Abstract
Although the impact of diarrhoeal disease on paediatric health in Nigeria has decreased in recent years, it remains an important cause of morbidity and mortality in children under 5 years. Rotavirus is recognised as an important aetiological agent, but information on the contribution of intestinal protozoa to watery diarrhoea in this age group in Nigeria is scarce. In this cross-sectional study, faecal samples from children admitted to healthcare centres in Abakaliki, Nigeria with acute watery diarrhoea (N = 199) and faecal samples from age-matched controls (N = 37) were examined for Cryptosporidium and Giardia using immunofluorescent antibody testing and molecular methods. Cryptosporidium was identified in 13 case samples (6.5%) and no control samples. For three samples, molecular characterisation indicated C. hominis, GP60 subtypes IaA30R3, IaA14R3 and IdA11. Giardia was not detected in any samples. This contrast in prevalence between the two intestinal protozoa may reflect their variable epidemiologies and probably differing routes of infection. Given that these two parasitic infections are often bracketed together, it is key to realise that they not only have differing clinical spectra but also that the importance of each parasite is not the same in different age groups and/or settings.
Highlights
In Nigeria, deaths from diarrhoea among children below the age of 5 years decreased by just over 20% between 2005 and 2015, but remained substantial at 327.6 per 100 000 children; in contrast, the global mortality from diarrhoea in children in this age group is estimated at 74.3 per 100 000 [1]
In the global enteric multicentre study (GEMS) in which the under-5 years age group was stratified into three age groups, it was noticed that at most study sites included, Cryptosporidium tended to be unimportant as a diarrhoeal pathogen in the oldest age stratum, with the greatest burden found in the youngest age groups [2]
The results reported here support those of earlier studies that suggest that in countries such as Nigeria, Giardia infection is not associated with paediatric diarrhoea
Summary
In Nigeria, deaths from diarrhoea among children below the age of 5 years decreased by just over 20% between 2005 and 2015, but remained substantial at 327.6 per 100 000 children; in contrast, the global mortality from diarrhoea in children in this age group is estimated at 74.3 per 100 000 [1]. An extended analysis has shown that: (1) diarrhoeal diseases in general in children under 5-years has a greater impact regarding long-term health burden than previously estimated [3], and (2) the considerable short-term impact of acute cryptosporidiosis on morbidity in this age group underestimates the true burden by 153% [4]. Another intestinal protozoan parasite that is often considered together with Cryptosporidium, is Giardia duodenalis. A previous meta-analysis of published data had concluded that Giardia is associated with persistent diarrhoea in children in developing countries, it does not generally cause acute paediatric diarrhoea among infants and children in those
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