title: A systematic review and meta-analysis of the association between Giardia lamblia and endemic pediatric diarrhea in developing countries.
abstract: We performed a systematic literature review and meta-analysis examining the association between diarrhea in young children in nonindustrialized settings and Giardia lamblia infection. Eligible were case/control and longitudinal studies that defined the outcome as acute or persistent (>14 days) diarrhea, adjusted for confounders and lasting for at least 1 year. Data on G. lamblia detection (mainly in stools) from diarrhea patients and controls without diarrhea were abstracted. Random effects model meta-analysis obtained pooled odds ratios (ORs) and 95% confidence intervals (CIs). Twelve nonindustrialized-setting acute pediatric diarrhea studies met the meta-analysis inclusion criteria. Random-effects model meta-analysis of combined results (9774 acute diarrhea cases and 8766 controls) yielded a pooled OR of 0.60 (95% CI, .38-.94; P = .03), indicating that G. lamblia was not associated with acute diarrhea. However, limited data suggest that initial Giardia infections in early infancy may be positively associated with diarrhea. Meta-analysis of 5 persistent diarrhea studies showed a pooled OR of 3.18 (95% CI, 1.50-6.76; P < .001), positively linking Giardia with that syndrome. The well-powered Global Enteric Multicenter Study (GEMS) is prospectively addressing the association between G. lamblia infection and diarrhea in children in developing countries.
authors.affiliation: Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD 21201, USA. kmuhsen@medicine.umaryland.edu
authors.forename: Khitam
authors.initials: K
authors.lastname: Muhsen
authors.forename: Myron M
authors.initials: MM
authors.lastname: Levine
mesh_terms: D058070:Asymptomatic Diseases / Q000453:epidemiology; D002675:Child, Preschool; D015331:Cohort Studies; D003906:Developing Countries / Q000706:statistics & numerical data; D003967:Diarrhea / Q000453:epidemiology* / Q000469:parasitology*; D015340:Epidemiologic Research Design; D005260:Female; D016829:Giardia lamblia / Q000302:isolation & purification*; D005873:Giardiasis / Q000453:epidemiology* / Q000469:parasitology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015337:Multicenter Studies as Topic