Burden of Diarrhea, Hospitalization and Mortality Due to Cryptosporidial Infections in Indian Children

Abstract

Background Cryptosporidium spp. is a common, but under-reported cause of childhood diarrhea throughout the world, especially in developing countries. A comprehensive estimate of the burden of cryptosporidiosis in resource-poor settings is not available. Methodology/Principal Findings We used published and unpublished studies to estimate the burden of diarrhea, hospitalization and mortality due to cryptosporidial infections in Indian children. Our estimates suggest that annually, one in every 6–11 children <2 years of age will have an episode of cryptosporidial diarrhea, 1 in every 169–633 children will be hospitalized and 1 in every 2890–7247 children will die due to cryptosporidiosis. Since there are approximately 42 million children <2 years of age in India, it is estimated that Cryptosporidium results in 3.9–7.1 million diarrheal episodes, 66.4–249.0 thousand hospitalizations, and 5.8–14.6 thousand deaths each year. Conclusions/Significance The findings of this study suggest a high burden of cryptosporidiosis among children <2 years of age in India and makes a compelling case for further research on transmission and prevention modalities of Cryptosporidium spp. in India and other developing countries. Author Summary Cryptosporidium spp. is a major cause of childhood diarrhea in India and other developing countries. Because of its link with poverty and its ability to impair childhood growth and development, Cryptosporidium spp. was included in the WHO Neglected Diseases Initiative in 2004. Despite this, the global impact of cryptosporidiosis is yet to be quantified due to the lack of country-specific estimates on cryptosporidial disease burden. In this study, we combined data from community-based studies in Vellore with the national statistics for India to obtain an estimate of the cryptosporidial disease burden in Indian children. Despite the inherent challenges in generating national estimates of disease burden for a country as large and diverse as India, our study provides a useful assessment of the under-recognized burden of cryptosporidiosis in Indian children.