Niger J Paed 2014; 41 (3):204 –208  
Musa S  
Yakubu AM  
Olayinka AT  
Prevalence of Cryptosporidiosis  
in diarrhoeal stools of children  
under-five years seen in Ahmadu  
Bello University Teaching  
Hospital Zaria, Nigeria  
Accepted: 14th February 2014  
Abstract: Introduction: Human  
cryptosporidiosis is a zoonotic dis-  
ease and is increasingly recognized  
as a major public health problem. It  
is associated with significant  
effects on growth, physical and  
cognitive functions and excess  
mortality especially among chil-  
Aim: To determine the prevalence  
of Cryptosporidium oocyst excre-  
tion in children less than 5years  
with diarrhoea in ABUTH Zaria.  
Methods: Children aged 0 to 59  
months managed in paediatrics  
wards of ABUTH for diarrhoea  
were studied between July 2008  
and June 2009. Stool specimens  
obtained from these subjects were  
analysed for Cryptosporidium oo-  
cysts using the modified ZN stain-  
ing technique.  
(42.2%) boys and 107(57.8%)  
girls. A total of 33 children studied  
excreted oocysts in their stools,  
giving a prevalence of Crypto-  
sporidium oocysts of 17.8%. The  
highest rate (21.7%) was observed  
in children aged between 13 and  
36 months, and no oocysts were  
observed in stools of neonates.  
Oocyst excretion was observed to  
be commoner in the rainy season.  
Conclusion: Cryptosporidium is a  
common cause of diarrhoea among  
under-five children in our environ-  
ment. It was commoner after in-  
fancy and in the rainy season.  
Musa S  
Yakubu AM  
Department of Paediatrics,  
Olayinka AT  
Department of Medical Microbiology,  
Ahmadu Bello University Teaching  
Hospital, Zaria, Nigeria.  
Email: musa4all@gmail.com  
Recommendation: Routine screen-  
ing for Cryptosporidium should be  
part of evaluation of diarrhoeal  
illness especially in children be-  
yond the neonatal age group.  
Results: A total of 185 children  
were enrolled. There were 78  
Key words: Cryptosporidiosis;  
diarrhoea; under-five; children  
stools of under-five children to range between 6.0% and  
.7% . A prevalence of 8.1% was reported among  
Cryptosporidium spp. is one of the leading causes of  
severe diarrhoea . It is said to be the third or fourth com-  
monest cause of diarrhoeal disease, and its prevalence is  
much higher in developing countries than elsewhere .  
It has been described as an emerging infectious threat ,  
with dire consequences including prolonged hospitaliza-  
under-five children in Addis Ababa . Reports from  
northern Ghana showed that Cryptosporidium oocysts  
was found only sporadically in both patients and  
controls . In Nigeria, the prevalence of  
Cryptosporidium oocystsin st1o3o,1l4 samples in Enugu  
varied between 12.5%and 29% . The prevalence was  
tion, adverse effect on the weight gain of children , s5e,-6  
10.8% in Port Harcourt and 14% in Ilorin . In one  
vere effects on growth and nutritional status  
report from south west Nigeria, Cryptosporidium oocyst  
diminish8ed cognitive function and may ultimately lead  
was not found in stool samples of patients studied , but  
to death .  
a more recent study showed that Cryptosporidium is the  
most prevalent intestinal pathogenic parasite in Lagos,  
It is a zoonotic disease with mainly bovine and human  
reservoirs . Several reports from parts of the developing  
especially among diarrhoeal cases .  
world suggest cryptosporidiosis is endemic and is one of  
the most common causes of persistent diarrhoea among  
children, being as9s,o10ciated with more than a quarter of all  
diarrhoeal illness . Prospective community studies of  
childhood diarrhoea conducted in Guinea Bissau, found  
prevalence of Cryptosporidiumoocysts in diarrhoeal  
While several workers had previously identified Crypto-  
sporidiosis to be an13i-1m6,1p8ortant cause of diarrhoeal illness  
in parts of Nigeria  
there are no studies focussed on  
the prevalence of Cryptosporidium oocysts excretion in  
diarrhoeal stools of under-five children in this commu-  
nity. This study was therefore undertaken with a view to  
determining the prevalence of Cryptosporidium oocysts  
excretion in diarrhoeal stools of children less than five  
years presenting to ABUTH Zaria. This will assist in  
formulating recommendations for the management and  
prevention of the condition in our environment.  
or improvement of nutrition.  
Ethical Consideration: Approval of the Scientific and  
Ethical committee of the Ahmadu Bello University  
Teaching Hospital Zaria was obtained before the com-  
mencement of the study. Informed consent of each of  
the children’s parents or caregivers was obtained before  
recruitment into the study.  
Subjects and methods  
Children between the ages of zero and fifty-nine months  
admitted to the paediatric wards of the Ahmadu Bello  
University Teaching Hospital (ABUTH) Zaria with diar-  
rhoea or who developed diarrhoea while on admission in  
the course of their hospital stay were consecutively re-  
cruited between July 2008 and June 2009. For the pur-  
pose of this study, diarrhoea was taken to be an increase  
A total of one hundred and eighty five children (185)  
with diarrhoea aged 0 to 59 months, who consented for  
the study were enrolled and all completed the study. The  
prevalence of Cryptosporidium oocysts excretion among  
the 185 under five children who had diarrhoea studied  
was 17.8%. (Figure 1).  
in frequency and fluidity of the stool of the patient.  
Children whose parents or caregivers declined consent  
for the study were excluded. Relevant demographic de-  
tails of all children enrolled for the study were obtained  
and recorded into a specifically designed proforma.  
Fig 1: Prevalence of Cryptosporidium among the studied chil-  
dren with diarrhoea  
Stool sample was collected in dry clean container on the  
day of recruitment from each study subject. This was  
transported on the same day to the microbiology labora-  
tory of ABUTH within 30 minutes of collection for mi-  
crobiologic evaluation. To maximize recovery of oo-  
cysts, stool samples were concentrated prior to micro-  
scopic examination using the formalin-ethyl acetate  
sedimentation stool concentration method for clinical  
laboratories . A smear was made from the stool sedi-  
ment on a clean slide, air dried and fixed with methanol,  
Staining was with unheated carbolfuchsin and counter-  
stained with 0.4% methylene blue. The smear was then  
carefully examined microscopically for Cryptosporidiu-  
Among the children studied, the gender distribution re-  
flected a slight preponderance of females with a male to  
female ratio of 0.73:1. The mean age of the children was  
moocysts . An experienced parasitologist rechecked the  
smears to ensure quality control.  
studied children were 9.1kg ± 2.4 and 73.3cm ± 11.5  
respectively. Those admitted with diarrhoea constituted  
9.8 ± 6.0 months. The mean weight and length of the  
Data obtained from the study was analyzed using the  
computer SPSS version 15.0. Results are presented in  
figures, tables and graphs as appropriate. Student’s t-test  
was used to compare the means of normally distributed  
continuous variable while differences between propor-  
tions were evaluated by the Chi-square test and Yate’s  
correction was applied as appropriate. A p-value of less  
than 0.05 was considered to be statistically significant in  
comparative analyses.  
3.8% of the total while the rest developed diarrhoea in  
the course of their hospital stay. There was no statisti-  
cally significant difference in gender between those ad-  
mitted with diarrhoea and those who developed diar-  
rhoea in the course of their hospital stay.  
Majority of the children (55.7%), as shown in Table 1,  
were toddlers aged between 13 and 36 months. Sixty  
three children (30.8 %) were infants, while nineteen  
Case Management of children: All children recruited  
for the study were routinely additionally investigated as  
appropriate based on their other presenting symptoms  
and signs to establish the existence or otherwise of con-  
comitant disease according to the standard of care in the  
hospital. All the children recruited for the study were  
then managed accordingly in the Diarrhoeal Therapy  
Unit (DTU) for diarrhoeal disease or in any of the paedi-  
atric units when there was a concomitant disease. The  
mothers and caregivers were taught the basic principles  
of personal and environmental hygiene, home manage-  
ment of diarrhoeal disease including prevention and  
correction of dehydration using ORS, and maintenance  
10.3%) were aged above thirty six months. Table 1  
also shows that male children predominated beyond the  
age of thirty six months. The age difference between  
gender was not statistically significant (c = 2.768, df =  
, p = 0.251).  
Age prevalence  
Table 2 shows the frequency distribution of Crypto-  
sporidium infection in diarrhoeal stools of children stud-  
ied by age category. The highest Cryptosporidium  
prevalence rate (9.75%) was observed in toddlers  
While cryptosporidiosis appears to be present in this  
community all year round, prevalence was found to  
increaseduring the rainyseason(69.7%). This clear  
seasonal variation in the rate of Cryptosporidium oocyst  
This study has revealed the presence of Cryptosporidiu-  
moocyts in the stools of children aged less than five  
years with diarrhoea in ABUTH. The 17.8% prevalence  
of Cryptosporidium infection in the study population  
may indicate that the organism is a significant pathogen  
in children less than five years with diarrhoea in this  
environment. This prevalence is within the observed  
range of up to a quarter of all diarrhoeal illness in the  
developing world in paediatric population being associ-  
excretion in this study was of statistical significance(c =  
4.509, p = 0.0337). The same seasonal variationhas als1o4  
been observed in other studies from Uganda, Enugu  
and the USA . Seasonal variation observed in this study  
might be related to increased agricultural activities dur-  
ing rainy season in our community that promote contact  
with animals and their wastes used for agricultural  
activities. This affects the number of oocysts in the  
environment and promotes exposure to oocysts.  
Furthermore, factors such as humidity and temperature  
during the rainy season may enhance oocysts survival in  
that season.  
ated with cryptosporidi1o6sis and similar to prevalence  
rates of 14% in Ilorin, but much lower than 29% re-  
ported among school children in Enugu . The rate of  
detection of Cryptosporidium in this study was higher  
than the reported rates of 12.5% in Enugu, 10.8% in  
Port Harcourt and much ,h8igher than 6.0% and 7.7%  
reported in Guinea-Bissau and 8.1% reported in under  
This study shows that the important clinical features  
associated with Cryptosporidiosis are persistent diar-  
rhea, watery stools, history of diarrheal illness in the  
past year, stool frequency more than four times a day  
and dehydration. This substantiates the literature where  
it has been said that symptomatic cryptosporidium infec-  
tion is char,9acterised by watery stools, persistent  
five children in Addis8 Ababa as well as rate reported  
in south west Nigeria.  
The reasons for these differences are possibly due to  
different methods used for detection of cryptosporidiosis  
and differences in the study population. While several  
community-based studies report lower prevalence rates  
of cryptosporidiosis in children w6,i1t1h diarrhea in the  
diarrhoea and a tendency to reoccur.  
range between 6.0% and 8.1%  
prevalence rates  
reported among childre16n recruited from hospitals tended  
to be generally higher.  
Although children aged 13 to 36 months were found to  
shed oocyts most in the study, however there was no  
statistically significant difference between the various  
This study has clearly demonstrated the presence of  
Cryptosporidium as an important pathogen among un-  
der-five children presenting to ABUTH with diarrhoea.  
It has also been able to identify some children more  
likely to excrete Cryptosporidium oocysts in diarrhoeal  
stools. Based on these findings, it is recommended that  
evaluation of cases of diarrhoeal illnesses in children  
less than five years presenting to the hospital should  
include screening for Cryptosporidium oocysts, espe-  
cially in children beyond the neonatal age.  
Prevention of Cryptosporidium infections is by avoid-  
ance of contamination of food and water sources by oo-  
cysts through protection of water sources. Implementa-  
tion of multiple barriers to safeguard public drinking  
water sources can prevent cryptosporidiosis. However,  
effective control of diarrhoea caused by cryptosporidium  
remains largely elus1i0ve in sub-Saharan Africa and other  
developing regions.  
age groups in oocysts excretion. (c = 1.464, df = 2, p =  
.481). The peak age of oocysts shedding in this study  
was 22 months. This is in contrast to studies that found  
that Cryptosporidium infectionpeaks at 10 months. This  
study however agrees with other studies that showed  
that young children less than 15 years, and in particular  
children 0-2 years of age appear to be more susceptible  
to Cryptosporidium. In this study, it appears that oocysts  
excretion in stools appear to taper off as the children  
approach sixty months. Similar finding was reported in a  
study that showed that oocysts excretion subsided after  
four years.  
6 months 5a-1n6d were not encountered after the age of  
Perhaps, a plausible reason for the later peak in age of  
infection in this study is the possibility that age 22  
months coincides with the age at cessation of breast  
milk and a complete transition to family diet in this  
community. It is also the age about which most children  
begin to freely explore their environment, coming in  
contact with animal dropings, contaminated foodand  
objects that they readily put in the mouths.  
Boys in this study were as affected as girls, with no sta-  
tistically significant difference in their rates of crypto-  
sporidium oocyst excretion in stools. This is in line with  
other studies reflecting equal exposure and susceptibility  
in the environment.  
Authors’ contribution  
Musa, S: Concept and design of study, data collection,  
analysis and interpretation, writing of the initial draft.  
Yakubu AM: Critical review for important intellectual  
input to draft, final approval of the manuscript.  
Olayinka AT: Design of laboratory method, contribution  
of intellectual input to draft, approval of manuscript.  
Conflict of interest: None  
Funding: None  
between the 13 to 36 months age bracket. Only three  
(1.6%) of the children aged more than 36 months had  
Types of diarrhoea  
Cryptosporidium Oocyts in their stools. However, these  
The type of diarrhoea seen among the studied population  
shows that acute watery diarrhoea occured in 132 (71%)  
of all children presenting with diarrhoea, while persis-  
tent diarrhoea and acute bloody diarrhoea were seen in  
differences, when subjected to statistical analyses, were  
found not to be significant.  
(c = 1.464, df = 2, p =  
9 (21%) and 14 (8%) of the children, respectively.  
Table 1: Characteristics of children with diarrhoea studied for  
Cryptosporidium oocysts in stools at ABUTH, Zaria.  
Clinical correlates of cryptosporidium oocysts excretion  
It was found out that oocysts excretion was more likely  
in children with persistent diarrhoeal illness (p = 0.0001,  
Fisher’s exact test), watery stools (p = 0.0002, Fisher’s  
exact test), previous history of diarrhoeal illness in the  
past year (p = 0.0005, Fisher’s exact test), high  
frequency stools (p = 0.0001, Fisher’s exact test) and  
dehydration (p = 0.0065, Fisher’s exact test) as shown in  
Table 4.  
Frequency (%)  
78 (42.2)  
107 (57.8)  
Period of development of diarrhoea*  
Admitted with Diarrhoea  
Developed diarrhoea on admission  
155 (83.8)  
65 (41.9)  
90 (58.1)  
30 (16.2)  
13 (43.3)  
17 (56.7)  
Table 4: Clinical correlates of cryptosporidium oocysts in  
children studied  
p value,  
exact test  
OR (95%  
diarrhoea and those who developed diarrhoea in the course of  
their hospital stay, c = 0.020, df = 1, p = 0.887)  
No difference in gender between those admitted with  
Cryptosporidium Oocyts  
Table 2: Distribution of Cryptosporidium infection by age  
Diarrhoea duration  
(2.764 –  
Cryptosporidium oocysts  
103 (55.7)  
49 (26.5)  
8 (4.3)  
25 (13.5)  
Category of children  
8 (12.7)  
63 (100.0)  
103 (100.0)  
19 (100.0)  
185 (100.0)  
22 (21.7) 81 (78.6)  
3 (15.8) 16 (84.2)  
33 (17.8) 152 (82.2)  
Type of stools  
32 (17.3)  
1 (0.5)  
01 (54.6)  
(2.146 –  
51 (27.6)  
tion between age groups studied, c = 1.464, df = 2, p = 0.481)  
No statistically significant difference in rate of oocyst excre-  
Previous history  
of diarrhoea  
30 (16.2)  
3 (1.6)  
91 (49.2)  
61 (33.0)  
Sex prevalence  
1.959 –  
Table 3 shows the distribution of Cryptosporidium  
oocyst excretion in diarrhoeal stools of children studied  
by gender. The highest Cryptosporidium prevalence rate  
Stool frequency  
6 (3.2)  
98 (53.0)  
54 (29.2)  
(3.1744 –  
10.3%) was observed in girls, while the prevalence in  
boys was 7.6%. These differences were found not to be  
statistically significant. (c = 0.001, df = 1, p = 0.973).  
Hydration status  
Not dehydrated  
1 (16.8)  
110 (70.3)  
42 (11.9)  
(1.356 –  
Table 3: Distribution of Cryptosporidium infection by gender  
ZN Positive  
ZN Negative  
Fig 2: Seasonal variation of detection of Cryptosporidium  
oocysts in stools of children with diarrhoea studied at ABUTH,  
Females 19 (10.3)  
Total 33 (17.8)  
14 (7.6)  
64 (34.6)  
88 (47.6)  
152 (82.2)  
78 (42.2)  
107 (57.8)  
185 (100.0)  
tion between gender of children studied, c = 0.001, df = 1, p =  
No statistically significant difference in rate of oocyst excre-  
Seasonal prevalence  
Ninety eight children were seen in the rainy season and  
oocysts during the rainy season (fig 2). The difference in  
excretion of oocysts between rainy and dry seasons is  
7 in the dry season. More children (69.7%) excreted  
oocyst excretion between rainy and dry seasons, c = 4.509,  
p = 0.0337)  
There was a statistically significant difference in rate of  
statistically significant. (c = 4.509, p = 0.0337).  
whose experience was invaluable in the laboratory work  
in this study. Finally, we most sincerely thank all the  
children and their caregivers for their cooperation. With-  
out them, this study could not have been done.  
We thank all colleagues, nurses and other staff of the  
paediatric wards of ABUTH, Zaria for assistance with  
the care of the patients. We also thank Mr Mike Agbo,  
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