High Prevalence of Giardia duodenalis Assemblage B Infection and Association with Underweight in Rwandan Children 英文参考文献.docVIP

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High Prevalence of Giardia duodenalis Assemblage B Infection and Association with Underweight in Rwandan Children 英文参考文献.doc

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High Prevalence of Giardia duodenalis Assemblage B Infection and Association with Underweight in Rwandan Children 英文参考文献

HighPrevalenceofGiardiaduodenalisAssemblageB InfectionandAssociationwithUnderweightinRwandan Children RalfIgnatius1.,JeanBoscoGahutu2.,ChristianKlotz3,ChristianSteininger1,CyprienShyirambere2, MichelLyng1,AndreMusemakweri2,ToniAebischer3,PeterMartus4,GundelHarms1, FrankP.Mockenhaupt1* 1Institute of Tropical Medicine and International Health, Charite′ – University Medicine Berlin, Berlin, Germany, 2University Teaching Hospital of Butare, Faculty of Medicine, National University of Rwanda, Butare, Rwanda, 3Robert Koch-Institute, Department of Mycology and Parasitology, Berlin, Germany, 4Institute of Clinical EpidemiologyandAppliedBiometry,EberhardKarlsUniversity,Tu¨bingen,Germany Abstract Background:GiardiaduodenalisishighlyendemicinEastAfricabutitseffectsonchildhealth,particularlyofsubmicroscopic infections,i.e.,thosebelowthethresholdofmicroscopy,andofgeneticsubgroups(assemblages),arenotwellunderstood. We aimed at addressing these questions and at examining epidemiological characteristics of G. duodenalis in southern highlandRwanda. Methodology/Principal Findings: In 583 children ,5 years of age from communities and health facilities, intestinal parasiteswereassessedbytriplicatelightmicroscopyandbyPCRassays,andG.duodenalisassemblagesweregenotyped. Cluster effects of villages were taken into account in statistical analysis. The prevalence of G. duodenalis as detected by microscopywas19.8%but60.1%includingPCRresults.Prevalencedifferedwithresidence,increasedwithage,andwas reduced by breastfeeding. In 492 community children without, with submicroscopic and with microscopic infection, underweight(weight-for-agez-score,22standarddeviations)wasobservedin19.7%,22.1%,and33.1%,respectively,and clinicallyassessedseveremalnutritionin4.5%,9.5%,and16.7%.MultivariateanalysisidentifiedmicroscopicallydetectableG. duodenalis infection as an independent predictor of underweight and clinically assessed severe malnutrition. Submicroscopic infection showed respective trends. Overall,