Risk factors for Giardia infection among hospitalized children in Cuba

Individual and Community-Level Risk Factors for Giardiasis in Children under Five Years of Age in Pakistan: A Prospective Multi-Regional Study

OBJECTIVES

This study aimed to estimate the prevalence of Giardia lamblia infection and identify associated risk factors at both individual and community levels in a pediatric population in different agroecological zones of Khyber Pakhtunkhwa, Pakistan.

METHODS

A community-based cross-sectional study was conducted from March to December 2022. Using stratified sampling, 1026 households were recruited from nine agroecological zones. Stool samples were collected from 1026 children up to the age of five years and processed for detection of Giardia using a commercial ELISA kit. Data on potential risk factors were collected using a pre-structured questionnaire. A multivariable logistic regression model was used to identify risk factors associated with giardiasis.

RESULTS

The study found that the prevalence of giardiasis in the study area was 3.31%. Children aged 13-24 months were found to be at higher risk for giardiasis. Illiterate mothers and fathers attending daycare institutions/kindergartens, mothers not practicing hand washing during critical times, households with companion animals, and homes where stray dogs/cats enter were identified as predictors of giardiasis at the individual level. Children living in sub-mountain valleys use un-piped water, inadequate domestic water storage vessels, drink un-boiled or unfiltered water, live near rubbish heaps or un-paved streets/pathways, and have unimproved latrine facilities were identified as risk factors of giardiasis at the community level.

CONCLUSIONS

The study highlights the need for integrated intervention approaches at both individual and community levels to reduce the incidence of giardiasis in Khyber Pakhtunkhwa, Pakistan. Interventions aimed at promoting behavioral change and providing safe and adequate water sources, combined with individual-level interventions such as hand washing and awareness of giardiasis prevention methods, would be critical to addressing this health concern. Inter-sectoral collaboration between the health sector and other sectors would also be necessary to achieve meaningful progress in reducing the incidence of giardiasis in resource-limited areas.

Toward waterborne protozoa detection using sensing technologies

Drought and limited sufficient water resources will be the main challenges for humankind during the coming years. The lack of water resources for washing, bathing, and drinking increases the use of contaminated water and the risk of waterborne diseases. A considerable number of waterborne outbreaks are due to protozoan parasites that may remain active/alive in harsh environmental conditions. Therefore, a regular monitoring program of water resources using sensitive techniques is needed to decrease the risk of waterborne outbreaks. Wellorganized point-of-care (POC) systems with enough sensitivity and specificity is the holy grail of research for monitoring platforms. In this review, we comprehensively gathered and discussed rapid, selective, and easy-to-use biosensor and nanobiosensor technologies, developed for the early detection of common waterborne protozoa.

Molecular characterization of Giardia lamblia and risk factors for giardiasis among immunocompromised patients in southern Brazil

Acute Giardia infections often cause diarrhea and stomach upset. Chronic infections can lead to malnutrition, micronutrient deficiencies, malabsorption and weight loss. This study assessed the prevalence of G. lambia infection and assessed associated risk factors among immunocompomised patients undergoing chemotherapeutic treatment in southern Brazil. A total of 110 immunocompromised patients in Pelotas, RS, Brazil, consented to participate in this study and were recruited. Socioeconomic and epidemiological profile of patients was collected by questionnaire. The prevalence for Giardia were determined through microscopy by the centrifugation-flotation technique using stool samples of every patient. In addition, the genetic characterization of the parasite was carried out by amplifying and sequencing the glutamate dehydrogenase (gdh) gene. By microscopy, the prevalence of giardiasis was 17.3% (19/110). Furthermore, the DNA sequences revealed that 7 (36.8%) out of 19 isolates belonged to assemblage B, while 6 of them (31.6%) belonged to assemblage C, 5 (26.3%) to assemblage A and 1 (5.3%) to assemblage D. Risk factors (p ≤ 0.05) for giardiasis were schooling level (OR=8.0 (1.02 - 62.91) sharing a house with more than three people (OR=14.1 (3.77 - 52.51), water sources (OR=38.9 (10.4 - 145.7), sewage treatment (OR=14.2 (3.1 - 65.5), waste destination (OR=7.44 (2.0 - 27.3), owning pets (OR=4.6 (1.0 - 21.2) and cultivating a vegetable garden (OR=4.2 (1.3 - 13.6). The prevalence of G. lamblia in immunocompromised patients was considered elevate with the identification of four assemblage of the parasite (A, B, C and D).

Anthropometric Indices of Giardia-Infected Under-Five Children Presenting with Moderate-to-Severe Diarrhea and Their Healthy Community Controls: Data from the Global Enteric Multicenter Study

Among all intestinal parasitosis, giardiasis has been reported to be associated with delayed growth in malnourished children under 5 living in low- and middle-income countries. Relevant data on the nutritional status of children aged 0–59 months presenting with moderate-to-severe diarrhea (MSD) and giardia infection were collected from sentinel health facilities of the Global Enteric Multicenter Study’s (GEMS) seven field settings, placed in diverse countries of Sub-Saharan Africa and South Asia between, December 2007 and February 2011. Then, this study analyzed a robust dataset of study participants (n = 22,569). Children having giardiasis with MSD constituted as cases (n = 1786), and those without MSD constituted as controls (n = 3470). Among the seven field sites, symptomatic giardiasis was 15% and 22% in Asian and African sites, respectively, whereas asymptomatic giardia infection (healthy without MSD) in Asian and African sites was 21.7% and 30.7%, respectively. Wasting and underweight were more frequently associated and stunting less often associated with symptomatic giardiasis (for all, p < 0.001). Symptomatic giardiasis had a significant association with worsening of nutritional status in under-five children. Improved socio-economic profile along with proper sanitation and hygienic practices are imperative to enhance child nutritional status, particularly in resource limited settings.

The risk factors for intestinal Giardia spp infection: Global systematic review and meta-analysis and meta-regression

Parasitic infections are a public health concern as they can cause aggression, growth retardation, weight loss, anemia, and other health problems. In this study, a systematic review and meta-analysis were performed to find an association between the probable social-environmental risk factors including lack of safe drinking water, no hand washing, sex, age, no access to education, no access to toilet, and Giardia spp infection. We conducted literature research among international databases including Scopus, PubMed, Web of Science and Cochrane from1 January 1995 to March 15, 2020, including 23 articles with 102 studies while the odds ratio (OR) was calculated using 2 × 2 tables or extracted. The pooled effect size with 95% confidence intervals (CIs) was estimated using a random or fixed-effects model. The results show a significant association between intestinal Giardia spp infection risk and lack of safe drinking water (OR: 1.14; 95%CI: 1.02-1.25); no access to toilet (OR: 1.22; 95%CI: 1.07-1.37); and age (2-10 vs 10-30 year) (OR: 1.42; 95%CI: 1.09-1.78). An insignificant association was observed between intestinal Giardia spp infection risk and age (<2 vs 2-10 year) (OR: 0.89; 95%CI: 0.75-1.02); no access to education (OR: 1.10; 95%CI: 0.80-1.40); Sex (male vs female) (OR: 1.04; 95%CI: 0.74-1.34); and no handwashing (OR: 1.18; 95%CI: 0.87-1.49). The results of meta-regression also indicate that intestinal Giardia spp infection has decreased over time (C= -0.024, p-value = 0.03) significantly, and also by growth of human development index (HDI) (C= - 0.42, p-value = 0.29) insignificantly. Improvement of personal hygiene, sanitation and raising public awareness can be effective in reducing Giardia spp infections.

Intestinal protozoan infections among children 0-168 months with diarrhea in Mozambique: June 2014 - January 2018

BACKGROUND

Intestinal parasites such as Cryptosporidium spp., Giardia lamblia and Entamoeba histolytica can cause severe diarrhea, especially among children in developing countries. This study aims to determine the frequency of Cryptosporidium spp., Giardia lamblia and Entamoeba histolytica in children with diarrhea and identify risk factors for infection.

METHODOLOGY

We conducted a cross-sectional study in children aged 0-168 months hospitalized with diarrhea in three regions of Mozambique, from June 2014 to January 2018. Following consent, caretakers were interviewed and a single stool specimen was collected from each child to diagnose Cryptosporidium spp., G. lamblia and E. histolytica using commercial immune-enzymatic assay (TechLab, Inc, Blacksburg, VA, USA). Anthropometric data were collected from the clinical reports. Multivariable logistic regression models were built to identify risk factors for Cryptosporidium spp. and G. lamblia infection.

RESULTS

Twenty-one percent of all specimens (212/1008) presented at least one parasitic infection. Cryptosporidium spp. infection was the most common 12.0% (118/985), followed by G. lamblia 9.7% (95/983) and E. histolytica 2.0% (20/1004). Risk factors for infection by Cryptosporidium spp. were: provenience (children from Nampula province showed the highest risk, OR: 8.176; CI: 1.916-34.894; p-value < 0.01); animal contact (children with animal contact had a protective effect OR: 0.627; CI: 0.398-0.986; p-value < 0.05); underweight (children severely underweight showed a risk of 2.309; CI: 1.310-4.069; p-value < 0.05). Risk factors for infection by G. lamblia were: age (group with highest risk, 60-168 months (OR: 2.322; CI: 1.000-5.393, p-value > 0.05)); and living in a household with five or more members (OR: 2.141; CI: 1.286-3.565, p-value < 0.01).

CONCLUSIONS

Parasitic infection is common among children with diarrhea. Routine testing, standard treatment, and assessment for risk exposure of children with diarrhea should be implemented at health facilities in Mozambique.

Chronic nail biting, orthodontic treatment and Enterobacteriaceae in the oral cavity

Background

Chronic nail biting is common in children and young adults. Auto inoculation of environmental pathogens can manifest as infection in distant organs. Multi-drug resistance gram negative bacteria are on the rise globally. Several of the foodborne bacteria fall within the Enterobacteriaceae family but very few studies have explored these microbes in the oral cavity of children with chronic nail-biting habit or orthodontic treatment. The study aims to investigate oral load of Enterobacteriaceae in children with chronic nail-biting habit and or those undergoing orthodontic treatment.

Material and Methods

150 children (no nail-biting n=30, nail biting n=60, fixed orthodontic treatment n =30 and a combination of fixed orthodontic appliance use and nail-biting habit n =30) were assessed for culture based microbiological investigation. The concentrated oral rinse technique was used. The rinse was inoculated in MacConkey’s and Blood Agar. The gram stained culture was subjected to biochemical tests for sub-species identification using Biomerieux Vitek 2 Compact Automated Microbiological Analyzer. Fisher’s exact and Kruskal Wallis with post hoc analysis using Dunn method was performed to test association and difference between groups.

Results

Enterobacteriaceae was positive for 72% of the children. Of them, nail biting or orthodontic treatment group comprised 89%. Those with a combination of nail biting and undergoing orthodontic treatment exhibited highest CFU/ml and those without nail biting or orthodontic treatment exhibited the lowest. Three of the four organisms isolated tested positive in the orthodontic treatment group. E. coli was positive in 38% of the children while Klebsiella and E. cloacae were isolated exclusively in the orthodontic treatment group.

Conclusions

Chronic nail biting or the use of fixed orthodontic appliances is associated with higher incidence of Enterobacteriaceae in the oral cavity. Oral health professionals play an important role in preventing multi drug resistance infectious diseases.

Key words:Enterobacteriaceae, nail-biting, Onychophagia, orthodontic treatment.

Cross-sectional epidemiological investigations of Giardia lamblia in children in Pakistan

BACKGROUND

The prevalence of Giardia lamblia in Pakistani children is currently unknown. The aim here was to evaluate the prevalence and risk factors of Giardia lamblia in children exhibiting diarrhea.

DESIGN AND SETTING

Cross-sectional study at different district healthcare hospitals in Pakistan.

METHODS

A total of 800 samples were collected from children aged 0-10 years. Information regarding personal data, demographic data and supposed risk factors was collected through a structured questionnaire. Giardia lamblia was detected through direct microscopy and antigens through the enzyme-linked immunosorbent assay (ELISA).

RESULTS

The prevalence of Giardia lamblia was 2.75% through direct microscopy and inflated to 9.5% through ELISA. The demographic factors positively associated with occurrences of giardiasis were age (P = 0.035; odds ratio, OR = 1.96; 95% confidence interval, CI = 1.094-3.533), mother's educational level (P = 0.031; OR = 2.67; 95% CI = 1.186-6.045) and father's educational level (P = 0.004; OR = 3.56; 95% CI = 1.612-7.899). Similarly, among the supposed risk factors, rural residency (P = 0.032; OR = 1.76; 95% CI = 1.098- 2.851), absence of proper sewerage system (P = 0.000; OR = 6.60; 95% CI = 4.029-10.841) and unavailability of safe drinking water (P = 0.000; OR = 4.08; 95% CI = 2.207-7.547) were the factors strongly connected with giardiasis. Abdominal discomfort was a prominent clinical sign with 46% frequency.

CONCLUSION

Various risk factors were associated with occurrences of Giardia, thus emphasizing the importance of parents' education, safe drinking water and proper sewerage systems for Pakistani children's health.

Risk factors for sporadic Giardia infection in the USA: a case-control study in Colorado and Minnesota

Giardia duodenalis is the most common intestinal parasite of humans in the USA, but the risk factors for sporadic (non-outbreak) giardiasis are not well described. The Centers for Disease Control and Prevention and the Colorado and Minnesota public health departments conducted a case-control study to assess risk factors for sporadic giardiasis in the USA. Cases (N = 199) were patients with non-outbreak-associated laboratory-confirmed Giardia infection in Colorado and Minnesota, and controls (N = 381) were matched by age and site. Identified risk factors included international travel (aOR = 13.9; 95% CI 4.9-39.8), drinking water from a river, lake, stream, or spring (aOR = 6.5; 95% CI 2.0-20.6), swimming in a natural body of water (aOR = 3.3; 95% CI 1.5-7.0), male-male sexual behaviour (aOR = 45.7; 95% CI 5.8-362.0), having contact with children in diapers (aOR = 1.6; 95% CI 1.01-2.6), taking antibiotics (aOR = 2.5; 95% CI 1.2-5.0) and having a chronic gastrointestinal condition (aOR = 1.8; 95% CI 1.1-3.0). Eating raw produce was inversely associated with infection (aOR = 0.2; 95% CI 0.1-0.7). Our results highlight the diversity of risk factors for sporadic giardiasis and the importance of non-international-travel-associated risk factors, particularly those involving person-to-person transmission. Prevention measures should focus on reducing risks associated with diaper handling, sexual contact, swimming in untreated water, and drinking untreated water.

Effects of Boiling Drinking Water on Diarrhea and Pathogen-Specific Infections in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Globally, approximately 2 billion people lack microbiologically safe drinking water. Boiling is the most prevalent household water treatment method, yet evidence of its health impact is limited. To conduct this systematic review, we searched four online databases with no limitations on language or publication date. Studies were eligible if health outcomes were measured for participants who reported consuming boiled and untreated water. We used reported and calculated odds ratios (ORs) and random-effects meta-analysis to estimate pathogen-specific and pooled effects by organism group and nonspecific diarrhea. Heterogeneity and publication bias were assessed using I2, meta-regression, and funnel plots; study quality was also assessed. Of the 1,998 records identified, 27 met inclusion criteria and reported extractable data. We found evidence of a significant protective effect of boiling for Vibrio cholerae infections (OR = 0.31, 95% confidence interval [CI] = 0.13-0.79, N = 4 studies), Blastocystis (OR = 0.35, 95% CI = 0.17-0.69, N = 3), protozoal infections overall (pooled OR = 0.61, 95% CI = 0.43-0.86, N = 11), viral infections overall (pooled OR = 0.83, 95% CI = 0.7-0.98, N = 4), and nonspecific diarrheal outcomes (OR = 0.58, 95% CI = 0.45-0.77, N = 7). We found no evidence of a protective effect for helminthic infections. Although our study was limited by the use of self-reported boiling and non-experimental designs, the evidence suggests that boiling provides measureable health benefits for pathogens whose transmission routes are primarily water based. Consequently, we believe a randomized controlled trial of boiling adherence and health outcomes is needed.

Prevention of intestinal parasites in a tri-border area of Latin America: Children perceptions and an integral health education strategy

To investigate knowledge of school-aged children and their perception on intestinal parasites, and to assess knowledge reconstruction on prevention practices after specific training in the subject. We performed an activity package that included the analysis of children's drawings of intestinal parasites, and information and communication technologies (ITCs) to transfer knowledge about these pathogens and prevention measures. Retrieval learning activities were performed to fixation of general and specific prevention and control measures.Overall, we found that there is a knowledge gap in many aspects of parasite biology and ecology, and therefore on the risk of infection and acquisition mechanisms. After ITCs, the children improved their knowledge over non-trained children.The approaches used to transfer knowledge and for learning, fixation were valuable tools for incorporating changes in misconceptions and in the deep-rooted habits that favour entero-parasitic diseases. This has important implications for the specific design of future education materials and campaigns. Understanding of perceptions helps to provide justifications and knowledge to achieve changes in unhealthy habits, and it constitutes the basis for the transformation of many risky practices.

Thumb-Sucking, Nail-Biting, and Atopic Sensitization, Asthma, and Hay Fever

BACKGROUND

The hygiene hypothesis suggests that early-life exposure to microbial organisms reduces the risk of developing allergies. Thumb-sucking and nail-biting are common childhood habits that may increase microbial exposures. We tested the hypothesis that children who suck their thumbs or bite their nails have a lower risk of developing atopy, asthma, and hay fever in a population-based birth cohort followed to adulthood.

METHODS

Parents reported children's thumb-sucking and nail-biting habits when their children were ages 5, 7, 9, and 11 years. Atopic sensitization was defined as a positive skin-prick test (≥2-mm weal) to ≥1 common allergen at 13 and 32 years. Associations between thumb-sucking and nail-biting in childhood, and atopic sensitization, asthma, and hay fever at these ages were assessed by using logistic regression with adjustments for sex and other potential confounding factors: parental atopy, breastfeeding, pet ownership, household crowding, socioeconomic status, and parental smoking.

RESULTS

Thirty-one percent of children were frequent thumb-suckers or nail-biters at ≥1 of the ages. These children had a lower risk of atopic sensitization at age 13 years (odds ratio 0.67, 95% confidence interval 0.48-0.92, P = .013) and age 32 years (odds ratio 0.61, 95% confidence interval 0.46-0.81, P = .001). These associations persisted when adjusted for multiple confounding factors. Children who had both habits had a lower risk of atopic sensitization than those who had only 1. No associations were found for nail-biting, thumb-sucking, and asthma or hay fever at either age.

CONCLUSIONS

Children who suck their thumbs or bite their nails are less likely to have atopic sensitization in childhood and adulthood.

Giardia lamblia infections in children in Ghana

INTRODUCTION

Though giardiasis is an important public health problem in Ghana, several aspects of its epidemiology, particularly the molecular epidemiology has not been investigated adequately. This could be a major hindrance to effective surveillance and control of giardiasis in the country. The study was carried out to determine the prevalence, risk factors and genotypes of Giardia lamblia infecting children at a paediatric hospital in Ghana.

METHODS

A total of 485 patients including 365 diarrhoea and 120 non-diarrhoea children were enrolled into the study. Stool samples were collected and analysed for parasite presence using microscopy, ELISA and PCR. Positive samples were subsequently characterized into assemblages by PCR-RFLP, and further confirmed with sequencing of the glutamate dehydrogenase (gdh) gene. Epidemiological data on demographic, clinical and behavioral features of the study subjects were also collected.

RESULTS

Prevalence of G. lamblia infections in diarrhoea and non-diarrhoea children were 5.8% and 5% respectively (P>0.5). Sequence data confirmed Giardia lamblia assemblage B as the predominant genotype in both diarrhoea and non-diarrhoea cases. There was no significant association of G. lamblia infection with any of the epidemiological variables investigated.

CONCLUSION

Our findings suggest that assemblage B could be the predominant genotype causing giardiasis in children. Increased public health education focusing on good sanitary practices, particularly among mothers and children, could decrease the risk of G. lamblia infection.

Hygiene practices and faecal contamination of the hands of children attending primary school in Mauritius

BACKGROUND

An increasing prevalence of paediatric infections have been associated with poor levels of hygienic practices.

METHODS

This study aimed at investigating the level of hygiene practices among 200 school children aged 6-10 years. Their hands were swabbed and the bacteria were identified by Gram staining and conventional biochemical tests.

RESULTS

Of the 200 samples, 91.0% (182) showed bacterial growth. Coagulase negative Staphylococcus was the most common bacterium isolated from 76.9% (140) of the samples followed by Micrococcus, Bacillus, Pseudomonas, Proteus and Escherichia coli. Children aged 9-10 years were more likely to wash their hands before eating than those aged 6-8 years (OR=2.0; p<0.05). A higher bacterial growth was noted from children who washed their hands with water only than those who used soap (OR=5.9; p<0.05). Furthermore, children aged 6-8 years were more likely to have oral-digital habits (OR=2.5; p<0.05), less likely to wash hands after using the toilet, more prone to use water only to wash their hands at home and had higher bacterial growth (p<0.05).

CONCLUSIONS

A scarcity of soap was noted in the schools which could prevent the children from adopting proper hygiene practices. Furthermore, children should be often reminded of the importance of hygienic practices.

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.

Potential impact of macroclimatic variability on the epidemiology of giardiasis in three provinces of Cuba, 2010-2012

Climate change and variability are common phenomena affecting various infectious diseases. Many studies have been performed on vector-borne diseases; however, few studies have addressed such influences on intestinal parasitic diseases (e.g., giardiasis). In this study, using nonlinear Poisson regression models, we assessed the potential associations between macroclimatic variation and giardiasis cases in children and school workers from three provinces of Cuba in the context of large sampling and parasitological assessment. Between 2010 and 2012, 293,019 subjects were assessed, resulting in 6357 positive for Giardia (216.95 cases/10,000 pop.; 95%CI 211.7-222.2). The variation in time for those giardiasis rates ranged from 35.8 to 525.8 cases/10,000 pop. Nonlinear Poisson regression models between the ONI index and the giardiasis incidence indicated a significant association (p<0.01). With lower values of ONI, lower incidence of giardiasis was observed at Havana (pseudo r(2)=0.0576; p<0.001) and Guantánamo (pseudo r(2)=0.0376; p<0.001). Although these results are preliminary and the magnitude of association is not higher, the results were of statistical significance. This result indicates the need to assess in detail in further studies the impact of additional macroclimatic and microclimatic variables on the epidemiology of this still important intestinal parasitic disease, not only in Cuba but also in other countries of the Caribbean and Latin American region.

Habit Reversal versus Object Manipulation Training for Treating Nail Biting: A Randomized Controlled Clinical Trial

OBJECTIVE

This is a parallel, three group, randomized, controlled clinical trial, with outcomes evaluated up to three months after randomization for children and adolescents with chronic nail biting. The current study investigates the efficacy of habit reversal training (HRT) and compares its effect with object manipulation training (OMT) considering the limitations of the current literature.

METHOD

Ninety one children and adolescents with nail biting were randomly allocated to one of the three groups. The three groups were HRT (n = 30), OMT (n = 30), and wait-list or control group (n = 31). The mean length of nail was considered as the main outcome.

RESULTS

The mean length of the nails after one month in HRT and OMT groups increased compared to the waiting list group (P < 0.001, P < 0.001, respectively). In long term, both OMT and HRT increased the mean length of nails (P < 0.01), but HRT was more effective than OMT (P < 0.021). The parent-reported frequency of nail biting did show similar results as to the mean length of nails assessment in long term. The number of children who completely stopped nail biting in HRT and OMT groups during three months was 8 and 7, respectively. This number was zero during one month for the wait-list group.

CONCLUSION

This trial showed that HRT is more effective than wait-list and OMT in increasing the mean length of nails of children and adolescents in long terms.

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.

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.