Frequency of Giardiasis in Pediatric Patients Presenting with Iron-Deficiency Anemia

Abstract

Background: Giardia duodenalis is a common enteric protozoan in children and may coexist with nutritional anemia through diarrhea, intestinal dysfunction, and impaired nutrient absorption. Objective: To determine the frequency of Giardia duodenalis infection among pediatric patients with laboratory-confirmed iron-deficiency anemia and identify associated clinical correlates. Methods: This single-center cross-sectional study enrolled 385 children aged 6 months to 12 years with confirmed iron-deficiency anemia at the Department of Pediatric Medicine, Allied Hospital-I, Faisalabad. Stool specimens were examined using microscopy and antigen testing, with polymerase chain reaction performed in a subset where available. Giardia positivity was defined as a positive result by any performed diagnostic modality. Demographic, clinical, hematologic, and biochemical variables were analyzed using SPSS version 26. Associations were assessed using chi-square testing and multivariable logistic regression. Results: Giardia duodenalis was detected in 171 children, giving a composite prevalence of 44.4% (95% CI 39.5-49.4%). Diarrhea was more frequent in Giardia-positive children than Giardia-negative children (42.7% vs 19.6%; unadjusted OR 3.05, 95% CI 1.94-4.80). In adjusted analysis, diarrhea (aOR 3.02, 95% CI 1.91-4.79; p<0.001) and male sex (aOR 1.64, 95% CI 1.07-2.51; p=0.022) were independently associated with Giardia positivity. Hemoglobin and ferritin were not independently associated with infection status. Conclusion: Giardia infection was common among children with iron-deficiency anemia, particularly in those with diarrhea, but was not independently associated with anemia severity or ferritin level. Targeted stool testing should be considered in symptomatic pediatric IDA patients in endemic settings.