RESEARCH ARTICLE


Socio-Behavioral Risk Factors Associated with Cryptosporidiosis in HIV/AIDS Patients Visiting the HIV Referral Clinic at Cape Coast Teaching Hospital, Ghana



Yeboah K. Opoku1, 2, Johnson N. Boampong1, Irene Ayi3, Godwin Kwakye-Nuako1, Dorcas Obiri-Yeboah4, Harriet Koranteng5, George Ghartey-Kwansah1, 6, Kwame K. Asare1, 7, 8, *
1 Department of Biomedical Sciences, School of Allied Health Sciences, Collage of Health and Allied Science, University of Cape Coast, Cape Coast, Ghana
2 Biopharmaceutical Laboratory, College of Life Sciences, Northeast Agricultural University, Harbin150030, China
3 Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, P. O. Box LG 581, Legon, Accra, Ghana
4 School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
5 Jiamusi University No. 148, Xuefu Road, Jiamusi, Heilongjiang, China
6 Laboratory of Cell Biology, Genetics and Developmental Biology, College of Life Sciences, Shaanxi Normal University, Xi'an710062, China
7 Department of Protozoology, Institute of Tropical Medicine (NEKKEN), Nagasaki University Sakamoto 1-12-4, Nagasaki852-8523, Japan
8 Leading Program, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan


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© 2018 Opoku et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Protozoology, Institute of Tropical Medicine (NEKKEN), Nagasaki University Sakamoto 1-12-4, Nagasaki 852-8523, Japan; Tel: (81)-95-819-7838; E-mail: kwamsare@hotmail.com


Abstract

Objective:

To identify the socio-behavioral risk factors associated with cryptosporidiosis among HIV/AIDS patients with chronic diarrhea symptoms visiting the HIV referral clinic at Cape Coast Teaching Hospital, Ghana.

Methods:

A cross-sectional study was conducted among 50 HIV/AIDS patients with recurrent diarrhea. Questionnaires were administered to collect social and behavioral risk factors associated with Cryptosporidium and other opportunistic protozoan parasitic infections in HIV patients. Stool samples were collected for the diagnosis of enteric protozoan pathogens using modified Ziehl-Neelsen and acid-fast staining methods. CD4+ cells counts of study subjects were obtained from patients clinical records. The data obtained were analyzed using Pearson chi-square and multivariate-adjusted statistics tool on SPSS 16 for Windows.

Results:

Twenty-seven (54%) of the subjects were infected with enteric protozoan pathogens. The prevalences of Cryptosporidium, Cyclospora and Microsporidium infections were 46%, 32% and 16%, respectively. Cryptosporidium infection was significantly associated with drinking water (×2=13.528, p<0.001), Cyclospora was associated with the type of drinking water (×2=14.931, p<0.001) and toilet facilities used by the study subjects (×2=12.463, p<0.01), whiles Microsporidium infection was associated with hand washing behavior (×2=12.463, p<0.01). Enteric protozoans were frequently encountered among subjects with CD4+ T-cell count <200 cells/mm3. However, coinfection of Cyclospora spp & Cryptosporidium spp was not observed in CD4+ cell count <200 and >500 cells/mm3. Multivariate analysis showed that the risk factor for Cryptosporidium infection among HIV/AIDS patients was the source of drinking water (pipe borne water 76.2% prevalence: sachet water 25%; OR=0.10, 95%CI: 0.03-0.39, p<0.001).

Conclusion:

We report the risk factor for exposure of Cryptosporidium infection among HIV/AIDS patients for the first time in Ghana. The contamination of drinking water by protozoan parasites should be a public health concern. These results provide the stepping block to understand the transmission dynamics of Cryptosporidium and other opportunistic pathogens in HIV/AIDS infected patients in Ghana.

Keywords: Cryptosporidium oocyst, HIV/AIDS, CD4+, Risk factors, Sachet water, Chronic diarrhea, HIV referral clinic, Cape Coast, Ghana.