American Journal of Epidemiology Advance Access originally published online on July 31, 2008
American Journal of Epidemiology 2008 168(6):647-655; doi:10.1093/aje/kwn177
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ORIGINAL CONTRIBUTIONS |
Lack of an Adverse Effect of Giardia intestinalis Infection on the Health of Peruvian Children
1 Département de Médecine Sociale et Préventive, Université de Montréal, Montréal, Québec, Canada
2 Department of International Health, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD
3 Proyectos en Informatica, Medicina, Salud y Agricultura, Lima, Peru
4 Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
5 Department of Veterinary Science and Microbiology, University of Arizona, Tucson, AZ
Correspondence to Dr. William Checkley, Department of International Health, Bloomberg School of Public Health, The Johns Hopkins University, 615 North Wolfe Street, E8546, Baltimore, MD 21205 (e-mail: wcheckl1{at}jhmi.edu).
Received for publication August 24, 2007. Accepted for publication May 22, 2008.
Giardia intestinalis is a common gastrointestinal protozoan worldwide, but its effects on childhood growth in developing countries are not clearly understood. The authors aimed to describe its effects on child growth. They followed 220 Peruvian children daily for diarrhea, weekly for stool samples, and monthly for anthropometry. The authors modeled the effect of nutritional status on the risk of Giardia infection and the risk of diarrhea attributable to Giardia using negative binomial regression. They modeled the effects of Giardia infection on growth using linear regression, with 85% of children becoming infected with Giardia and 87% of these becoming reinfected. In multivariable analysis, the risk of Giardia infection did not vary with weight for age (relative risk = 1.00, 95% confidence interval: 0.89, 1.12) or height for age (relative risk = 0.92, 95% confidence interval: 0.82, 1.04). Giardiasis did not affect growth at 1 or 2 months following the first infection at any age interval. The longitudinal prevalence of Giardia between 6 and 24 months of age was not associated with height gain in that interval (p = 0.981). Giardia was not associated with an increased risk of diarrhea at any age interval. Study results question the importance of Giardia as a childhood pathogen in developing countries where giardiasis is hyperendemic.
developing countries; diarrhea; Giardia lamblia; growth; natural history; Peru
Abbreviations: CI, confidence interval; HAZ, height-for-age z score; RR, relative risk; WAZ, weight-for-age z score; WHZ, weight-for-height z score
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