Care-seeking behaviour and diagnostic processes for symptomatic giardiasis in children attending an academic paediatric hospital.

Giardiasis is one of the commonest intestinal parasitic infections in Cuba. In order to determine care-seeking behaviour and diagnostic processes in paediatric in-patients with giardiasis, structured questionnaires were administered by interview mothers of children with giardiasis during January to December 2010. During the study period, 97 children were diagnosed with giardiasis, of whom 86 (88·6%) caregivers were interviewed. The median number of days from symptoms onset to the first presentation in a health unit was 2 days (range: 0-15 days). The pattern of care-seeking behaviour was variable; 41 (47·7%) of children initially visited the emergency unit in a paediatric hospital. Sixty-six children had, at least, one further contact for help before diagnosis of giardiasis was made (range: 1-5 contacts) and of the 128 contact visits, 94 (73·4%) were also targeted more to hospitals. There was a median time of 6 days between the first presentation to a health unit until diagnosis, which was mainly made by microscopic examination of duodenal aspiration. Among factors investigated in mothers, only knowing other person with giardiasis had significant association with their ability to suspect giardiasis [odds ratio (OR): 29·8, 95% confidence interval (CI): 3·71-239·4, P = 0·001]. Requesting a faecal specimen or ordering duodenal aspiration for microscopic examination during the first visit appeared associated with correct diagnosis (OR: 3·84, 95% CI: 1·57-9·40, P = 0·003). Efforts should be made to increase doctors' awareness of- and diagnostic skills for childhood giardiasis. At the same time, it is necessary to improve caregivers' awareness about giardiasis.

[Clinical features of giardiasis in different age groups of pediatric in-patients]. / Variaciones en las manifestaciones clínicas de la giardiosis en pacientes pediátricos hospitalizados, según grupos de edades.

INTRODUCTION: It has been suggested that the clinical features of giardiasis might vary in patients of different age groups. OBJECTIVE: To compare clinical presentation of giardiasis in children less than 5 years of age and older children. METHODS: A retrospective study of patients hospitalized with giardiasis during 2007 was performed. The clinical features of the two age groups were compared. Additionally, length of stay was analyzed. RESULTS: In total, 170 patients were included. In children ≥ 5 years of age, abdominal pain and urticaria were significantly more frequent (OR=9.46; 95%CI: 4.35-20.52,P5=0.000+ and OR=11.0; 95%CI: 1.205-101.11, P=0.023, respectively). Diarrhoea was more frequently found in children younger than 5 years (OR=6.45; IC 95%: 3. 12-13.37, P=0.000+). The frequencies of other symptoms were similar. Length of stay was significantly higher in children under 5 years of age. DISCUSSION AND CONCLUSIONS: Clinical presentations differed in some aspects among the examined age group of our paediatric patients. Our finding might be of importance for an early recognition of giardiasis, which is essential for an accurate diagnosis and a prompt treatment.

Variaciones en las manifestaciones clínicas de la giardiosis en pacientes pediátricos hospitalizados, según grupos de edades / Clinical features of giardiasis in different age groups of pediatric in-patients

It has been suggested that the clinical features of giardiasis might vary in patients of different age groups. Objective: To compare clinical presentation of giardiasis in children less than 5 years of age and older children. Methods: A retrospective study of patients hospitalized with giardiasis during 2007 was performed. The clinical features of the two age groups were compared. Additionally, length of stay was analyzed. Results: In total, 170 patients were included. In children ≥ 5 years of age, abdominal pain and urticaria were significantly more frequent (OR=9.46; 95%CI: 4.35-20.52,P5=0.000+ and OR=11.0; 95%CI: 1.205-101.11, P=0.023, respectively). Diarrhoea was more frequently found in children younger than 5 years (OR=6.45; IC 95%: 3. 12-13.37, P=0.000+). The frequencies of other symptoms were similar. Length of stay was significantly higher in children under 5 years of age. Discussion and conclusions: Clinical presentations differed in some aspects among the examined age group of our paediatric patients. Our finding might be of importance for an early recognition of giardiasis, which is essential for an accurate diagnosis and a prompt treatment.

La giardiosis es una enfermedad frecuente a escala internacional. Se ha sugerido por algunos autores que su presentación clínica puede variar con la edad. Objetivo: Comparar las manifestaciones clínicas de la giardiosis en los niños hospitalizados bajo 5 años de edad con las de niños de 5 años o más. Métodos: Estudio retrospectivo realizado en el Hospital Pediátrico de Centro Habana durante el año 2007. Las manifestaciones clínicas fueron extraídas utilizando un formulario prediseñado y separadas de acuerdo a los grupos de edades estudiados. Adicionalmente, se extrajo la estadía hospitalaria. Resultados: Se incluyeron 170 pacientes. Los niños de 5 y más años de edad manifestaron con mayor frecuencia dolor abdominal (OR = 9,46; IC 95%: 4,35-20,52, p = 0,000+) y urticaria (OR = 11,0; IC 95%: 1,205-101,11, p = 0,023), mientras que la diarrea se encontró más frecuentemente bajo 5 años de edad (OR = 6,45; IC 95%: 3,12-13,37, p = 0,000+). En el resto de las manifestaciones clínicas no se encontraron diferencias significativas en sus frecuencias entre ambos grupos de edades (p > 0,05). La estadía hospitalaria fue significativamente más prolongada entre los pacientes bajo 5 años de edad. Discusión y conclusiones: Las manifestaciones clínicas pueden variar en algunos aspectos entre los diferentes grupos de edades pediátricas. Su rápido reconocimiento es esencial con el fin de arribar a un diagnóstico preciso y al tratamiento oportuno.

Parental perceptions of giardiasis: a study in an outpatient paediatric hospital setting in havana, cuba.

Background. Giardia lamblia is an important cause of diarrhoeal disease throughout the world. Giardiasis- a mild and self-limiting disease that this protozoan causes- is perceived as a harmful disease. Aim. To explore the general level of awareness about giardiasis, clinical features, mode of transmission, prevention, and consequences and describe the sources and channels of information caregivers would prefer using to be informed about this disease. Methods. A cross-sectional survey was conducted among caregivers attending to the outpatient paediatric hospital setting in Havana. Results. A total of 202 caregivers were interviewed. Nearly 73% considered giardiasis as a modern problem, and 39% considered that it could be a fatal disease. Although 76.7% were aware that small intestine is the organ affected, other localizations were cited. Abdominal pain and diarrhoea were recognized as the commonest symptoms. Around one-third could identify that giardiasis may spread through drinking unboiled water and unwashed vegetables other incorrect ways were mentioned; respondents with more than 12 years of formal education were more likely to have better knowledge. Discussion. Strategies to control giardiasis need to be through an integrated approach aiming at boosting caregivers' knowledge and encouraging healthcare workers to act as a readily available source for health information.

Mebendazole compared with secnidazole in the treatment of adult giardiasis: a randomised, no-inferiority, open clinical trial.

To compare the efficacy and safety of mebendazole and secnidazole in the treatment of giardiasis in adult patients, a single-centre, parallel group, open-label, randomized non-inferiority trial was carried out. One-hundred and 26 participants who had symptomatic Giardia mono-infection took part in the study. Direct wet mount and/or Ritchie concentration techniques and physical examinations were conducted at the time of enrolment and at the follow-up visit. The primary outcome measure was parasitological cure, performed at 3, 5, 10 days post-treatment. Negative faecal specimens for Giardia were ensured by the same parasitological techniques. At follow up (day 10) the parasitological cure rate for the per protocol populations was 88.7% (55/62) for MBZ and 91.8% (56/61) for SNZ. For the intention to treat populations the cure rate at the end of treatment was 85.9% (55/64) for MBZ and 90.3% (56/62) for SNZ. Both analyzes showed there was not significant statistical difference between MBZ and SNZ treatment efficacy. Both drugs were well tolerated, only mild, transient and self-limited side effects were reported and did not require discontinuation of treatment. A 3-day course of mebendazole seems to be as efficacious and safe for treatment of giardiasis as a single dose of secnidazole in adults.

Caregiver perspectives for the prevention, diagnosis and treatment of childhood giardiasis in Havana City, Cuba. A qualitative study.

Although long considered a non-pathogenic protozoan, Giardia lamblia is now a well recognized cause of abdominal discomfort, diarrhoea and failure-to-thrive in children. The overall prevalence of this infection in Cuban population is about 7.2%; however, higher prevalences have been found among young children attending day-care centres and primary school in the country. Anecdotally, clinical giardiasis is generally considered to place a large burden on both diagnostic and treatment services in Cuba. In order to gain insight into caregivers' perspectives with respect to this infection in children, a qualitative study was carried out in a paediatric hospital in Cuba. Focus group discussions were conducted to gather information about the awareness of the giardiasis, their mode of transmission and symptoms, diagnosis process, treatment seeking behaviour, possible ways of prevention, and barriers for not adopting preventive behaviours, the source and channels of information about this disease. Caregivers have knowledge of giardiasis, although there were myths and misconceptions regarding giardiasis. Manifestations like diarrhoea, abdominal pain and nausea were cited; however, asymptomatic forms of these infections are hardly accepted. Boiling water and washing hands before eating and after defecation and washing vegetables were mentioned among the principal ways of preventing this infection. The most commonly mentioned reasons for not adopting preventive behaviours included lack of time due to outdoor activities and limitation of combustible distribution. Treatment-seeking behaviour when giardiasis suspected mainly included visiting the nearby family doctor. The findings of this study reveal the need for a health education intervention in areas of misperceptions and confusion.