Risk factors for pediatric hydatid cyst disease: a case-control study of environmental, socioeconomic, and perinatal exposures

Cystic echinococcosis (CE) is a preventable zoonotic disease endemic in low- and middle-income countries, including Jordan, driven by livestock farming and environmental contamination. Children are vulnerable due to early exposure and prolonged incubation. Although environmental and socioeconomic determinants have been implicated, few pediatric studies integrate environmental, socioeconomic, and perinatal factors within one framework. This study evaluated integrated risk factors for pediatric hydatid cyst disease using a case-control design. A retrospective hospital-based case-control study was conducted at two tertiary referral centers in Jordan (2019-24). Thirty surgically and histopathologically confirmed pediatric CE cases were frequency-matched to 30 controls by sex and predefined age categories; controls were admitted for noninfectious conditions. Demographic, socioeconomic, environmental, and perinatal variables were extracted from standardized electronic medical records. Multivariable logistic regression was performed to determine independent predictors. In univariable analyses, exploratory associations were observed for paternal occupation (P = .004), paternal education (P = .041), maternal education (P = .017), higher birth order (median 3.5 vs 2.0; P = .038), larger household size (median 5.5 vs 4.0; P = .002), rural residence (60.0% vs 16.6%; P < .001), and infant feeding type (P = .022). After adjustment for household size and maternal education, rural residence remained the only independent predictor (adjusted OR = 6.04; 95% CI: 1.54-23.63; P = .010). Pediatric CE was independently associated with rural residence-serving as a broad contextual marker of community-level vulnerability rather than direct causality-whereas perinatal and domestic hygiene factors were not. These findings highlight high-risk settings to guide targeted, community-level prevention.