Morbidity, mortality, and long-term consequences associated with diarrhoea from Cryptosporidium infection in children younger than 5 years: a meta-analyses study

Ibrahim A Khalil, MD; Christopher Troeger, MPH; Puja C Rao, MPH; Brigette F Blacker, MPH; Alexandria Brown, MA; Thomas G Brewer, MD; Danny V Colombara, PhD; Eugenio L De Hostos, PhD; Cyril Engmann, ProfMD; Richard L Guerrant, MD; Rashidul Haque, MD; Eric R Houpt, MD; Gagandeep Kang, ProfMD; Poonum S Korpe, MD; Karen L Kotloff, ProfMD; Aldo A M Lima, MD; William A Petri, Jr, MD; James A Platts-Mills, MD; David A Shoultz, PhD; Mohammed H Forouzanfar, MD; Simon I Hay, ProfFMedSci; Robert C Reiner, Jr, PhD; Ali H Mokdad, ProfPhD

The Lancet Global Health (Jul 2018)

Morbidity, mortality, and long-term consequences associated with diarrhoea from Cryptosporidium infection in children younger than 5 years: a meta-analyses study

Ibrahim A Khalil, MD,
Christopher Troeger, MPH,
Puja C Rao, MPH,
Brigette F Blacker, MPH,
Alexandria Brown, MA,
Thomas G Brewer, MD,
Danny V Colombara, PhD,
Eugenio L De Hostos, PhD,
Cyril Engmann, ProfMD,
Richard L Guerrant, MD,
Rashidul Haque, MD,
Eric R Houpt, MD,
Gagandeep Kang, ProfMD,
Poonum S Korpe, MD,
Karen L Kotloff, ProfMD,
Aldo A M Lima, MD,
William A Petri, Jr, MD,
James A Platts-Mills, MD,
David A Shoultz, PhD,
Mohammed H Forouzanfar, MD,
Simon I Hay, ProfFMedSci,
Robert C Reiner, Jr, PhD,
Ali H Mokdad, ProfPhD

Affiliations

Ibrahim A Khalil, MD: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
Christopher Troeger, MPH: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
Puja C Rao, MPH: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
Brigette F Blacker, MPH: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
Alexandria Brown, MA: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
Thomas G Brewer, MD: Department of Global Health, University of Washington, Seattle, WA, USA
Danny V Colombara, PhD: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
Eugenio L De Hostos, PhD: PATH, San Fransisco, CA, USA
Cyril Engmann, ProfMD: PATH, Seattle, WA, USA; School of Public Health, University of Washington, Seattle, WA, USA
Richard L Guerrant, MD: Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
Rashidul Haque, MD: icddr,b, Dhaka, Bangladesh
Eric R Houpt, MD: Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
Gagandeep Kang, ProfMD: Translational Health Science and Technology Institute, Faridabad, India
Poonum S Korpe, MD: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Karen L Kotloff, ProfMD: Departments of Pediatrics and Medicine, Center for Vaccine Development, Institute for Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
Aldo A M Lima, MD: Center for Global Health, Federal University of Ceara, Fortaleza, Ceara, Brazil
William A Petri, Jr, MD: Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
James A Platts-Mills, MD: Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
David A Shoultz, PhD: PATH, Seattle, WA, USA
Mohammed H Forouzanfar, MD: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
Simon I Hay, ProfFMedSci: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
Robert C Reiner, Jr, PhD: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
Ali H Mokdad, ProfPhD: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Correspondence to: Prof Ali H Mokdad, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA

Journal volume & issue: Vol. 6, no. 7
pp. e758 – e768

Abstract

Read online

Summary: Background: The protozoan Cryptosporidium is a leading cause of diarrhoea morbidity and mortality in children younger than 5 years. However, the true global burden of Cryptosporidium infection in children younger than 5 years might have been underestimated in previous quantifications because it only took account of the acute effects of diarrhoea. We aimed to demonstrate whether there is a causal relation between Cryptosporidium and childhood growth and, if so, to quantify the associated additional burden. Methods: The Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2016 was a systematic and scientific effort to quantify the morbidity and mortality associated with more than 300 causes of death and disability, including diarrhoea caused by Cryptosporidium infection. We supplemented estimates on the burden of Cryptosporidium in GBD 2016 with findings from a systematic review of published and unpublished cohort studies and a meta-analysis of the effect of childhood diarrhoea caused by Cryptosporidium infection on physical growth. Findings: In 2016, Cryptosporidium infection was the fifth leading diarrhoeal aetiology in children younger than 5 years, and acute infection caused more than 48 000 deaths (95% uncertainty interval [UI] 24 600–81 900) and more than 4·2 million disability-adjusted life-years lost (95% UI 2·2 million–7·2 million). We identified seven data sources from the scientific literature and six individual-level data sources describing the relation between Cryptosporidium and childhood growth. Each episode of diarrhoea caused by Cryptosporidium infection was associated with a decrease in height-for-age Z score (0·049, 95% CI 0·014–0·080), weight-for-age Z score (0·095, 0·055–0·134), and weight-for-height Z score (0·126, 0·057–0·194). We estimated that diarrhoea from Cryptosporidium infection caused an additional 7·85 million disability-adjusted life-years (95% UI 5·42 million–10·11 million) after we accounted for its effect on growth faltering—153% more than that estimated from acute effects alone. Interpretation: Our findings show that the substantial short-term burden of diarrhoea from Cryptosporidium infection on childhood growth and wellbeing is an underestimate of the true burden. Interventions designed to prevent and effectively treat infection in children younger than 5 years will have enormous public health and social development impacts. Funding: The Bill & Melinda Gates Foundation.

Published in The Lancet Global Health

ISSN: 2214-109X (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Medicine: Public aspects of medicine
Website: http://www.lancet.com/journals/langlo/issue/current

About the journal