Intestinal protozoan infections among children 0-168 months with diarrhea in Mozambique: June 2014-January 2018

Background

Intestinal parasites such as Cryptosporidium spp., Giardia lamblia and Entamoeba histolytica can cause severe diarrhea, especially among children in developing countries. This study aims to determine the frequency of Cryptosporidium spp., Giardia lamblia and Entamoeba histolytica in children with diarrhea and identify risk factors for infection.

Methodology

We conducted a cross-sectional study in children aged 0-168 months hospitalized with diarrhea in three regions of Mozambique, from June 2014 to January 2018. Following consent, caretakers were interviewed and a single stool specimen was collected from each child to diagnose Cryptosporidium spp., G. lamblia and E. histolytica using commercial immune-enzymatic assay (TechLab, Inc, Blacksburg, VA, USA). Anthropometric data were collected from the clinical reports. Multivariable logistic regression models were built to identify risk factors for Cryptosporidium spp. and G. lamblia infection.

Results

Twenty-one percent of all specimens (212/1008) presented at least one parasitic infection. Cryptosporidium spp. infection was the most common 12.0% (118/985), followed by G. lamblia 9.7% (95/983) and E. histolytica 2.0% (20/1004). Risk factors for infection by Cryptosporidium spp. were: provenience (children from Nampula province showed the highest risk, OR: 8.176; CI: 1.916-34.894; p-value <0.01); animal contact (children with animal contact had a protective effect OR: 0.627; CI: 0.398-0.986; p-value <0.05); underweight (children severely underweight showed a risk of 2.309; CI: 1.310-4.069; p-value <0.05). Risk factors for infection by G. lamblia were: age (group with highest risk, 60-168 months (OR: 2.322; CI: 1.000-5.393, p-value > 0.05)); and living in a household with five or more members (OR: 2.141; CI: 1.286-3.565, p-value <0.01).

Conclusions

Parasitic infection is common among children with diarrhea. Routine testing, standard treatment, and assessment for risk exposure of children with diarrhea should be implemented at health facilities in Mozambique.

Author summary

Intestinal parasites can cause diarrhea in children, being most reported in developing countries, such as Mozambique. Mozambique dual high burden of HIV and malnutrition poses an ideal setting for parasites occurrence. To date, little information is published regarding intestinal parasites in children (0-168 months) in Mozambique, most of the published information focus on children under fifty-nine months and focus Mozambique's South region. We determine Cryptosporidium spp., Giardia lamblia and Entamoeba histolytica frequency in the three regions of Mozambique in children hospitalized with diarrhea and we identified factors that are associated with intestinal parasite infections. Cryptosporidium spp. infection was the most common parasite among children in this study, with an occurrence of one in ten. The percentage of children infected with Cryptosporidium spp. decreased with age. G. lamblia was the second more common parasite, being the number of members in the household a predictor for its occurrence in children. E. histolytica was the less common of them all although it was found in all studied provinces. Our study highlights the burden of most common intestinal protozoans found in children (0-168 months) hospitalized due to diarrhea.