Risk factors for Cryptosporidium infection in low and middle income countries: A systematic review and meta-analysis.

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cryptosporidiosis 24 infectiousdiseases
infectious disease 1 infectiousdiseases

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cryptosporidiosis 2977 old. In this review, we looked at published studies on factors that increase the risk of contracting cryptosporidiosis in Low and Middle Income Countries. These factors could be targeted to limit the transmission of the
cryptosporidiosis 3879 due to contaminated water supplies or food sources [[1]]. In Low and Middle Income Countries (LMICs), cryptosporidiosis is much more prevalent and is associated with a significant burden of gastrointestinal disease. Cryptosporidiosis
cryptosporidiosis 5177 aged 12–23 months [[8]]. In immunocompromised people such as HIV-positive and transplant patients, cryptosporidiosis is more severe and could result in high mortality rates [[1]]. The disease burden in both developed
cryptosporidiosis 5644 detection, which is associated with low specificity and sensitivity.Due to the significant burden of cryptosporidiosis , several studies attempted to elucidate Cryptosporidium transmission pathways and risk factors [[1],
cryptosporidiosis 6441 these reviews focused on developed countries and one on the USA. To our knowledge, no such review of cryptosporidiosis risk factors in LMICs exists. Therefore, we attempted to address this gap and conducted a systematic
cryptosporidiosis 7114 was limited to title/ abstract/ keyword using the following MeSH terms/ keywords: (Cryptosporidium OR cryptosporidiosis ) AND (risk factor OR case control OR cohort OR infection OR sporadic OR prevalence). Reference lists
cryptosporidiosis 8266 age, gender, rural/urban living, stunting, malnutrition (arguably potential cause and consequence of cryptosporidiosis ), household income and type of dwelling, as these could not be directly targeted by preventive public
cryptosporidiosis 11835 because of the following reasons: not a developing country, no Cryptosporidium specific risk factors, cryptosporidiosis outbreak/ case report, review, cryptosporidiosis in animals, treatment studies, seroprevalence surveys,
cryptosporidiosis 11884 country, no Cryptosporidium specific risk factors, cryptosporidiosis outbreak/ case report, review, cryptosporidiosis in animals, treatment studies, seroprevalence surveys, detection in water/rivers, and cryptosporidiosis
cryptosporidiosis 11988 cryptosporidiosis in animals, treatment studies, seroprevalence surveys, detection in water/rivers, and cryptosporidiosis in immunocompromised patients.10.1371/journal.pntd.0006553.g001Fig 1PRISMA flow diagram for peer-reviewed
cryptosporidiosis 16012 While the majority of studies found that contact with animals is associated with increased risk of cryptosporidiosis [[16]–[22]], a few reported a protective effect. The combined odds ratio was 1.98 (95%CI: 1.11–3.54)
cryptosporidiosis 16344 2Meta-analysis for animal contact.Poor drinking water qualityThe impact of non-piped drinking water on cryptosporidiosis was investigated in all 15 studies. Meta-analysis was possible for 10 studies. The combined odds ratio
cryptosporidiosis 17218 relatively moderate combined risk associated with open defecation, all studies consistently showed increased cryptosporidiosis risk.10.1371/journal.pntd.0006553.g004Fig 4Meta-analysis for open defecation/ lack of toilet facility.Overcrowded
cryptosporidiosis 17784 [[23]].10.1371/journal.pntd.0006553.g005Fig 5Meta-analysis for overcrowded living conditions.Diarrhoea in householdHousehold diarrhoea was a cryptosporidiosis risk factor in 4 studies, all of which were included in the meta-analysis. The combined odds ratio was
cryptosporidiosis 18571 Heterogeneity was substantial (I2 = 83%). Only one study reported that breastfeeding was conducive to acquiring cryptosporidiosis in infants [[21]].10.1371/journal.pntd.0006553.g007Fig 7Meta-analysis for breastfeeding.For each exposure,
cryptosporidiosis 20773 where animal contact/ farm visits/ petting zoo visits were significantly associated with acquiring cryptosporidiosis [[7], [11]]. Diarrhoea in the household was associated with a similar Cryptosporidium infection risk,
cryptosporidiosis 22302 lack of appropriate sanitation/ open defecation was associated with a significant risk of acquiring cryptosporidiosis , pooled odds ratio 1.82 (95%CI: 1.19–2.8) based on 5 studies. This result is comparable to the systematic
cryptosporidiosis 24764 a quasi-experimental study in India, drinking bottled water was not associated with reduced risk of cryptosporidiosis in children [[31]].Breastfeeding (or lack of) was investigated in numerous studies that focused on childhood
cryptosporidiosis 24891 children [[31]].Breastfeeding (or lack of) was investigated in numerous studies that focused on childhood cryptosporidiosis . Breastfeeding was associated with a protective effect, however, this was not statistically significant.
cryptosporidiosis 25257 specific antibodies in breast milk [[32]]. Additionally, bottle feeding was found to increase the risk of cryptosporidiosis [[33]], most likely due to one or a combination of the following factors: poor water quality, lack of
cryptosporidiosis 25534 Indeed, one study found that washing hands before infant feeding was associated with a significant cryptosporidiosis risk, multivariate adjusted odds ratio 5.02 (95%CI: 1.11–22.78) [[34]], which demonstrates the poor
cryptosporidiosis 26614 transmission pathways. The main limitations of some of the included studies are the small number of cryptosporidiosis cases and poor quality in terms of study design and duration, number of exposures investigated and data
cryptosporidiosis 28292 of data and poor quality of several studies. Considering the significant morbidity and mortality of cryptosporidiosis in sub-Saharan Africa and South Asia, especially for under 5 years (and HIV+), strategies to reduce
cryptosporidiosis 28439 South Asia, especially for under 5 years (and HIV+), strategies to reduce the prevalence and burden of cryptosporidiosis and other gastrointestinal opportunistic diseases should be prioritised and offered adequate funding.Supporting
infectious disease 21046 was also statistically significant. Case contact is understandably a risk factor for transmitting any infectious disease and this is relevant in both developed and developing nations. However, as the majority of Cryptosporidium

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