The prevalence of Hymenolepis nana among preschool children of displacement communities in Khartoum state, Sudan: a cross-sectional study

Intestinal parasitic infections in children from marginalised Roma communities: prevalence and risk factors

BACKGROUND

Intestinal parasitic infections remain a significant global health issue, particularly affecting poor and marginalised populations. These infections significantly contribute to children's diseases, malnutrition, poor school performance, cognitive disorders, and future economic losses. This study aimed to explore and compare the occurrence of intestinal parasites in early childhood among the group of infants from the Slovak majority population and from marginalised Roma communities (MRCs). Furthermore, it aimed to explore the health complaints of children with and without intestinal parasitic infection in the past month and assess the effect of various risk factors on the occurrence of intestinal parasitic infection in infants from MRCs.

METHODS

We obtained cross-sectional data from mothers and stool samples of their children aged 13-21 months using the first wave of the longitudinal RomaREACH study. A total of 181 stools from infants were analysed: 105 infants from the Slovak majority population and 76 from MRCs.

RESULTS

Infants from MRCs are significantly more often infected by Ascaris lumbricoides, Trichuris trichiura and Giardia duodenalis than their better-off peers from the majority population. Infection rates are 30% in infants from MRCs vs. 0% in the majority population (p < 0.001). Single and mixed infections were observed in children from MRCs. Infants with intestinal parasitic infections suffer significantly more often from various health complaints, particularly cough, stomach ache, irritability, and diarrhoea. Within MRCs, the risk of parasitic infections in infants is significantly increased by risk factors such as the absence of flushing toilets in households (OR = 4.17, p < 0.05) and contact with un-dewormed animals (OR = 3.61, p < 0.05). Together with the absence of running water in the household, these three factors combined increase the risk more than ten times (p < 0.01).

CONCLUSION

Maintaining hygienic standards in conditions of socioeconomic deprivation in MRCs without running water and sewage in the presence of un-dewormed animals is problematic. These living conditions contribute to the higher prevalence of parasitic infections in children from MRCs, causing various health complaints and thus threatening their health and healthy development.

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Epidemiologic Investigation of Intestinal Parasite Infection and Associated Risk Factors among Primary Schoolchildren in the Manzini and Lubombo Provinces, the Kingdom of Eswatini

Although the deworming program has been executed since 2000, the intestinal parasitic infection (IPI) rates among primary schoolchildren (PSC) in the two provinces of the Kingdom of Eswatini investigated in 2010 remained high, reaching 32.2%. In this study, we monitored the IPI status along with the associated risk factors for PSC in two provinces—Manzini and Lubombo. After consent from their parents/guardians, a total of 316 samples collected from PSC with grades 1 to 3 from four primary schools in Manzini and Lubombo were examined by the Merthiolate-Iodine-Formaldehyde (MIF) method. In addition, demographic characteristics and risk factors acquired by questionnaire surveys were included to be statistically analyzed. The overall prevalence was 40.5% (128/316), of which the infection rate in Manzini and Lubombo was 28.8% (19/66) and 58.3% (74/140), respectively. Pathogenic protozoa had the highest infection rate of 20.6% (65/316), including Entamoeba histolytica/dispar (8.5%, 27/316), Giardia duodenalis (14.6%, 46/316), and Blastocystis hominis (9.8%, 31/316). In terms of helminth infection, the infection rate was quite low, 1.6% only, and these five infected cases included four cases of Hymenolepis nana and one case of Enterobius vermicularis infection. Present study showed that 27.8% (88/316) of PSC were infected by more than one pathogenic parasite. Personal hygiene like washing hands before a meal has a significant protection effect (OR = 0.32, 95% CI = 0.14–0.75, $p=0.009$ ). Rain or well water and the type of water supply from which they drank also showed a considerable risk factor (OR = 2.44, 95% CI = 1.25–4.79, $p=0.04$ ). The IPI rate in PSC seems unlikely changed compared to that of the previous survey conducted in 2010, especially when the pathogenic protozoan infection rate remains high. Treatment of infected PSC with appropriate medication to reduce intestinal pathogenic protozoan infection should be seriously considered by Eswatini Health Authority.

A parasitological survey of zoonotic cestodes carried by house rats in Aswan, Egypt, reveals cryptic diversity at the molecular level

Background and Aim:

Some rat cestodes are zoonotic and are capable of parasitizing humans and animals, raising serious concerns regarding human and veterinary health. The study aimed to determine the prevalence and risk factors for cestodes in Egyptian house rats and to characterize the cestodes molecularly.

Materials and Methods:

The current survey examined 115 house rats (Rattus rattus) in two cities (Edfu and Aswan) in Egypt’s Aswan Governorate for cestode infection using integrated molecular approaches (polymerase chain reaction, sequencing, and phylogenetic analysis) and morphological/morphometrical approaches.

Results:

The cestodes identified in this study exhibited the typical morphological characteristics of Hymenolepis diminuta (Rudolphi, 1819), Hymenolepis nana (Siebold, 1852) (from rat intestine), and Hydatigera taeniaeformis (from rat liver). The species prevalence rates from these three studies were reported to be 8.7%, 10.4%, and 20.9%, respectively. The ribosomal DNA (ITS1, 18S, and complete ITS) sequences revealed that the hymenolepid sequences were highly distinct but were related to other sequences in the GenBank database, with some sequences showing high similarities to those of H. nana and H. diminuta. In addition, the H. taeniaeformis sequences (ITS2 and mitochondrial cytochrome c oxidase subunit 1 [mtCOX1]) obtained in this study were highly similar to some Taenia taeniaeformis GenBank sequences. The constructed phylogram revealed that the hymenolepidid tapeworms examined in this study were classified into four major branches (the majority of which were hybrids of the two species) and belonged to the genus Hymenolepis. In addition, the phylogram of H. taeniaeformis assigned this species to T. taeniaeformis.

Conclusion:

When typical hymenolepid morphology is combined with molecular and phylogenetic divergence, it may indicate the existence of possible cryptic species. In addition, on the basis of the phylogenetic analysis, genetic diversity within T. taeniaeformis may exist as determined by comparing the metacestode mtCOX1 sequences. The current study presents the prevalence values of zoonotic cestodes and contributes to the body of knowledge, including identification keys and the use of molecular tools for species confirmation.

The health of internally displaced children in sub-Saharan Africa: a scoping review

Background

Internally displaced children are those who have been forced to flee their homes due to severe unfavourable conditions (war, violence or disasters) but have not crossed international borders. Emerging research shows these children face multiple health challenges. However, we found no review focused solely on the health of such internally displaced children. Thus, this review sought to examine what is known about their health and their health concerns.

Methods

A scoping review of the literature was conducted. A total of 10 databases were searched in January 2019, yielding 6602 articles after duplicates were eliminated. Two research assistants independently selected articles that met inclusion criteria. A numerical summary and thematic analysis were conducted to facilitate data extraction and data analysis.

Results

A total of 25 articles met the inclusion criteria, including 16 quantitative, 6 qualitative and 3 mixed methods studies. The findings reveal elevated mental health problems and infectious diseases in this population. Findings on the nutritional status of internally displaced children as a broad group are mixed, with some studies showing poorer nutritional status among the children in this group and others showing poorer nutritional health status among host society children. Internally displaced children also experience challenges with access to health services. Premigration factors (trauma) and postmigration factors (humanitarian assistance on displacement) all contribute to the health of internally displaced children.

Conclusion

Findings provide insight into the complex array of factors influencing the health of internally displaced children. More intervention studies are required to address the needs of this population.

The Neglected Cestode Infection: Epidemiology of Hymenolepis Nana Infection Among Children in Rural Yemen

Hymenolepis nana is the most common cestode reported in humans worldwide. It is prevalent among children in the tropics and subtropics, particularly in rural poor communities where sanitation is inadequate or lacking. This cross-sectional study aims to determine the prevalence and significant risk factors of H. nana infection among children in rural Yemen. Faecal samples were collected from 498 children and screened for intestinal parasites by using wet mount, formalin-ether concentration and Kato–Katz techniques. A pretested questionnaire was used to collect demographic, socioeconomic, housing condition, and personal hygiene information. Overall, 77.5 % (386/498) of the children were found to be infected by at least one intestinal parasite species. The overall prevalence of H. nana was 17.5 % (87/498). Multivariate analysis confirmed that an age of < 6 years (adjusted odds ratio [AOR] = 4.28; 95 % (confidence interval [CI] = 2.04, 8.98), presence of other family members infected with H. nana (AOR = 2.48; 95 % CI = 1.45, 4.24), living in the highlands (AOR = 2.87; 95 % CI = 1.56, 5.26), living in a house without improved toilet facilities (AOR = 2.19; 95 % CI = 1.23, 3.88), not washing vegetables before consumption (AOR = 2.11; 95 % CI = 1.06, 4.19), and not washing hands after defecation (AOR = 1.88; 95 % CI = 1.08, 3.27) were the key factors significantly associated with H. nana infection among the studied children. In conclusion, H. nana is prevalent among children in rural Yemen, particularly among preschool-aged children. Thus, an integrated and effective programme to control intestinal parasitic infections should include preschool-aged children. Such a programme should focus on providing health education on hygienic practices, providing adequate sanitation and improved sources of drinking water, and screening and treating other infected family members.

A systematic review and meta-analysis of Hymenolepis nana in human and rodent hosts in Iran: A remaining public health concern

Hymenolepis nana, as a neglected zoonotic helminth, naturally occurs in both humans and rodents. Herein, a systematic review and meta-analysis was carried out to estimate pooled prevalence of H. nana infection among human and rodent hosts for the first time in Iran. PubMed, Web of Science, Scopus, and Embase databases (English articles) and SID and Magiran databases (Persian articles) were systematically searched for relevant studies published from inception till May 24, 2020. Chi² and I² index were used to assess the heterogeneity of the included studies. Publication bias was assessed using Egger's intercept and visual inspection of the funnel plot. Pooled prevalence was estimated using random-effects model with 95 % confidence interval (CI) and depicted as a forest plot. STATA software was used for analysis. The overall pooled prevalence estimate of H. nana in humans included 1.2 % (95 % CI = 1.0-1.4%). Subgroup analysis revealed 2.2 % (95 % CI = 1.8-2.6%) and 0.5 % (95 % CI = 0.3 to 0.8 %) of H. nana infection among school children and food handlers, respectively. In terms of rodent hosts, the overall pooled prevalence of H. nana infection included 13 % (95 % CI = 9.3-16.6%). Subgroup analysis revealed the highest rate of the infection was in Rattus spp. (19.6 %; 95 % CI = 10.6-28.6%), a genus with synanthropic behavior. It seems, despite the advancement in sanitation infrastructure and hygiene status, the H. nana infection compares to other helminthic diseases remains a challenging public health problem in Iran.

Morphological and molecular identification of hymenolepidid cestodes in children and synanthropic rodents from rural Mexico

Hymenolepidid cestodes of synanthropic rodents represent a risk for public health. In order to describe the occurrence of hymenolepidids in children and the role of rodents as a potential source of infection, we conducted a morphological and molecular survey on cestodes in two rural villages from Yucatan, Mexico. One hundred and thirty-five stool samples from children (64 from Paraíso and 71 from Xkalakdzonot), 233 Mus musculus (159 from Paraíso and 74 from Xkalakdzonot) and 125 Rattus rattus (7 from Paraíso and 118 from Xkalakdzonot) were analyzed for the presence of cestodes. Three hymenolepidid species were identified morphologically: Hymenolepis nana in 7.8% of children from Paraíso, Hymenolepis microstoma in 4.4% of M. musculus from Paraíso and Hymenolepis diminuta in 15.3% of R. rattus from Xkalakdzonot. The molecular characterization and phylogenetic analysis based on mitochondrial cytochrome c subunit 1 (CO1) gene and ribosomal internal transcribed spacer 1 (ITS1) region, confirmed the identity of the three cestodes isolated from Yucatan. Phylogeny of the CO1 gene identified intraspecific genetic differences within H. nana ranging from 0 to 5%, in H. microstoma from 0 to 0.4%, and in H. diminuta ranged from 0 to 6.5% which suggests, the presence of complex species within H. nana and H. diminuta infecting humans and rodents, as reported by other authors. Based on the morphological and molecular results, and the epidemiological evidence, infections with H. nana suggest a non-zoonotic transmission; however, the presence of H. microstoma and H. diminuta in synanthropic rodents serve as a possible source for human infection.

Epidemiological Survey on Schistosomiasis and Intestinal Helminthiasis among Village Residents of the Rural River Basin Area in White Nile State, Sudan

There have been some reports on schistosomiasis of school children in Sudan’s Nile River basin area; however, information about the infection status of Schistosoma species and intestinal helminths among village residents of this area is very limited. Urine and stool samples were collected from the 1,138 residents of the Al Hidaib and Khour Ajwal villages of White Nile State, Sudan in 2014. The prevalence of overall schistosomiasis and intestinal helminthiasis was 36.3% and 7.7%, respectively. Egg positive rates were 35.6% for Schistosoma haematobium, 2.6% for S. mansoni, and 1.4% were mixed. The prevalence of schistosomiasis was significantly higher in men (45.6%) than in women (32.0%), in Khou Ajwal villagers (39.4%) than in Al Hidaib villagers (19.2%), and for age groups ≤15 years old (51.5%) than for age groups >15 years old (13.2%). The average number of eggs per 10 ml urine (EP10) of S. haematobium infections was 18.9, with 22.2 eggs in men vs 17.0 in women and 20.4 in Khou Ajwal villagers vs 8.1 in Al Hidaib villagers. In addition to S. mansoni eggs, 4 different species of intestinal helminths were found in the stool, including Hymenolepis nana (6.6%) and H. diminuta (1.0%). Collectively, urinary schistosomiasis is still prevalent among village residents in Sudan’s White Nile River basin and was especially high in men, children ≤15 years, and in the village without a clean water system. H. nana was the most frequently detected intestinal helminths in the 2 villages.

A Case Report of an Intestinal Helminth Infection of Human Hymenolepiasis in Rural Gambia

Background

Hymenolepis nana, also called dwarf tapeworm infection, is an intestinal helminth not previously reported in The Gambia and only very rarely reported in West Africa.

Case presentation

We report a case of H. nana infection in a 29-month-old child living in a rural community of the north bank of the Upper River Region (URR) in The Gambia. The child presented with mild iron deficiency anaemia and granulocytosis but was otherwise mostly asymptomatic despite the moderate-intensity of infection.

Conclusions

We support treatment of H. nana infection even in largely asymptomatic children to prevent autoinfection and spread of this intestinal helminth in The Gambia and in other West African countries.

Abbreviations

GCP: Good Clinical Practice; HAZ: Height-for-age z-score; IHAT-GUT: Acronym for the Iron Hydroxide Adipate Tartrate Supplementation Study; ICH: International Conference on Harmonisation; SD: Standard Deviation; URR: Upper River Region; WAZ: Weight-for-age z-score; WHO: World Health Organization; WHZ: Weight-for-height z-score.

Intestinal cestodes

PURPOSE OF REVIEW

Cestodes infections in humans are among the most prevalent parasitosis worldwide. Although tapeworm infection is often asymptomatic, they can be associated with a range of symptoms. The landscape of cestode infections is changing with rapid diagnosis techniques and advanced molecular diagnosis aiding in identification of species specific epidemiology.

RECENT FINDINGS

Traditional descriptions of species by location have been challenged with molecular diagnostic techniques, which show variation in distribution of species, thought to be because of globalization and importation of disease.

MAIN THEMES IN LITERATURE

Epidemiology, molecular diagnostic techniques.

SUMMARY

Infection by tapeworms is often asymptomatic or accompanied by mild symptoms though can occasionally cause severe disease and contribute to anemia and malnutrition. Tapeworm infection is most prevalent in resource-poor countries but the distribution is worldwide. Epidemiology of infection is changing because of molecular diagnostics, which allow more accurate tracking of species.

Therapeutic efficacy of Artemisia absinthium against Hymenolepis nana: in vitro and in vivo studies in comparison with the anthelmintic praziquantel

Hymenolepis nana is a common intestinal tapeworm that affects humans. Drugs are available for the treatment of this infection, including praziquantel (PZQ), nitazoxanide and niclosamide. Although the drug of choice is praziquantel, due to its high cure rates, indicators of the development of PZQ resistance by different parasites have begun to appear over recent decades. Therefore, this study was a trial to find an alternative to PZQ by assessing the activity of the crude aqueous extract of the medicinal herb Artemisia absinthium against H. nana. In vitro, the extract was used against adult worms at concentrations of 1 and 5 mg/ml, in comparison with 1 mg/ml of PZQ. The times of worm paralysis and death were determined. Ultrastructural morphological changes were studied using transmission electron microscopy (TEM). For the in vivo study, infected mice were divided into untreated, PZQ-treated and A. absinthium-treated groups (400 mg/kg and 800 mg/kg). Pre- and post-treatment egg counts per gram of faeces (EPG) were performed; then, the reduction percentages of the EPG and worm burden were calculated. The best results were obtained with praziquantel. Artemisia absinthium induced worm paralysis, death and ultrastructural alterations, such as tegumental damage, lipid accumulation, and destruction of the nephridial canal and the intrauterine eggs, in a dose-dependent manner. Additionally, significant reductions in the EPG and worm burden were recorded in A. absinthium-treated mice. Although the results obtained with A. absinthium were promising and comparable to PZQ, further studies using different extracts, active ingredients and concentrations against different parasites should be conducted.

Intestinal Parasite Infections and Accuracy of Direct Thin and Thick Smear, Formol-Ether Sedimentation, Centrifugal Flotation, and Mini-FLOTAC Techniques Among Patients with Gastrointestinal Tract Disorders from the Greater Cairo Region, Egypt

The aim of the present study was to assess the frequency of intestinal parasitic infection among patients with gastrointestinal tract disorders from the Greater Cairo region, Egypt. In addition, a comparison was made of the accuracy of direct thin and thick smear, formol-ether sedimentation (FEC), centrifugal flotation (CF), and mini-FLOTAC techniques in the diagnosis of infection. Out of 100 patients, the overall prevalence of parasitic infection was 51%. Only 6% had dual infection. Giardia lamblia was the most common parasite (26%), followed by Hymenolepis nana (20%), Entamoeba coli (8%), and Enterobius vermicularis (3%). Except the statistically significant association between E. vermicularis infection and perianal itching and insomnia (P < 0.001), age, gender, and complaints of the examined individuals had no association with prevalence of parasitic infection. Both FEC and CF were equally the most accurate techniques (accuracy = 98.2%, confidence interval [CI] = 0.95-1.0, and κ index = 0.962), whereas the Kato-Katz method was the least accurate (accuracy = 67.5%, CI = 0.57-0.78, and κ index = 0.333). However, mini-FLOTAC-ZnSO₄ was the most accurate for diagnosis of helminthic infection, and FEC was more accurate for diagnosis of protozoal infection (accuracy = 100%, CI = 1.0-1.0, and κ index = 1).

Hymenolepis nana Impact Among Children in the Highlands of Cusco, Peru: An Emerging Neglected Parasite Infection

Hymenolepis nana is the most common cestode infection in the world. However, limited information is available regarding its impact on affected populations. We studied the epidemiology and symptoms associated with hymenolepiasis among children 3-16 years old in 16 rural communities of the highlands of the Cusco region in Peru. Information on demographics, socioeconomic status, symptoms as reported by parents, and parasitological testing was obtained from the database of an ongoing Fasciola hepatica epidemiologic study. A total of 1,230 children were included in the study. Forty-five percent were infected with at least one pathogenic intestinal parasite. Giardia spp. (22.9%) was the most common, followed by Hymenolepis (17.4%), Fasciola (14.1%), Ascaris lumbricoides (6.1%), and Strongyloides stercoralis (2%). The prevalence of Hymenolepis infection varied by community, by other parasitic infections, and by socioeconomic status. However, only years of education of the mother, use of well water, and age less than 10 years were associated with Hymenolepis infection in the multivariate analysis. Hymenolepis nana infection was associated with diarrhea, jaundice, headaches, fever, and fatigue. Children with > 500 eggs/g of stool were more likely to have symptoms of weight loss, jaundice, diarrhea, and fever. Hymenolepis nana infection and age were the only factors retained in the multivariate analysis modeling diarrhea. Hymenolepiasis is a common gastrointestinal helminth in the Cusco region and is associated with significant morbidity in children in rural communities. The impact caused by the emergence of Hymenolepis as a prevalent intestinal parasite deserves closer scrutiny.

Infection by Intestinal Parasites, Stunting and Anemia in School-Aged Children from Southern Angola

INTRODUCTION

Intestinal parasites are responsible for morbidity in children worldwide, especially in low income countries. In the present study we determine the prevalence of intestinal parasites and explore its association with anemia and stunting in school-aged children.

METHODS

A cross-sectional study was conducted from September to October 2010 enrolling 328 children attending the primary school in Lubango, the second largest city after the capital Luanda. Stool samples were collected for parasite detection through microscopy and molecular identification of Entamoeba histolytica and Entamoeba dispar. Stunting was assessed using the z-scores of height for age and hemoglobin concentration was determined using a portable hemoglobin analyzing system.

RESULTS

The global prevalence of pathogenic intestinal parasites was 44.2%, the most common being Ascaris lumbricoides (22.0%), Giardia lamblia (20.1%) and Hymenolepis nana (8.8%). Molecular detection revealed that 13.1% of the children carried E. dispar and 0.3% were infected with E. histolytica. The prevalence of stunting (mild to severe) was 41.5%. Stunting was more frequent in older children (p = 0.006, OR = 1.886), while anemia was more frequent in younger children (p = 0.005, OR = 2.210). The prevalence of anemia was 21.6%, and we found a significant association with infection by H. nana (p = 0.031, OR = 2.449).

CONCLUSIONS

This is one of the few published studies reporting intestinal parasites infection, nutritional status and anemia in children from Angola. Furthermore, the present work highlights the importance of regular intestinal parasites screening in children.