Kang, G, Lang, D, Gottlieb, M, Samie, A, Bessong, P, Faruque, ASG, Mduma, E, Nshama, R, Havt, A, Lima, IFN, Lima, AAM, Bodhidatta, L, Shreshtha, A, Petri, WA, Ahmed, T & Duggal, P 2018, 'Epidemiology and Risk Factors for Cryptosporidiosis in Children from 8 Low-income Sites: Results from the MAL-ED Study', Clinical Infectious Diseases, vol. 67, no. 11, pp. 1660-1669. https://doi.org/10.1093/cid/ciy355

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title = "Epidemiology and Risk Factors for Cryptosporidiosis in Children from 8 Low-income Sites: Results from the MAL-ED Study",

abstract = "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.",

keywords = "Cryptosporidium species, diarrhea, MAL-ED, malnutrition, stunting",

author = "Korpe, {Poonum S.} and Cristian Valencia and Rashidul Haque and Mustafa Mahfuz and Monica McGrath and Eric Houpt and Margaret Kosek and McCormick, {Benjamin J.J.} and {Penataro Yori}, Pablo and Sudhir Babji and Gagandeep Kang and Dennis Lang and Michael Gottlieb and Amidou Samie and Pascal Bessong and Faruque, {A. S.G.} and Esto Mduma and Rosemary Nshama and Alexandre Havt and Lima, {Ila F.N.} and Lima, {Aldo A.M.} and Ladaporn Bodhidatta and Ashish Shreshtha and Petri, {William A.} and Tahmeed Ahmed and Priya Duggal",

note = "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 AI087910 to P. K. and K23 AI087910 to W. A. P.) and by the Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases Discovery Program (to P. D.). ",

year = "2018",

month = dec,

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doi = "10.1093/cid/ciy355",

language = "English",

volume = "67",

pages = "1660--1669",

journal = "Clinical Infectious Diseases",

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publisher = "Oxford University Press",

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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 AI087910 to P. K. and K23 AI087910 to W. A. P.) and by the Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases Discovery Program (to P. D.).

PY - 2018/12/1

Y1 - 2018/12/1

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 - diarrhea

KW - MAL-ED

KW - malnutrition

KW - stunting

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DO - 10.1093/cid/ciy355

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SN - 1058-4838

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JO - Clinical Infectious Diseases

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IS - 11

ER -

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

Abstract

Bibliographical note

Data Availability Statement

Keywords

UN SDGs

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