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Controlled trial of Giardia lamblia: control strategies in day care centers
A V Bartlett1, S J Englender, B A Jarvis
1Department of International Health, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD 21205.
Insights
Controlling Giardia lamblia in daycares through stricter interventions, including treating asymptomatic infections, proved more costly without significantly improving infection control. Less intensive strategies were equally effective.
Area of Science:
- Pediatric infectious diseases
- Public health interventions
- Daycare epidemiology
Background:
- Giardia lamblia infections pose a significant challenge in childcare settings, necessitating effective control strategies.
- Current Giardia control methods in daycares vary, with unclear differences in cost-effectiveness and impact on parents and operators.
- Systematic evaluation of Giardia control strategy effectiveness in daycare environments is lacking.
Purpose of the Study:
- To compare the effectiveness of three distinct Giardia control strategies in infant-toddler daycare centers.
- To evaluate the costs associated with different Giardia intervention approaches for parents and daycare providers.
- To determine the most effective and economically viable method for Giardia infection control in daycares.
Main Methods:
- A prospective randomized controlled trial was conducted across 31 daycare centers.
- Three intervention groups were compared: comprehensive treatment (symptomatic and asymptomatic), symptomatic treatment only, and symptomatic treatment plus center-wide asymptomatic treatment.
- Giardia prevalence was monitored for 6 months, including testing new admissions.
Main Results:
- Initial Giardia prevalence ranged from 18% to 22% across groups.
- Giardia was detected in 10.5% of newly admitted children during the study period.
- At 6 months post-intervention, Giardia prevalences were 7%, 8%, and 8% in the respective groups, showing no significant difference.
Conclusions:
- Stricter Giardia control measures, including treating asymptomatic infections, incurred higher costs for daycares and parents.
- Intensified intervention strategies did not yield significantly superior control of Giardia infections within the daycare setting.
- The findings suggest that less intensive Giardia control strategies may be as effective and more cost-efficient in daycare environments.
Background:
Strategies for control of Giardia lamblia in day care differ in numbers of children treated and in costs to parents and day care operators. The effectiveness of these strategies has not been systematically evaluated.
Methods:
We conducted a prospective randomized controlled trial comparing three strategies for control of Giardia in infant-toddler day care centers: Group 1, exclusion and treatment of symptomatic and asymptomatic infected children; Group 2, exclusion and treatment of symptomatic infection only; Group 3, exclusion and treatment of symptomatic infection, treatment of asymptomatic infection in the center. The study included 31 day care centers with 4180 child-months of observation. Giardia prevalence was determined before intervention and 1, 2, 4, and 6 months later; new infants and toddlers were tested on admission.
Results:
Initial Giardia prevalences were 18% to 22% in the three groups. Giardia was identified in 10.5% of 676 new infants and toddlers entering study day care centers during the 6-month follow-up. Giardia prevalences by intervention group were 8%, 12%, and 7% at 1 month, and 7%, 8%, and 8% at 6 months.
Conclusions:
The stricter intervention resulted in greater cost in terms of child day care and parents' work days lost, but did not result in significantly better control of Giardia infections in this day care environment.