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

Abstract

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 C ryptosporidium infection in children younger than 5 years might have been underestimated in previous quantifications because it only took account of the acute eects of diarrhoea. W e aimed to demonstrate whether there is a causal relation between C ryptosporidium and childhood growth and, if so, to quantify the associated additional burden. Methods The Global Burden of Diseases, Injuries, and Risk F actors study (GBD) 2016 was a systematic and scientific eort to quantify the morbidity and mortality associated with more than 300 causes of death and disability , including diarrhoea caused by C ryptosporidium infection. W e supplemented estimates on the burden of C ryptosporidium in GBD 2016 with findings from a systematic review of published and unpublished cohort studies and a meta-analysis of the eect of childhood diarrhoea caused by C ryptosporidium infection on physical growth Findings In 2016,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). W e identified seven data sources from the scientific literature and six individual-level data sources describing the relation between C ryptosporidium and childhood growth. Each episode of diarrhoea caused by C ryptosporidium 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). W e estimated that diarrhoea from C ryptosporidium infection caused an additional 7·85 million disability-adjusted life-years (95% UI 5·42 million–10·11 million) after we accounted for its eect on growth faltering—153% more than that estimated from acute eects 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 eectively treat infection in children younger than 5 years will have enormous public health and social development impacts.