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

BACKGROUND

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 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 infection were evaluated using prevalence ratios (PRs). Secondary analyses evaluated host and clinical risk factors of child/caregiver infection.

RESULTS

Among 243 child-caregiver pairs enrolled, 77 children (32%) and 57 caregivers (23%) had identified by either immunoassay or PCR. Twenty-six of the 243 child-caregiver pairs (11%) had concordant detection of . infection in children was associated with detection of in caregivers (adjusted PR [aPR], 1.8; 95% CI, 1.2 to 2.6; .002) and unprotected water source (aPR, 2.0; 95% CI, 1.3 to 3.2; .003). Risk factors for detection in caregivers included child infection (aPR, 2.0; 95% CI, 1.3 to 3.0; .002) as well as cow (aPR, 3.1; 95% CI, 1.4 to 7.0; .02) and other livestock ownership (aPR, 2.6; 95% CI, 1.1 to 6.3; .03) vs no livestock ownership. Recent diarrhea in caregivers and children was independently associated with child and caregiver infections, respectively.

CONCLUSIONS

Our results are consistent with the hypothesis that 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 infection is warranted.