Systematic review and meta-analysis on the prevalence of cryptosporidiosis among children in India

Diarrhoea is the second leading cause of death in children under five years in India. The overall prevalence of childhood diarrhoea in India stands at 7.3%. Cryptosporidium is the third major contributor to diarrhoea-related morbidity and mortality, associated with growth stunting, malnutrition, and cognitive dysfunction in children. Nevertheless, the contribution of Cryptosporidium to the diarrhoeal burden in India remains unclear, underscoring the need for a systematic review to address the existing knowledge gap. This systematic review aims to determine the overall pooled prevalence of Cryptosporidium infection among Indian children. Systematic review was registered in PROSPERO (CRD4202455077), and studies reporting the prevalence in Indian children were systematically searched in PubMed, Google Scholar, and Scopus from inception through 2024 following PRISMA guidelines. Out of the 642 articles screened, only 34 met the eligibility criteria and were included in the systematic review and meta-analysis. The data extraction process utilized critical data such as prevalence rates, age, sex, sample size, and clinical symptoms. The risk of bias of the included studies was assessed using the AXIS tool. The prevalence rate of Cryptosporidium reported in individual studies was pooled using a random effect model (Dersimonian and Laird method). Meta-analysis indicated that the pooled prevalence of Cryptosporidium among diarrheic children was 5.7% (95% CI: 4.0% – 8.1%, I² = 96.0%), and non-diarrheic children were 3.2% (95% CI: 1.9% – 5.2%, I² = 85.7%). Subgroup analysis based on age indicated that the mean prevalence of infection is higher in infants (1-2yrs). Our findings indicate a substantial burden of cryptosporidiosis in Indian children and highlight the need for more studies to determine the accurate burden of cryptosporidiosis, which appears to be a neglected disease in India.