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.

中文翻译：

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来自8个低收入站点的儿童隐孢子虫病的流行病学和危险因素：MAL-ED研究的结果。

背景隐孢子虫种是肠原生动物，会导致全世界儿童的明显发病和死亡。我们对非洲，亚洲和南美8个资源有限的站点的儿童隐孢子虫的流行病学进行了表征。方法在出生后17天内入组儿童，然后每周两次随访24个月。通过酶联免疫吸附测定法检测腹泻和每月监测的粪便样本中的隐孢子虫。通过调查收集社会经济数据，并每月测量人体测量学。结果百分之六十五（962/1486）的儿童患有隐孢子虫感染，而54％（802/1486）的儿童至少有1次隐孢子虫相关的腹泻发作。隐孢子虫腹泻更可能与脱水有关（16.5％比8.3％，P <0.01）。秘鲁（10.9％）和巴基斯坦（9.2％）地区的隐孢子虫腹泻发生率最高。在多变量回归分析中，家庭过度拥挤是孟加拉国感染的重要危险因素（赔率为2.3 [95％置信区间{CI}，为1.2-4.6]）。多元线性回归表明，印度（β= -.26 [95％CI，-。51至-.01]）和孟加拉国（β=- 0.20 [95％CI，-。44至.05]）网站。结论这项多国队列研究证实了隐孢子虫感染与南亚2个站点发育迟缓的相关性，突出了隐孢子虫病作为生长不良的危险因素的重要性。我们观察到每个部位的感染率，发病年龄和重复感染次数各不相同。