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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.

plos neglected tropical diseases

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)