Environmental, Behavioral, and Clinical Characteristics Associated with Cryptosporidium Infection among Children Less than Five Years Old with Moderate-to-Severe Diarrhea in Rural Western Kenya Público

Abstract

Purpose: Outbreaks of Cryptosporidium in developed countries have been studied in detail; however, less is known about risk factors for endemic cryptosporidiosis. The purposes of this study are: to describe the prevalence of Cryptosporidium infections in children less than five years old with moderate-to-severe diarrhea enrolled in the rural western Kenya site of the Global Enteric Multicenter Study (case children), to assess environmental, behavioral, and clinical characteristics associated with Cryptosporidium infections, and to describe the outcomes and consequences of Cryptosporidium infections among these children.

Methods: Stool samples were tested at enrollment for presence of enteric pathogens, data on environmental, behavioral, and clinical characteristics were collected at enrollment, and each child's health status was recorded at a 60-day follow-up. Data were analyzed using multivariable logistic regression to assess characteristics associated with Cryptosporidium.

Results: Overall, 10.8% of 1,476 case children had a Cryptosporidium infection and 4.6% of these children had died by their 60-day follow-up. There was no significant difference between the proportion of children with and without Cryptosporidium infections who were underweight or wasted at baseline; however, those with Cryptosporidium infections were significantly more likely to be underweight or wasted by the time of follow-up. Characteristics significantly positively associated with Cryptosporidium included age less than two years, producing a watery stool sample at enrollment, and having flaky skin at enrollment. Characteristics significantly negatively associated with Cryptosporidium were having a rotavirus infection, coming from a household in which rainwater was the main source of drinking water or a household that reports boiling drinking water, and coming from a household in which the caretaker reports washing hands after defecation.

Discussion: Cryptosporidium contributes significantly to the burden of diarrheal illness in the study site, particularly among those less than two years old. Rapid and reliable diagnostic tests for Cryptosporidium, improved diarrhea case management and treatment of cryptosporidiosis, vaccine research, adequate access to improved drinking water, and future research on ceramic water filters are recommended for reducing the burden of cryptosporidiosis in rural western Kenya.

Table of Contents

INTRODUCTION.. 1
BACKGROUND.. 1
LITERATURE REVIEW... 3
Cryptosporidium Characteristics and Transmission. 3
Diagnostic Techniques for Cryptosporidium and Cryptosporidium Genotypes. 3
Clinical Features of Cryptosporidium Infection in Humans. 4
Cryptosporidium Infections in Immunocompromised Individuals. 5
Cryptosporidium in Children. 6
Growth Faltering, Malnutrition, and Developmental Deficiencies. 6
Known Risk Factors for Cryptosporidium Infection in Developing Countries. 7
Water Treatment for Cryptosporidium Removal or Inactivation. 8
Treatment, Management, and Prevention of Cryptosporidiosis. 8
Seasonality of Cryptosporidium Infections in Developing Countries. 8
Global Burden of Disease from Cryptosporidium.. 9
Cryptosporidium in Kenya. 10
METHODS. 12
Global Enteric Multicenter Study (GEMS): Overview and Enrollment 12
Study Site. 14
Cryptosporidium Identification. 14
Anthropometric Measurements. 15
Days of Diarrhea. 16
HIV Testing. 17
Temperature and Rainfall 17
Definitions. 18
Statistical Analysis. 19
Ethical review.. 21
RESULTS. 23
Demographics. 23
Clinical Signs and Symptoms during MSD Episode. 25
Stool Sample Consistency and Characteristics, and Co-Infections Identified in Stool 26
Cryptosporidium Sub-Typing. 29
Days of Diarrhea. 30
Anthropometric Measurements as Indicators of Malnutrition. 32
Hospitalizations and Deaths. 33
Breastfeeding. 34
HIV Status. 35
Water, Sanitation, and Hygiene Characteristics. 36
Characteristics Associated with Cryptosporidium Infections. 39
Potential Risk Factors for Cryptosporidium.. 40
DISCUSSION AND RECOMMENDATIONS. 42
Age. 43
Clinical Signs and Symptoms and Days of Diarrhea. 44
Malnutrition. 45
Breastfeeding. 46
Drinking Water Source. 47
Water Treatment 48
Improved Sanitation. 48
Cryptosporidium Genotypes. 49
Limitations. 50
Recommendations and Future Research. 52
CONCLUSION.. 54
Additional Figures. 56
References. 59
APPENDIX.. 67

About this Master's Thesis

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School	Rollins School of Public Health
Department	Environmental Health
Degree	MSPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Hygiene Health Sciences, Epidemiology
Palavra-chave	Sanitation Hygiene Cryptosporidium Malnutrition Diarrhea Water
Committee Chair / Thesis Advisor	Null, Clair, Emory University
Committee Members	O'Reilly, Ciara, Centers for Disease Control and Prevention Tolbert, Paige, Emory University
Partnering Agencies	CDC

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