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Author Notes:

Correspondence: Miranda J. Delahoy; mjdelah@emory.edu

Author Contributions: Conceptualization: Miranda J. Delahoy, Richard Omore, Tracy L. Ayers, Tamer H. Farag, Dilruba Nasrin, Karen L. Kotloff, Myron M. Levine, Eric D. Mintz, Robert F. Breiman, Ciara E. O’Reilly.

Data curation: Miranda J. Delahoy, Richard Omore, Tracy L. Ayers, Katharine A. Schilling, J. Benjamin Ochieng, Feny Moke, Peter Jaron, Alex Awuor, Caleb Okonji, Jane Juma, Tamer H. Farag, Dilruba Nasrin, Joseph Oundo, Robert F. Breiman, Ciara E. O’Reilly.

Formal analysis: Miranda J. Delahoy, Richard Omore, Tracy L. Ayers, Katharine A. Schilling, Anna J. Blackstock.

Funding acquisition: Myron M. Levine.

See publication for full list of author contributions.

Acknowledgments: This study includes data generated by the Kenya Medical Research Institute/Centers for Disease Control and Prevention (KEMRI/CDC) Health and Demographic Surveillance System (HDSS) which is a member of the International Network for the Demographic Evaluation of Populations and their Health (INDEPTH).

We acknowledge the contributions of and thank all of the GEMS-Kenya staff for supporting the clinical and epidemiologic data collection andmanagement, and laboratory specimen processing and testing; KEMRI/CDC, Kisumu, Kenya; KEMRI/CDC HDSS team; Division of Global HIV & TB, KEMRI/CDC, Kisumu, Kenya; Anna Bowen and Benjamin Nygren, Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA for technical support; GEMS Data Coordinating Center, Perry Point Veterans Administration Medical Center, Perry Point, MD; and Clair Null, Department of Global Health, Emory University, Atlanta, GA, USA for analytic advice.

We are grateful to the caretakers and children in the Asembo, Gem and Karemo communities who participated in this work.

Disclosures:The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the U.S. Centers for Disease Control and Prevention

The authors have declared that no competing interests exist.


Research Funding:

The Bill & Melinda Gates Foundation (www.gatesfoundation.org) funded the Global Enteric Multicenter Study (GEMS) under grants #38874 (GEMS) and #OPP10333572 (GEMS1A) awarded to Principal Investigator MML.

The U.S. Agency for International Development provided additional support for technical assistance through an Inter-Agency Agreement with the U.S. Centers for Disease Control and Prevention.

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Infectious Diseases
  • Parasitology
  • Tropical Medicine
  • RISK

Clinical, environmental, and behavioral characteristics associated with Cryptosporidium infection among children with moderate-to-severe diarrhea in rural western Kenya, 2008-2012: The Global Enteric Multicenter Study (GEMS)

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Journal Title:

PLoS Neglected Tropical Diseases


Volume 12, Number 7


, Pages e0006640-e0006640

Type of Work:

Article | Final Publisher PDF


Background: Cryptosporidium is a leading cause of moderate-to-severe diarrhea (MSD) in young children in Africa. We examined factors associated with Cryptosporidium infection in MSD cases enrolled at the rural western Kenya Global Enteric Multicenter Study (GEMS) site from 2008-2012. Methodology/Principal findings: At health facility enrollment, stool samples were tested for enteric pathogens and data on clinical, environmental, and behavioral characteristics collected. Each child’s health status was recorded at 60-day follow-up. Data were analyzed using logistic regression. Of the 1,778 children with MSD enrolled as cases in the GEMS-Kenya case-control study, 11% had Cryptosporidium detected in stool by enzyme immunoassay; in a genotyped subset, 81% were C. hominis. Among MSD cases, being an infant, having mucus in stool, and having prolonged/persistent duration diarrhea were associated with being Cryptosporidium-positive. Both boiling drinking water and using rainwater as the main drinking water source were protective factors for being Cryptosporidium-positive. At follow-up, Cryptosporidium-positive cases had increased odds of being stunted (adjusted odds ratio [aOR] = 1.65, 95% CI: 1.06–2.57), underweight (aOR = 2.08, 95% CI: 1.34–3.22), or wasted (aOR = 2.04, 95% CI: 1.21–3.43), and had significantly larger negative changes in height- and weight-for-age z-scores from enrollment. Conclusions/Significance: Cryptosporidium contributes significantly to diarrheal illness in young children in western Kenya. Advances in point of care detection, prevention/control approaches, effective water treatment technologies, and clinical management options for children with cryptosporidiosis are needed.

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