Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
NIHR Health Protection Research Unit in Gastrointestinal Infections, University of East Anglia, Norwich, United Kingdom.
PLoS Negl Trop Dis. 2018 Jun 7;12(6):e0006553. doi: 10.1371/journal.pntd.0006553. eCollection 2018 Jun.
Cryptosporidium infection causes gastrointestinal disease and has a worldwide distribution. The highest burden is in developing countries.
We sought to conduct a systematic review and meta-analysis to identify Cryptosporidium risk factors in Low and Middle Income countries (LMICs).
Medline Ovid and Scopus databases were searched with no restriction on year or language of publication. All references were screened independently in duplicate and were included if they presented data on at least 3 risk factors. Meta-analyses using random effects models were used to calculate overall estimates for each exposure.
The most frequently reported risk factors in the 15 included studies were overcrowding, household diarrhoea, poor quality drinking water, animal contact, open defecation/ lack of toilet and breastfeeding. The combined odds ratio for animal contact was 1.98 (95%CI: 1.11-3.54) based on 11 studies and for diarrhoea in the household 1.98 (95%CI: 1.13-3.49) based on 4 studies. Open defecation was associated with a pooled odds ratio of 1.82 (95%CI: 1.19-2.8) based on 5 studies. Poor drinking water quality was not associated with a significant Cryptosporidium risk, odds ratio 1.06 (95%CI: 0.77-1.47). Breastfeeding was protective with pooled odds ratio 0.4 (95%CI: 0.13-1.22), which was not statistically significant.
Based on the included studies, crowded living conditions, animal contact and open defecation are responsible for the majority of Cryptosporidium cases in LMICs. Future studies investigating Cryptosporidium risk factors should have a good study design and duration, include appropriate number of cases, select suitable controls, investigate multiple relevant risk factors, fully report data and perform multivariate analysis.
隐孢子虫感染会导致胃肠道疾病，且分布于世界各地。在发展中国家，其负担最重。
我们旨在进行系统评价和荟萃分析，以确定中低收入国家（LMICs）中隐孢子虫的风险因素。
我们在 Ovid 医学全文数据库和 Scopus 数据库中进行了检索，对发表年份和语言未设任何限制。我们独立地对所有参考文献进行了筛选，如果文献至少报告了 3 种风险因素，就将其纳入分析。使用随机效应模型进行荟萃分析，以计算每种暴露的总体估计值。
在纳入的 15 项研究中，最常报告的风险因素为拥挤、家庭腹泻、饮用水质量差、接触动物、露天排便/缺乏厕所和母乳喂养。基于 11 项研究，接触动物的合并优势比为 1.98（95%CI：1.11-3.54），基于 4 项研究，家庭腹泻的合并优势比为 1.98（95%CI：1.13-3.49）。基于 5 项研究，露天排便与合并优势比 1.82（95%CI：1.19-2.8）相关。饮用水质量差与隐孢子虫感染风险无显著相关性，优势比为 1.06（95%CI：0.77-1.47）。母乳喂养具有保护作用，合并优势比为 0.4（95%CI：0.13-1.22），但无统计学意义。
基于纳入的研究，拥挤的生活条件、接触动物和露天排便导致了 LMICs 中大多数隐孢子虫病例。未来研究隐孢子虫风险因素时，应具有良好的研究设计和持续时间，纳入适当数量的病例，选择合适的对照，调查多个相关的风险因素，充分报告数据并进行多变量分析。
