Prevalence and potential risk factors for gastrointestinal parasitic infections in children in urban Bissau, Guinea-Bissau

A cross-sectional study on the prevalence and associated risk factors for intestinal parasitic infections among under-five aged children in Dabat primary hospital, north Gondar, Ethiopia

Intestinal parasitic infections (IPIs) are the main public health problems in several developing countries, and under-five-aged children are the most vulnerable groups of the population. The current study aimed to determine the prevalence and associated risk factors of IPIs among under-five-aged children at Dabat primary hospital, northwest Ethiopia. A cross-sectional hospital-based study including 384 under-five-aged children was conducted from February to June 2022. A structured questionnaire was used to collect relevant information on risk factors, and stool samples were collected and examined using wet mount and sedimentation techniques to determine prevalence. Chi-square and logistic regression were used to evaluate the possible association and the strength of the association between dependent and independent variables. The overall prevalence of intestinal parasites was 32.81%. Ten species of intestinal parasites were identified. Entamoeba histolytica / dispar was the predominant intestinal parasite species, with a prevalence of 7.55%. Giardia lamblia and hookworm had prevalence of 6.77% and 5.47% respectively. Those children whose Mother/guardian do not wash their hand before feeding their child are more than five time infected than those who do wash (AOR = 5.26, CI = 2.28-12.2, p < 0.001). Children who do not wear shoe are more infected than who did (AOR = 14.5, CI = 5.77-36.5, p < 0.001). Several risk factors were identified in this study among these washing hands after toilet before touching child, washing hands before feeding their child, Child meal and habit of shoes wearing were the main predictors of IPI. Since the prevalence of IPI observed in this study is that of under-five-aged children; raising awareness of mothers/guardians about how to keep hygiene; transmission ways and health impacts of IPIs; and proper way of feeding their children to avoid risk is crucial.

Prevalence and Associated Risk Factors of Intestinal Parasites among Diarrheic Under-Five Children Attending Bahir Dar and Han Health Centers, Northwest Ethiopia: A Cross-Sectional Study

Background. Intestinal parasitic infection is one of the major public health problems in developing countries including Ethiopia. The problem is highly pronounced in children under five years of age who are not able to adhere to prevention and control precautions. Objective. To assess the prevalence of intestinal parasitic infections (IPIs) and associated factors among diarrheic children under five years of age attending Bahir Dar and Han Health Centers, Bahir Dar, Northwest Ethiopia. Methods. An institution-based cross-sectional study was conducted among diarrheic children less than five years of age at Bahir Dar and Han Health Centers, Northwest Ethiopia, 2020. A total of 221 diarrheic children less than five years of age were recruited using the convenience sampling technique. Data were collected using a pretested structured Amharic version questionnaire after obtaining informed consent from children’s parents or guardians. Approximately 1 mL of fresh fecal specimen was collected and subjected to direct saline wet mount microscopy. All data were entered into Epi Info version 7 and transferred to SPSS statistical software version 20 for analysis. Logistic regression was employed to assess risk factors associated with increased prevalence of intestinal parasitic infection in diarrheic children under five years of age, and a $P$ value < 0.05 was taken as statistically significant. Results. The overall prevalence of intestinal parasites was 19% ( $95\%\text{CI}=14–24.6$ ). The most prevalent intestinal parasites were Entamoeba histolytica/Entamoeba dispar (24 (10.86%)), Giardia lamblia (12 (5.43%)), and Ascaris lumbricoides (2 (0.9%)). Children’s mother/guardian washed their hands sometimes after the toilet ( $\text{AOR}=2.98$ , 95% CI: 1.09-8.18), children who always eat unwashed fruits and vegetables ( $\text{AOR}=4.63$ , 95% CI: 1.09–19.75), and children’s mother/guardian who had no knowledge about the mode of transmission ( $\text{AOR}=4.03$ , 95% CI: 1.04–15.64) were risk factors significantly associated with increased intestinal parasitic infections. Conclusion. The prevalence of intestinal parasitic infections was found low compared to the population prevalence reported by WHO. However, strengthening health education about food and personal hygiene of both children and their mothers/guardians is crucial to limit the transmission of IPIs.

Ecology impacts the decrease of Spirochaetes and Prevotella in the fecal gut microbiota of urban humans

Compared to the huge microbial diversity in most mammals, human gut microbiomes have lost diversity while becoming specialized for animal-based diets – especially compared to chimps, their genetically closest ancestors. The lowered microbial diversity within the gut of westernized populations has also been associated with different kinds of chronic inflammatory diseases in humans. To further deepen our knowledge on phylogenetic and ecologic impacts on human health and fitness, we established the herein presented biobank as well as its comprehensive microbiota analysis. In total, 368 stool samples from 38 different animal species, including Homo sapiens, belonging to four diverse mammalian orders were collected at seven different locations and analyzed by 16S rRNA gene amplicon sequencing. Comprehensive data analysis was performed to (i) determine the overall impact of host phylogeny vs. diet, location, and ecology and to (ii) examine the general pattern of fecal bacterial diversity across captive mammals and humans.

By using a controlled study design with captive mammals we could verify that host phylogeny is the most dominant driver of mammalian gut microbiota composition. However, the effect of ecology appears to be able to overcome host phylogeny and should therefore be studied in more detail in future studies. Most importantly, our study could observe a remarkable decrease of Spirochaetes and Prevotella in westernized humans and platyrrhines, which is probably not only due to diet, but also to the social behavior and structure in these communities.

Our study highlights the importance of phylogenetic relationship and ecology within the evolution of mammalian fecal microbiota composition. Particularly, the observed decrease of Spirochaetes and Prevotella in westernized communities might be associated to lifestyle dependent rapid evolutionary changes, potentially involved in the establishment of dysbiotic microbiomes, which promote the etiology of chronic diseases.

Intestinal protozoan infections shape fecal bacterial microbiota in children from Guinea-Bissau

Intestinal parasitic infections, caused by helminths and protozoa, are globally distributed and major causes of worldwide morbidity. The gut microbiota may modulate parasite virulence and host response upon infection. The complex interplay between parasites and the gut microbiota is poorly understood, partly due to sampling difficulties in remote areas with high parasite burden. In a large study of children in Guinea-Bissau, we found high prevalence of intestinal parasites. By sequencing of the 16S rRNA genes of fecal samples stored on filter paper from a total of 1,204 children, we demonstrate that the bacterial microbiota is not significantly altered by helminth infections, whereas it is shaped by the presence of both pathogenic and nonpathogenic protozoa, including Entamoeba (E.) spp. and Giardia (G.) lamblia. Within-sample diversity remains largely unaffected, whereas overall community composition is significantly affected by infection with both nonpathogenic E. coli (R2 = 0.0131, P = 0.0001) and Endolimax nana (R2 = 0.00902, P = 0.0001), and by pathogenic E. histolytica (R2 = 0.0164, P = 0.0001) and G. lamblia (R2 = 0.00676, P = 0.0001). Infections with multiple parasite species induces more pronounced shifts in microbiota community than mild ones. A total of 31 bacterial genera across all four major bacterial phyla were differentially abundant in protozoan infection as compared to noninfected individuals, including increased abundance of Prevotella, Campylobacter and two Clostridium clades, and decreased abundance of Collinsella, Lactobacillus, Ruminococcus, Veillonella and one Clostridium clade. In the present study, we demonstrate that the fecal bacterial microbiota is shaped by intestinal parasitic infection, with most pronounced associations for protozoan species. Our results provide insights into the interplay between the microbiota and intestinal parasites, which are valuable to understand infection biology and design further studies aimed at optimizing treatment strategies.

Prevalence and Clinical Manifestations of Giardia intestinalis and Other Intestinal Parasites in Children and Adults in Algeria

Giardia intestinalis is one of the most common causes of parasite-induced diarrhea, abdominal pain, flatulence, and malabsorption. Yet, data on the epidemiology of G. intestinalis infections in North Africa are limited. The purpose of this study was to carry out a retrospective survey on the level of intestinal parasitism with a particular emphasis on G. intestinalis in children and adults in Algiers, Algeria. A total of 2,054 individuals from outpatient clinics or hospitalized at Beni-Messous University Hospital of Algiers undergoing stool microscopy for ova and parasites were included. The overall parasite infection rate was 28%. In the 567 parasite-positive samples, Blastocystis was found most frequently (57.3%), followed in frequency by Endolimax nana (41.0%), Entamoeba histolytica/dispar (19.6%), G. intestinalis (17.1%), Entamoeba coli (13.9%), Chilomastix mesnili (1.0%), Iodamoeba bütschlii (0.7%), Entamoeba hartmanni (0.5%), and Cryptosporidium spp. (0.2%). Intestinal parasites were generally more common in adults than in children, except for Giardia, which was more common in children (P = 0.0001). Giardia infection was independent of gender (P = 0.94). Compared with other intestinal parasitic infections, clinical manifestations, such as abdominal pain (P = 0.28) and diarrhea (P = 0.82), were found not to be significantly linked to Giardia infection. In conclusion, G. intestinalis is common in individuals referred to the University Hospital of Beni-Messous with digestive symptoms, particularly so in children. However, in our study, intestinal symptoms appeared not to be more linked to Giardia than to other intestinal parasites.

Prevalence, risk factors and health consequences of soil-transmitted helminth infection on the Bijagos Islands, Guinea Bissau: A community-wide cross-sectional study

Soil-transmitted helminths (STH) are endemic and widespread across Sub-Saharan Africa. A community wide soil-transmitted helminth (STH) prevalence survey was performed on the island of Bubaque in Guinea-Bissau using both Kato-katz microscopy and qPCR methodology. Predictors of infection and morbidity indicators were identified using multivariable logistic regression, and diagnostic methods were compared using k statistics. Among 396 participants, prevalence of STH by microscopy was 23.2%, hookworm was the only species identified by this method and the mean infection intensity was 312 eggs per gram. qPCR analysis revealed an overall prevalence of any STH infection of 47.3%, with the majority A. duodenale (32.3%), followed by N. americanus (15.01%) and S. stercoralis (13.2%). A. lumbricoides, and T. trichiura infections were negligible, with a prevalence of 0.25% each. Agreement between diagnostic tests was k = 0.22, interpreted as fair agreement, and infection intensity measured by both methods was only minimally correlated (Rs = -0.03). STH infection overall was more common in females and adults aged 31-40. STH infection was associated with open defaecation, low socio-economic status and further distance to a water-source. The prevalence of anaemia (defined as a binary outcome by the WHO standards for age and sex) was 69.1%, and 44.2% of children were malnourished according to WHO child growth standards. Hookworm infection intensity by faecal egg count showed no statistically significant association with age (Rs 0.06) but S. Stercoralis infection intensity by qPCR cycle threshold was higher in pre-school aged children (Rs = 0.30, p-value 0.03) There was no statistically significant association between STH infection and anaemia (OR 1.0 p = 0.8), stunting (OR 1.9, p-value 0.5) and wasting (OR 2.0, p-value 0.2) in children. This study reveals a persistent reservoir of STH infection across the community, with high rates of anaemia and malnutrition, despite high-coverage of mebendazole mass-drug administration in pre-school children. This reflects the need for a new strategy to soil-transmitted helminth control, to reduce infections and ultimately eliminate transmission.

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.

Human intestinal parasitic infection: a narrative review on global prevalence and epidemiological insights on preventive, therapeutic and diagnostic strategies for future perspectives

INTRODUCTION

Intestinal parasitic infection (IPI) is a global health concern among socioeconomically deprived communities in many developing countries. Many preventative strategies have been deployed to control IPI, however, there is a lack in standards on the techniques used to diagnose and monitor the prevalence of IPI.

AREAS COVERED

The present article will review the diseases associated with IPI and discuss the current IPI control strategies such as the water, sanitation, and hygiene (WASH) interventions, community-led total sanitation (CLTS) approach, and regular anthelminthic treatments. For the first time, this review will also evaluate all currently practised diagnostic techniques for the detection of intestinal parasites and provide insights on future IPI control strategies.

EXPERT OPINION

Advanced and improved diagnostic methods such as qPCR coupled with a high-resolution melting curve, aptamers, biosensors, and detection of extracellular vesicles can be used for detection of IPI. Vaccination against intestinal parasites can be made available to increase antibodies to interfere with the blood-feeding process by the parasites, which subsequently reduces the reproductive rates of the parasites. These methods collectively can serve as future management strategies for intestinal parasitic infections.

Infections with Giardia duodenalis and Entamoeba histolytica/Entamoeba dispar as Hidden and Prevalent Conditions in Periurban Communities in the State of Rio de Janeiro, Brazil

This study aims to assess the prevalence, distribution, and etiological profile of intestinal parasitism in children living in periurban areas in Cachoeiras de Macacu, Rio de Janeiro, Brazil. A community-based cross-sectional survey (n = 479) was carried out. Prevalence of infection with G. duodenalis and E. histolytica/E. dispar was 8.6% (n = 41) and 13.4% (n = 64), respectively. Infection with G. duodenalis was significantly more frequent among children living in poor families (24/187 (12.8%) vs. 16/272 (5.9%); prevalence ratio (PR) = 2.18; 95% confidence interval (CI) = 1.19–3.99; p=0.011). This difference was also significant for infection with any pathogenic parasite (43/187 (23%) vs. 40/272 (14/7%); PR = 1.56; 95% CI = 1.06–2.30; p=0.026). In addition, people residing in houses with more than four inhabitants showed significantly higher positivity for infections with G. duodenalis and with E. histolytica/E. dispar (22/138 (15.9%) vs. 16/311 (5.1%); PR = 3.09; 95% CI = 1.68–5.71; p < 0.001 for G. duodenalis and 32/138 (23.2%) vs. 30/311 (9.6%); PR = 2.40; 95% CI = 1.52–3.79; p < 0.001 for E. histolytica/E. dispar). Laboratory diagnosis of protozoan enteric infections and effective drugs for their treatment are unmet goals in the primary health care system. Therefore, giardiasis and amebiasis are neglected conditions.

Prevalence of selected intestinal protozoan infections in marginalized rural communities in Palestine

Background

Intestinal parasitic infections are common in rural areas with poor infrastructure and low socioeconomic status. The aim of this study was to estimate the prevalence of selected parasitic infections in marginalized rural areas in the northern part of the Palestinian West Bank Region, using conventional and PCR-based methods, and also to assess risk predictors of infection.

Methods

A cross-sectional study was conducted on 104 individuals from three rural villages in the Jordan Valley. Stool samples were collected and examined by a battery of tests that included microscopy of wet fecal samples in normal saline with iodine, concentration by ethyl acetate sedimentation and also by zinc sulfate floatation, a conventional PCR and a real-time PCR (qPCR). Risk factors were assessed that included demographic, socioeconomic, and behavioral characteristics. Data on method performance was analyzed by kappa-statistic, Cochrane’s Q, and McNemar post hoc test. Mid-P exact test and odds ratio were used to discern association between outcome and risk predictors.

Results

The overall prevalence of intestinal parasitic infections was 48% (49/102). The predominant parasites were Giardia lamblia at 37% (37/102) and Hymenolepis nana at 9% (9/102). To concentrate cysts and eggs, sedimentation can be used as an alternative to floatation with a loss of 1% of positive cases. The methods employing PCRs proved crucial as it increased the detected infection rate of G. lamblia approximately three-fold from 13% by the conventional methods to 37% by the qPCR. Multiple infections were present in 13% (13/102) of the study group, which included double (10%) and triple (3%) infections. Regarding the genus Entamoeba, E. dispar and E. coli were detected at rates of 2 and 8%, respectively. While none of the individuals were infected with the pathogenic E. histolytica, E. nana (4%) was detected for the first time in the area. Age was a risk predictor for infection (OR = 2.61, CI 95% 1.05–6.45, P = 0.038).

Conclusions

The increased prevalence of intestinal parasitic infections in children in marginalized rural areas in Palestine is worrying. The addition of PCR-based methods is important for the diagnosis of such infections as, with cautious interpretation, it increases proficiency and overcomes underestimation and misdiagnosis of cases. Control measures including education on personal hygiene and environmental sanitation, should be introduced to reduce the prevalence of the intestinal parasites and, thus, the infections they cause in this and other areas.