• 1.

    Kosek M, Bern C, Guerrant RL, 2003. The global burden of diarrhoeal disease, as estimated from studies published between 1992 and 2000. Bull World Health Organ 81: 197204.

    • Search Google Scholar
    • Export Citation
  • 2.

    Checkley W, Epstein LD, Gilman RH, Cabrera L, Black RE, 2003. Effects of acute diarrhea on linear growth in Peruvian children. Am J Epidemiol 157: 166175.

    • Search Google Scholar
    • Export Citation
  • 3.

    Checkley W, Buckley G, Gilman RH, Assis AM, Guerrant RL, Morris SS, Molbak K, Valentiner-Branth P, Lanata CF, Black RE, 2008. Multi-country analysis of the effects of diarrhoea on childhood stunting. Int J Epidemiol 37: 816830.

    • Search Google Scholar
    • Export Citation
  • 4.

    Niehaus MD, Moore SR, Patrick PD, Derr LL, Lorntz B, Lima AA, Guerrant RL, 2002. Early childhood diarrhea is associated with diminished cognitive function 4 to 7 years later in children in a northeast Brazilian shantytown. Am J Trop Med Hyg 66: 590593.

    • Search Google Scholar
    • Export Citation
  • 5.

    Bern C, Ortega Y, Checkley W, Roberts JM, Lescano AG, Cabrera L, Verastegui M, Black RE, Sterling C, Gilman RH, 2002. Epidemiologic differences between cyclosporiasis and cryptosporidiosis in Peruvian children. Emerg Infect Dis 8: 581585.

    • Search Google Scholar
    • Export Citation
  • 6.

    Checkley W, Gilman RH, Black RE, Epstein LD, Cabrera L, Sterling CR, Moulton LH, 2004. Effect of water and sanitation on childhood health in a poor Peruvian peri-urban community. Lancet 363: 112118.

    • Search Google Scholar
    • Export Citation
  • 7.

    Teixeira JC, Heller L, Barreto ML, 2007. Giardia duodenalis infection: risk factors for children living in sub-standard settlements in Brazil. Cad Saude Publica 23: 14891493.

    • Search Google Scholar
    • Export Citation
  • 8.

    Checkley W, Gilman RH, Black RE, Lescano AG, Cabrera L, Taylor DN, Moulton LH, 2002. Effects of nutritional status on diarrhea in Peruvian children. J Pediatr 140: 210218.

    • Search Google Scholar
    • Export Citation
  • 9.

    Hatt LE, Waters HR, 2006. Determinants of child morbidity in Latin America: a pooled analysis of interactions between parental education and economic status. Soc Sci Med 62: 375386.

    • Search Google Scholar
    • Export Citation
  • 10.

    Schellenberg JA, Victora CG, Mushi A, de Savigny D, Schellenberg D, Mshinda H, Bryce J, 2003. Inequities among the very poor: health care for children in rural southern Tanzania. Lancet 361: 561566.

    • Search Google Scholar
    • Export Citation
  • 11.

    Gwatkin DR, 2003. How well do health programmes reach the poor? Lancet 361: 540541.

  • 12.

    Fayer R, 1997. Cryptosporidium and Cryptosporidiosis. Boca Raton, FL: CRC Press, 4364.

  • 13.

    Eberhard ML, Pieniazek NJ, Arrowood MJ, 1997. Laboratory diagnosis of Cyclospora infections. Arch Pathol Lab Med 121: 792797.

  • 14.

    Filmer D, Pritchett LH, 2001. Estimating wealth effects without expenditure data—or tears: an application to educational enrollments in states of India. Demography 38: 115132.

    • Search Google Scholar
    • Export Citation
  • 15.

    Rutstein SO, Johnson K, 2004. The DHS Wealth Index. Calverton, MD: ORC Macro, MEASURE DHS+.

  • 16.

    Montgomery MR, Gragnolati M, Burke KA, Paredes E, 2000. Measuring living standards with proxy variables. Demography 37: 155174.

  • 17.

    Daly MC, Duncan GJ, McDonough P, Williams DR, 2002. Optimal indicators of socioeconomic status for health research. Am J Public Health 92: 11511157.

    • Search Google Scholar
    • Export Citation
  • 18.

    Bollen KA, Glanville JL, Stecklov G, 2002. Economic status proxies in studies of fertility in developing countries: does the measure matter? Popul Stud (Camb) 56: 8196.

    • Search Google Scholar
    • Export Citation
  • 19.

    Oswald WE, Hunter GC, Lescano AG, Cabrera L, Leontsini E, Pan WK, Soldan VP, Gilman RH, 2008. Direct observation of hygiene in a Peruvian shantytown: not enough handwashing and too little water. Trop Med Int Health 13: 14211428.

    • Search Google Scholar
    • Export Citation
  • 20.

    Houweling TA, Kunst AE, Mackenbach JP, 2003. Measuring health inequality among children in developing countries: does the choice of the indicator of economic status matter? Int J Equity Health 2: 8.

    • Search Google Scholar
    • Export Citation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Wealth and Its Associations with Enteric Parasitic Infections in a Low-Income Community in Peru: Use of Principal Component Analysis

View More View Less
  • Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland; Departamento de Investigación, Asociación Benéfica Proyectos en Informática, Salud, Medicina y Agricultura, Lima, Peru; Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Center for Food Safety, University of Georgia, Griffin, Georgia

The association of wealth and infections with Giardia, Cryptosporidium, Cyclospora, and microsporidia were examined in a longitudinal cohort conducted in Peru from 2001 to 2006. Data from 492 participants were daily clinical manifestations, weekly copro-parasitological diagnosis, and housing characteristics and assets owned (48 variables), and these data were used to construct a global wealth index using principal component analysis. Data were analyzed using continuous and categorical (wealth tertiles) models. Participant's mean age was 3.43 years (range = 0–12 years), with average follow-up of 993 days. Univariate and multivariate analyses identified significant associations between wealth and infections with Giardia and microsporidia. Participants with greater wealth indexes were associated with protection against Giardia (P < 0.001) and persistent Giardia infections (> 14 days). For microsporidia, greater wealth was protective (P = 0.066 continuous and P = 0.042 by tertiles). Contrarily, infections with Cryptosporidium and Cyclospora were independent of wealth. Thus, subtle differences in wealth may affect the frequency of specific parasitic infections within low-income communities.

Author Notes

*Address correspondence to Vitaliano A. Cama, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, 1600 Clifton Road, Building 23, Room 10-164, MS D-65, Atlanta, GA 30329. E-mail: VCama@cdc.gov

Authors' addresses: Shantanu Nundy, Department of Internal Medicine, University of Chicago Medical Center, Chicago, IL, E-mail: shantanu.nundy@gmail.com. Robert H. Gilman, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, E-mail: gilmanbob@gmail.com. Lihua Xiao, Geoffrey Kahn, and Vitaliano A. Cama, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: Lxiao@cdc.gov, geoff.kahn@gmail.com, and VCama@cdc.gov. Lilia Cabrera and Rosa Cama, Calle Carlos Gonzáles N°251 Urbanización Maranga, Lima, Perú, E-mails: Lcabrera@peruresearch.org and rosacama@hotmail.com. Ynes R. Ortega, Center for Food Safety, Department of Food Science and Technology, University of Georgia, Griffin, GA, E-mail: Ortega@uga.edu.

Save