ABSTRACT
OBJECTIVES: To determine the prevalence of cryptosporidiosis and the associated factors, and characterise the Cryptosporidium isolates from children aged five years and less with diarrhoea. DESIGN: A prospective cross-sectional study. SETTING: This was a health facility and laboratory based study. Screening for Cryptosporidium oocysts was done at the Microbiology laboratory, School of Medicine, Moi University, Eldoret and genotyping and sub-genotyping at the Kenya Medical Research Institute, Nairobi, Kenya. SUBJECTS: Children aged five years and less seen at the outpatient clinic and those admitted in the pediatric wards at MTRH were recruited into the study upon obtaining assent and written consent from the parents or guardians. RESULTS: The prevalence of cryptosporidiosis was 9.8% (N = 317). A duration of diarrhoea of more than two weeks was associated with cryptosporidiosis (OR = 1.8301) compared to those with diarrhoea for less than one week. There were no sex related differences in the cryptosporidiosis prevalence (P = 0.9752). Waste disposal, water sources and treatment, and livestock in homesteads were not associated with cryptosporidiosis. About 82% of the isolates were C. hominis and 18% were C. parvum. There were 6 subtypes of C. hominis and 4 subtypes of C. parvum in circulation. CONCLUSION: The prevalence of cryptosporidiosis is comparable to other regions of the worldwith C. hominis being the most common followed by C. parvum. Human-to-human transmission is the mainmode of spread of cryptosporidiosis. All the Cryptosporidium isolates were from children residing in peri-urban and rural areas.
Subject(s)
Cryptosporidiosis/genetics , Cryptosporidium/genetics , Hospitals, Pediatric , Hospitals, University , Child, Preschool , Cross-Sectional Studies , Cryptosporidiosis/epidemiology , Cryptosporidiosis/parasitology , Cryptosporidium/classification , Cryptosporidium/isolation & purification , Cryptosporidium parvum/genetics , Diarrhea/parasitology , Feces/parasitology , Female , Genotype , Hospitals, Pediatric/statistics & numerical data , Hospitals, University/statistics & numerical data , Humans , Infant , Infant, Newborn , Kenya/epidemiology , Male , Prospective Studies , Rural Population/statistics & numerical data , Secondary Care Centers/statistics & numerical data , Suburban Population/statistics & numerical data , Urban Population/statistics & numerical data , Vomiting/parasitologyABSTRACT
OBJECTIVE: To review the prevalence and distribution of resistance to chloroquine and pyrimethamine-sulphadoxine combination and the use of molecular markers for monitoring the spread of the resistance. DATA SOURCES: Literature search on compact disk-read only memory (CD-ROM), Medline and Internet, using the key words: Malaria and epidemiology, malaria and resistance, sulphadoxine-pyrimethamine resistance and chloroquine resistance. Some articles were manually reviewed. STUDY SELECTION: Relevant studies or articles on resistance to chloroquine, sulphadoxine pyrimethamine combination and other antimalarials and molecular resistance markers from various sources are included in the review. DATA EXTRACTION: From individual study or articles. DATA SYNTHESIS: Information on antimalarial resistance is harmonised under the headings; Introduction, Prevalence and distribution of resistance to antimalarials, Use of molecular markers for epidemiological monitoring of antimalarial resistance. CONCLUSION: The spread and status of resistance to sulphadoxine-pyrimethamine (SP) and chloroquine should be monitored constantly in major health facilities. This will not only detect the emergence of resistance to these drugs but also generate information on the extent of resistance to these antimalarials. Mutations in the dhfr and dhps genes can be used as markers in SP resistance surveilance while the presence of pfcrt mutations thought to confer resistance should also be analysed to ascertain whether they truly correlate to the resistance patterns that have been observed in various malarious regions. Little is known on the interaction and exact role(s) of PfCRT protein in conferring the resistance trait.
