Abstract
Cryptosporidium species are intestinal protozoan parasites that infect and cause diarrhoea in animals and humans. The current study was conducted to determine the prevalence and risk factors of Cryptosporidium infection among HIV-infected patients in the Central region of Ghana. In this cross-sectional study, four hundred eighteen documented HIV-infected participants from four health facilities that provide antiretroviral therapy (ART) services across the Central region of Ghana were selected by systematic random sampling. An enzyme-linked immunosorbent assay (CoproELISATM, Cryptosporidium Savyon® Diagnostics Ltd., Ashdod, Israel) was used to detect Cryptosporidium antigens in stool samples obtained from participants. Information regarding participants’ sociodemographic characteristics and clinical symptoms as well as potential environmental and behavioral risk factors were collected using a structured questionnaire. Chi-square or Fisher’s exact tests were used to determine associations between Cryptosporidium infections and explanatory variables, while risk factors were assessed using multivariate logistic regression analysis. The overall prevalence of Cryptosporidium infection among HIV-infected participants in this study was 6.2% (95% CI: 3.90–8.54). Cryptosporidium was not significantly associated with any of the sociodemographic variables, patient clinical symptoms, and environmental factors. However, the prevalence of the parasite was significantly higher 25% (95% CI: 1.17–48.83; p = 0.013) among participants who did not always wash their hands before meals and those who did not always wash vegetables before eating them, 23.5% (95% CI: 1.05–46.01; p = 0.016). Multivariate logistic regression analysis showed that participants who used public water closet facilities were approximately 9 times more likely to become infected with the parasite than those who practised open defecation (OR: 8.83; 95% CI: 1.22–64.13; p = 0.031). In conclusion, Cryptosporidium is prevalent among HIV-infected patients in the Central region of Ghana. An important risk factor identified was the use of the public water closet toilet facility. More attention should be given to ensuring cleanliness at shared water closet facilities in addition to adequate disinfection of hands after using such facilities.
Highlights
Cryptosporidium species are apicomplexan parasites that infect man and other vertebrates [1,2]
enzyme-linked immunosorbent assay (ELISA) has proven in many cases to be more sensitive in the detection of Cryptosporidium species than microscopy, its use is limited to a few studies in Ghana [24,25,26]
The prevalence of the parasite in the current study was lower than that in an earlier study in a tertiary hospital in Ghana which involved HIV-infected patients with chronic diarrhoea and reported a 46% prevalence rate [20]. This may be because only approximately a quarter of participants in the current study reported having diarrhoea
Summary
Cryptosporidium species are apicomplexan parasites that infect man and other vertebrates [1,2]. More than 38 species of the parasite have been described worldwide with Cryptosporidium hominis and Cryptosporidium parvum implicated in most human infections [3,4]. The Global Enteric Multicenter Study (GEMS) revealed the parasite as a significant contributor to the diarrhoea burden in children less than two years old in sub-Saharan Africa [9]. This is because of the ubiquitous and robust nature of the oocysts of the parasite, which is transmitted either directly from person to person or indirectly through vehicles such as contaminated food or water, or from animals to humans [10,11]
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