Risk Factors for Giardia lamblia, Entamoeba histolytica, and Cryptosporidium parvum Co-infection amongst Youthful Malaria Patients Attending Hospitals in the Buea Health District, Cameroon

Abstract

Background: Co-infection of malaria with gastrointestinal parasites alter host immune responses, contribute to anemia, and affect clinical presentation and treatment outcomes. Aim: This study investigated the prevalence and risk factors of Giardia lamblia, Entamoeba histolytica, and Cryptosporidium parvum co-infection among malaria patients aged 0–20 years attending hospitals in the Buea Health District, Cameroon. Method: It was a hospital-based cross-sectional study conducted at Buea Regional Hospital, Muea Sub-Divisional District Hospital, and Family Care Clinic between January 5 and June 25, 2025. A total of 121 consenting malaria-confirmed patients were enrolled in the study. A structured questionnaire was administered to collect socio-demographic, environmental, and behavioral data. Fresh stool samples were collected from all 121 participants and analyzed by direct wet mount microscopy and 48 randomly selected samples from the 121 collected stool samples were further subjected to nested PCR targeting the 18S rRNA gene (E. histolytica), triose phosphate isomerase (tpi) gene (G. lamblia), and Cryptosporidium oocyst wall protein (COWP) gene (C. parvum). Data were analyzed using Microsoft Excel 2019 and SPSS version 25.0, with associations assessed by chi-square test and multivariate logistic regression. Results: Microscopy detected only E. histolytica, with an overall prevalence of 27.3% (33/121). Nested PCR revealed significantly higher prevalence rates; E. histolytica 52.1% (25/48), G. lamblia 8.3% (4/48) and C. parvum was not detected. E. histolytica infection was significantly (p=0.028) associated with flush toilet users (35.0%), compared to participants who use pit toilets (12.2%). Conclusion: These findings highlight the critical need to integrate molecular diagnostic techniques into routine gastro-intestinal parasite diagnosis and underscores the need for better hygienic practices amongst flush toilet users in Buea Health District.