High prevalence of Plasmodium falciparum and soil-transmitted helminth co-infections in a periurban community in Kwara State, Nigeria

Soil-transmitted helminths: A critical review of the impact of co-infections and implications for control and elimination

Researchers have raised the possibility that soil-transmitted helminth (STH) infections might modify the host's immune response against other systemic infections. STH infections can alter the immune response towards type 2 immunity that could then affect the likelihood and severity of other illnesses. However, the importance of co-infections is not completely understood, and the impact and direction of their effects vary considerably by infection. This review synthesizes evidence regarding the relevance of STH co-infections, the potential mechanisms that explain their effects, and how they might affect control and elimination efforts. According to the literature reviewed, there are both positive and negative effects associated with STH infections on other diseases such as malaria, human immunodeficiency virus (HIV), tuberculosis, gestational anemia, pediatric anemia, neglected tropical diseases (NTDs) like lymphatic filariasis, onchocerciasis, schistosomiasis, and trachoma, as well as Coronavirus Disease 2019 (COVID-19) and human papillomavirus (HPV). Studies typically describe how STHs can affect the immune system and promote increased susceptibility, survival, and persistence of the infection in the host by causing a TH2-dominated immune response. The co-infection of STH with other diseases has important implications for the development of treatment and control strategies. Eliminating parasites from a human host can be more challenging because the TH2-dominated immune response induced by STH infection can suppress the TH1 immune response required to control other infections, resulting in an increased pathogen load and more severe disease. Preventive chemotherapy and treatment are currently the most common approaches used for the control of STH infections, but these approaches alone may not be adequate to achieve elimination goals. Based on the conclusions drawn from this review, integrated approaches that combine drug administration with water, sanitation and hygiene (WASH) interventions, hygiene education, community engagement, and vaccines are most likely to succeed in interrupting the transmission of STH co-infections. Gaining a better understanding of the behavior and relevance of STH co-infections in the context of elimination efforts is an important intermediate step toward reducing the associated burden of disease.

Malarial and intestinal parasitic co-infections in indigenous populations of the Brazilian Amazon rainforest

The Brazilian Amazon rainforest region has a significant prevalence of malarial and intestinal parasitic infections in indigenous populations, accounting for a disproportionate burden. Thus, a cross-sectional study was conducted to assess the prevalence and association between malarial and intestinal protozoan and helminth infections in four remote indigenous villages in the Brazilian Amazon Forest. A total of 430 individuals participated in the study, and Plasmodium infections were diagnosed by examination of thick blood smears and PCR. Stool samples 295 individuals (69%) were examined by direct smear and the Kato-Katz technique. The overall prevalence of malaria, intestinal protozoan infection, and intestinal helminth infection was 14.2%, 100%, and 39.3%, respectively. Polyparasitism was predominant (83.7%), and most infected individuals had at least two or more different species of intestinal protozoan and/or helminth parasites. The prevalence of co-infection was 49.5%, and in individuals with intestinal protozoa and helminth infections (34%), Entamoeba. coli, Entamoeba histolytica, and Ascaris lumbricoides were the most common parasites. In individuals with malaria and protozoa infections (10.2%), P. vivax, E. coli, and E. histolytica predominated, and in individuals with malaria, protozoa, and helminth infections (5.4%). P. vivax, E. coli, E. histolytica, and A. lumbricoides predominated. Intestinal polyparasitism was common in the study population, and the presence of helminths was associated with an increased number of intestinal parasitic species. However, Plasmodium infections were neither a risk nor a protective factor for helminth infections; the same was true for helminth infections in relation to Plasmodium. The high prevalence of intestinal polyparasitism with Plasmodium co-infections highlights the need for combining strategies that may help control both malaria and intestinal parasite and generate a health approach aligned with indigenous perspectives.

Prevalence of malaria-helminth co-infections among children living in a setting of high coverage of standard interventions for malaria and helminths: Two population-based studies in Senegal

Background

Concurrent infections of Plasmodium falciparum with Soil Transmitted Helminths (STH) and Schistosoma spp are still a major public health problem among children living in Sub-Saharan Africa. We conducted two prospective studies among children living in urban and rural settings of Senegal, where control programmes for malaria, STH and schistosomiasis have been sustained, to determine the prevalence of malaria-helminth co-infection.

Methods

We enrolled 910 children aged 1-14 years from Saraya and Diourbel districts of Senegal in June and November 2021, respectively. We collected finger-prick blood samples from the children for malaria parasite detection using microscopy and PCR methods. Stool samples were also collected and Kato-Katz and PCR methods were used to detect STH and S. mansoni; and Merthiolate-iodine-formalin (MIF) test for other intestinal protozoans. Urine samples were analyzed using a filtration test, Point of Care Circulating Cathodic Antigens (POC-CCA) and PCR methods for detection of S. haematobium. Statistical analyses were performed to compare the continuous and categorical variables across the two study sites and age groups, as well as using the adjusted Odds ratios (aOR) to explore risk factors for malaria-helminth co-infections.

Results

The overall prevalence of polyparasitism with P. falciparum, STH, S. haematobium and S. mansoni among children in the two study sites was 2.2% (20/910) while prevalence of P. falciparum-S. haematobium co-infection was 1.1% (10/910); P. falciparum-S. mansoni 0.7% (6/910) and P. falciparum with any intestinal protozoan 2.4% (22/910). Co-infection was slightly higher among 5-14 year old children (17/629, 2.7%; 95% CI: 1.43-3.97) than 1-4 years (3/281, 1.1%; 95% CI: -0.12-2.32) and, in boys (13/567, 2.3%; 95% CI: 1.27-3.96) than girls (7/343, 2.1%; 95% CI: 0.52-3.48). Children aged 5-14 years (aOR = 3.37; 95% CI: 0.82-13.77, p = 0.09), who were boys (aOR = 1.44; 95% CI: 0.48-4.36, p = 0.51) and lived in Saraya (aOR = 1.27; 95% CI: 0.24-6.69, p = 0.77) had a higher risk of malaria-helminth co-infection than other age group, in girls and those who lived in Diourbel. Living in houses with spaces between the walls and roofs as well as frequent contacts with water during swimming were statistically significant risk factors for malaria-helminth co-infection.

Conclusions

The prevalence of malaria-helminth co-infection is low in two districts in Senegal, possibly due to sustained implementation of effective control measures for malaria and NTDs. These findings could help to develop and implement strategies that would lead to elimination of malaria and helminths in the study areas.

Urude R, Kadimbo J, Danboyi J, Miri E, Nute AW, Rakers L, Nebe O, Anyaike C, Weiss P, S. Noland G, Richards F. Impact of Three to Five Rounds of Mass Drug Administration on Schistosomiasis and Soil-Transmitted Helminths in School-Aged Children in North-Central Nigeria

Nasarawa and Plateau states of north-central Nigeria have implemented programs to control schistosomiasis (SCH) and soil-transmitted helminths (STH) in children since the 1990s. Statewide mapping surveys were conducted in 2013, when 11,332 school-aged children were sampled from 226 schools. The local government areas (LGAs) then received varying combinations of mass drug administration (MDA) for the next 5 years. We revisited 196 (87%) schools in 2018 plus an additional six (202 schools in total), sampling 9,660 children. We calculated overall prevalence and intensity of infection and evaluated associations with gender; age; behaviors; water, sanitation, and hygiene (WASH); and treatment regimen. Urine heme detection dipsticks were used for Schistosoma hematobium in both surveys, with egg counts added in 2018. Stool samples were examined by Kato-Katz for Ascaris lumbricoides, Trichuris trichiura, Schistosoma mansoni, and hookworm. Schistosomiasis prevalence among sampled students dropped from 12.9% (95% confidence interval [CI]: 11.1-14.9%) to 9.0% (95% CI: 7.5-10.9%), a statistically significant change (P < 0.05). In 2018, eight LGAs still had > 1% of children with heavy-intensity schistosome infections. Prevalence of STH infection did not significantly change, with 10.8% (95% CI: 9.36-12.5%) of children positive in 2013 and 9.4% (95% CI: 8.0-10.9%) in 2018 (P = 0.182). Heavy-intensity STH infections were found in < 1% of children with hookworm, and none in children with A. lumbricoides or T. trichiura in either study. The WASH data were collected in 2018, indicating 43.6% of schools had a latrine and 14.4% had handwashing facilities. Although progress is evident, SCH remains a public health problem in Nasarawa and Plateau states.

Prevalence and effect of Plasmodium spp. and hookworm co-infection on malaria parasite density and haemoglobin level: a meta-analysis

The dual effects of co-infection of Plasmodium spp. and hookworm on malaria remain under debate. This study investigated prevalence, prevalence odds ratio (POR) of co-infection and impact of co-infection on malaria parasite density and haemoglobin levels in comparison to Plasmodium mono-infection. The protocol for this systematic review and meta-analysis is registered at PROPERO under ID: CRD42020202156. Relevant literatures were obtained from PubMed, ISI Web of Science, and Scopus on 25 December 2020. Mean difference (MD) and confidence interval (CI) of malaria parasite density and haemoglobin were compared using a random effect model. Heterogeneity was assessed using Cochrane Q and I² statistics. Publication bias was determined by visualising funnel plot asymmetry. Of 1756 articles examined, 22,191 malaria cases across 37 studies included 6096 cases of co-infection of Plasmodium spp. and hookworm. The pooled prevalence was 20% (95% CI 15–26%, I² 99.6%, 37 studies) and was varied in terms of geographical region. Co-infection occurred by chance (OR 0.97, p 0.97, 95% CI 0.73–1.27, I² 95%, 30 studies). The mean malaria parasite density for co-infection (478 cases) was similar to Plasmodium mono-infection (920 cases) (p 0.24, MD 0.86, 95% CI − 0.58–2.29, I² 100%, 7 studies). The mean haemoglobin level for co-infection (90 cases) was similar to Plasmodium mono-infection (415 cases) (p 0.15, MD − 0.63, 95% CI − 1.49–0.23, I² 98%, 4 studies). Co-infection was common and occurred by chance but varied by geographic region. Further studies are required to investigate the mechanism of hookworm infection on malaria severity. Additionally, detection of hookworm infections among patients with malaria in endemic areas of both diseases is recommended to prevent severe malaria.

Prevalence of Schistosoma mono- and co-infections with multiple common parasites and associated risk factors and morbidity profile among adults in the Taabo health and demographic surveillance system, South-Central Côte d'Ivoire

Background

Schistosomiasis remains an important public health problem, also among adults, and infected individuals not treated serve as a reservoir for continued transmission. Despite this fact, evidence on the epidemiology of schistosomiasis in adults in Côte d’Ivoire is scanty. This study aimed to determine the prevalence and risk factors of Schistosoma infection and co-infection with other helminth species and Plasmodium among adults in the Taabo region in the south-central part of Côte d’Ivoire.

Methods

A cross-sectional survey was carried out in April and May 2017 in the frame of the “Côte d’Ivoire Dual Burden of Disease Study” (CoDuBu). A total of 901 randomly selected individuals, aged 18–90 years, provided blood, stool and urine samples for the diagnosis of malaria and helminth infections. Stool samples were subjected to the Kato-Katz technique for detection of Schistosoma mansoni and soil-transmitted helminth eggs, while urine samples were examined for eggs of Schistosoma haematobium and circulating cathodic antigen of S. mansoni. Risk factors and morbidity profiles were assessed using health examination and questionnaires. Multinomial logistic regressions were employed to identify risk factors and morbidity patterns associated with S. mansoni mono- and co-infections.

Results

The prevalence of S. mansoni and S. haematobium was 23.2% and 1.0%, respectively. Most S. mansoni were mono-infections (81.3%). Independent determinants of S. mansoni infection were young age, low socioeconomic status (mono- and co-infection) and poor hygiene practices (co-infection) (P < 0.05). S. mansoni infection was independently associated with higher pain and symptom scores (mono-infection), poor self-rated health and low healthcare use (co-infection) (P < 0.05).

Conclusions

This study showed that adults represent a substantial reservoir of S. mansoni. To sustain schistosomiasis control and improve people’s wellbeing, it is important to expand preventive chemotherapy from school-aged children to adults, coupled with hygiene and health education.

Plasmodium falciparum and Helminth Coinfections Increase IgE and Parasite-Specific IgG Responses

Coinfection with Plasmodium falciparum and helminths may impact the immune response to these parasites because they induce different immune profiles. We studied the effects of coinfections on the antibody profile in a cohort of 715 Mozambican children and adults using the Luminex technology with a panel of 16 antigens from P. falciparum and 11 antigens from helminths (Ascaris lumbricoides, hookworm, Trichuris trichiura, Strongyloides stercoralis, and Schistosoma spp.) and measured antigen-specific IgG and total IgE responses. We compared the antibody profile between groups defined by P. falciparum and helminth previous exposure (based on serology) and/or current infection (determined by microscopy and/or qPCR). In multivariable regression models adjusted by demographic, socioeconomic, water, and sanitation variables, individuals exposed/infected with P. falciparum and helminths had significantly higher total IgE and antigen-specific IgG levels, magnitude (sum of all levels) and breadth of response to both types of parasites compared to individuals exposed/infected with only one type of parasite (P ≤ 0.05). There was a positive association between exposure/infection with P. falciparum and exposure/infection with helminths or the number of helminth species, and vice versa (P ≤ 0.001). In addition, children coexposed/coinfected tended (P = 0.062) to have higher P. falciparum parasitemia than those single exposed/infected. Our results suggest that an increase in the antibody responses in coexposed/coinfected individuals may reflect higher exposure and be due to a more permissive immune environment to infection in the host. IMPORTANCE Coinfection with Plasmodium falciparum and helminths may impact the immune response to these parasites because they induce different immune profiles. We compared the antibody profile between groups of Mozambican individuals defined by P. falciparum and helminth previous exposure and/or current infection. Our results show a significant increase in antibody responses in individuals coexposed/coinfected with P. falciparum and helminths in comparison with individuals exposed/infected with only one of these parasites, and suggest that this increase is due to a more permissive immune environment to infection in the host. Importantly, this study takes previous exposure into account, which is particularly relevant in endemic areas where continuous infections imprint and shape the immune system. Deciphering the implications of coinfections deserves attention because accounting for the real interactions that occur in nature could improve the design of integrated disease control strategies.

Understanding Asthma and Allergies by the Lens of Biodiversity and Epigenetic Changes

Exposure to different organisms (bacteria, mold, virus, protozoan, helminths, among others) can induce epigenetic changes affecting the modulation of immune responses and consequently increasing the susceptibility to inflammatory diseases. Epigenomic regulatory features are highly affected during embryonic development and are responsible for the expression or repression of different genes associated with cell development and targeting/conducting immune responses. The well-known, "window of opportunity" that includes maternal and post-natal environmental exposures, which include maternal infections, microbiota, diet, drugs, and pollutant exposures are of fundamental importance to immune modulation and these events are almost always accompanied by epigenetic changes. Recently, it has been shown that these alterations could be involved in both risk and protection of allergic diseases through mechanisms, such as DNA methylation and histone modifications, which can enhance Th2 responses and maintain memory Th2 cells or decrease Treg cells differentiation. In addition, epigenetic changes may differ according to the microbial agent involved and may even influence different asthma or allergy phenotypes. In this review, we discuss how exposure to different organisms, including bacteria, viruses, and helminths can lead to epigenetic modulations and how this correlates with allergic diseases considering different genetic backgrounds of several ancestral populations.

Comorbidity of Geo-Helminthes among Malaria Outpatients of the Health Facilities in Ethiopia: Systematic Review and Meta-Analysis

Background: Coinfection of malaria and intestinal helminths affects one third of the global population, largely among communities with severe poverty. The spread of these parasitic infections overlays in several epidemiological locations and the host shows different outcomes. This systematic review and meta-analysis determine the pooled prevalence of malaria and intestinal helminthiases coinfections among malaria suspected patients in Ethiopia. Methods: Primary studies published in English language were retrieved using appropriate search terms on Google Scholar, PubMed/MEDLINE, CINHAL, Scopus, and Embase. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for critical appraisal of studies. A pooled statistical meta-analysis was conducted using STATA Version 14.0 software. The heterogeneity and publication bias were assessed using the I2 statistics and Egger’s test, respectively. Duval and Tweedie’s nonparametric trim and fill analysis using the random-effect analysis. The Random effects model was used to estimate the summary prevalence of comorbidity of malaria and soil transmitted helminthiases and the corresponding 95% confidence intervals (CI). The review protocol has registered in PROSPERO number CRD42019144803. Results: We identified ten studies (n = 6633 participants) in this study. The overall pooled result showed 13% of the ambulatory patients infected by malaria and intestinal helminths concurrently in Ethiopia. The pooled prevalence of Plasmodium falciparum and Plasmodium vivax, and mixed infections were 12, 30, and 6%, respectively. The most common intestinal helminth parasites detected were Hookworm, Ascaris lumbricoides, and Tirchuris trichiura. Conclusions: The comorbidity of malaria and intestinal helminths causes lower hemoglobin level leading to maternal anemia, preterm delivery, and still birth in pregnant women and lactating mother. School-aged children and neonates coinfected by plasmodium species and soil transmitted helminths develop cognitive impairment, protein energy malnutrition, low birth weight, small for gestational age, and gross motor delay. The Ministry of Health of Ethiopia and its international partners working on malaria elimination programs should give more emphasis to the effect of the interface of malaria and soil transmitted helminths, which calls for an integrated disease control and prevention.

Immune Response and Microbiota Profiles during Coinfection with Plasmodium vivax and Soil-Transmitted Helminths

Plasmodium (malaria) and helminth parasite coinfections are frequent, and both infections can be affected by the host gut microbiota. However, the relationship between coinfection and the gut microbiota is unclear. By performing comprehensive analyses on blood/stool samples from 130 individuals in Colombia, we found that the gut microbiota may have a stronger relationship with the number of P. vivax (malaria) parasites than with the number of helminth parasites infecting a host. Microbiota analysis identified more predictors of the P. vivax parasite burden, whereas analysis of blood samples identified predictors of the helminth parasite burden. These results were unexpected, because we expected each parasite to be associated with greater differences in its biological niche (blood for P. vivax and the intestine for helminths). Instead, we find that bacterial taxa were the strongest predictors of P. vivax parasitemia levels, while circulating TGF-β levels were the strongest predictor of helminth parasite burdens.

The role of the gut microbiota during coinfection with soil-transmitted helminths (STH) and Plasmodium spp. is poorly understood. We examined peripheral blood and fecal samples from 130 individuals who were either infected with Plasmodium vivax only, coinfected with P. vivax and STH, infected with STH alone, or not infected with either P. vivax or STH. In addition to a complete blood count (CBC) with differential, transcriptional profiling of peripheral blood samples was performed by transcriptome sequencing (RNA-Seq), fecal microbial communities were determined by 16S rRNA gene sequencing, and circulating cytokine levels were measured by bead-based immunoassays. Differences in blood cell counts, including an increased percentage of neutrophils, associated with a transcriptional signature of neutrophil activation, were driven primarily by P. vivax infection. P. vivax infection was also associated with increased levels of interleukin 6 (IL-6), IL-8, and IL-10; these cytokine levels were not affected by STH coinfection. Surprisingly, P. vivax infection was more strongly associated with differences in the microbiota than STH infection. Children infected with only P. vivax exhibited elevated Bacteroides and reduced Prevotella and Clostridiaceae levels, but these differences were not observed in individuals coinfected with STH. We also observed that P. vivax parasitemia was higher in the STH-infected population. When we used machine learning to identify the most important predictors of the P. vivax parasite burden (among P. vivax-infected individuals), bacterial taxa were the strongest predictors of parasitemia. In contrast, circulating transforming growth factor β (TGF-β) was the strongest predictor of the Trichuris trichiura egg burden. This study provides unexpected evidence that the gut microbiota may have a stronger link with P. vivax than with STH infection.

Trichinella spiralis co-infection exacerbates Plasmodium berghei malaria-induced hepatopathy

Background

Although Plasmodium parasites and intestinal helminths share common endemic areas, the mechanisms of these co-infections on the host immune response remain not fully understood. Liver involvement in severe Plasmodium falciparum infections is a significant cause of morbidity and mortality. However, the effect of pre-existing Trichinella spiralis infection on the immune response and liver immune-pathogenesis in P. berghei ANKA (PbANKA)-infected mice needs to be elucidated.

Methods

Outbred Kunming mice were infected with T. spiralis and 9 days later were challenged with P. berghei ANKA (PbANKA), and the investigation occurred at 13 days after co-infection.

Results

Compared with PbANKA-mono-infected mice, T. spiralis + PbANKA-co-infected mice had similar survival rate but lower PbANKA parasitaemia; however, there were more severe hepatosplenomegaly, increased liver and spleen indexes, and increased liver pathology observed by hematoxylin and eosin staining; higher expression levels of galectin (Gal)-1, Gal-3, CD68⁺ macrophages, and elastase-positive neutrophils measured by immunohistochemical staining; upregulated mRNA expression levels of Gal-1, Gal-3, cytokines (interferon-gamma (IFNγ) and interleukin (IL)-6), and M1 macrophage polarization marker (inducible nitric oxide synthase (iNOS)) in the liver, and increased expression levels of Gal-1, IFNγ, IL-6, eosinophil cationic protein, eosinophil protein X, and M1 (IL-1β and iNOS) and M2 (Ym1) macrophage polarization markers in the spleen of co-infected mice detected by using quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR). In vitro study showed that compared with PbANKA-mono-infected mice, there were significantly increased expression levels of Gal-1, Gal-3, IL-6, IL-1β, and iNOS in the peritoneal macrophage isolated from co-infected mice detected by using qRT-PCR. Correlation analysis revealed significant positive correlations between Gal-3 and IL-1β in the peritoneal macrophages isolated from PbANKA-mono-infected mice, between Gal-3 and IFNγ in the spleen of co-infected mice, and between Gal-1 and Ym1 in the peritoneal macrophages isolated from co-infected mice.

Conclusions

Our data indicate that pre-existing infection of T. spiralis may suppress P. berghei parasitaemia and aggravate malaria-induced liver pathology through stimulating Gal-1 and Gal-3 expression, activating macrophages, neutrophils, and eosinophils, and promoting mediator release and cytokine production.

Malaria coinfection with Neglected Tropical Diseases (NTDs) in children at Internally Displaced Persons (IDP) camp in Benin City, Nigeria

Malaria and Neglected Tropical Diseases (NTDs) are highly endemic in poorer countries of the world. The research investigated the prevalence of parasitic infections among children in Internally Displaced Persons (IDP) camp in Benin City. Faecal, urine and blood specimen were collected from 184 children (100 males and 84 females) aged 6–15. Blood samples were prepared using thick film method and analyzed microscopically. Direct smear technique was employed for faecal sample and sedimentation method to concentrate ova from the urine sample. Ten species of parasites were identified in this study. The predominant species were Plasmodium falciparum (67.93%), Entamoeba histolytica (67.93%) and Giardia duodenalis (59.78%). Plasmodium falciparum and E. histolytica were most prevalent in both sexes, with P. falciparum infecting 68% males and 67.86% females while E. histolytica infected 66% males and 70.24% females (P = 0.24). Mixed infections with blood and intestinal parasites were recorded in 41.18% in age group 5–10 and 47.90% in age group 11–15 (P < 0.5). Also, mixed infections with blood and intestinal parasites were detected in 45% males and 50% females (P = 0.51). Urinary schistosomiasis was recorded in 28.80% of the participants. Parasitic infections especially P. falciparum malaria and amoebiasis were predominant among the children. Therefore, our findings call for specific intervention programmes to reduce parasite intensity and morbidity in the children. Environmental and personal hygiene should be implemented in order to curb parasitosis in the study area.

The burden and epidemiology of polyparasitism among rural communities in Kano State, Nigeria

BACKGROUND

Parasitic infections constitute a major public health problem worldwide, particularly among underprivileged communities in developing countries including Nigeria. The present study aimed to determine the epidemiology of polyparasitism (multiple parasitic infections) among rural communities in Kano State, North Central Nigeria.

METHODS

A total of 551 individuals were screened for the presence of intestinal, urogenital and blood parasites by using different diagnostic techniques. Demographic, socioeconomic, household and behavioural characteristics were collected using a pre-tested questionnaire.

RESULTS

Overall, 84.0% (463/551) of the participants were found to be infected with at least one parasite species, with 51.2% (282/551) of them having polyparasitism. The most prevalent parasites were Plasmodium falciparum (60.6%) followed by Blastocystis sp. (29.2%) and hookworm (15.4%). No significant association was found between malaria and helminth infections (p>0.05). Univariate and multivariate analyses showed that the presence of other family members who had intestinal polyparasitism (adjusted odds ratio [AOR]=4.12; 95% CI=2.72, 6.24), walking barefoot outside (AOR=1.70; 95% CI=1.09, 2.63) and being male (AOR=1.74; 95% CI=1.14, 2.66) were the significant risk factors of intestinal polyparasitism among the population studied.

CONCLUSION

Polyparasitism is highly prevalent among rural communities in Kano State. Therefore, effective, sustainable and integrated control measures should be identified and implemented to significantly reduce the burden and consequences of these infections in rural Nigeria.

Malaria Parasitemia in Febrile Patients Mono- and Coinfected with Soil-Transmitted Helminthiasis Attending Sanja Hospital, Northwest Ethiopia

Background

Malaria is a life-threatening disease associated with high morbidity and mortality. Helminths are among the most widespread infectious agents prevalent in tropical and subtropical regions of the developing world. Malaria and soil-transmitted helminthiasis (STHs) are coendemic and major public health problems in Ethiopia. The effects of helminth coinfection on malaria parasitemia remained poorly understood. Therefore, the objective of this study was to assess malaria parasitemia among malaria-monoinfected and malaria-soil-transmitted helminthiasis-coinfected febrile patients attending Sanja Hospital, Northwest Ethiopia.

Methods

A cross-sectional study with parallel groups was conducted to assess malaria parasitemia among malaria-monoinfected and malaria-soil-transmitted helminthiasis-coinfected febrile patients in Sanja Hospital from January to March 2019. Double population proportion formula was used for sample size calculation, and convenient sampling technique was used to select 134 study participants. Data were entered and analyzed by using the Statistical Package for Social Sciences (SPSS) version 20. Descriptive statistics, independent t-test, and one-way analysis of variance (ANOVA) were performed. A P value of <0.05 was considered as statistically significant.

Results

From 134 malaria-positive study participants, 67 were malaria-monoinfected and 67 were malaria-STHs-coinfected patients. Out of 67 malaria STHs-coinfected patients, 54 (80.6%) were infected with hookworm followed by Ascaris lumbricoides 11 (16.4%) and Strongyloides stercoralis 2 (3%). The mean Plasmodium parasite density was significantly higher in malaria-STHs-coinfected patients than in patients infected with only Plasmodium parasite density was significantly higher in malaria-STHs-coinfected patients than in patients infected with only P value of <0.05 was considered as statistically significant. Plasmodium parasite density was significantly higher in malaria-STHs-coinfected patients than in patients infected with only F = 6.953, P value of <0.05 was considered as statistically significant.

Conclusions

Infections with STHs, especially hookworm, were positively associated with Plasmodium parasite density. The current study finding also revealed that increased worm burden of hookworm as expressed by egg intensity had significantly increased Plasmodium parasite density.Plasmodium parasite density was significantly higher in malaria-STHs-coinfected patients than in patients infected with only Plasmodium parasite density was significantly higher in malaria-STHs-coinfected patients than in patients infected with only.

Prevalence and Intensity of Soil-Transmitted Helminth Infection among Rural Community of Southwest Ethiopia: A Community-Based Study

Background

Helminths are significant contributors to global health problems. Subgroup soil-transmitted helminths are among the listed neglected tropical diseases. The rural inhabitants often suffer from heavy infection, particularly children and pregnant women.

Objective

The study aimed at determining the magnitude and intensity of soil-transmitted helminth infection and associated risk factors in the study area where the prevalence and intensity of the infection are yet unknown at the community level.

Method

A community-based cross-sectional study was conducted between April and June 2016 on 377 individuals. Systematic random sampling was utilized to select the households. Lottery method was used for study subject selection in the households. Sociodemographic and risk factor data were collected using a pretested questionnaire. Parasitological tests were processed using Kato-Katz thick smear and duplicate direct wet mount analysis of the stool sample.

Results

A total of 377 subjects aged from 2 to 55 years were enrolled in the study, of which 211 were female (56%) and 166 were male (44%). The overall prevalence of soil-transmitted helminths was 265 (70.3%). The females shared more (36.6%, 138) as compared to males (33.7%, 127) at P < 0.05. Of all identified soil-transmitted helminths, Trichuris trichiura was the predominant infectious agent (66.8%, 252) followed by Ascaris lumbricoides (16.4%, 62) and hookworm (14.1%, 53). Gender (AOR: 1.67 (95% CI: 1.034-2.706)), lack of fruit washing before consumption (AOR: 1.7 (95% CI: 1.1-2.6)), open defecation habit (AOR: 1.75 (95% CI: 0.921-3.338)), and drinking untreated water (AOR: 1.994 (95% CI: 1.019-3.90)) were significantly associated with soil-transmitted helminth infection.

Conclusion

High prevalence of STH infection was still an important health issue of the community even after the implementation of the health extension program. Hence, intervention considering all population of the residents as eligible to deworm and health education are mandatory.

Drinking water and sanitation conditions are associated with the risk of malaria among children under five years old in sub-Saharan Africa: A logistic regression model analysis of national survey data

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Drinking water and sanitation is a risk factor to malaria infection.

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Wealth brought mixed effects of the relationship between WS and malaria.

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The associations between WS and malaria were more pronounced among the non-poor children.

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This pooling multi-country data eliminates many bias seen in traditional meta-analysis.

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Improved drinking water and sanitation seemed to be promising in preventing malaria.

Current efforts for the prevention of malaria have resulted in notable reductions in the global malaria burden; however, they are not enough. Good hygiene is universally considered one of the most efficacious and straightforward measures to prevent disease transmission. This work analyzed whether improved drinking water and sanitation (WS) conditions were associated with a decreased risk of malaria infection. Data were acquired through surveys published between 2006 and 2018 from the Demographic and Health Program in sub-Saharan Africa (SSA). Multiple logistic regression was used for each national survey to identify the associations between WS conditions and malaria infection diagnosed by microscopy or a malaria rapid diagnostic test (RDT) among children (0–59 months), with adjustments for age, gender, indoor residual spraying (IRS), insecticide-treated net (ITN) use, house quality, and the mother’s highest educational level. Individual nationally representative survey odds ratios (ORs) were combined to obtain a summary OR using a random-effects meta-analysis. Among the 247,440 included children, 18.8% and 24.2% were positive for malaria infection based on microscopy and RDT results, respectively. Across all surveys, both unprotected water and no facility users were associated with increased malaria risks (unprotected water: aOR 1.17, 95% CI 1.07–1.27, P = 0.001; no facilities: aOR 1.35, 95% CI 1.24–1.47, P < 0.001; respectively), according to microscopy, whereas the odds of malaria infection were 48% and 49% less among piped water and flush-toilet users, respectively (piped water: aOR 0.52, 95% CI 0.45–0.59, P < 0.001; flush toilets: aOR 0.51, 95% CI 0.43–0.61, P < 0.001). The trends of individuals diagnosed by RDT were consistent with those of individuals diagnosed by microscopy. Risk associations were more pronounced among children with a “nonpoor” socioeconomic status who were unprotected water or no facility users. WS conditions are a vital risk factor for malarial infection among children (0–59 months) across SSA. Improved WS conditions should be considered a potential intervention for the prevention of malaria in the long term.

Schistosoma haematobium effects on Plasmodium falciparum infection modified by soil-transmitted helminths in school-age children living in rural areas of Gabon

BACKGROUND

Malaria burden remains high in the sub-Saharan region where helminths are prevalent and where children are often infected with both types of parasites. Although the effect of helminths on malaria infection is evident, the impact of these co-infections is not clearly elucidated yet and the scarce findings are conflicting. In this study, we investigated the effect of schistosomiasis, considering soil-transmitted helminths (STH), on prevalence and incidence of Plasmodium falciparum infection.

METHODOLOGY

This longitudinal survey was conducted in school-age children living in two rural communities in the vicinity of Lambaréné, Gabon. Thick blood smear light microscopy, urine filtration and the Kato-Katz technique were performed to detect malaria parasites, S. haematobium eggs and, STH eggs, respectively. P. falciparum carriage was assessed at inclusion, and incidence of malaria and time to the first malaria event were recorded in correlation with Schistosoma carriage status. Stratified multivariate analysis using generalized linear model was used to assess the risk of plasmodium infection considering interaction with STH, and survival analysis to assess time to malaria.

MAIN FINDINGS

The overall prevalence on subject enrolment was 30%, 23% and 9% for S. haematobium, P. falciparum infections and co-infection with both parasites, respectively. Our results showed that schistosomiasis in children tends to increase the risk of plasmodium infection but a combined effect with Trichuris trichiura or hookworm infection clearly increase the risk (aOR = 3.9 [95%CI: 1.7-9.2]). The incidence of malaria over time was 0.51[95%CI: 0.45-0.57] per person-year and was higher in the Schistosoma-infected group compared to the non-infected group (0.61 vs 0.43, p = 0.02), with a significant delay of time-to first-malaria event only in children aged from 6 to 10-years-old infected with Schistosoma haematobium.

CONCLUSIONS

Our results suggest that STH enhance the risk for P. falciparum infection in schistosomiasis-positive children, and when infected, that schistosomiasis enhances susceptibility to developing malaria in young children but not in older children.

Results of the first mapping of soil-transmitted helminths in Benin: Evidence of countrywide hookworm predominance

Background

National mapping of soil-transmitted helminth infections (STH) was conducted for the first time in all of the 77 districts of Benin (West Africa) from 2013 to 2015. This mapping aimed to provide basic epidemiological data essential for the implementation of the national strategy against the neglected tropical diseases (NTDs) in the context of achieving the WHO target of controlling these infections by 2020.

Methods

In each district, 5 schools were purposively selected in 5 villages and 50 school-children (25 girls and 25 boys) from ages 8 to 14 years were randomly enrolled in each school. In total, 19,250 stool samples of school children (9,625 girls and 9,625 boys) from 385 schools were examined by Kato-Katz technique.

Results

The three major species of STH (hookworm, Ascaris lumbricoides and Trichuris trichiura) were observed with intra- and inter-specific variations in the prevalence and the intensity of these parasites. Hookworm infection was present in all of the surveyed districts with an average prevalence of 17.14% (95% CI 16.6%-17.6%). Among the infected schoolchildren, at national level, 90.82%, 6.73% and 2.45% of infections were of light, moderate and heavy parasite intensities respectively. A. lumbricoides infection, with a national average prevalence of 5.35% (95% CI 5.00%-5.60%),was the second most prevalent STH, and 84.37%, 14.27% and 1.36% of the infections were of light, moderate and heavy parasite intensities, respectively. T. trichiura had a national average prevalence of 1.15% (95% CI 0.90%-1.20%) and 80.45%, 13.18% and 6.36% infections were of light, moderate and heavy parasite intensities, respectively. The national cumulative prevalence of the three STH infections was 22.74% (95% CI 22.15%-23.33%), with58.44% (45/77) of the districts requiring mass treatment according to WHO recommendations. In all of the surveyed districts, multiple infections by STH species were common, and boys seemed more at risk of hookworm and Ascaris infections.

Conclusions

This first national mapping provided an overview of the epidemiological pattern of STH infections and was essential for the implementation of a control strategy with an effective preventive chemotherapy treatment (PCT). Results show that while preventive chemotherapy is not indicated for children in 32/77 districts, 43 require annual deworming and two require twice yearly deworming. If no environmental change occurs, and no mass treatment is delivered, prevalence is likely to remain stable for many years owing to poor hygiene and sanitation.

Benin, like other low or moderate-income countries in the African continent, is endemic for several neglected tropical diseases, including soil-transmitted helminthiases. The National Program for Neglected Tropical Diseases of the Ministry of Health has conducted the national STH mapping using the Kato-Katz method to assess the baseline epidemiological status in all 77 districts of Benin, in order to guide implementation of a preventive chemotherapy program using albendazole. The results of the survey showed that infection with at least one of the three targeted species (hookworm, roundworm or whipworm) affected 20% or more of school aged children in 45 out of 77 districts, and which therefore require PCT. Hookworm infection was the most prevalent followed by ascariasis and trichuriasis. Boys were significantly more likely than girls to be infected with hookworm or ascariasis.