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Background    Cryptosporidium  is a leading cause of diarrhea in Sub-Saharan Africa and is associated with substantial morbidity and mortality in young children.    Methods   We analyzed data from children aged 6–71 months presenting to 2 public hospitals in Western Kenya with acute diarrhea and their primary caregivers, including detection of  Cryptosporidium  by quantitative polymerase chain reaction (PCR) and immunoassay analysis in stool samples from both children and their caregivers. Associations between potential transmission sources and child/caregiver  Cryptosporidium  infection were evaluated using prevalence ratios (PRs). Secondary analyses evaluated host and clinical risk factors of child/caregiver  Cryptosporidium  infection.    Results  Among 243 child–caregiver pairs enrolled, 77 children (32%) and 57 caregivers (23%) had  Cryptosporidium  identified by either immunoassay or PCR. Twenty-six of the 243 child–caregiver pairs (11%) had concordant detection of  Cryptosporidium .  Cryptosporidium  infection in children was associated with detection of  Cryptosporidium  in caregivers (adjusted PR [aPR], 1.8; 95% CI, 1.2 to 2.6;  P =  .002) and unprotected water source (aPR, 2.0; 95% CI, 1.3 to 3.2;  P =  .003). Risk factors for  Cryptosporidium  detection in caregivers included child  Cryptosporidium  infection (aPR, 2.0; 95% CI, 1.3 to 3.0;  P =  .002) as well as cow (aPR, 3.1; 95% CI, 1.4 to 7.0;  P =  .02) and other livestock ownership (aPR, 2.6; 95% CI, 1.1 to 6.3;  P =  .03) vs no livestock ownership. Recent diarrhea in caregivers and children was independently associated with child and caregiver  Cryptosporidium  infections, respectively.    Conclusions  Our results are consistent with the hypothesis that  Cryptosporidium  transmission can occur directly between child–caregiver dyads as well as through other pathways involving water and livestock. Additional research into caregivers as a source of childhood  Cryptosporidium  infection is warranted.

Prevalence and Correlates of Cryptosporidium Infections in Kenyan Children With Diarrhea and Their Primary Caregivers