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Sedekia Y, Kapiga S, Mcharo O, Makata K, Torondel B, Dreibelbis R, Okello E. Does a school-based intervention to engage parents change opportunity for handwashing with soap at home? Practical experience from the Mikono Safi trial in Northwestern Tanzania. PLoS Negl Trop Dis 2022; 16:e0010438. [PMID: 35666720 PMCID: PMC9170081 DOI: 10.1371/journal.pntd.0010438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 04/20/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND School-based de-worming is advocated as a strategy for reducing the burden of soil-transmitted helminth (STH) infections among children. However, re-infection tends to occur rapidly, suggesting that comprehensive water, sanitation, and hygiene (WASH) improvements may be needed to prevent this. We qualitatively assessed the influence of parental engagement activities on parents' motivation to improve WASH infrastructure and hygiene practices at home in the context of a school-based de-worming programme. METHODOLOGY We conducted a longitudinal qualitative study nested within the Mikono Safi trial, designed to assess the effect of a WASH intervention on STH infection prevalence in children. Meetings were organized for parents/guardians at schools where they were given information about STH infection, the role of WASH in STH infection prevention, and actionable steps they could take at home. During the meetings, parents/guardians received information about their own child's STH infection status. Twenty purposively selected households were visited and interviewed 3 times over a period of about 8-months. We employed thematic analysis; findings are reported following the Capability-Opportunity-Motivation and Behaviour (COM-B) framework. PRINCIPAL FINDINGS The engagement strategy improved parents'/guardians' knowledge and skills about handwashing with soap and its benefits. Parents/guardians reported that the sessions had motivated them to improve WASH infrastructure at home. Of 20 households included in this study, 17 renovated or built new latrines and 18 installed handwashing facilities. However, only 8 households established and maintained handwashing stations with both soap and water at 8 months. CONCLUSIONS The engagement of parents/guardians in a school-based WASH education intervention as part of the Mikono Safi trial resulted in increased knowledge and motivation about handwashing and sanitation. This led to improvements in sanitation facilities and handwashing opportunities at home. However, long-term success in provision of water and soap was limited, indicating that sustained engagement may be required to encourage households to ensure these materials are consistently available at home.
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Affiliation(s)
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine [LSHTM], London, United Kingdom
| | - Onike Mcharo
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | | | - Belen Torondel
- Department of Disease Control, London School of Hygiene and Tropical Medicine [LSHTM], London, United Kingdom
| | - Robert Dreibelbis
- Department of Disease Control, London School of Hygiene and Tropical Medicine [LSHTM], London, United Kingdom
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Mero S, Timonen S, Lääveri T, Løfberg S, Kirveskari J, Ursing J, Rombo L, Kofoed PE, Kantele A. Prevalence of diarrhoeal pathogens among children under five years of age with and without diarrhoea in Guinea-Bissau. PLoS Negl Trop Dis 2021; 15:e0009709. [PMID: 34587158 PMCID: PMC8504977 DOI: 10.1371/journal.pntd.0009709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 10/11/2021] [Accepted: 08/05/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Childhood diarrhoea, a major cause of morbidity and mortality in low-income regions, remains scarcely studied in many countries, such as Guinea-Bissau. Stool sample drying enables later qPCR analyses of pathogens without concern about electricity shortages. METHODS Dried stool samples of children under five years treated at the Bandim Health Centre in Bissau, Guinea-Bissau were screened by qPCR for nine enteric bacteria, five viruses, and four parasites. The findings of children having and not having diarrhoea were compared in age groups 0-11 and 12-59 months. RESULTS Of the 429 children- 228 with and 201 without diarrhoea- 96.9% and 93.5% had bacterial, 62.7% and 44.3% viral, and 52.6% and 48.3% parasitic pathogen findings, respectively. Enteroaggregarive Escherichia coli (EAEC; 60.5% versus 66.7%), enteropathogenic E. coli (EPEC; 61.4% versus 62.7%), Campylobacter (53.2% versus 51.8%), and enterotoxigenic E. coli (ETEC; 54.4% versus 44.3%) were the most common bacterial pathogens. Diarrhoea was associated with enteroinvasive E. coli (EIEC)/Shigella (63.3%), ETEC (54.4%), astrovirus (75.0%), norovirus GII (72.6%) and Cryptosporidium (71.2%). The only pathogen associated with severe diarrhoea was EIEC/Shigella (p<0.001). EAEC was found more frequent among the infants, and EIEC/Shigella, Giardia duodenalis and Dientamoeba fragilis among the older children. CONCLUSIONS Stool pathogens proved common among all the children regardless of them having diarrhoea or not.
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Affiliation(s)
- Sointu Mero
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Meilahti Infectious Diseases and Vaccine Research Center, MeiVac, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Suvi Timonen
- Division of Clinical Microbiology, Helsinki University Hospital, HUSLAB, Helsinki, Finland
| | - Tinja Lääveri
- Meilahti Infectious Diseases and Vaccine Research Center, MeiVac, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sandra Løfberg
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | | | - Johan Ursing
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
- Department of Infectious Diseases, Danderyds Hospital, Stockholm, Sweden
| | - Lars Rombo
- Unit of Infectious Diseases, Uppsala University, Uppsala, Sweden
- Centre for Clinical Research, Sörmland County Council, Eskilstuna, Sweden and Uppsala University, Uppsala, Sweden
| | - Poul-Erik Kofoed
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Anu Kantele
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Meilahti Infectious Diseases and Vaccine Research Center, MeiVac, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- * E-mail:
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Hlashwayo DF, Sigaúque B, Noormahomed EV, Afonso SMS, Mandomando IM, Bila CG. A systematic review and meta-analysis reveal that Campylobacter spp. and antibiotic resistance are widespread in humans in sub-Saharan Africa. PLoS One 2021; 16:e0245951. [PMID: 33503068 PMCID: PMC7840040 DOI: 10.1371/journal.pone.0245951] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/11/2021] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Campylobacter spp. are zoonotic bacteria that cause gastroenteritis in humans worldwide, whose main symptom is diarrhea. In certain cases, extra intestinal manifestations may occur, such as Guillain Barré syndrome. The bacteria cause severe diarrhea mostly in children and in immunocompromised individuals. This review aims to address the prevalence of Campylobacter spp. in humans in sub-Saharan Africa. It also aims to understand the impact of HIV in the prevalence, as well as to report data on antibiotic resistance and propose research priorities. METHODS We followed PRISMA guidelines to find studies on the occurrence of Campylobacter spp. in humans in all countries from sub-Saharan Africa. Studies published between 2000 and 2020 were searched in PubMed, Cochrane Library, CINAHL, African Index Medicus, African Journals Online, Google Scholar and Science Direct. We have conducted a random-effect meta-analysis and calculated the proportion of resistant isolates to different antibiotics. RESULTS AND DISCUSSION We found 77 studies that described such occurrence in humans in 20 out of 53 sub-Saharan African countries. Campylobacter jejuni was the most prevalent species. Pooled prevalence was 9.9% (CI: 8.4%-11.6%). No major variations within the different sub-regions were found. Most studies reported Campylobacter spp. as the cause of diarrhea, mainly in children. Some studies reported the bacteria as a possible etiologic agent of acute flaccid paralysis and urinary tract infection. Campylobacter spp. presented a higher pooled prevalence in HIV infected patients, although not statistically significant. High proportions of resistant strains were reported for many antibiotics, including erythromycin and tetracycline. CONCLUSION Campylobacter spp. occur in sub-Saharan Africa, although information is scarce or inexistent for many countries. Research priorities should include investigation of the understudied species; extra intestinal manifestations; the impact of HIV infection and associated risk factors. Control strategies should be reinforced to contain the spread of this pathogen and drug resistance.
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Affiliation(s)
- Delfina F. Hlashwayo
- Department of Biological Sciences, Faculty of Sciences, Eduardo Mondlane University, Maputo, Mozambique
- Faculty of Veterinary Science, Eduardo Mondlane University, Maputo, Mozambique
| | - Betuel Sigaúque
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Emília V. Noormahomed
- Department of Microbiology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Infectious Disease Division, Department of Medicine, University of California, San Diego, San Diego, CA, United States of America
- Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique
| | - Sónia M. S. Afonso
- Faculty of Veterinary Science, Eduardo Mondlane University, Maputo, Mozambique
| | - Inácio M. Mandomando
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- Instituto Nacional de Saúde (INS), Ministério da Saúde, Marracuene, Mozambique
| | - Custódio G. Bila
- Faculty of Veterinary Science, Eduardo Mondlane University, Maputo, Mozambique
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von Huth S, Kofoed PE, Holmskov U. Prevalence and potential risk factors for gastrointestinal parasitic infections in children in urban Bissau, Guinea-Bissau. Trans R Soc Trop Med Hyg 2019; 113:545-554. [PMID: 31034044 DOI: 10.1093/trstmh/trz032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 03/28/2019] [Accepted: 04/01/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Gastrointestinal (GI) parasitic infections cause significant morbidity and mortality in tropical and subtropical countries. We aimed to investigate the prevalence of GI parasitic infections in children from Bissau, Guinea-Bissau and to identify the possible risk factors for these infections. METHODS We performed an observational study on two comparable cohorts of children 2-15 y of age: one study covering health care-seeking children (n=748) and one study covering children from the background population (n=851). A total of 1274 faecal samples from the two cohorts were investigated for parasites by microscopy and the risk factors for infection were identified by logistic regression. RESULTS Intestinal parasitic infections were found in 54.8% of health care-seeking children and 55.5% of children from the background population. Helminth infections were more common among health care-seeking children and were mainly due to hookworms. Pathogenic protozoa included Entamoeba histolytica/dispar and Giardia lamblia. The risk factors for infections included increasing age, household crowding and poor sanitation and water supply. CONCLUSIONS We found a high prevalence of intestinal parasites among both health care-seeking children and children from the background population. Compared with previous studies, we found a decreasing prevalence of intestinal helminths. This study further identifies potential risk factors for infections, including inadequate sanitation and water supply.
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Affiliation(s)
- Sebastian von Huth
- Cancer and Inflammation Research, Department of Molecular Medicine, University of Southern Denmark, J. B. Winslows, Odense C, Denmark
| | - Poul-Erik Kofoed
- Department of Pediatrics, Kolding Hospital, Skovvangen 2-8, Kolding, Denmark
- Bandim Health Project, INDEPTH Network, Apartado, Bissau, Guinea-Bissau
| | - Uffe Holmskov
- Cancer and Inflammation Research, Department of Molecular Medicine, University of Southern Denmark, J. B. Winslows, Odense C, Denmark
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Gabrie JA, Rueda MM, Canales M, Gyorkos TW, Sanchez AL. School hygiene and deworming are key protective factors for reduced transmission of soil-transmitted helminths among schoolchildren in Honduras. Parasit Vectors 2014; 7:354. [PMID: 25091035 PMCID: PMC4132920 DOI: 10.1186/1756-3305-7-354] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 07/29/2014] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Among many neglected tropical diseases endemic in Honduras, soil-transmitted helminth (STH) infections are of particular importance. However, knowledge gaps remain in terms of risk factors involved in infection transmission. The aim of this study was to investigate risk factors associated with STH infections in schoolchildren living in rural Honduras. METHODS A cross-sectional study was conducted among Honduran rural schoolchildren in 2011. Demographic, socio-economic, and epidemiological data were obtained through a standardized questionnaire and STH infections were determined by the Kato-Katz method. Logistic regression models accounting for school clustering were used to assess putative risk factors for infection. RESULTS A total of 320 children completed the study. Prevalences for any STH and for Ascaris lumbricoides, Trichuris trichiura and hookworms were: 72.5%, 30.3%, 66.9% and 15.9%, respectively. A number of risk factors were identified at the individual, household, and school level. Boys were at increased odds of infection with hookworms (OR 2.33, 95% CI = 1.23-4.42). Higher socio-economic status in the family had a protective effect against infections by A. lumbricoides (OR 0.80, 95% CI = 0.65-0.99) and T. trichiura (OR 0.77, 95% CI = 0.63-0.94).Low school hygiene conditions significantly increased the odds for ascariasis (OR 14.85, 95% CI = 7.29-30.24), trichuriasis (OR 7.32, 95% CI = 3.71-14.45), mixed infections (OR 9.02, 95% CI = 4.66-17.46), and ascariasis intensity of infection (OR 3.32, 95% CI = 1.05 -10.52).Children attending schools not providing deworming treatment or that had provided it only once a year were at increased odds of ascariasis (OR 10.40, 95% CI = 4.39-24.65), hookworm (OR 2.92, 95% CI = 1.09-7.85) and mixed infections (OR 10.57, 95% CI = 4.53-24.66). CONCLUSIONS Poverty-reduction strategies will ultimately lead to sustainable control of STH infections in Honduras, but as shorter-term measures, uninterrupted bi-annual deworming treatment paired with improvements in school sanitary conditions may result in significant reductions of STH prevalence among Honduran schoolchildren.
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Affiliation(s)
| | | | | | | | - Ana Lourdes Sanchez
- Department of Health Sciences, Brock University, St, Catharines, Ontario, Canada.
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Strunz EC, Addiss DG, Stocks ME, Ogden S, Utzinger J, Freeman MC. Water, sanitation, hygiene, and soil-transmitted helminth infection: a systematic review and meta-analysis. PLoS Med 2014; 11:e1001620. [PMID: 24667810 PMCID: PMC3965411 DOI: 10.1371/journal.pmed.1001620] [Citation(s) in RCA: 439] [Impact Index Per Article: 43.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 02/13/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Preventive chemotherapy represents a powerful but short-term control strategy for soil-transmitted helminthiasis. Since humans are often re-infected rapidly, long-term solutions require improvements in water, sanitation, and hygiene (WASH). The purpose of this study was to quantitatively summarize the relationship between WASH access or practices and soil-transmitted helminth (STH) infection. METHODS AND FINDINGS We conducted a systematic review and meta-analysis to examine the associations of improved WASH on infection with STH (Ascaris lumbricoides, Trichuris trichiura, hookworm [Ancylostoma duodenale and Necator americanus], and Strongyloides stercoralis). PubMed, Embase, Web of Science, and LILACS were searched from inception to October 28, 2013 with no language restrictions. Studies were eligible for inclusion if they provided an estimate for the effect of WASH access or practices on STH infection. We assessed the quality of published studies with the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. A total of 94 studies met our eligibility criteria; five were randomized controlled trials, whilst most others were cross-sectional studies. We used random-effects meta-analyses and analyzed only adjusted estimates to help account for heterogeneity and potential confounding respectively. Use of treated water was associated with lower odds of STH infection (odds ratio [OR] 0.46, 95% CI 0.36-0.60). Piped water access was associated with lower odds of A. lumbricoides (OR 0.40, 95% CI 0.39-0.41) and T. trichiura infection (OR 0.57, 95% CI 0.45-0.72), but not any STH infection (OR 0.93, 95% CI 0.28-3.11). Access to sanitation was associated with decreased likelihood of infection with any STH (OR 0.66, 95% CI 0.57-0.76), T. trichiura (OR 0.61, 95% CI 0.50-0.74), and A. lumbricoides (OR 0.62, 95% CI 0.44-0.88), but not with hookworm infection (OR 0.80, 95% CI 0.61-1.06). Wearing shoes was associated with reduced odds of hookworm infection (OR 0.29, 95% CI 0.18-0.47) and infection with any STH (OR 0.30, 95% CI 0.11-0.83). Handwashing, both before eating (OR 0.38, 95% CI 0.26-0.55) and after defecating (OR 0.45, 95% CI 0.35-0.58), was associated with lower odds of A. lumbricoides infection. Soap use or availability was significantly associated with lower infection with any STH (OR 0.53, 95% CI 0.29-0.98), as was handwashing after defecation (OR 0.47, 95% CI 0.24-0.90). Observational evidence constituted the majority of included literature, which limits any attempt to make causal inferences. Due to underlying heterogeneity across observational studies, the meta-analysis results reflect an average of many potentially distinct effects, not an average of one specific exposure-outcome relationship. CONCLUSIONS WASH access and practices are generally associated with reduced odds of STH infection. Pooled estimates from all meta-analyses, except for two, indicated at least a 33% reduction in odds of infection associated with individual WASH practices or access. Although most WASH interventions for STH have focused on sanitation, access to water and hygiene also appear to significantly reduce odds of infection. Overall quality of evidence was low due to the preponderance of observational studies, though recent randomized controlled trials have further underscored the benefit of handwashing interventions. Limited use of the Joint Monitoring Program's standardized water and sanitation definitions in the literature restricted efforts to generalize across studies. While further research is warranted to determine the magnitude of benefit from WASH interventions for STH control, these results call for multi-sectoral, integrated intervention packages that are tailored to social-ecological contexts.
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Affiliation(s)
- Eric C. Strunz
- Children Without Worms, The Task Force for Global Health, Decatur, Georgia, United States of America
| | - David G. Addiss
- Children Without Worms, The Task Force for Global Health, Decatur, Georgia, United States of America
| | - Meredith E. Stocks
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Stephanie Ogden
- Children Without Worms, The Task Force for Global Health, Decatur, Georgia, United States of America
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- International Trachoma Initiative, The Task Force for Global Health, Decatur, Georgia, United States of America
| | - Jürg Utzinger
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Matthew C. Freeman
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
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Ferreira FS, Centeno-Lima S, Gomes J, Rosa F, Rosado V, Parreira R, Cravo L, Atouguia J, Távora Tavira L. Molecular characterization of Giardia duodenalis in children from the Cufada Lagoon Natural Park, Guinea-Bissau. Parasitol Res 2012; 111:2173-7. [DOI: 10.1007/s00436-012-3068-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 07/29/2012] [Indexed: 10/28/2022]
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Al-Mohammed HI, Amin TT, Aboulmagd E, Hablus HR, Zaza BO. Prevalence of intestinal parasitic infections and its relationship with socio–demographics and hygienic habits among male primary schoolchildren in Al–Ahsa, Saudi Arabia. ASIAN PAC J TROP MED 2010. [DOI: 10.1016/s1995-7645(10)60218-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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