A Survey of U.S. Obstetrician-Gynecologists' Clinical and Epidemiological Knowledge of Cryptosporidiosis in Pregnancy sampled from the American College of Obstetricians and Gynecologists, 2010 Público

Abstract

A Survey of U.S. Obstetrician-Gynecologists' Clinical and Epidemiological Knowledge of
Cryptosporidiosis in Pregnancy sampled from the American Col ege of Obstetricians
and Gynecologists, 2010
Background:

Although stil largely unexplored, studies suggest that pregnancy increases the
likelihood and severity of Cryptosporidium infection. Although cryptosporidiosis is common in
the U.S., there has been very little assessment of obstetrician-gynecologist knowledge about this
disease. A divergence between perceived risk and knowledge and estimated annual case load in
pregnant patients impacts not only clinical management and preventative strategies but also
can illuminate weaknesses of public health surveillance networks.
Goal: The goal of this joint CDC and American College of Obstetricians and Gynecologists
Cryptosporidium spp. survey analysis is to pinpoint weaknesses of American obstetrician and
gynecologists' knowledge of risk factors, diagnosis, treatment, and prevention of
cryptosporidiosis in pregnant women.
Methods: In 2010, the American College of Obstetrics and Gynecology (ACOG) and Centers of
Disease Control distributed a questionnaire about the diagnosis and treatment of the parasitic
disease cryptosporidiosis with 3 mailings to a national sample of 1000 obstetrician-gynecologists
and received 431 surveys that met inclusion criteria (43.1% response rate). The questionnaire
was developed at ACOG and CDC and pilot tested
obstetrician-gynecologists. Data
were analyzed through multivariate regression models.
Results: Clinically oriented questions had a higher rate of correct responses than
epidemiological y oriented questions, though no survey question had higher than a 50% correct
response rate and overall provider knowledge about cryptosporidiosis was low. Only 44.4% of
providers correctly identified that prolonged, intermittent diarrhea would lead them to consider
cryptosporidiosis in a differential diagnosis. Routine ova and parasites (O&P) testing was
incorrectly chosen by 30.4% respondents to identify cryptosporidiosis in stool. As for
prevention-related knowledge, only 14.1% of respondents identified alcohol-based hand
sanitizers as an ineffective tool to inactivate Cryptosporidium spp., and less than 10% of
physicians knew that cryptosporidiosis is a reportable disease in their state of practice.
Mutivariate analysis found that greater than 19 years in practice, correlating to higher physician
experience, was positively associated with knowledge of O&P diagnostic testing, while rural
practice location, compared to suburban practice location, was significantly associated with
knowledge of FDA guidelines for the drug nitazoxanide, as well as knowledge of the correct FDA
pharmaceutical pregnancy category for nitazoxanide.
Discussion and Conclusion: The low overall clinical and epidemiological knowledge level of
obstetrician-gynecologists about cryptosporidiosis in pregnancy indicates a lack of
communication and congruency between current clinical education curricula and the public
health system. This analysis found an overwhelming need to educate physicians about all
aspects of cryptosporidiosis, particularly treatment guidelines and prevention strategies with
short, tailored education tools that pinpoint current weaknesses in diagnosis, treatment,
prevention, and reporting to optimize patient care and strengthen national reportable disease
surveillance for cryptosporidiosis in pregnancy.

Table of Contents

Table of Contents Review of the Literature............................................................................................. 1 Introduction.......................................................................................................... 1 Brief History.......................................................................................................... 2 Ecology and Organism........................................................................................... 3 Clinical Features of Cryptosporidiosis in Pregnancy.................................................. 8 Diagnosis and Treatment of Cryptosporidiosis in Pregnancy................................... 11 Physician Knowledge of Infections in Pregnancy..................................................... 13 Conclusions.......................................................................................................... 21 Goal........................................................................................................... 22 Aims.......................................................................................................... 22 Significance................................................................................................ 23 Introduction................................................................................................................ 26 Methods...................................................................................................................... 30 Study Population.................................................................................................. 30 Sample size......................................................................................................... 30 Data Cleaning and Inclusion Criteria....................................................................... 30 Statistical Analyses............................................................................................... 31 Results........................................................................................................................ 33 Clinical Knowledge................................................................................................ 34 Epidemiological Knowledge.................................................................................... 36 Discussion.................................................................................................................... 39 Clinical Concepts................................................................................................... 39 Epidemiological Concepts...................................................................................... 45 Strengths, Limitations and Future Research............................................................ 48 Acknowledgements...................................................................................... 49 Public Health Implications........................................................................................... 50 References................................................................................................................... 60

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Education Health Sciences, Public Health
Palavra-chave	obstetrician-gynecologist survey Cryptosporidium infection cryptosporidiosis Physician knowledge of parasites in pregnancy
Committee Chair / Thesis Advisor	Leon, Juan, Emory University
Committee Members	Jones, Jeffrey, Centers for Disease Control and Prevention
Partnering Agencies	National or regional non-profit organization (e.g., American Cancer Society) CDC

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