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Observational Study
. 2018 Jul 12;12(7):e0006640.
doi: 10.1371/journal.pntd.0006640. eCollection 2018 Jul.

Clinical, environmental, and behavioral characteristics associated with Cryptosporidium infection among children with moderate-to-severe diarrhea in rural western Kenya, 2008-2012: The Global Enteric Multicenter Study (GEMS)

Miranda J Delahoy  1   2 , Richard Omore  3   4 , Tracy L Ayers  1 , Katharine A Schilling  1 , Anna J Blackstock  1 , J Benjamin Ochieng  3   4 , Feny Moke  3   4 , Peter Jaron  3   4 , Alex Awuor  3   4 , Caleb Okonji  3   4 , Jane Juma  3   4 , Tamer H Farag  5   6 , Dilruba Nasrin  5 , Sandra Panchalingam  5 , James P Nataro  5   7 , Karen L Kotloff  5 , Myron M Levine  5 , Joseph Oundo  8 , Dawn M Roellig  1 , Lihua Xiao  1 , Michele B Parsons  1   9 , Kayla Laserson  3   9   10 , Eric D Mintz  1 , Robert F Breiman  8   9   11 , Ciara E O'Reilly  1
Affiliations
Observational Study

Clinical, environmental, and behavioral characteristics associated with Cryptosporidium infection among children with moderate-to-severe diarrhea in rural western Kenya, 2008-2012: The Global Enteric Multicenter Study (GEMS)

Miranda J Delahoy et al. PLoS Negl Trop Dis. .

Abstract

Background: Cryptosporidium is a leading cause of moderate-to-severe diarrhea (MSD) in young children in Africa. We examined factors associated with Cryptosporidium infection in MSD cases enrolled at the rural western Kenya Global Enteric Multicenter Study (GEMS) site from 2008-2012.

Methodology/principal findings: At health facility enrollment, stool samples were tested for enteric pathogens and data on clinical, environmental, and behavioral characteristics collected. Each child's health status was recorded at 60-day follow-up. Data were analyzed using logistic regression. Of the 1,778 children with MSD enrolled as cases in the GEMS-Kenya case-control study, 11% had Cryptosporidium detected in stool by enzyme immunoassay; in a genotyped subset, 81% were C. hominis. Among MSD cases, being an infant, having mucus in stool, and having prolonged/persistent duration diarrhea were associated with being Cryptosporidium-positive. Both boiling drinking water and using rainwater as the main drinking water source were protective factors for being Cryptosporidium-positive. At follow-up, Cryptosporidium-positive cases had increased odds of being stunted (adjusted odds ratio [aOR] = 1.65, 95% CI: 1.06-2.57), underweight (aOR = 2.08, 95% CI: 1.34-3.22), or wasted (aOR = 2.04, 95% CI: 1.21-3.43), and had significantly larger negative changes in height- and weight-for-age z-scores from enrollment.

Conclusions/significance: Cryptosporidium contributes significantly to diarrheal illness in young children in western Kenya. Advances in point of care detection, prevention/control approaches, effective water treatment technologies, and clinical management options for children with cryptosporidiosis are needed.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Percent of GEMS-Kenya cases (N = 1,778) with Cryptosporidium by age, western Kenya, 2008–2012.
Fig 2
Fig 2. GEMS-Kenya cases (N = 1,778) with Cryptosporidium status and follow-up status/anthropometric measurements, western Kenya, 2008–2012.
See this image and copyright information in PMC

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