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Open Access Highly Accessed Research article

Faecal calprotectin concentrations in apparently healthy children aged 0-12 years in urban Kampala, Uganda: a community-based survey

Elin Hestvik12*, James K Tumwine3, Thorkild Tylleskar1, Lena Grahnquist4, Grace Ndeezi13, Deogratias H Kaddu-Mulindwa5, Lage Aksnes26 and Edda Olafsdottir2

Author Affiliations

1 Centre for International Health, University of Bergen, Årstadveien 21, N-5009 Bergen, Norway

2 Department of Paediatrics, Haukeland University Hospital, N-5021 Bergen, Norway

3 Department of Paediatrics and Child Health, Makerere University College of Health Sciences, School of Medicine, P.O Box 7072, Kampala, Uganda

4 Department of Women's and Children's Health, Karolinska Institutet, 17176 Stockholm, Sweden

5 Department of Microbiology, Makerere University College of Health Sciences, School of Medicine, School of Biomedical Sciences, P.O Box 7072, Kampala, Uganda

6 Department of Clinical Medicine, University of Bergen, Bergen, Norway

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BMC Pediatrics 2011, 11:9  doi:10.1186/1471-2431-11-9

Published: 2 February 2011

Abstract

Background

Calprotectin is a calcium and zinc binding protein, abundant in neutrophils and is extremely stable in faeces. Faecal calprotectin is used as a non-specific marker for gastrointestinal inflammation. It has a good diagnostic precision to distinguish between irritable bowel syndrome and inflammatory bowel disease. Studies have established normal concentrations in healthy children; all these studies have been performed in high-income countries. The objective of this study was to determine the concentration of faecal calprotectin in apparently healthy children aged 0-12 years in urban Kampala, Uganda.

Method

We tested 302 apparently healthy children aged, age 0-12 years (162 female, 140 male) in urban Kampala, Uganda. The children were recruited consecutively by door-to-door visits. Faecal calprotectin was analyzed using a quantitative enzyme-linked immunosorbent assay. Faeces were also tested for Helicobacter pylori (H. pylori) antigen, for growth of enteropathogens and microscopy was performed to assess protozoa and helminths. A short standardized interview with socio-demographic information and medical history was obtained to assess health status of the children.

Results

In the different age groups the median faecal calprotectin concentrations were 249 mg/kg in 0 < 1 year (n = 54), 75 mg/kg in 1 < 4 years (n = 89) and 28 mg/kg in 4 < 12 years (n = 159). There was no significant difference in faecal calprotectin concentrations and education of female caretaker, wealth index, gender, habits of using mosquito nets, being colonized with H. pylori or having other pathogens in the stool.

Conclusion

Concentrations of faecal calprotectin among healthy children, living in urban Ugandan, a low-income country, are comparable to those in healthy children living in high-income countries. In children older than 4 years, the faecal calprotectin concentration is low. In healthy infants faecal calprotectin is high. The suggested cut-off concentrations in the literature can be used in apparently healthy Ugandan children. This finding also shows that healthy children living under poor circumstances do not have a constant inflammation in the gut. We see an opportunity to use this relatively inexpensive test for further understanding and investigations of gut inflammation in children living in low-income countries.