A Survey of U.S. Obstetrician-Gynecologists' Clinical and Epidemiological Knowledge of Cryptosporidiosis in Pregnancy

Authors

  • B. T. Domjahn,

    Corresponding author
    1. Department of Obstetrics and Gynecology, Emory University School of Medicine, Atlanta, GA, USA
    • Correspondence:

      B. T. Domjahn. Department of Obstetrics and Gynecology, Emory University School of Medicine, 1365 Clifton Road NE, Bldg. A 4th Floor # 4503, Atlanta, GA 30322, USA. Tel.: +1 517 242 8578; Fax: +1 404 778 4165; E-mail: briyana.teague.domjahn@emory.edu

    Search for more papers by this author
  • M. C. Hlavsa,

    1. Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
    Search for more papers by this author
  • B. Anderson,

    1. Department of Research, American College of Obstetricians and Gynecologists, Washington, DC, USA
    Search for more papers by this author
  • J. Schulkin,

    1. Department of Research, American College of Obstetricians and Gynecologists, Washington, DC, USA
    Search for more papers by this author
  • J. Leon,

    1. Hubert Department of Global Health, Departments of Epidemiology and Environmental and Occupational Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
    Search for more papers by this author
  • J. L. Jones

    1. Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
    Search for more papers by this author

  • Research was conducted in the Department of Research, American College of Obstetricians and Gynecologists, in Washington, DC, and data was analysed at Emory University and the Centers for Disease Control and Prevention, in Atlanta, Georgia.

Summary

Although cryptosporidiosis is frequently diagnosed in the U.S., there has been very little assessment of obstetrician–gynaecologist knowledge about this disease. In 2010, we surveyed U.S. obstetricians about the diagnosis, treatment and epidemiology of cryptosporidiosis. Data were examined through univariable analysis and multivariable regression models. Of 1000 obstetrician–gynaecologists surveyed, 431 (43.1%) responded. Only 44.4% of respondents correctly identified that prolonged, intermittent diarrhoea would lead them to consider cryptosporidiosis in a differential diagnosis. Routine ova and parasites (O&P) testing was incorrectly chosen to identify Cryptosporidium in stool by 30.4% of respondents. Questions about nitazoxanide, the only drug approved by the U.S. Food & Drug Administration (FDA) for treatment of cryptosporidiosis, were the most frequently missed questions. Only 9.0% of respondents correctly classified nitazoxanide as an FDA pregnancy Category B drug, and only 5.6% of respondents correctly indicated that FDA approved nitazoxanide for immunocompetent patients aged ≥1 years. Regarding prevention- and control-related knowledge, only 14.1% of respondents correctly indicated that alcohol-based hand sanitizers were not effective at inactivating Cryptosporidium spp., and <10% correctly indicated that cryptosporidiosis is a reportable disease in their state of practice. Multivariable analysis found that ≥19 years in practice was positively associated with O&P diagnostic testing knowledge, while rural and urban non-inner city practice location, compared with suburban practice location, was positively associated with nitazoxanide knowledge. The low level of knowledge among obstetrician–gynaecologists about cryptosporidiosis indicates a need to develop resources for physicians about all aspects of cryptosporidiosis, particularly on diagnosis, treatment and prevention strategies.

Ancillary