Prevalence and Correlates of Cryptosporidium Infections in Kenyan Children With Diarrhea and Their Primary Caregivers

Emily L Deichsel; Heidi K Hillesland; Carol A Gilchrist; Jaqueline M Naulikha; Christine J McGrath; Wesley C Van Voorhis; Doreen Rwigi; Benson O Singa; Judd L Walson; Patricia B Pavlinac

doi:10.1093/ofid/ofaa533

Prevalence and Correlates of Cryptosporidium Infections in Kenyan Children With Diarrhea and Their Primary Caregivers

Open Forum Infect Dis. 2020 Oct 31;7(12):ofaa533. doi: 10.1093/ofid/ofaa533. eCollection 2020 Dec.

Authors

Affiliations

¹ University of Maryland, Baltimore, Maryland, USA.
² Hawai'i Pacific Health, Lihue HI.
³ University of Virginia, Charlottesville, Virginia, USA.
⁴ Maasai Mara University, Narok, Kenya.
⁵ University of Washington, Seattle, Washington, USA.
⁶ Kenya Medical Research Institute, Nairobi, Kenya.
⁷ Child Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya.

Abstract

Background: Cryptosporidium is a leading cause of diarrhea in Sub-Saharan Africa and is associated with substantial morbidity and mortality in young children.

Methods: We analyzed data from children aged 6-71 months presenting to 2 public hospitals in Western Kenya with acute diarrhea and their primary caregivers, including detection of Cryptosporidium by quantitative polymerase chain reaction (PCR) and immunoassay analysis in stool samples from both children and their caregivers. Associations between potential transmission sources and child/caregiver Cryptosporidium infection were evaluated using prevalence ratios (PRs). Secondary analyses evaluated host and clinical risk factors of child/caregiver Cryptosporidium infection.

Results: Among 243 child-caregiver pairs enrolled, 77 children (32%) and 57 caregivers (23%) had Cryptosporidium identified by either immunoassay or PCR. Twenty-six of the 243 child-caregiver pairs (11%) had concordant detection of Cryptosporidium. Cryptosporidium infection in children was associated with detection of Cryptosporidium in caregivers (adjusted PR [aPR], 1.8; 95% CI, 1.2 to 2.6; P = .002) and unprotected water source (aPR, 2.0; 95% CI, 1.3 to 3.2; P = .003). Risk factors for Cryptosporidium detection in caregivers included child Cryptosporidium infection (aPR, 2.0; 95% CI, 1.3 to 3.0; P = .002) as well as cow (aPR, 3.1; 95% CI, 1.4 to 7.0; P = .02) and other livestock ownership (aPR, 2.6; 95% CI, 1.1 to 6.3; P = .03) vs no livestock ownership. Recent diarrhea in caregivers and children was independently associated with child and caregiver Cryptosporidium infections, respectively.

Conclusions: Our results are consistent with the hypothesis that Cryptosporidium transmission can occur directly between child-caregiver dyads as well as through other pathways involving water and livestock. Additional research into caregivers as a source of childhood Cryptosporidium infection is warranted.

Keywords: Cryptosporidium; caregiver; diarrhea; infant; transmission.

Abstract

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