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

BackgroundIntestinal 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.MethodologyWe 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.ResultsTwenty-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 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 ConclusionsParasitic 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.背景 隐孢子虫属（Cryptosporidium spp.）、蓝氏贾第鞭毛虫（Giardia lamblia）以及溶组织内阿米巴（Entamoeba histolytica）等肠道寄生虫可引发重症腹泻，在发展中国家的儿童群体中尤为高发。本研究旨在明确腹泻儿童感染隐孢子虫属、蓝氏贾第鞭毛虫与溶组织内阿米巴的检出率，并明确该类感染的危险因素。方法 本研究于2014年6月至2018年1月期间，在莫桑比克三个地区针对因腹泻住院的0~168月龄儿童开展横断面研究。获取知情同意后，研究人员对儿童照护者进行访谈，并采集每名儿童的单份粪便标本，采用商用免疫酶联检测试剂盒（美国弗吉尼亚州布莱克斯堡TechLab公司）检测隐孢子虫属、蓝氏贾第鞭毛虫与溶组织内阿米巴感染。从临床报告中提取人体测量学数据，并构建多变量logistic回归模型，以明确隐孢子虫属与蓝氏贾第鞭毛虫感染的危险因素。结果 所有粪便标本中，21.0%（212/1008）检出至少一种寄生虫感染。其中隐孢子虫属感染最为常见，检出率为12.0%（118/985），其次为蓝氏贾第鞭毛虫感染（9.7%，95/983）与溶组织内阿米巴感染（2.0%，20/1004）。隐孢子虫属感染的危险因素包括：来源地（来自楠普拉省的儿童感染风险最高，比值比（odds ratio, OR）=8.176，置信区间（confidence interval, CI）=1.916~34.894，P<0.05）。蓝氏贾第鞭毛虫感染的危险因素包括：年龄（感染风险最高的群体为60~168月龄儿童，OR=2.322，CI=1.000~5.393，P>0.05）以及家庭常住人口≥5人（OR=2.141，CI=1.286~3.565，P<0.05）。结论 腹泻儿童群体中寄生虫感染较为普遍。莫桑比克的医疗卫生机构应常规开展腹泻儿童的寄生虫检测、标准化治疗以及感染风险暴露评估工作。