CRYPTOSPORIDIOSIS IN INFANCY AND CHILDHOOD MORTALITY IN GUINEA-BISSAU, WEST-AFRICA

Objective-To investigate the epidemiology of and mortality from crypto sporidiosis in young children in Guinea Bissau, West Africa. Design-Th ree year community study of an open cohort followed up weekly. Setting -301 randomly selected houses in a semi-urban area in the capital, Bis sau. Subjects-1315 children aged less than 4 years. Main outcome measu res-Cryptosporidium infection detected by examination of stools during episode of diarrhoea and death of a child. Results-Cryptosporidium sp p were found in 239 (7.4%) out of 3215 episodes of diarrhoea. The para site was most common in younger children (median age 12 months) and at the beginning of the rainy seasons. The prevalence of cryptosporidios is was 15% (77/513) in cases of persistent diarrhoea compared with 6.1 % (148/2428) in diarrhoea lasting less than two weeks (p < 0-0001). Cr yptosporidiosis was associated with excess mortality in children who h ad the infection in infancy, and this excess mortality persisted into the second year of life (relative mortality 2.9 (95% confidence interv al 1.7 to 4.9)). The excess mortality could not be explained by malnut rition, or by socioeconomic factors, hygienic conditions, or breast fe eding. Conclusions-Cryptosporidiosis is an important cause of death in otherwise healthy children in developing countries.