Risk factors for Cryptosporidium infection in low and middle income countries: A systematic review and meta-analysis
Maha Bouzid, Erica Kintz, Paul R Hunter
Water Security Research Centre
Public Health and Health Services Research
Background: Cryptosporidium infection causes gastrointestinal disease and has a worldwide distribution. The highest burden is in developing countries.
Objectives: We sought to conduct a systematic review and meta-analysis to identify Cryptosporidium risk factors in Low and Middle Income countries (LMICs).
Methods: Medline Ovid and Scopus databases were searched with no restriction on year or language of publication. All references were screened independently in duplicate and were included if they presented data on at least 3 risk factors. Meta-analyses using random effects models were used to calculate overall estimates for each exposure.
Results: The most frequently reported risk factors in the 15 included studies were overcrowding, household diarrhoea, poor quality drinking water, animal contact, open defecation/ lack of toilet and breastfeeding. The combined odds ratio for animal contact was 1.98 (95%CI: 1.11–3.54) based on 11 studies and for diarrhoea in the household 1.98 (95%CI: 1.13–3.49) based on 4 studies. Open defecation was associated with a pooled odds ratio of 1.82 (95%CI: 1.19–2.8) based on 5 studies. Poor drinking water quality was not associated with a significant Cryptosporidium risk, odds ratio 1.06 (95%CI: 0.77–1.47). Breastfeeding was protective with pooled odds ratio 0.4 (95%CI: 0.13–1.22), which was not statistically significant.
Conclusions: Based on the included studies, crowded living conditions, animal contact and open defecation are responsible for the majority of Cryptosporidium cases in LMICs. Future studies investigating Cryptosporidium risk factors should have a good study design and duration, include appropriate number of cases, select suitable controls, investigate multiple relevant risk factors, fully report data and perform multivariate analysis.
PLoS Neglected Tropical Diseases
https://doi.org/10.1371/journal.pntd.0006553
10.1371/journal.pntd.0006553Licence: CC BY
Published_VersionFinal published version, 2.13 MBLicence: CC BY
http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0006553Licence: CC BY
AQUAVALENS - Protecting the health of Europeans by improving methods for the detection of pathogens in drinking water and water used in food preparation
Hunter, P., Bosch, A., Pedley, S., Tyler, K. & Risebro, H.
CEC (Framework 7)
Bouzid, M., Kintz, E., & Hunter, P. R. (2018). Risk factors for Cryptosporidium infection in low and middle income countries: A systematic review and meta-analysis. PLoS Neglected Tropical Diseases, 12(6), [e0006553]. https://doi.org/10.1371/journal.pntd.0006553
Bouzid, Maha ; Kintz, Erica ; Hunter, Paul R. / Risk factors for Cryptosporidium infection in low and middle income countries: A systematic review and meta-analysis. In: PLoS Neglected Tropical Diseases. 2018 ; Vol. 12, No. 6.
@article{52135a3bf39a45b7a231637581ad9a1c,
title = "Risk factors for Cryptosporidium infection in low and middle income countries: A systematic review and meta-analysis",
abstract = "Background: Cryptosporidium infection causes gastrointestinal disease and has a worldwide distribution. The highest burden is in developing countries. Objectives: We sought to conduct a systematic review and meta-analysis to identify Cryptosporidium risk factors in Low and Middle Income countries (LMICs). Methods: Medline Ovid and Scopus databases were searched with no restriction on year or language of publication. All references were screened independently in duplicate and were included if they presented data on at least 3 risk factors. Meta-analyses using random effects models were used to calculate overall estimates for each exposure. Results: The most frequently reported risk factors in the 15 included studies were overcrowding, household diarrhoea, poor quality drinking water, animal contact, open defecation/ lack of toilet and breastfeeding. The combined odds ratio for animal contact was 1.98 (95%CI: 1.11–3.54) based on 11 studies and for diarrhoea in the household 1.98 (95%CI: 1.13–3.49) based on 4 studies. Open defecation was associated with a pooled odds ratio of 1.82 (95%CI: 1.19–2.8) based on 5 studies. Poor drinking water quality was not associated with a significant Cryptosporidium risk, odds ratio 1.06 (95%CI: 0.77–1.47). Breastfeeding was protective with pooled odds ratio 0.4 (95%CI: 0.13–1.22), which was not statistically significant. Conclusions: Based on the included studies, crowded living conditions, animal contact and open defecation are responsible for the majority of Cryptosporidium cases in LMICs. Future studies investigating Cryptosporidium risk factors should have a good study design and duration, include appropriate number of cases, select suitable controls, investigate multiple relevant risk factors, fully report data and perform multivariate analysis.",
author = "Maha Bouzid and Erica Kintz and Hunter, {Paul R}",
doi = "10.1371/journal.pntd.0006553",
journal = "PLoS Neglected Tropical Diseases",
Bouzid, M, Kintz, E & Hunter, PR 2018, 'Risk factors for Cryptosporidium infection in low and middle income countries: A systematic review and meta-analysis', PLoS Neglected Tropical Diseases, vol. 12, no. 6, e0006553. https://doi.org/10.1371/journal.pntd.0006553
Risk factors for Cryptosporidium infection in low and middle income countries: A systematic review and meta-analysis. / Bouzid, Maha; Kintz, Erica; Hunter, Paul R.
In: PLoS Neglected Tropical Diseases, Vol. 12, No. 6, e0006553, 07.06.2018.
T1 - Risk factors for Cryptosporidium infection in low and middle income countries: A systematic review and meta-analysis
AU - Bouzid, Maha
AU - Kintz, Erica
AU - Hunter, Paul R
N2 - Background: Cryptosporidium infection causes gastrointestinal disease and has a worldwide distribution. The highest burden is in developing countries. Objectives: We sought to conduct a systematic review and meta-analysis to identify Cryptosporidium risk factors in Low and Middle Income countries (LMICs). Methods: Medline Ovid and Scopus databases were searched with no restriction on year or language of publication. All references were screened independently in duplicate and were included if they presented data on at least 3 risk factors. Meta-analyses using random effects models were used to calculate overall estimates for each exposure. Results: The most frequently reported risk factors in the 15 included studies were overcrowding, household diarrhoea, poor quality drinking water, animal contact, open defecation/ lack of toilet and breastfeeding. The combined odds ratio for animal contact was 1.98 (95%CI: 1.11–3.54) based on 11 studies and for diarrhoea in the household 1.98 (95%CI: 1.13–3.49) based on 4 studies. Open defecation was associated with a pooled odds ratio of 1.82 (95%CI: 1.19–2.8) based on 5 studies. Poor drinking water quality was not associated with a significant Cryptosporidium risk, odds ratio 1.06 (95%CI: 0.77–1.47). Breastfeeding was protective with pooled odds ratio 0.4 (95%CI: 0.13–1.22), which was not statistically significant. Conclusions: Based on the included studies, crowded living conditions, animal contact and open defecation are responsible for the majority of Cryptosporidium cases in LMICs. Future studies investigating Cryptosporidium risk factors should have a good study design and duration, include appropriate number of cases, select suitable controls, investigate multiple relevant risk factors, fully report data and perform multivariate analysis.
AB - Background: Cryptosporidium infection causes gastrointestinal disease and has a worldwide distribution. The highest burden is in developing countries. Objectives: We sought to conduct a systematic review and meta-analysis to identify Cryptosporidium risk factors in Low and Middle Income countries (LMICs). Methods: Medline Ovid and Scopus databases were searched with no restriction on year or language of publication. All references were screened independently in duplicate and were included if they presented data on at least 3 risk factors. Meta-analyses using random effects models were used to calculate overall estimates for each exposure. Results: The most frequently reported risk factors in the 15 included studies were overcrowding, household diarrhoea, poor quality drinking water, animal contact, open defecation/ lack of toilet and breastfeeding. The combined odds ratio for animal contact was 1.98 (95%CI: 1.11–3.54) based on 11 studies and for diarrhoea in the household 1.98 (95%CI: 1.13–3.49) based on 4 studies. Open defecation was associated with a pooled odds ratio of 1.82 (95%CI: 1.19–2.8) based on 5 studies. Poor drinking water quality was not associated with a significant Cryptosporidium risk, odds ratio 1.06 (95%CI: 0.77–1.47). Breastfeeding was protective with pooled odds ratio 0.4 (95%CI: 0.13–1.22), which was not statistically significant. Conclusions: Based on the included studies, crowded living conditions, animal contact and open defecation are responsible for the majority of Cryptosporidium cases in LMICs. Future studies investigating Cryptosporidium risk factors should have a good study design and duration, include appropriate number of cases, select suitable controls, investigate multiple relevant risk factors, fully report data and perform multivariate analysis.
U2 - 10.1371/journal.pntd.0006553
DO - 10.1371/journal.pntd.0006553
JO - PLoS Neglected Tropical Diseases
JF - PLoS Neglected Tropical Diseases
Bouzid M, Kintz E, Hunter PR. Risk factors for Cryptosporidium infection in low and middle income countries: A systematic review and meta-analysis. PLoS Neglected Tropical Diseases. 2018 Jun 7;12(6). e0006553. https://doi.org/10.1371/journal.pntd.0006553