Giardia and Cryptosporidium in children with diarrhea, Kufra, Libya, a North African migration route city
Background: Giardia and Cryptosporidium are common parasitic diarrhea agents of children contributing to childhood morbidity and mortality in developing countries. Major risk factors, based on the international literature, are expected to include domestic animals, fresh vegetables and drinking water and foodstuffs purchased from street vendors. These factors and sub Saharan migrants are common in the study area. Reports elsewhere indicate that person-to-person transmission is also important. Objective: To assess the prevalence Cryptosporidium and Giardia in children with diarrhea in the Kufra City hospital and to assess risk factors for cryptosporidiosis and giardiasis. Methods: A 10-month study, September 2013-June 2014 provided a fecal sample from 505 patients with diarrhea aged from 2 to 17 attending the outpatient clinics of local Kufra hospital, plus100 non symptomatic controls. Specimens were assayed for parasitic infection and for bacterial pathogens. Demographic information was obtained by questionnaire. Results: Giardia was found in nearly 1/3 of the symptomatic population but few had Cryptosporidium. Mixed parasite infections were found in 1/7th of samples including: Shigella, Salmonella, Ascaris ova, E. coli, and E. histolytica. Infection frequency was age related, and risk factors included: domestic animals, foreign workers from Africa, contaminated fresh vegetables and drinking water. Conclusion: Cryptosporidium and Giardia were frequently associated with diarrhea in children in a remote desert agricultural community with many opportunities for infection. Contact with animals, foreign workers from Africa, fresh vegetables and drinking water sources contaminated with sewage materials are the likely modes of transmission of both organisms.