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. LimaAldo A.M. Lima, Ladaporn Bodhidatta, Ashish Shreshtha, William A. Petri, Tahmeed Ahmed, Priya Duggal

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


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 languageEnglish (US)
Pages (from-to)1660-1669
Number of pages10
JournalClinical Infectious Diseases
Issue number11
StatePublished - Nov 13 2018


  • Cryptosporidium species
  • MAL-ED
  • diarrhea
  • malnutrition
  • stunting

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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