Background and rationale

Diarrhoea is one of the leading reasons of malnutrition and is globally estimated to cause more than one million deaths yearly, even though most being preventable and treatable. According to the World Health Organisation (WHO), diarrhoeal diseases are one of the leading causes of death in children under five years old with the highest mortality rates concentrated in sub-Saharan Africa and the southern part of Asia (Kotloff et al., 2013). While the number of people affected by diarrhoea has been reduced during the last 10 years, it remains to be a significant problem for children, especially for those living in rural areas in Low- and Middle income countries (LMICs) (Bray et al., 2019).

Enteric parasitic diseases play a significant role to the public health, as an effective drug or vaccine is not always available. The route of transmission for various enteric parasites are commonly through oral-faecal transmission attained through contaminated food and water, by contact with animals, their environments or by contact with the faeces of an infected individual (CDC, 2016; Julian, 2016; Montealegre et al., 2018). In endemic regions, diarrhoea-causing parasitic infections are usually related to poor sanitation, poverty, animal rearing, and malnutrition (Sow et al., 2016). This illustrates the importance of recognizing the interconnection of the parasite prevalence between people, animals, plants, and their shared environment especially as a thorough investigation on the presence, spread and transmission dynamics of these pathogens are lacking in LMICs.

Unfortunately, most regions where enteric infections are prevalent, limited access to clean waters as well as limited involvement in reduction of transmission is habitual, resulting in continuous long-term persistence of the pathogens. In addition, data regarding the prevalence of parasitic diseases that are known to cause diarrhoea is limited in Somalia. Thus, this project aims to answer fundamental questions concerning, source, prevalence, transmission dynamics and prevention of diarrhoeal diseases in Somalia under the One Health umbrella.

Study hypotheses

1. Based on our previous experience from other LMICs, we hypothesise that a large proportion of the analysed stool samples will contain at least one of the diarrhoea-causing parasites we are screening for (Cryptosporidium, Entamoeba histolytica, Giardia intestinalis and Blastocystis species).
2. Parasites of interest will be present in humans, other animals and possibly in environmental samples from the same household.
3. We also hypothesise that the gut microbiome composition of the hosts will not be much different from those that are uninfected.

Objective(s) of the study

• Detecting the prevalence, environmental loading, zoonosis, and molecular characteristics of diarrhoeal-causing agents (Cryptosporidium, Entamoeba histolytica Giardia intestinalis and Blastocystis species) in vulnerable populations in Somalia
• What is the source of the infections in the developing world (especially in rural areas)? Are there any associated gastrointestinal diseases linked to these infections?
• Which methods can be employed towards detecting diarrhoea agents in a timely manner, reducing transmission, and eliminating disease spreading in urban areas?

Research Investigators:

1. Ahmed Abdulkadir Hassan-Kadle
2. Anastasios Tsaousis
3. Sadiya Maxamhud
4. Eleni Gentekaki
5. Dr. Abdalla Mohamed Ibrahim
6. Aamir Muse Osman
7. Mohamed Abdulkadir Shair