The triple threat of Cryptosporidium, Giardia, and Entamoeba infections in Nigerian children

The epidemiological patterns and risk factors of three protozoan parasites, Cryptosporidium, Giardia, and Entamoeba, that cause diarrheal diseases in low-resource settings were investigated among children aged 10 years and below across ten states in Nigeria. Previous studies in Nigeria relied primarily on microscopy, a method with limited sensitivity for parasite detection, which underestimated the true burden of infection. We applied a real-time PCR technique on DNA extracted from 977 stool samples collected from children who answered a structured questionnaire in this cross-sectional survey. The overall prevalence of Cryptosporidium, Giardia, and Entamoeba infections was 18.1%, 77.6%, and 12.3%, respectively. Coinfections were frequent, with 17.1% harbouring both Cryptosporidium and Giardia, 2.9% with Cryptosporidium and Entamoeba, 11.5% with Giardia and Entamoeba, and 2.8% with all three parasites. Jigawa State recorded the highest burden of coinfections (7.9%). Cryptosporidum infection rates were significantly higher in children five years and above, while males had higher Entamoeba infection rates. Giardia infection varied significantly with educational level. Trading was significantly associated with the burden of single infections and Cryptosporidium and Giardia, and Giardia and Entamoeba coinfections. Risk factors for infection and coinfection included geographical location, water source, household density, and contact with animals. The study highlights the importance of integrating molecular diagnostic tools into public health surveillance to accurately assess parasitic disease burdens and guide interventions. The high prevalence of Giardia, in particular, underscores the urgent need to improve access to clean water, sanitation, and hygiene (WASH) infrastructure in Nigeria. Addressing these infections through improved diagnostics, sanitation infrastructure, and targeted interventions could substantially reduce childhood morbidity and mortality associated with diarrheal diseases.