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Protection against diarrhea associated with Giardia intestinalis Is lost with multi-nutrient supplementation: a study in Tanzanian children.
- Source :
-
PLoS neglected tropical diseases [PLoS Negl Trop Dis] 2011 Jun; Vol. 5 (6), pp. e1158. Date of Electronic Publication: 2011 Jun 07. - Publication Year :
- 2011
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Abstract
- Background: Asymptomatic carriage of Giardia intestinalis is highly prevalent among children in developing countries, and evidence regarding its role as a diarrhea-causing agent in these settings is controversial. Impaired linear growth and cognition have been associated with giardiasis, presumably mediated by malabsorption of nutrients. In a prospective cohort study, we aim to compare diarrhea rates in pre-school children with and without Giardia infection. Because the study was conducted in the context of an intervention trial assessing the effects of multi-nutrients on morbidity, we also assessed how supplementation influenced the relationship between Giardia and diarrhoea rates, and to what extent Giardia modifies the intervention effect on nutritional status.<br />Methods and Findings: Data were collected in the context of a randomized placebo-controlled efficacy trial with 2×2 factorial design assessing the effects of zinc and/or multi-micronutrients on morbidity (n=612; height-for-age z-score <-1.5 SD). Outcomes measures were episodes of diarrhea (any reported, or with ≥3 stools in the last 24 h) and fever without localizing signs, as detected with health-facility based surveillance. Giardia was detected in stool by enzyme-linked immunosorbent assay. Among children who did not receive multi-nutrients, asymptomatic Giardia infection at baseline was associated with a substantial reduction in the rate of diarrhea (HR 0.32; 0.15-0.66) and fever without localizing signs (HR 0.56; 0.36-0.87), whereas no such effect was observed among children who received multi-nutrients (p-values for interaction 0.03 for both outcomes). This interaction was independent of age, HAZ-scores and distance to the research dispensary. There was no evidence that Giardia modified the intervention effect on nutritional status.<br />Conclusion: Although causality of the Giardia-associated reduction in morbidity cannot be established, multi-nutrient supplementation results in a loss of this protection and thus seems to influence the proliferation or virulence of Giardia or associated intestinal pathogens.
- Subjects :
- Child, Preschool
Cohort Studies
Feces parasitology
Female
Fever prevention & control
Giardia lamblia pathogenicity
Humans
Infant
Male
Placebos administration & dosage
Prospective Studies
Tanzania
Treatment Outcome
Virulence
Carrier State therapy
Diarrhea prevention & control
Diet Therapy adverse effects
Diet Therapy methods
Food adverse effects
Giardia lamblia isolation & purification
Giardiasis therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1935-2735
- Volume :
- 5
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- PLoS neglected tropical diseases
- Publication Type :
- Academic Journal
- Accession number :
- 21666789
- Full Text :
- https://doi.org/10.1371/journal.pntd.0001158