(P07-016-23) Symptomatic and Asymptomatic Enteric Protozoan Parasitic Infection and Their Association With Growth in Young Under 5 Children in South Asia and Sub-Saharan Africa

Objectives: Entamoeba histolytica, Giardia, and Cryptosporidium are common intestinal protozoan parasites contributing to a high childhood morbidity and mortality burden. Our study quantified the association between infection with these parasites and child anthropometric outcomes among children under-5.

Methods: We analyzed data collected from fecal samples of 7,800 children that were positive for intestinal protozoan parasites from December 2007 to March 2011. These children, enrolled in seven study sites -in South Asia and sub-Saharan Africa in the Global Enteric Multicenter Study (GEMS), had either symptomatic infection with moderate-to-severe diarrhea or an asymptomatic infection without diarrhea. Parasitic infection was assessed using stool immunoassays (ELISA). We applied multiple linear regression to test the association between any or concurrent parasitic infection and length/height-for-age (HAZ), weight-for-age (WAZ), and weight-for-length/height (WHZ) z-score. Models were stratified by diarrheal symptoms, driven by the study design, and adjusted for potential covariates.

Results: Among the asymptomatic children, negative associations were observed between Giardia infection with HAZ [β: -0.13; 95% CI: ­-0.17, 0.09] and WAZ [β -0.07; 95% CI: -0.11, -0.04], but not WHZ [β: -0.02; 95% CI:-0.06, 0.02]; Cryptosporidium infection with WAZ[β: -0.15; 95% CI: -0.22, -0.09] and WHZ [β: -0.18; 95%CI: -0.25, -0.12], but not with HAZ [β: -0.03; 95% CI: -0.09, 0.04]. For symptomatic children, no associations were found between Giardia and anthropometry; negative associations were found between Cryptosporidium with HAZ [β: -0.17; 95% CI: -0.23, -0.11], WAZ [β: -0.25; 95% CI: -0.31, -0.19] and WHZ [β: -0.23; 95% CI: -0.30, -0.17]. Among the asymptomatic 24-59 months old children, Giardia infection had a negative association with HAZ [β: -0.09; 95% CI: -0.15, -0.04]. No significant associations were found between symptomatic and asymptomatic E. Histolytica infection with child growth.

Conclusions: Our observation underscores the need for preventive strategies targeting enteric protozoan parasitic infections among symptomatic and asymptomatic young children, which could potentially reduce the burden of childhood growth faltering.

Funding Sources: BMGF