Cryptosporidiosis among children in an endemic semiurban community in southern India: does a protected drinking water
Rajiv Sarkar1, Sitara S R Ajjampur, Ashok D Prabakaran
1Department of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India.
Insights
Providing bottled water did not prevent cryptosporidiosis in Indian children. This suggests cryptosporidiosis spreads through multiple pathways beyond contaminated drinking water.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Cryptosporidial infections pose a significant health risk to children in endemic communities.
- Understanding transmission routes is crucial for effective prevention strategies.
Purpose of the Study:
- To investigate if a protected water supply (bottled water) could prevent or delay cryptosporidiosis in children in an endemic Indian community.
- To assess the association between bottled water consumption and the incidence of cryptosporidiosis.
Main Methods:
- A quasi-experimental study involving 176 children in a semiurban slum in southern India.
- Children received either bottled or municipal drinking water.
- Weekly surveillance and monthly stool sample collection for Cryptosporidium testing via PCR until age two.
- Poisson survival and propensity score models were used for analysis.
Main Results:
- A high incidence of cryptosporidiosis (0.59 episodes/child-year) was observed in 67% of children, often asymptomatic.
- Stunting at 6 months was linked to increased cryptosporidiosis risk (RR=1.40).
- Bottled water consumption showed no significant reduction in cryptosporidiosis risk (adjusted RR=0.86).
Conclusions:
- A high burden of cryptosporidiosis exists among children in this Indian slum.
- The lack of association between bottled water and reduced risk suggests transmission occurs through multiple pathways, potentially including asymptomatic individuals.
- Further research into diverse transmission routes is warranted.
Background:
A quasi-experimental study was conducted to determine whether or not a protected water supply (bottled drinking water) could prevent or delay cryptosporidial infections among children residing in an endemic community.
Methods:
A total of 176 children residing in a semiurban slum area in southern India were enrolled preweaning and received either bottled (n = 90) or municipal (n = 86) drinking water based on residence in specific streets. Weekly surveillance visits were conducted until children reached their second birthday. Stool samples were collected every month and during diarrheal episodes, and were tested for the presence of Cryptosporidium species by polymerase chain reaction. Differences in the incidence of cryptosporidiosis between bottled and municipal water groups were compared using Poisson survival models, and a propensity score model was developed to adjust for the effect of potential confounders.
Results:
A total of 186 episodes of cryptosporidiosis, mostly asymptomatic, were observed in 118 (67%) children during the follow-up period at a rate of 0.59 episodes per child-year. Diarrhea associated with Cryptosporidium species tended to be longer in duration and more severe. Stunting at 6 months was associated with a higher risk of cryptosporidiosis (rate ratio [RR] = 1.40; 95% confidence interval [CI], 1.03-1.91). A higher gastrointestinal disease burden was also seen in children with cryptosporidiosis. Drinking bottled water was not associated with a reduced risk of cryptosporidiosis (adjusted RR = 0.86; 95% CI, .60-1.23).
Conclusions:
This study documented a high burden of cryptosporidiosis among children in an endemic Indian slum community. The lack of association between drinking bottled water and cryptosporidiosis suggests possible spread from asymptomatically infected individuals involving multiple transmission pathways.
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