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Clin Infect Dis. 2016 Sep 15;63(6):792-7. doi: 10.1093/cid/ciw391. Epub 2016 Jun 16.

A Prospective Longitudinal Cohort to Investigate the Effects of Early Life Giardiasis on Growth and All Cause Diarrhea.

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Division of Pediatric Infectious Diseases, Children's Hospital of Richmond at Virginia Commonwealth University.
Parasitology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka.
Department of Public Health Sciences, University of Virginia, Charlottesville.
Department of Medicine and Vaccine Testing Center, The University of Vermont College of Medicine, Burlington.
Division of Infectious Diseases and International Health, University of Virginia, Charlottesville.
Division of Infectious Diseases, University of North Carolina-Chapel Hill.



Growth stunting in children under 2 years of age in low-income countries is common. Giardia is a ubiquitous pathogen in this age group but studies investigating Giardia's effect on both growth and diarrhea have produced conflicting results.


We conducted a prospective longitudinal birth cohort study in Dhaka, Bangladesh, with monthly Giardia and continuous diarrheal surveillance.


629 children were enrolled within the first 72 hours of life, and 445 completed 2 years of the study. 12% of children were stunted at birth with 57% stunted by 2 years. 7% of children had a Giardia positive surveillance stool in the first 6 months of life, whereas 74% had a positive stool by 2 years. The median time to first Giardia positive surveillance stool was 17 months. Presence of Giardia in a monthly surveillance stool within the first 6 months of life decreased length-for-age Z score at 2 years by 0.4 (95% confidence interval, -.80 to -.001; P value .05) whereas total number of Giardia positive months over the 2-year period of observation did not. Neither variable was associated with weight-for-age Z score at 2 years. In our model to examine predictors of diarrhea only exclusive breastfeeding was significantly associated with decreased diarrhea (P value <.001). Concomitant giardiasis was neither a risk factor nor protective.


Early life Giardia was a risk factor for stunting at age 2 but not poor weight gain. Presence of Giardia neither increased nor decreased odds of acute all cause diarrhea.


Giardia; diarrhea; growth; low-income countries; stunting

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