Temporal and spatial epidemiology of enteric parasitic infections in a pediatric cohort of children living in the peri-urban areas of Lima, Peru Open Access

Arcury-Quandt, Alice Elizabeth (2013)

Permanent URL: https://etd.library.emory.edu/concern/etds/qr46r158w?locale=en
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Abstract

Parasitic infection is an important cause of diarrhea in children in low-income countries. In these children, diarrhea is a common source of morbidity and mortality. Knowing spatio-temporal patterns of infection allows investigators to understand the transmission dynamics of these parasites, leading to more efficient preventative interventions. This is a study of Giardia, Cryptosporidium, Cyclospora, and microsporidia infection in a longitudinal cohort of children in a peri-urban shantytown of Lima, Peru. Weekly stool samples were collected from 465 children over a five-year period. These samples were microscopically analyzed for infections. The temporal and spatial distributions of infections were statistically analyzed for clustering with scan statistics. Seasonal patterns of infection were also qualitatively described. Cyclospora displayed consistent, annual seasonality, though infections with the other evaluated pathogens showed different clusters over time. The spatial analysis identified two regions with high prevalence of infection. Adding time to the spatial analysis confirmed these areas of high prevalence, showing that they were consistently infected over time. Studying multiple parasites allowed for the identification of these areas. No analysis showed consistent infection over the entire study period in these areas for a single parasite, but comparing the results for these areas for all parasites showed that there was a cluster of at least one parasite in these regions in each warm season during the study. This analysis shows the benefits of examining an endemic community to understand the natural occurrence of infection and demonstrate the differential patterns of infection among these parasites. These findings can help elucidate infection risk factor heterogeneity and for the development of better strategies for infection control and prevention.

Table of Contents

Chapter 1: Review of the Literature……………………………………………………….1

Chapter 2: Manuscript………………………………………………………………........….11

Introduction…………………………………………………………………......……13 Methods………………………………………………………………………….........14 Results………………………………………………………………………........……16 Discussion………………………………………………………………………........18 Tables and Figures………………………………………………………………....23

Chapter 3: Public Health Implications…………………………………………………..30

References……………………………………………………………………………….............32

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