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Ochola S, Lelei A, Korir J, Ombati C, Chebet C, Doledec D, Mutea F, Nielsen J, Omariba S, Njeri E, Baker MM. Feasibility of delivering vitamin A supplementation (VAS) and deworming through routine community health services in Siaya County, Kenya: A cross-sectional study. MATERNAL & CHILD NUTRITION 2024; 20:e13626. [PMID: 38311791 PMCID: PMC10981474 DOI: 10.1111/mcn.13626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 12/03/2023] [Accepted: 01/09/2024] [Indexed: 02/06/2024]
Abstract
Vitamin A deficiency and soil-transmitted helminth infection are serious public health problems in Kenya. The coverage of vitamin A supplementation and deworming medication (VASD) provided through mass campaigns is generally high, yet with a cost that is not sustainable, while coverage offered through routine health services is low. Alternative strategies are needed that achieve the recommended coverage of >80% of children twice annually and can be managed by health systems with limited resources. We undertook a study from September to December 2021 to compare the feasibility and coverage of VASD locally delivered by community health volunteers (CHV) ("intervention arm") to that achieved by the bi-annual Malezi Bora campaign event ("control arm"). This comparative cross-sectional study was conducted in sub-counties of Siaya County using both qualitative and quantitative methods. VASD were offered through the CHS in Alego Usonga and through Malezi Bora in Bondo Sub-County. Coverage was assessed by a post-event coverage survey among caregivers of children aged 6-59 months (n = 307 intervention; n = 318 control). Key informant interviews were conducted with n = 43 personnel across both modalities, and 10 focus group discussions were conducted with caregivers of children aged 6-59 months to explore knowledge, attitudes and perceptions of the two strategies. VAS coverage by CHV was 90.6% [95% CI: 87.3-93.9] compared to 70.4% [95% CI: 65.4-75.4] through the Malezi Bora, while deworming coverage was 73.9% [95% CI: 69.0-78.7] and 54.7% [95% CI: 49.2-60.2], respectively. With sufficient training and oversight, CHV can achieve superior coverage to campaigns.
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Affiliation(s)
- Sophie Ochola
- Department of Food Nutrition and DieteticsKenyatta UniversityNairobiKenya
| | - Asa Lelei
- Department of NutritionHelen Keller InternationalNew YorkNew YorkUSA
| | - Julius Korir
- Department of Food Nutrition and DieteticsKenyatta UniversityNairobiKenya
| | - Caleb Ombati
- Department of NutritionHelen Keller InternationalNew YorkNew YorkUSA
| | - Caroline Chebet
- Department of NutritionHelen Keller InternationalNew YorkNew YorkUSA
| | - David Doledec
- Department of NutritionHelen Keller InternationalNew YorkNew YorkUSA
| | - Fridah Mutea
- Department of NutritionHelen Keller InternationalNew YorkNew YorkUSA
| | - Jennifer Nielsen
- Department of NutritionHelen Keller InternationalNew YorkNew YorkUSA
| | - Solomon Omariba
- Department of NutritionHelen Keller InternationalNew YorkNew YorkUSA
| | - Esther Njeri
- Department of NutritionHelen Keller InternationalNew YorkNew YorkUSA
| | - Melissa M. Baker
- Department of NutritionHelen Keller InternationalNew YorkNew YorkUSA
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Agrawal R, Pattnaik S, Kshatri JS, Kanungo S, Mandal N, Palo SK, Pati S. Prevalence and correlates of soil-transmitted helminths in schoolchildren aged 5 to 18 years in low- and middle-income countries: a systematic review and meta-analysis. Front Public Health 2024; 12:1283054. [PMID: 38577281 PMCID: PMC10991833 DOI: 10.3389/fpubh.2024.1283054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/01/2024] [Indexed: 04/06/2024] Open
Abstract
Background According to the Global Burden of Disease (GBD) 2019 report, up to 1.5 million disability-adjusted life years (DALYs) are lost due to soil-transmitted helminths (STHs), and 5.9 million people are at risk of acquiring STHs. Regions with the highest prevalence of STH infections include Sub-Saharan Africa, China, South America, and Asia. While there are numerous fragmented studies on STH, comprehensive information on the prevalence and geographic distribution of different species, as well as their regional variations in the context of STHs is limited. The present systematic review and meta-analysis study attempts to provide a summary of the prevalence, geographical variation, and determinants of STHs among schoolchildren aged 5 to 18 years. Methods An extensive literature search was carried out using PubMed, Embase, Cinhal, and Psychinfo for studies published between 1999 and 2022 that reported the rate of STH infection in school-going children aged 5-18 years. A random effects model was employed in this meta-analysis due to expected heterogeneity. Subgroup analysis was carried out based on sex and STH species because of expected geographical variation. Results A total of 19,725 of the 49,630 children examined were infected with STH, yielding an overall pooled prevalence of 37.16% (95% CI: 29.74-44.89). The prevalence was highest in the Western Pacific region at 50.41% (95% CI: 33.74-67.04) followed by Europe at 39.74% (95% CI: 20.40-61.0) and Africa at 37.10% (95% CI: 26.84-47.95). Ascaris lumbricoides was found to be the most prevalent helminth with a prevalence of 24.07% (95% CI: 17.07-31.83). Conclusion The Western Pacific region is classified as a High-risk Zone (HRZ), while Southeast Asia, Africa, Europe, and the Eastern Mediterranean are classified as moderate-risk zones (MRZs). We found a 12% reduction in the pooled prevalence of STH infection from 1999 to 2012. Ascaris lumbricoides was the predominant species among schoolchildren. Mass Drug Administration (MDA) of Albendazole tablets and improved water, sanitation, and hygiene (WASH) practices are effective in controlling and preventing STH. Ensuring their implementation and access is crucial to addressing the problem. Systematic review registration https://www.crd.york.ac.uk/prospero/#loginpage, CRD42022333341.
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Hon KL, Leung AKC. An update on the current and emerging pharmacotherapy for the treatment of human ascariasis. Expert Opin Pharmacother 2024. [PMID: 38372051 DOI: 10.1080/14656566.2024.2319686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 02/13/2024] [Indexed: 02/20/2024]
Abstract
INTRODUCTION Globally, Ascaris lumbricoides is the commonest helminthic infection that affects people in underdeveloped countries and returning immigrants in industrialized nations. This article aims to provide latest updates on the epidemiology, clinical manifestations, and pharmacotherapy of ascariasis. AREAS COVERED A PubMed search was conducted using Clinical Queries and the key terms 'human ascariasis' OR 'Ascaris lumbricoides.' Ascaris lumbricoides is highly endemic in tropical and subtropic regions and among returning immigrants in industrialized nations. Predisposing factors include poor sanitation and poverty. The prevalence is greatest in young children. Most infected patients are asymptomatic. Patients with A. lumbricoides infection should be treated with anti-helminthic drugs to prevent complications from migration of the worm. Mebendazole and albendazole are indicated for children and nonpregnant women. Pregnant individuals should be treated with pyrantel pamoate. EXPERT OPINION Cure rates with anthelmintic treatment are high. No emerging pharmacotherapy can replace these existing drugs of good efficacy, safety profile and low cost for public health. It is opinioned that advances in the management of ascariasis include diagnostic accuracy at affordable costs, Emodepside is highly effective in single doses against ascarids in mammals and in human trials. The drug could be registered for human use in multiple neglected tropical diseases.
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Affiliation(s)
- Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, and Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, China
| | - Alexander K C Leung
- Department of Pediatrics, The University of Calgary and the Alberta Children's Hospital, Calgary, Alberta, Canada
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Adrizain R, Nagari MV, Sukandar H, Berbudi A, Setiabudi D, Setiabudiawan B. Surveillance of Soil-Transmitted Helminth Infection in Preschool Child Population: Do Changes in Behavior and Immunological Responses Affect Prevalence? Trop Med Infect Dis 2024; 9:33. [PMID: 38393122 PMCID: PMC10892740 DOI: 10.3390/tropicalmed9020033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024] Open
Abstract
Soil-transmitted helminths (STHs) persist as a significant global public health issue among neglected tropical diseases (NTDs), particularly in children. STH infection can induce immune responses that affect the course of the disease; if treatment fails, chronic infection can lead to stunting, especially among children aged 24-59 months, which is a vulnerable period for growth and development. We conducted a correlational, cross-sectional data collection study to evaluate the characteristics and association of 25(OH)D, interleukin-5 (IL-5), and interleukin-13 (IL-13) with the prevalence of STH infection in children aged 24-59 months in Bandung District, Indonesia, in October 2019-January 2023. We recruited 694 subjects (401 stunted and 293 normal-height children). The prevalence of STH infection among the stunted and normal-height groups was 5.7% (95% CI: 3.85-8.46%) and 3.4% (95% CI; 1.86-6.17%) (p = 0.156), respectively. The probability of the prevalence of STH infection in children with levels of 25(OH)D, IL-5, and IL-13 below the cut-off point was 6,93 to 16.71 times higher. We found a relationship between IL-5, IL-13, and environmental factors and the prevalence of STH infection in stunted children.
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Affiliation(s)
- Riyadi Adrizain
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Bandung 40161, Indonesia (B.S.)
| | | | - Hadyana Sukandar
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung 40161, Indonesia
| | - Afiat Berbudi
- Department of Biomedical Science, Faculty of Medicine, Universitas Padjadjaran, Bandung 40161, Indonesia;
| | - Djatnika Setiabudi
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Bandung 40161, Indonesia (B.S.)
| | - Budi Setiabudiawan
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Bandung 40161, Indonesia (B.S.)
- Faculty of Medicine, President University, Bekasi 17550, Indonesia
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Krause RJ, Scott ME, Sinisterra OT, Koski KG. Preschool child growth attainment and velocity during an agriculture intervention in rural Panama may be diminished by soil-transmitted helminths. Front Public Health 2023; 11:1122528. [PMID: 37829089 PMCID: PMC10565504 DOI: 10.3389/fpubh.2023.1122528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 09/06/2023] [Indexed: 10/14/2023] Open
Abstract
Background Agricultural interventions are often recommended to address undernutrition in subsistence farming communities. However, intensified agriculture exposure can increase soil transmitted helminth (STH) infections, which are linked with poor child growth. This study examined impacts of the VERASAN public health and agricultural intervention program on preschool child growth attainment (HAZ and WAZ) and relative growth velocity over 7 months [change in height-for-age (∆HAD) and weight-for-age (∆WAD) difference]. Methods VERASAN was initiated in 15 subsistence farming communities in rural Panama experiencing chronic undernutrition. Activities targeted improved household food security, preschool child diets and growth by intensifying and diversifying household agriculture. Our objectives were to explore the relationship between VERASAN and preschool child growth attainment (HAZ and WAZ) and velocity (∆HAD and ∆WAD) during one agricultural cycle in 238 households. We compared those new to VERASAN with those involved for 1 or 5 years, and identified if agricultural practices, food security, diet diversity and treatment of pre-existing STH infection were associated with growth attainment or velocity. Results Prior participation in VERASAN did not directly influence WAZ, HAZ or ΔHAD but VERASAN-related benefits had an indirect influence. ΔHAD was positively associated with VERASAN-associated improvements in diet diversity and food security. HAZ and WAZ during land preparation were positively associated with diet diversity and HAZ with food security during harvest. HAZ was negatively associated with children visiting the agricultural plot, consuming leafy green vegetables and pre-existing hookworm infections. Both agricultural season and STH influenced ΔWAD. Children in VERASAN for 1 or 5 years experienced growth faltering between land preparation and growing season, but not those new to VERASAN. In contrast, between growing and harvest, ∆WAD declined in children new to VERASAN compared to children in VERASAN for longer. ΔWAD from land preparation to harvest was higher with pre-existing Ascaris infection whereas it was lower between growing season and harvest for pre-existing hookworm infection. Conclusion In a context of preschool child growth faltering, malnutrition and STH infections, improved food security, agricultural production and diet diversity associated with VERASAN were associated with improved growth. In contrast, STH infections were negatively associated with some, but not all, growth outcomes.
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Affiliation(s)
- Rachel J. Krause
- Department of Science, Canadian Mennonite University, Winnipeg, MB, Canada
- Institute of Parasitology, McGill University, Montreal, QC, Canada
| | - Marilyn E. Scott
- Institute of Parasitology, McGill University, Montreal, QC, Canada
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Zeinali S, Rezgi M, Gholinejad M, Jafari R. A large-scale study on the prevalence of intestinal parasites in patients referred to medical laboratories in Urmia, Northwest Iran. BMC Gastroenterol 2023; 23:322. [PMID: 37730548 PMCID: PMC10510251 DOI: 10.1186/s12876-023-02947-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION Intestinal parasitic infections (IPIs), caused by helminths and protozoans, are among the most prevalent infections in humans in developing countries. This study aimed to determine the prevalence of IPIs in patients referred to three educational and medical centers affiliated with Urmia University of Medical Sciences in Urmia. MATERIALS AND METHODS In this cross-sectional study, 2845 stool samples, including 2174 (76.4%) males and 671 (23.6%) females, were collected from patients referred to Imam Khomeini and Shahid Motahhari hospitals and Shahid Nikkhah Health Center in Urmia, Northwest Iran, from January 2020 to February 2022. The microscopic examination for IPIs was carried out using the wet mount method, and the hard-to-identify samples were stained by trichrome for accurate identification of protozoa. For diagnosis of infections by coccidian parasites modified Ziehl-Neelsen (mZN) staining was used. RESULTS Based on the results, two hundred nine intestinal parasites were identified in 184 out of 2845 (6.5%) patients of which 136 out of 2174 males (6.3%) and 48 out of 671 females (7.2%) were positive. Some patients had tested positive for multiple protozoa. The observed intestinal protozoa are as follows: Blastocystis spp. 118 (4.1%), Endolimax Nana 42 (1.5%), Entamoeba coli 24 (0.8%), Giardia lamblia 13 (0.5%), Cryptosporidium spp. 6 (0.2%), Iodamoeba butschlii 3 (0.1%), Chilomastix mesnili 2 (0.1%), and an accidentally detected helminthic infection Enterobius vermicularis 1 (0.05%). CONCLUSION According to the results, the most prevalent IPIs in West Azerbaijan Province are caused by Blastocystis spp., and Giardia lamblia. Most intestinal protozoa observed in the study were nonpathogenic and commensal, which shows water or food contamination in the area. Thus, medical technologists in the parasitology section must be trained and aware of IPIs in medical laboratories.
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Affiliation(s)
- Shiva Zeinali
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
- Department of Parasitology and Mycology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Mahsa Rezgi
- Department of Parasitology and Mycology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Morteza Gholinejad
- Department of Parasitology and Mycology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Rasool Jafari
- Department of Parasitology and Mycology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran.
- Cellular and Molecular Research Center, Cellular and Molecular Medicine Research Institute, Urmia University of Medical Sciences, Urmia, Iran.
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Moshi CC, Sebastian PJ, Azizi KA, Killel E, Mushumbusi DG, Meghji WP, Kitunda ME, Millinga FK, Adam H, Kasankala LM. Effect of Deworming on Health Outcomes among Children Aged 12-59 Months in Tanzania: A Multilevel Mixed Effects Analysis. J Nutr Metab 2023; 2023:9529600. [PMID: 37520400 PMCID: PMC10382239 DOI: 10.1155/2023/9529600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 06/24/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Mass deworming of preschool children is a strategy suggested to prevent soil-transmitted helminth infections in most developing countries. Nonetheless, there is a scarcity of data showing the contribution of mass deworming to a child's nutritional status. The purpose of this study was to assess the effect of deworming on nutritional health outcomes (stunting, underweight, and anemia) in children aged 12 to 59 months. Methods A secondary analysis of data extracted from the Tanzania Demographic and Health Survey (TDHS) 2015-16 data was carried out. A total of 7,962 children were included in this study. A multilevel logistic regression was used at a 5% level of significance to determine the individual- and community-level determinants of deworming on health outcomes among children. Results The prevalence of underweight (62.6%), stunting (61.0%), and anemia (61.8%) was higher in children who were not dewormed than those who were dewormed. Female children were more likely to suffer from poor health outcomes (OR = 1.01 and 95% CI = 0.95-1.07) than male children. Children aged 24-35 months and 36-47 months were significantly less likely to suffer from poor health outcomes (OR = 0.89; 95% CI = 0.82-0.97 and OR = 0.88; 96% CI = 0.81-0.96, respectively; p < 0.01). Children from households with unimproved toilets (OR = 1.38 and 95% CI = 1.25-1.52), unimproved water sources (OR = 1.08 and 95% CI = 1.01-1.16), and living in rural areas (OR = 1.02 and 95% CI = 0.91-1.14) had higher odds for poor health outcomes. Conclusion Deworming may be an effective technique for preventing poor health outcomes in children and the risks associated with them, such as poor growth and development.
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Affiliation(s)
| | | | - Kaunara Ally Azizi
- Tanzania Food and Nutrition Center, P.O. Box 977, Dar es Salaam, Tanzania
| | - Erick Killel
- Tanzania Food and Nutrition Center, P.O. Box 977, Dar es Salaam, Tanzania
| | | | | | | | | | - Hancy Adam
- Tanzania Food and Nutrition Center, P.O. Box 977, Dar es Salaam, Tanzania
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Scavuzzo CM, Delgado C, Goy M, Crudo F, Porcasi X, Periago MV. Intestinal parasitic infections in a community from Pampa del Indio, Chaco (Argentina) and their association with socioeconomic and environmental factors. PLoS One 2023; 18:e0285371. [PMID: 37384739 PMCID: PMC10310042 DOI: 10.1371/journal.pone.0285371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 04/21/2023] [Indexed: 07/01/2023] Open
Abstract
Neglected tropical diseases are a group of 20 disabling diseases, which, in particular, are the most common chronic infections in the most vulnerable people. This study aimed to characterize the infection by intestinal parasites (IPs) in dwellings from a peri-urban neighborhood in Pampa del Indio, Chaco (Argentina), and its association with socioeconomic and environmental variables. Single stool samples were collected from all individuals older than 1 year through household visits and processed using coprological sedimentation and flotation techniques. Standardized questionnaires were used at the household level to collect socio-economic information. Environmental variables were obtained from the Planetscope image, Landsat 8 images and remote sensors, while land-use layers were obtained through the use of a maximum likelihood algorithm. Stool samples were provided by 314 individuals. The prevalence of IPs found was 30.6% (n = 96), with a predominance of Giardia lamblia (12.7%, n = 40) and Hymenolepis nana (7.6%, n = 24). The only soil-transmitted helminth found was Strongyloides stercoralis with a 2.5% prevalence (n = 8). Individuals of adult age (> 18 years) were 0.65 times less likely to present parasitic infections with respect to children and adolescents. The only environmental variable that was closely associated with the presence of IPs, was the Normalized Difference Water Index (NDWI), a measure of humidity; being higher around houses with positive individuals. Most of the IPs found in this study were of water-borne transmission and those transmitted directly from person-to-person, therefore fecal contamination is present. We believe that the low prevalence of STH in this area, which requires a passage through the soil, is related to the environmental characteristics, which are unsuitable for the development/permanence of the infective stages of these parasites. The geospatial data and tools used herein proved to be useful for the study of the relationship between the different factors that influence the presence of IPs in a community, from an eco-health approach.
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Affiliation(s)
- Carlos Matias Scavuzzo
- Fundación Mundo Sano, Buenos Aires, Argentina
- Instituto de Altos Estudios Espaciales Mario Gulich, Universidad Nacional de Córdoba, Comisión Nacional de Actividades Espaciales, Córdoba, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | | | - Marcia Goy
- Hospital Dr. Dante Tardelli, Pampa del Indio, Chaco, Argentina
| | - Favio Crudo
- Fundación Mundo Sano, Buenos Aires, Argentina
| | - Ximena Porcasi
- Instituto de Altos Estudios Espaciales Mario Gulich, Universidad Nacional de Córdoba, Comisión Nacional de Actividades Espaciales, Córdoba, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - María Victoria Periago
- Fundación Mundo Sano, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
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Kalinda C, Phri M, Qambayot MA, Ishimwe MCS, Gebremariam A, Bekele A, Wong R. Socio-demographic and environmental determinants of under-5 stunting in Rwanda: Evidence from a multisectoral study. Front Public Health 2023; 11:1107300. [PMID: 36998275 PMCID: PMC10043183 DOI: 10.3389/fpubh.2023.1107300] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
Child stunting is an important household, socio-economic, environmental and nutritional stress indicator. Nationally, 33% of children under 5 in Rwanda are stunted necessitating the need to identify factors perpetuating stunting for targeted interventions. Our study assessed the individual and community-level determinants of under-5 stunting essential for designing appropriate policy and program responses for addressing stunting in Rwanda. A cross-sectional study was conducted between September 6 and October 9, 2022, in five districts of Rwanda including, Kicukiro, Ngoma, Burera, Nyabihu and Nyanza. 2788 children and their caregivers were enrolled in the study and data on the individual level (child, caregiver/household characteristics), and community-level variables were collected. A multilevel logistic regression model was used to determine the influence of individual and community-level factors on stunting. The prevalence of stunting was 31.4% (95% CI: 29.5–33.1). Of this, 12.2% were severely stunted while 19.2% were moderately stunted. In addition, male gender, age above 11 months, child disability, more than six people in the household, having two children below the age of five, a child having diarrhea 1–2 weeks before the study, eating from own plate when feeding, toilet sharing, and open defecation increased the odds of childhood stunting. The full model accounted for 20% of the total variation in the odds of stunting. Socio-demographic and environmental factors are significant determinants of childhood stunting in Rwanda. Interventions to address under-five stunting should be tailored toward addressing individual factors at household levels to improve the nutritional status and early development of children.
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Affiliation(s)
- Chester Kalinda
- Bill and Joyce Cummings Institute of Global Health, University of Global Health Equity, Kigali, Rwanda
- *Correspondence: Chester Kalinda ;
| | - Million Phri
- School of Humanities and Social Sciences, University of Zambia, Great East Road Campus, Lusaka, Zambia
| | | | | | | | - Abebe Bekele
- School of Medicine, University of Global Health Equity, Kigali, Rwanda
| | - Rex Wong
- Bill and Joyce Cummings Institute of Global Health, University of Global Health Equity, Kigali, Rwanda
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Debash H, Alemu M, Bisetegn H. The prevalence of intestinal parasites, undernutrition and their associated risk factors among school-age children in Sekota Town, Northeast Ethiopia: A community-based cross-sectional study. Health Sci Rep 2023; 6:e1137. [PMID: 36860204 PMCID: PMC9969049 DOI: 10.1002/hsr2.1137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 03/02/2023] Open
Abstract
Background and Aims In developing countries, intestinal parasitic infections and malnutrition are among the most serious health issues affecting school-aged children. They have synergetic consequences. This study aimed to determine the prevalence of intestinal parasites, undernutrition, and their associated risk factors among school-age children. Methods A community-based cross-sectional study was conducted from April to June 2021 among school-age children in Sekota Town, Northeast Ethiopia. Households were selected using a systematic random sampling technique. Risk factor variables were collected using pretested questionnaires. Stool samples were collected from study participants and examined using a wet mount, formol-ether concentration, and modified acid-fast techniques. The height and weight of children were also measured using a meter and a standard calibrated balance, respectively. Data were analyzed using SPSS version 26.0 statistical software. Results The overall prevalence of intestinal parasites among school-age children was 44.3% (178/402). About seven species of intestinal parasites were identified. The predominant parasite identified was E. histolytica/dispar (11.2%), followed by H. nana (9.2%) and G. lamblia (6.7%). The well as a source of drinking water (adjusted odds ratio [AOR] = 7.93; 95% confidence interval [CI]: 4.38-14.36), habit of open-field defecation (AOR = 7.02; 95% CI: 13.05-12.06), and being undernourished (AOR = 5.67; 95% CI: 2.98-10.79) were independent predictors of intestinal parasitic infections. On the other hand, the overall prevalence of undernutrition was 46.3%. Undernutrition was significantly more likely in children with a dietary diversity score (DDS) of 3 (AOR = 3.73, 95% CI: 2.37-5.88), meal frequency of no more than three times per day (AOR = 2.00, 95% CI: 1.71-2.98), intestinal parasite infection (AOR = 5.25, 95% CI: 3.24-8.52), and no access to school-based feeding (AOR = 3.52, 95% CI: 2.17-7.96). Conclusion The prevalence of intestinal parasitic infections and undernutrition was high among school-age children in Sekota Town. The results imply the need for strengthening integrated strategies for the reduction of intestinal parasitic infections and undernutrition.
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Affiliation(s)
- Habtu Debash
- Deparment of Medical Laboratory Sciences, College of Medicine and Health SciencesWollo UniversityDessieEthiopia
| | - Megbaru Alemu
- Department of Medical Laboratory Sciences, College of Medicine and Health SciencesBahirdar UniversityBahirdarEthiopia
| | - Habtye Bisetegn
- Deparment of Medical Laboratory Sciences, College of Medicine and Health SciencesWollo UniversityDessieEthiopia
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Mationg MLS, Williams GM, Tallo VL, Olveda RM, Aung E, Alday P, Reñosa MD, Daga CM, Landicho J, Demonteverde MP, Santos ED, Bravo TA, Bourke S, Munira SL, Bieri FA, Li YS, Clements AC, Steinmann P, Halton K, Stewart DE, McManus DP, Gray DJ. Cost analysis for "The Magic Glasses Philippines" health education package to prevent intestinal worm infections among Filipino schoolchildren. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 31:100597. [PMID: 36879776 PMCID: PMC9985036 DOI: 10.1016/j.lanwpc.2022.100597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Soil-transmitted helminth (STH) infections are a significant public health problem affecting over 900 million people globally. Health education has been shown to complement mass drug administration (MDA) for the control of these intestinal worms. We reported recently results of a cluster randomised control trial (RCT) showing the positive impact of the "The Magic Glasses Philippines (MGP)" health education package in reducing STH infections among schoolchildren in intervention schools with ≤15% STH baseline prevalence in Laguna province, the Philippines. To inform decision making on the economic implications of the MGP, we evaluated the in-trial costs and then quantified the costs of scaling up the intervention both regionally and nationally. METHODS Costs were determined for the MGP RCT conducted in 40 schools in Laguna province. We estimated the total cost and the costs incurred per student for the actual RCT and the total costs for regional and national scale-up in all schools regardless of STH endemicity. The costs associated with the implementation of standard health education (SHE) activities and mass drug administration (MDA) were determined with a public sector perspective. FINDINGS The cost per participating student in the MGP RCT was Php 58.65 (USD 1.15) but if teachers instead of research staff had been involved, the estimated cost would have been considerably lower at Php 39.45 (USD 0.77). Extrapolating the costs for regional scale-up, the costs per student were estimated to be Php 15.24 (USD 0.30). As it is scaled up at the national level to include more schoolchildren, the estimated cost was increased at Php 17.46 (USD 0.34). In scenario 2 and 3, consistently, labour/salary costs associated with the delivery of the MGP contributed most to overall programme expenditure. Furthermore, the estimated average cost per student for SHE and MDA were Php 117.34 (USD 2.30) and Php 58.17 (USD 1.14), respectively. Using national scale up estimates, the cost of combining the MGP with SHE and MDA was Php 192.97 (USD 3.79). INTERPRETATION These findings suggest that the integration of MGP into the school curriculum would be an affordable and scalable approach to respond to the continuous burden of STH infection among schoolchildren in the Philippines. FUNDING National and Medical Research Council, Australia, and the UBS-Optimus Foundation, Switzerland.
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Affiliation(s)
- Mary Lorraine S. Mationg
- National Center for Epidemiology and Population Health, The Australian National University, Canberra, Australia
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Gail M. Williams
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Veronica L. Tallo
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Remigio M. Olveda
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Eindra Aung
- National Center for Epidemiology and Population Health, The Australian National University, Canberra, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Portia Alday
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Mark Donald Reñosa
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Chona Mae Daga
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Jhoys Landicho
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Maria Paz Demonteverde
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Eunice Diane Santos
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Thea Andrea Bravo
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Siobhan Bourke
- National Center for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Syarifah Liza Munira
- National Center for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Franziska Angly Bieri
- National Center for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Yuesheng S. Li
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, Australia
- Hunan Institute of Parasitic Diseases, World Health Organization Collaborating Centre for Research and Control on Schistosomiasis in Lake Region, Yueyang, China
| | | | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Kate Halton
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Donald E. Stewart
- National Center for Epidemiology and Population Health, The Australian National University, Canberra, Australia
- School of Medicine, Griffith University, Brisbane, Australia
| | - Donald P. McManus
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Darren J. Gray
- National Center for Epidemiology and Population Health, The Australian National University, Canberra, Australia
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Marume A, Archary M, Mahomed S. Predictors of stunting among children aged 6-59 months, Zimbabwe. Public Health Nutr 2023; 26:1-14. [PMID: 36621006 PMCID: PMC10131138 DOI: 10.1017/s1368980023000046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 09/15/2022] [Accepted: 12/05/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Stunted children have an increased risk of diminished cognitive development, diabetes, degenerative and CVD later in life. Numerous modifiable factors decrease the risk of stunting in children. This study aimed to assess the role of the individual, household and social factors on stunting in Zimbabwean children. DESIGN A 1:2 unmatched case-control study. SETTING This study was conducted in two predominantly rural provinces (one with the highest national prevalence of stunting and one with the lowest prevalence) in Zimbabwe. PARTICIPANTS Data were obtained from the caregivers of 150 children aged between 6 and 59 months with stunting and from the caregivers of 300 children without stunting. RESULTS Multiple (39) correlates of stunting were identified. Child's age, birth length, birth weight, and weight-for-age outcome (child-related factors), caregiver's age, maternal HIV status, occupation, and education (parental factors), breast-feeding status, number of meals, and dietary quality (dietary factors), child's appetite, diarrhoeal and worm infection (childhood illnesses), income status, access to safe water, access to a toilet, health clubs and maternal support in infant feeding (household, socio-cultural factors) were all found to be significant predictors of childhood stunting. CONCLUSION Nearly all aspects under review from the individual-, household- to social-level factors were significantly associated with childhood stunting. These findings add to the growing body of evidence supporting the WHO stunting framework and strengthen the need to focus interventions on a multi-sectoral approach to effectively address stunting in high prevalence countries.
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Affiliation(s)
- Anesu Marume
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Ministry of Health and Child Care, Parirenyatwa Hospital, A178 Avondale, Harare, Zimbabwe
| | - Moherndran Archary
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- King Edward VIII Hospital, Durban, South Africa
| | - Saajida Mahomed
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Haque S, Al Rafi DA, Zaman N, Salman M, Al Noman MA, Hoque MN, Bhattacharjee L, Farquhar S, Yasmin S, Hasan MM, Hira FTZ, Prithi AA, Shammi SA, Banu B, Hossain A. Nutritional status of under-five aged children of ready-made garment workers in Bangladesh: A cross-sectional study. PLoS One 2023; 18:e0284325. [PMID: 37053193 PMCID: PMC10101446 DOI: 10.1371/journal.pone.0284325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/28/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND The ready-made garment (RMG) sector is a significant contributor to the economic growth of Bangladesh, accounting for 10% of the country's GDP and more than 80% of its foreign exchange earnings. The workforce in this sector is predominantly made up of women, with 2.5 million women working in the industry. However, these women face numerous challenges in carrying out their culturally-expected household responsibilities, including childcare, due to severe resource constraints. As a result, the children of these working women have a higher incidence of malnutrition, particularly stunted growth. This study aims to identify the factors that contribute to stunting in children under the age of five whose mothers work in the RMG sector in Bangladesh. METHODS The study collected data from 267 female RMG workers in the Gazipur district of Bangladesh using a simple random sampling technique. Chi-square tests were used to determine the associations between the factors influencing child stunting, and Multinomial Logit Models were used to estimate the prevalence of these factors. RESULTS The study found that the prevalence of moderate and severe stunting among the children of RMG workers living in the Gazipur RMG hub was 19% and 20%, respectively. The study identified several significant predictors of child stunting, including the mother's education level, nutritional knowledge, control over resources, receipt of antenatal care, household size, sanitation facilities, and childbirth weight. The study found that improving the mother's education level, increasing household size, and receiving antenatal care during pregnancy were important factors in reducing the likelihood of child stunting. For example, if a mother's education level increased from no education to primary or secondary level, the child would be 0.211 (0.071-0.627) and 0.384 (0.138-1.065) times more likely to have a normal weight and height, respectively, than to be moderately stunted. CONCLUSION The study highlights the challenges faced by working women in the RMG sector, who often receive minimal wages and have limited access to antenatal care services. To address these challenges, the study recommends policies that support antenatal care for working-class mothers, provide daycare facilities for their children, and implement a comprehensive social safety net program that targets child nutrition. Improving the socioeconomic status of mothers is also critical to reducing child malnutrition in this population.
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Affiliation(s)
- Sadika Haque
- Department of Agricultural Economics, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Dewan Abdullah Al Rafi
- Department of Agricultural and Resource Economics, The University of Arizona, Tucson, Arizona, United States of America
| | - Nafisa Zaman
- Department of Agricultural Economics, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Md Salman
- Department of Agricultural Economics, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Md Abdullah Al Noman
- Department of Agricultural Economics, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Md Nazmul Hoque
- Student Affairs Division, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Lalita Bhattacharjee
- Senior Nutrition Advisor, Meeting the Undernutrition Challenge Programme, Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Samantha Farquhar
- Integrated Coastal Sciences, East Carolina University, Greenville, North Carolina, United States of America
| | - Sabina Yasmin
- Socio Economics Research Division, Bangladesh Livestock Research Institute, Savar Union, Bangladesh
| | - Md Mehedi Hasan
- Department of Agricultural Economics, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Fatema Tuj Zohora Hira
- Department of Agricultural Economics, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Aunjuman Ara Prithi
- Department of Agricultural Economics, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Shamim Ara Shammi
- Department of Agricultural Economics, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Bilkish Banu
- Faculty of Social Science and Humanities, Department of Economics, Hajee Mohammad Danesh Science & Technology University, Dinajpur, Bangladesh
| | - Akbar Hossain
- Division of Soil Science, Bangladesh Wheat and Maize Research Institute, Dinajpur, Bangladesh
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Ouédraogo JCRP, Anto F, Addo-Lartey AA. Factors determining preventive chemotherapy uptake against soil-transmitted helminthiasis among school-age children in Ghana. Parasitol Res 2022; 121:3641-3651. [PMID: 36264508 DOI: 10.1007/s00436-022-07691-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 10/11/2022] [Indexed: 11/26/2022]
Abstract
By 2020, the World Health Organization and the Ghana Neglected Tropical Diseases programme intended to treat 75% and 100% of school-age children, respectively, during preventative chemotherapy (PCT), to control soil-transmitted helminths. The performance of PCT was assessed, and the factors associated with albendazole uptake in 2019 were determined. This study comprised secondary data (2019 PCT) and a community-based cross-sectional study conducted among 352 children aged from 7 to 14 years and enrolled with their caregivers. Logistic regression was used to determine the factors hindering or favouring the PCT uptake. According to surveillance data (2019 PCT), Krachi East Municipal reported coverage of 83% in schools and 40.9% for all children between 5 and 14 years. The cross-sectional data showed that the median child age was 11 years (IQR: 9-12). There was no gap in the estimates for coverage and uptake, which were both 90.9% (95%CI: 87.4-93.5%). Christians made up the majority of the caregivers (87.5%), and 48.0% had completed secondary or higher education. After controlling for potential confounders, caregiver religion (aOR = 0.07 95%CI: 0.01-0.36) and the perception of a child's PCT risk (aOR = 0.33 95%CI: 0.13-0.84) were the significant barriers of PCT uptake, whereas the child's age (aOR = 1.49 95%CI: 1.19-1.88) and the perception of a child's PCT's benefit (aOR = 10.26 95%CI: 2.57-40.95) were the significant facilitators among children 7-14 years old. Although the performance of PCT was high, the national treatment target was not attained. Intensive and focused health education is therefore needed to improve positive perceptions towards PCT for school-age children.
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Affiliation(s)
- Jean Claude Romaric Pingdwindé Ouédraogo
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
- Département de Médecine Et Pharmacopée Traditionnelles, Pharmacie (MEPHATRA-PH), Institut de Recherche en Sciences de La Santé (IRSS), Ouagadougou, Burkina Faso
| | - Francis Anto
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
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Assoum M, Ortu G, Basáñez MG, Lau C, Clements ACA, Halton K, Fenwick A, Magalhães RJS. Impact of a 5-Year Mass Drug Administration Programme for Soil-Transmitted Helminthiases on the Spatial Distribution of Childhood Anaemia in Burundi from 2007 to 2011. Trop Med Infect Dis 2022; 7:tropicalmed7100307. [PMID: 36288048 PMCID: PMC9611614 DOI: 10.3390/tropicalmed7100307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Childhood anaemia affects 1.8 billion people globally. Little is known about the long-term impact of mass drug administration (MDA) for the control of soil-transmitted helminthiases (STH) on the spatiotemporal variation of anaemia prevalence and severity. We describe the long-term spatiotemporal impact of a 5-year STH MDA programme (2007−2011) on the prevalence of anaemia and anaemia severity in school-aged children (SAC) in Burundi. Methodology/Principal Findings: We used annual haemoglobin concentration and STH data collected during 2007−2011 in 31 schools in Burundi. Spatial dependence in prevalence and severity of anaemia was assessed using semivariograms. Bayesian geostatistical models were developed to (a) quantify the role of STH (adjusted for other anaemia determinants) in the spatiotemporal distribution of anaemia prevalence/severity, and (b) predict the geographical variation of both outcomes across Burundi. Adjusted population data were used to estimate the geographical distribution of the number of SAC at risk of anaemia and with low and moderate/severe anaemia. Infections with Ascaris lumbricoides and Trichuris trichiura were positively and significantly associated with childhood anaemia; hookworm infections were not. A significant decrease in anaemia prevalence, from 40−50% (2008) to 10−20% (2011) was predicted in western areas. The predicted prevalence of low-severity anaemia decreased from 40−50% (2008) to <20% (2011) in southern and eastern areas. Moderate/high-severity anaemia was concentrated in western regions of Burundi, with pockets of moderate/high-severity anaemia in central and northern regions in 2008. The overall number of predicted anaemic children decreased from 443,657 (2008) to 232,304 (2011), with a resurgence after MDA disruption in 2010 (to 480,605). Prevalence of low- and moderate-severity anaemia was higher in boys than in girls. Conclusions/Significance: Despite ongoing MDA, the prevalence of anaemia in SAC remained high and increased in certain parts of the country. It is recommended that MDA programmes targeting STH are complemented with specific anaemia interventions.
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Affiliation(s)
- Mohamad Assoum
- Children’s Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, QLD 4101, Australia
- UQ Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Via Warrego Highway, Gatton, QLD 4343, Australia
- School of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia
- Correspondence:
| | - Giuseppina Ortu
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary’s Campus), Imperial College London, Norfolk Place, London W2 1PG, UK
| | - Maria-Gloria Basáñez
- London Centre for Neglected Tropical Disease Research and MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK
| | - Colleen Lau
- Children’s Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, QLD 4101, Australia
- Research School of Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Archie C. A. Clements
- Research School of Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Kate Halton
- Institute of Health and Biomedical Innovations, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Alan Fenwick
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary’s Campus), Imperial College London, Norfolk Place, London W2 1PG, UK
| | - Ricardo J. Soares Magalhães
- Children’s Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, QLD 4101, Australia
- UQ Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Via Warrego Highway, Gatton, QLD 4343, Australia
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Deka S, Kalita D, Hazarika NK. Heavy Load of Intestinal Fluke in a Four-Year-Old Child with Severe Acute Malnutrition: A Case Report. J Lab Physicians 2022; 15:139-141. [PMID: 37064969 PMCID: PMC10104706 DOI: 10.1055/s-0042-1748830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
AbstractFasciolopsiasis, a food-borne intestinal parasitosis, occurs focally, and remains a significant public health problem in endemic areas. However, due to the wide spectrum of clinical presentation and unclear diagnosis or even misdiagnosis, it often goes unreported. The correlation between trematode infection and malnutrition is also often debated. We report a case of heavy infection of Fasciolopsis buski in a 4-year-old girl with severe acute malnutrition (SAM). The patient presented with a passage of many adult worms per stool following the consumption of some herbal concoction. A wet mount of the stool revealed ova of Fasciolopsis buski. She was treated successfully with praziquantel and food supplements. It raises the possibility of unidentified cases in this region and necessitates more extensive studies in the targeted population. This will also help raise awareness of fasciolopsiasis among clinicians, especially in vulnerable populations such as malnourished children.
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Affiliation(s)
- Sangeeta Deka
- Department of Microbiology, Fakhruddin Ali Ahmed Medical College & Hospital (FAAMCH), Barpeta, Assam, India
| | - Deepjyoti Kalita
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Virbhadra Road, Rishikesh, Uttarakhand, India
| | - Naba Kumar Hazarika
- Department of Microbiology, Gauhati Medical College & Hospital (GMCH), Guwahati, Assam, India
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Kabatende J, Barry A, Mugisha M, Ntirenganya L, Bergman U, Bienvenu E, Aklillu E. Safety of Praziquantel and Albendazole Coadministration for the Control and Elimination of Schistosomiasis and Soil-Transmitted Helminths Among Children in Rwanda: An Active Surveillance Study. Drug Saf 2022; 45:909-922. [PMID: 35819751 PMCID: PMC9360141 DOI: 10.1007/s40264-022-01201-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 11/30/2022]
Abstract
Introduction School-based preventive chemotherapy (Deworming) with praziquantel and albendazole to control and eliminate schistosomiasis and soil-transmitted helminths as public health problems is recommended by the World Health Organization (WHO). Safety monitoring during mass drug administration (MDA) is imperative but data from sub-Saharan Africa are scarce. Objective The aim of this active safety surveillance study was to identify the incidence, type, severity, and risk factors for adverse events (AEs) following mass administration of praziquantel and albendazole. Methods Overall, 8037 school children aged 5–15 years in Rwanda were enrolled. Baseline sociodemographic, medical history and any pre-existing clinical symptoms were recorded. Participants received a single dose of praziquantel and albendazole during MDA. AEs were actively monitored on days 1, 2, and 7 post MDA. Results Overall, 3196 AEs were reported by 1658 children; 91.3%, 8.4%, and 0.3% of the AEs were mild, moderate, and severe, respectively, and most resolved within 3 days. Headache (21%), dizziness or fainting (15.2 %), nausea (12.8%) and stomach pain (12.2%) were the most common AEs. The overall cumulative incidence of experiencing at least one type of AE was 20.6% (95% confidence interval [CI] 19.7–21.5%), being significantly higher (p < 0.001) in children with pre-MDA clinical events (27.5%, 95% CI 25.4–29.6%) than those without (18.7%, 95% CI 17.7–19.7%). Females, older age, having pre-MDA events, types of food taken before MDA and taking two or more praziquantel tablets were significant predictors of AEs. Conclusions Praziquantel and albendazole MDA is safe and well-tolerated; however, one in five children experience transient mild to moderate, and in few cases severe, AEs. The incidence of AEs varies significantly between sex and age groups. Pharmacovigilance in the MDA program is recommended for timely detection and management of AEs.
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Affiliation(s)
- Joseph Kabatende
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden.,Rwanda Food and Drugs Authority, Nyarutarama Plaza, KG 9 Avenue, Kigali, Rwanda
| | - Abbie Barry
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden
| | - Michael Mugisha
- College of Medicine and Health Sciences, University of Rwanda, KK 737, Kigali, Rwanda
| | - Lazare Ntirenganya
- Rwanda Food and Drugs Authority, Nyarutarama Plaza, KG 9 Avenue, Kigali, Rwanda
| | - Ulf Bergman
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden
| | - Emile Bienvenu
- Rwanda Food and Drugs Authority, Nyarutarama Plaza, KG 9 Avenue, Kigali, Rwanda.,College of Medicine and Health Sciences, University of Rwanda, KK 737, Kigali, Rwanda
| | - Eleni Aklillu
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden.
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Jordan S, Kreuels B. [Parasites - important endemic and imported pathogens]. Dtsch Med Wochenschr 2022; 147:687-696. [PMID: 35636420 DOI: 10.1055/a-1664-7518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Parasites are a diverse group of pathogens; they range from unicellular protozoa (e. g. Giardia lamblia) to tapeworms that can grow several meters long. Parasites have adapted to humans over millions of years and cause a wide, colorful variety of diseases. Due to increasing travel and climate change, previously rare pathogens occur more frequently in patients in Germany.Often the history, clinical findings and imaging are suggestive of the causative parasite and the suspected diagnosis only needs to be confirmed with pathogen detection in order to initiate targeted therapy. Nonetheless, the diagnosis is often delayed due to lack of experience of attending clinicians with parasitic infections.In this review article we give an overview of the epidemiology, transmission, diagnosis and treatment of some of the most common parasitic infections that are endemic, or regularly imported to Germany. We also discuss current and future challenges in the diagnosis, treatment and control of these pathogens.
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Affiliation(s)
| | - Benno Kreuels
- Universitätsklinikum Hamburg Eppendorf.,Bernhard-Nocht-Institut für Tropenmedizin
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Gildner TE, Cepon-Robins TJ, Urlacher SS. Cumulative host energetic costs of soil-transmitted helminth infection. Trends Parasitol 2022; 38:629-641. [DOI: 10.1016/j.pt.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/24/2022]
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Raj E, Calvo-Urbano B, Heffernan C, Halder J, Webster JP. Systematic review to evaluate a potential association between helminth infection and physical stunting in children. Parasit Vectors 2022; 15:135. [PMID: 35443698 PMCID: PMC9022337 DOI: 10.1186/s13071-022-05235-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/10/2022] [Indexed: 01/02/2023] Open
Abstract
Background Despite considerable public health efforts over the past 20 years, childhood stunting (physical and/or cognitive) levels globally remain unacceptably high—at 22% amongst children under 5 years old in 2020. The aetiology of stunting is complex and still largely unknown. Helminths can cause significant mortality and morbidity and have often been cited as major causative agents for stunting, although their actual role in childhood stunting remains unclear. Our aim was to systematically review the current evidence to help support or refute the hypothesis that helminths cause physical stunting in children. Methods Inclusion criteria were as follows: infected with (and/or exposed to) helminths (soil-transmitted helminths, schistosomes or food-borne trematodes), children, pregnant or breastfeeding women as study participants (children included infants 0–1 year old, preschool-age children 1–5 years and school-age children > 5 years old), anthelmintic treatment intervention, stunting-related variables reported (e.g. height, height-for-age z-score, birth weight), helminth infection reported in relation to stunting, any geographic location, any date, peer-reviewed literature only. Exclusion criteria were: non-primary research, study protocols, studies with no new data, non-English language papers and animal (non-human) helminth studies. Seven databases were searched on 28 May 2021. Risk of bias was assessed for included studies and GRADE was used for studies included in RCT subgroup meta-analyses (in preschool-age children and pregnant women). This systematic review was registered with PROSPERO (CRD42021256201). Results Eighty studies were included in the analyses. No significant overall evidence was found in support of the hypothesis that helminths cause physical stunting in children, although there was some association with wasting. Conclusions Whilst analyses of the available literature to date failed to support a direct association between helminth infection and childhood stunting, there was significant heterogeneity between studies, and many had follow-up periods which may have been too short to detect impacts on growth. Most apparent was a lack of available data from key demographic groups wherein one may predict the greatest association of helminth infection with stunting—notably that of infants, preschool-age children, and pregnant or nursing women. Thus this review highlights the urgent need for further targeted empirical research amongst these potentially most vulnerable demographic groups. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13071-022-05235-5.
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Affiliation(s)
- E Raj
- Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, Hertfordshire, AL9 7TA, UK.
| | - B Calvo-Urbano
- Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, Hertfordshire, AL9 7TA, UK.,London Centre for Neglected Tropical Disease Research, Imperial College Faculty of Medicine, W2 1PG, London, UK
| | - C Heffernan
- Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, Hertfordshire, AL9 7TA, UK.,London International Development Centre, London, WC1A 2NS, UK
| | - J Halder
- Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, Hertfordshire, AL9 7TA, UK.,London Centre for Neglected Tropical Disease Research, Imperial College Faculty of Medicine, W2 1PG, London, UK
| | - J P Webster
- Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, Hertfordshire, AL9 7TA, UK. .,London Centre for Neglected Tropical Disease Research, Imperial College Faculty of Medicine, W2 1PG, London, UK.
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Rivero J, García-Sánchez ÁM, Callejón R, Cutillas C. Characterization of trichuris species from porcupine (Hystrix cristata) at zoological garden of Spain. Acta Trop 2022; 228:106276. [PMID: 34973955 DOI: 10.1016/j.actatropica.2021.106276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 11/20/2022]
Abstract
Population of Trichuris sp. isolated from Hystrix cristata was analyzed based on morphological, biometrical characteristics and mitochondrial (cox1, cob, rrnL) and ribosomal (ITS1) (rDNA) region sequences. Morphological and biometrical results revealed that Trichuris sp. from H. cristata present a high similarity with Trichuris landak from Hystrix javanica and less similarity with other Trichuris species from porcupine species (Trichuris hystricis, Trichuris lenkorani and Trichuris mettami). The lack of molecular data corresponding to Trichuris species that parasitize the porcupine (genus Hystrix and Atelerix) has not allowed a comparative molecular or phylogenetic study. Molecular analyses revealed the existence of two different haplotypes that did not correspond to different morphospecies. Relationships among Trichuris sp. from H. cristata and other Trichuris spp. have been resolved by molecular sequence data in this study. Thus, the combined analysis of one ribosomal and three mitochondrial markers revealed a sister relationship between whipworms parasitizing porcupine and other Trichuris spp. from rodents and canids and separated from the rest of Trichuris spp. from other hosts species. It is necessary accurate information on the possible zoonotic behavior of different Trichuris species for health workers to improve existing control measures. Thus, it is necessary to increase the studies of integrative taxonomy on Trichuris spp. based on morphological, biometrical and molecular data, which will inevitably contribute to our knowledge on the etiology of trichuriasis.
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Affiliation(s)
- Julia Rivero
- Department of Microbiology and Parasitology, Faculty of Pharmacy, University of Seville, Seville, Spain.
| | | | - Rocío Callejón
- Department of Microbiology and Parasitology, Faculty of Pharmacy, University of Seville, Seville, Spain.
| | - Cristina Cutillas
- Department of Microbiology and Parasitology, Faculty of Pharmacy, University of Seville, Seville, Spain.
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22
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Bustamante J, Sainz T, Montojo FA, Almirón MD, Subirats M, Vega DM, Mellado MJ, López-Hortelano MG. Screening for parasites in migrant children. Travel Med Infect Dis 2022; 47:102287. [PMID: 35304329 DOI: 10.1016/j.tmaid.2022.102287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 01/26/2022] [Accepted: 02/23/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Globalization has pushed population movements in the last decades, turning imported diseases into the focus. Due to behavioral habits, children are at higher risk of acquiring iparasitosis. This study aims to investigate the prevalence of parasites in migrant children and factors associated with parasitic diseases. METHOD Retrospective cross-sectional study (2014-2018) including children diagnosed with parasitosis. The diagnosis was based on serology and/or microscopic stool-sample evaluation. Epidemiological and clinical data were recorded. RESULTS Out of 813 migrant children screened, 241 (29.6%) presented at least one parasite, and 89 (10.9%) more than one. The median age was 6.6 years (IQR: 3.1-11.9) and 58.9% were males. Most cases were referred for a health exam; only 52.3% of children were symptomatic, but 43.6% had eosinophilia. The most common diagnosis were giardiasis (35.3%), schistosomiasis (19.1%), toxocariasis (15.4%), and strongyloidiasis (9.1%). After the multivariate analysis, African origin and presenting with eosinophilia were the main risk factors for parasitism. CONCLUSIONS parasitosis are frequent among migrant children. Children are often asymptomatic, and thus active screening for parasitosis should be considered among high-risk populations. Eosinophilia can be useful to guide complimentary tests, as well as geographical origin, but normal eosinophil count does not exclude parasitosis.
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Affiliation(s)
- Jorge Bustamante
- Department of Pediatrics, Hospital General de Valdepeñas, Ciudad Real, Spain; La Paz Research Institute (IdiPAZ) Madrid, Spain; Universidad Autónoma de Madrid (UAM), Spain
| | - Talía Sainz
- La Paz Research Institute (IdiPAZ) Madrid, Spain; Universidad Autónoma de Madrid (UAM), Spain; General Pediatrics and Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain; Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Spain.
| | - Fátima Ara Montojo
- La Paz Research Institute (IdiPAZ) Madrid, Spain; General Pediatrics Department, Hospital de Quiron, Pozuelo, Spain
| | - Mariana Díaz Almirón
- La Paz Research Institute (IdiPAZ) Madrid, Spain; Biostatistics Department, La Paz University Hospital, Spain
| | - Mercedes Subirats
- La Paz Research Institute (IdiPAZ) Madrid, Spain; Department of Microbiology and Parasitology, Hospital La Paz Madrid, Spain
| | - Dolores Montero Vega
- La Paz Research Institute (IdiPAZ) Madrid, Spain; Department of Microbiology and Parasitology, Hospital La Paz Madrid, Spain
| | - María José Mellado
- La Paz Research Institute (IdiPAZ) Madrid, Spain; Universidad Autónoma de Madrid (UAM), Spain; General Pediatrics and Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain; Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Spain
| | - Milagros García López-Hortelano
- La Paz Research Institute (IdiPAZ) Madrid, Spain; General Pediatrics and Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain; Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Spain
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Widaad A, Zulkipli IN, Petalcorin MIR. Anthelmintic Effect of Leucaena leucocephala Extract and Its Active Compound, Mimosine, on Vital Behavioral Activities in Caenorhabditis elegans. MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27061875. [PMID: 35335240 PMCID: PMC8950933 DOI: 10.3390/molecules27061875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/22/2022] [Accepted: 03/07/2022] [Indexed: 12/03/2022]
Abstract
Helminth infections continue to be a neglected global threat in tropical regions, and there have been growing cases of anthelmintic resistance reported towards the existing anthelmintic drugs. Thus, the search for a novel anthelmintic agent has been increasing, especially those derived from plants. Leucaena leucocephala (LL) is a leguminous plant that is known to have several pharmacological activities, including anthelmintic activity. It is widely known to contain a toxic compound called mimosine, which we believed could be a potential lead candidate that could exert a potent anthelmintic effect. Hence, this study aimed to validate the presence of mimosine in LL extract and to investigate the anthelmintic effect of LL extract and mimosine on head thrashing, egg-laying, and pharyngeal pumping activities using the animal model Caenorhabditis elegans (C. elegans). Mimosine content in LL extract was confirmed through an HPLC analysis of spiking LL extract with different mimosine concentrations, whereby an increasing trend in peak heights was observed at a retention time of 0.9 min. LL extract and mimosine caused a significant dose-dependent increase in the percentage of worm mortality, which produced LC50s of 73 mg/mL and 6.39 mg/mL, respectively. Exposure of C. elegans to different concentrations of LL extract and mimosine significantly decreased the head thrashing, egg-laying, and mean pump amplitude of pharyngeal pumping activity. We speculated that these behavioral changes are due to the inhibitory effect of LL extract and mimosine on an L-type calcium channel called EGL-19. Our findings provide evidential support for the potential of LL extract and its active compound, mimosine, as novel anthelmintic candidates. However, the underlying mechanism of the anthelmintic action has yet to be elucidated.
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Excretion of dietary zinc in mammals (rats) fed overdoses of zinc lactate and infected with tapeworms. Helminthologia 2021; 58:339-345. [PMID: 35095309 PMCID: PMC8776305 DOI: 10.2478/helm-2021-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 07/03/2021] [Indexed: 11/21/2022] Open
Abstract
Tapeworms parasitize at sites that are important for the management of micronutrients, including zinc. Therefore, it has been hypothesized that tapeworms will significantly affect the excretion of zinc in the feces of a host. The aim of this work was to evaluate the effects that tapeworms have on the excretion of zinc in the feces of the host. Rats were divided into 4 groups: groups 0T and MT (infected with Hymenolepis diminuta (Rudolphi, 1819)) and groups 00 and M0 (uninfected). The experimental groups (M0 and MT) were fed a standard rodent compound feed (ST-1) with added zinc lactate; the daily zinc intake was 20.5 mg. The control groups (00 and 0T) were fed only ST-1 with 1.75 mg of added Zn per day. For six weeks, the amount of consumed feed was recorded and fecal samples were taken. The samples were then analyzed by optical emission spectrometry (ICP-OES), and levels of excreted zinc were subsequently calculated as a percentage. The most signifi cant difference in zinc excretion levels between the experimental groups was observed in the third week, when rats infected with tapeworms (MT) excreted substantially lower levels of zinc than did uninfected rats (M0). This difference amounted to 28.36 % (p <0.01). In the control groups, tapeworms affected the excretion of zinc in the feces to a lesser extent, and the most substantial difference in zinc levels was seen in the fifth week (8.46 %). However, there was no signifi cant difference in zinc excretion levels between the control groups during any of the monitored weeks. Tapeworms in the host affect levels of zinc excreted in the feces. However, this is dependent on the amount or form of zinc ingested.
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25
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Mationg MLS, Williams GM, Tallo VL, Olveda RM, Aung E, Alday P, Reñosa MD, Daga CM, Landicho J, Demonteverde MP, Santos ED, Bravo TA, Bieri FA, Li Y, Clements ACA, Steinmann P, Halton K, Stewart DE, McManus DP, Gray DJ. Soil-transmitted helminth infections and nutritional indices among Filipino schoolchildren. PLoS Negl Trop Dis 2021; 15:e0010008. [PMID: 34936644 PMCID: PMC8694453 DOI: 10.1371/journal.pntd.0010008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/19/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Soil-transmitted helminth (STH) infections are still prevalent among schoolchildren in the Philippines. We evaluated the risk factors associated with STH and the relationship between STH and nutritional indices among schoolchildren aged 9-10 years in Laguna province, the Philippines. METHODS We used the baseline data from 40 schools enrolled in a randomised controlled trial of the Magic Glasses Philippines health education package. Data on demographic and socio-economic variables, and STH related knowledge, attitudes and practices, were obtained through a questionnaire. Stool samples were collected and assessed for STH egg presence using the Kato-Katz technique. Haemoglobin levels and height and weight of study participants were also determined. The generalized estimating equations approach was used to construct logistic regression models to assess STH-associated risk factors, and the association between any STH infection and anaemia, child stunting, wasting and being underweight. The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12616000508471). FINDINGS Among 1,689 schoolchildren, the prevalence of any STH was 23%. The prevalence of anaemia, stunting, being underweight and wasting was 13%, 20.2%, 19% and 9.5%, respectively. Age, socio-economic status, rural/urban classification of schools and knowledge of STH were significant risk factors for acquiring a STH infection. Moreover, infections with any STH were significantly associated with stunting (P = <0.001) and being underweight (P = <0.003), but not wasting (P = 0.375) or anaemia (P = 0.462) after controlling for confounding covariates. CONCLUSION The study findings emphasise the need for sustainable deworming in tandem with other measures such as the provision of health education, improvements in sanitation and hygiene, and nutritional programs in order to control STH infections and improve morbidity outcomes in schoolchildren. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN12616000508471).
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Affiliation(s)
- Mary Lorraine S. Mationg
- Research School of Population Heath, The Australian National University, Canberra, Australia
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Gail M. Williams
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Veronica L. Tallo
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Remigio M. Olveda
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Eindra Aung
- Research School of Population Heath, The Australian National University, Canberra, Australia
- St Vincent’s Clinical School, University of New South Wales, Sydney, Australia
| | - Portia Alday
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Mark Donald Reñosa
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Chona Mae Daga
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Jhoys Landicho
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Maria Paz Demonteverde
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Eunice Diane Santos
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Thea Andrea Bravo
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Franziska Angly Bieri
- Research School of Population Heath, The Australian National University, Canberra, Australia
| | - Yuesheng Li
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, Australia
- Hunan Institute of Parasitic Diseases, World Health Organization Collaborating Centre for Research and Control on Schistosomiasis in Lake Region, Yueyang, China
| | | | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Kate Halton
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Donald E. Stewart
- Research School of Population Heath, The Australian National University, Canberra, Australia
- School of Medicine, Griffith University, Brisbane, Australia
| | - Donald P. McManus
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Darren J. Gray
- Research School of Population Heath, The Australian National University, Canberra, Australia
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Forman R, Partridge FA, Sattelle DB, Else KJ. Un-‘Egg’-Plored: Characterisation of Embryonation in the Whipworm Model Organism Trichuris muris. FRONTIERS IN TROPICAL DISEASES 2021. [DOI: 10.3389/fitd.2021.790311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Trichuris muris, is the murine parasite and widely deployed model for the human whipworm Trichuris trichiura, a parasite that infects around 500 million people globally. Trichuriasis is a classical disease of poverty with a cycle of re-infection due to the continual exposure of humans, particularly children, to infective eggs, which contaminate the soil in endemic areas. Indeed, modelling studies of trichuriasis have demonstrated that the low efficacy rate of current anthelmintics combined with the high possibility of re-infection from the reservoir of infective eggs within the environment, mean that the elimination of morbidity due to trichuriasis is unlikely to occur. Despite the importance of the infective egg stage in the perpetuation of infections, understanding the biology of the Trichuris ova has been neglected for decades. Here we perform experiments to assess the impact of temperature on the embryonation process of T. muris eggs and describe in detail the stages of larval development within these eggs. In keeping with the early works performed in the early 1900s, we show that the embryonation of T. muris is accelerated by an elevation in temperature, up to 37°C above which eggs do not fully develop and become degenerate. We extend these data to provide a detailed description of T. muris egg development with clear images depicting the various stages of development. To the best of our knowledge we have, for the first time, described the presence of birefringent granules within egg-stage larvae, as well as providing a qualitative and quantitative description of a motile larval stage prior to quiescence within the egg. These experiments are the first step towards a better understanding of the basic biology which underlies the process of egg embryonation. With the threat of elevation in global temperatures, the accelerated embryonation rate we observe at higher temperatures may have important consequences for parasite transmission rates and prospective modelling studies. In addition, a deeper understanding of the Trichuris ova may allow the development of novel control strategies targeting the egg stage of Trichuris in the environment as an adjunct to MDA.
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Colella V, Khieu V, Worsley A, Senevirathna D, Muth S, Huy R, Odermatt P, Traub RJ. Risk profiling and efficacy of albendazole against the hookworms Necator americanus and Ancylostoma ceylanicum in Cambodia to support control programs in Southeast Asia and the Western Pacific. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2021; 16:100258. [PMID: 34590062 PMCID: PMC8403762 DOI: 10.1016/j.lanwpc.2021.100258] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/17/2021] [Accepted: 07/26/2021] [Indexed: 11/18/2022]
Abstract
Background: Hookworm disease is endemic throughout many parts of the Asia Pacific, despite targeted control programs of at-risk populations. The success of these programs has been hindered by the limited efficacy of widely-used mebendazole, rapid re-infection rates linked to persistent reservoirs of untreated people and dogs, and the low sensitivity of conventional coprodiagnostic techniques employed. Methods: Here, we used standard faecal flotation (SFF) and a multiplex qPCR (mqPCR) assay to calculate and compare species-specific cure and egg reduction rates of single dose albendazole (400 mg) against hookworm infections at community level. Data from a cross-sectional survey in 1,232 people from Cambodia were used to inform a generalised linear mixed model to identify risk factors linked to hookworm infection(s) at baseline. Furthermore, we calculated risk factors associated to the probability of being cured after albendazole administration. Findings: Overall, 13·5% of all 1,232 people tested by SFF were positive for hookworm infection(s). Most (80·1%) infected people were >12 years of age, hence above the age targeted by the WHO control program. We estimate that as age increases, the odds of being infected increases at a faster rate for females than for males. We revealed a substantial difference in cure rate of hookworm infection(s) following albendazole treatment using the SFF (81·5%) and mqPCR (46·4%) assays, and provide the first data on the efficacy of this drug against the zoonotic hookworm Ancylostoma ceylanicum. We estimated that as age increases by one year, the odds of being cured decreases by 0·4%-3·7%. Similarly, the odds of being cured for people who boiled drinking water was estimated to be between 1·02 and 6·82. Interpretation: These findings show that the adoption of refined diagnostic techniques is central to monitoring hookworm infection(s) and the success of control strategies, which can ultimately aid in reducing associated morbidity in human populations. The approach taken is likely to be directly applicable to other parts of Southeast Asia and the Western Pacific, where specific epidemiological conditions might hamper the success of targeted treatment programs. Funding: Faculty of Veterinary and Agricultural Sciences Strategic Research Funds, The University of Melbourne.
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Affiliation(s)
- Vito Colella
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Australia
| | - Virak Khieu
- National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | | | - Dammika Senevirathna
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Australia
| | - Sinuon Muth
- National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Rekol Huy
- National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Peter Odermatt
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Rebecca J. Traub
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Australia
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Jaadla H, Shaw-Taylor L, Davenport R. Height and health in late eighteenth-century England. POPULATION STUDIES 2021; 75:381-401. [PMID: 32990142 PMCID: PMC8516076 DOI: 10.1080/00324728.2020.1823011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/15/2020] [Indexed: 02/06/2023]
Abstract
Adult stature has become a widely used indicator of childhood nutritional status in historical populations and may provide insights into health inequalities that are not discernible in mortality rates. However, most pre-twentieth-century British data on heights suffer from selection biases. Here we present unique evidence on heights of adult males by occupation from an unbiased sample of adult males in Dorset in 1798-99. The mean height of fully grown (married) men was very similar to that of older military recruits, and our sample therefore confirms the taller stature of English males relative to males of other European countries in the same period. In contrast to previous evidence of negligible or U-shaped socio-economic gradients in mortality in this period, we found a fairly linear gradient in height by socio-economic status, that is similar in magnitude to class differences in adult height among English males born in the mid-twentieth century.Supplementary material for this article is available at: https://doi.org/10.1080/00324728.2020.1823011.
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Functional Characterization of the Oxantel-Sensitive Acetylcholine Receptor from Trichuris muris. Pharmaceuticals (Basel) 2021; 14:ph14070698. [PMID: 34358124 PMCID: PMC8308736 DOI: 10.3390/ph14070698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/10/2021] [Accepted: 07/16/2021] [Indexed: 12/05/2022] Open
Abstract
The human whipworm, Trichuris trichiura, is estimated to infect 289.6 million people globally. Control of human trichuriasis is a particular challenge, as most anthelmintics have a limited single-dose efficacy, with the striking exception of the narrow-spectrum anthelmintic, oxantel. We recently identified a novel ACR-16-like subunit from the pig whipworm, T. suis which gave rise to a functional acetylcholine receptor (nAChR) preferentially activated by oxantel. However, there is no ion channel described in the mouse model parasite T. muris so far. Here, we have identified the ACR-16-like and ACR-19 subunits from T. muris, and performed the functional characterization of the receptors in Xenopus laevis oocytes using two-electrode voltage-clamp electrophysiology. We found that the ACR-16-like subunit from T. muris formed a homomeric receptor gated by acetylcholine whereas the ACR-19 failed to create a functional channel. The subsequent pharmacological analysis of the Tmu-ACR-16-like receptor revealed that acetylcholine and oxantel were equally potent. The Tmu-ACR-16-like was more responsive to the toxic agonist epibatidine, but insensitive to pyrantel, in contrast to the Tsu-ACR-16-like receptor. These findings confirm that the ACR-16-like nAChR from Trichuris spp. is a preferential drug target for oxantel, and highlights the pharmacological difference between Trichuris species.
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Keller L, Welsche S, Patel C, Sayasone S, Ali SM, Ame SM, Hattendorf J, Hürlimann E, Keiser J. Long-term outcomes of ivermectin-albendazole versus albendazole alone against soil-transmitted helminths: Results from randomized controlled trials in Lao PDR and Pemba Island, Tanzania. PLoS Negl Trop Dis 2021; 15:e0009561. [PMID: 34191812 PMCID: PMC8277064 DOI: 10.1371/journal.pntd.0009561] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/13/2021] [Accepted: 06/14/2021] [Indexed: 12/13/2022] Open
Abstract
Background Preventive chemotherapy is the cornerstone of soil-transmitted helminth (STH) control. Long-term outcomes and adequate treatment frequency of the recently recommended albendazole-ivermectin have not been studied to date. Methodology/principal findings Double-blind randomized controlled trials were conducted in Lao PDR, Pemba Island, Tanzania and Côte d’Ivoire between 2018 and 2020 to evaluate the efficacy and safety of ivermectin-albendazole versus albendazole-placebo in Trichuris trichiura-infected individuals aged 6 to 60. In the framework of this study, in Lao PDR 466 and 413 participants and on Pemba Island, 558 and 515 participants were followed-up six and 12 months post-treatment, respectively. From each participant at least one stool sample was processed for Kato-Katz diagnosis and cure rates (CRs), egg reduction rates (ERRs) and apparent reinfection rates were calculated. If found helminth-positive at six months, participants were re-treated according to their allocated treatment. Long-term outcomes against T. trichiura based on CRs and ERRs of ivermectin-albendazole compared to albendazole were significantly higher at six months in Lao PDR (CR, 65.8 vs 13.4%, difference; 52.4; 95% CI 45.0–60.0; ERRs, 99.0 vs 79.6, difference 19.4; 95% CI 14.4–24.4) and Pemba Island (CR, 17.8 vs 1.4%, difference; 16.4; 95% CI 11.6–21.0; ERRs, 84.9 vs 21.2, difference 63.8; 95% CI 50.6–76.9) and also at 12 months in Lao PDR (CR, 74.0 vs 23.4%, difference; 50.6; 95% CI 42.6–61.0; ERRs, 99.6 vs 91.3, difference 8.3; 95% CI 5.7–10.8) and Pemba Island (CR, 19.5 vs 3.4%, difference; 16.1; 95% CI 10.7–21.5; ERRs, 92.9 vs 53.6, difference 39.3; 95% CI 31.2–47.4) respectively. Apparent reinfection rates with T. trichiura were considerably higher on Pemba Island (100.0%, 95% CI, 29.2–100.0) than in Lao PDR (10.0%, 95% CI, 0.2–44.5) at 12 months post-treatment for participants treated with albendazole alone. Conclusions/significance The long-term outcomes against T. trichiura of ivermectin-albendazole are superior to albendazole in terms of CRs and ERRs and in reducing infection intensities. Our results will help to guide decisions on how to best use ivermectin-albendazole in the context of large-scale PC programs tailored to the local context to sustainably control STH infections. Trial registration ClinicalTrials.gov registered with clinicaltrials.gov, reference: NCT03527732, date assigned: 17 May 2018. Around 1.5 billion people are infected with the gastrointestinal dwelling nematodes, the so-called soil-transmitted helminths (STHs). Especially chronic high-intensity infections with these parasites can cause substantial morbidity in endemic regions. Preventive chemotherapy, which is the regular administration of a single dose of an anthelmintic drug to at-risk populations, aims to reduce morbidity by lowering the prevalence and intensity of STH infections. Due to the suboptimal efficacy of these recommended single dose monotherapies, particularly against Trichuris trichiura, the use of drug combinations with dissimilar modes of action may enhance treatment efficacy. In double-blind randomized controlled trials in Lao PDR and on Pemba Island, Tanzania, we examined the long-term outcomes of ivermectin-albendazole versus albendazole alone, against T. trichiura. We assessed the infection status, apparent reinfections, new infections and the change of infection intensity for the three major STH species six and 12 months post-treatment. The long-term outcomes (in terms of cure and egg-reduction rates) of the ivermectin-albendazole combination therapy against T. trichiura were significantly higher than that of albendazole alone at all-time points and in both countries. Bi-annual treatment intervals using the ivermectin-albendazole combination might be necessary to sustainably decrease transmission of STH infections.
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Affiliation(s)
- Ladina Keller
- Medical Parasitology and Infection Biology, Helminth Drug Development Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sophie Welsche
- Medical Parasitology and Infection Biology, Helminth Drug Development Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Chandni Patel
- Medical Parasitology and Infection Biology, Helminth Drug Development Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Somphou Sayasone
- Medical Parasitology and Infection Biology, Helminth Drug Development Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Department of International Program for Health in the Tropics, Lao Tropical and Public Health Institute, Vientiane, Lao People’s Democratic Republic
| | - Said M. Ali
- Public Health Laboratory Ivo de Carneri, Chake Chake, Pemba, Zanzibar, Tanzania
| | - Shaali M. Ame
- Public Health Laboratory Ivo de Carneri, Chake Chake, Pemba, Zanzibar, Tanzania
| | - Jan Hattendorf
- Medical Parasitology and Infection Biology, Helminth Drug Development Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Eveline Hürlimann
- Medical Parasitology and Infection Biology, Helminth Drug Development Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Jennifer Keiser
- Medical Parasitology and Infection Biology, Helminth Drug Development Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
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Bertoncello C, Amoruso I, Moscardino U, Fonzo M, Maharjan M, Buja A, Baldo V, Cocchio S, Baldovin T. Sex-Biased Prevalence of Intestinal Parasitic Infections and Gender Inequality in Rural Nepal. Int J Infect Dis 2021; 109:148-154. [PMID: 34182133 DOI: 10.1016/j.ijid.2021.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Intestinal parasitic infections (IPIs) are related to poverty and socioeconomic disparities. In rural Nepal, IPIs are highly endemic and gender inequality is still deeply rooted. This study provides a novel epidemiological assessment of IPIs in Nepal, juxtaposing spatial, age and sex stratification of prevalence. METHODS A PRISMA and PICO-based systematic review of peer-reviewed and grey literature provided IPI prevalence data for the Nepalese population. Demographic and environmental variables were considered to investigate differences related to dwelling area and sex. Variations among prevalence rates were calculated with 95% CI and significance level for odds ratio evaluated with chi-square test. RESULTS The IPI prevalence rate for the Nepalese general population was 37.6%. Moreover, IPI prevalence (52.3%) was significantly higher in rural areas than in urban areas (32.4%), and school-age girls (55.2%) were more infected than boys (48.6%). CONCLUSIONS The IPI infection rate appeared to be enhanced among young women living in rural Nepal, where they experienced low school attendance and heavy enrolment in agricultural work, as result of gender discrimination. Plausibly, these dynamics affect both girls' environmental exposure and fruition of periodic school-based preventive chemotherapy, thus increasing the chances of IPI infection.
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Affiliation(s)
- Chiara Bertoncello
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Hygiene and Public Health, University of Padua, Padua, Italy
| | - Irene Amoruso
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Hygiene and Public Health, University of Padua, Padua, Italy.
| | - Ughetta Moscardino
- Department of Developmental Psychology and Socialisation, University of Padua, Padua, Italy
| | - Marco Fonzo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Hygiene and Public Health, University of Padua, Padua, Italy
| | - Mahendra Maharjan
- Central Department of Zoology, Tribhuvan University, Kirtipur, Nepal
| | - Alessandra Buja
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Hygiene and Public Health, University of Padua, Padua, Italy
| | - Vincenzo Baldo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Hygiene and Public Health, University of Padua, Padua, Italy
| | - Silvia Cocchio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Hygiene and Public Health, University of Padua, Padua, Italy
| | - Tatjana Baldovin
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Hygiene and Public Health, University of Padua, Padua, Italy
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Mohd-Shaharuddin N, Lim YAL, Ngui R, Nathan S. Expression of Ascaris lumbricoides putative virulence-associated genes when infecting a human host. Parasit Vectors 2021; 14:176. [PMID: 33757548 PMCID: PMC7985925 DOI: 10.1186/s13071-021-04680-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ascaris lumbricoides is the most common causative agent of soil-transmitted helminth infections worldwide, with an estimated 450 million people infected with this nematode globally. It is suggested that helminths are capable of evading and manipulating the host immune system through the release of a spectrum of worm proteins which underpins their long-term survival in the host. We hypothesise that the worm overexpresses these proteins when infecting adults compared to children to cirvumvent the more robust defence mechanisms of adults. However, little is known about the parasite's genes and encoded proteins involved during A. lumbricoides infection. Hence, this study was conducted to assess the expression profile of putative virulence-associated genes during an active infection of adults and children. METHODS In this study, quantitative PCR was performed to evaluate the expression profile of putative virulence-associated genes in A. lumbricoides isolated from infected children and adults. The study was initiated by collecting adult worms expelled from adults and children following anthelminthic treatment. High-quality RNA was successfully extracted from each of six adult worms expelled by three adults and three children, respectively. Eleven putative homologues of helminth virulence-associated genes reported in previous studies were selected, primers were designed and specific amplicons of A. lumbricoides genes were noted. The expression profiles of these putative virulence-associated genes in A. lumbricoides from infected adults were compared to those in A. lumbricoides from infected children. RESULTS The putative virulence-associated genes VENOM, CADHERIN and PEBP were significantly upregulated at 166-fold, 13-fold and fivefold, respectively, in adults compared to children. Conversely, the transcription of ABA-1 (fourfold), CATH-L (threefold) and INTEGRIN (twofold) was significantly suppressed in A. lumbricoides from infected adults. CONCLUSIONS On the basis of the expression profile of the putative virulence-associated genes, we propose that the encoded proteins have potential roles in evasion mechanisms, which could guide the development of therapeutic interventions.
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Affiliation(s)
| | - Yvonne Ai Lian Lim
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Romano Ngui
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sheila Nathan
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Selangor, Malaysia.
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Patel C, Keller L, Welsche S, Hattendorf J, Sayasone S, Ali SM, Ame SM, Coulibaly JT, Hürlimann E, Keiser J. Assessment of fecal calprotectin and fecal occult blood as point-of-care markers for soil-transmitted helminth attributable intestinal morbidity in a case-control substudy conducted in Côte d'Ivoire, Lao PDR and Pemba Island, Tanzania. EClinicalMedicine 2021; 32:100724. [PMID: 33554091 PMCID: PMC7851339 DOI: 10.1016/j.eclinm.2021.100724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Infections with soil-transmitted helminths (STHs) may result in chronic inflammatory disorders affecting the human host. The objective of this study was to evaluate Fecal Calprotectin (FC) and Fecal Occult Blood (FOB) in individuals infected and non-infected with STHs to identify potential intestinal morbidity markers. METHODS Stool from participants diagnosed positive for Trichuris trichiura and concomitant STH infections from three countries was used to perform FC and FOB point-of-care assays. Simultaneously, identified STH negative participants underwent FC and FOB testing as controls. Potential associations between test results and determinants were analyzed using multivariable logistic regression. FINDINGS In total, 1034 T. trichiura infected cases (mostly light infections) and 157 STH negative controls were tested for FC and FOB. Among all participants tested, 18·5% had ≥ 50 µg/g FC concentration, while 14 (1·2%) were positive for FOB. No statistically significant association was found between T. trichiura infection or Ascaris lumbricoides co-infection and FC concentration, while an inverse association (odds ratio (OR): 0·45, 95% credible intervals (CrI): 0·26, 0·75) was found between hookworm co-infection and FC concentration. In Lao PDR, the proportion of participants in the ≥ 50 µg/g FC category was significantly higher in the oldest age category compared to the 5-11 years group (OR: 3·31, 95% CrI: 1·62, 7·24). Too few participants were found positive for FOB to derive any conclusions. INTERPRETATION Studies are needed to better understand the relationship between intestinal morbidity and STH infections. Suitable, standardized, low-cost markers of STH attributable morbidity to better monitor the impact of STH control interventions are necessary. FUNDING BMGF (OPP1153928).
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Affiliation(s)
- Chandni Patel
- Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Ladina Keller
- Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sophie Welsche
- Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Jan Hattendorf
- Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Somphou Sayasone
- Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Department of International Program for Health in the Tropics, Lao Tropical and Public Health Institute, Vientiane, Lao People's Democratic Republic
| | - Said M. Ali
- Public Health Laboratory Ivo de Carneri, Chake Chake, Pemba, Zanzibar, Tanzania
| | - Shaali M. Ame
- Public Health Laboratory Ivo de Carneri, Chake Chake, Pemba, Zanzibar, Tanzania
| | - Jean Tenena Coulibaly
- Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
- Department of Research and Development, Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Eveline Hürlimann
- Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Jennifer Keiser
- Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Hansen TVA, Cirera S, Neveu C, Courtot E, Charvet CL, Calloe K, Klaerke DA, Martin RJ. The narrow-spectrum anthelmintic oxantel is a potent agonist of a novel acetylcholine receptor subtype in whipworms. PLoS Pathog 2021; 17:e1008982. [PMID: 33544769 PMCID: PMC7891710 DOI: 10.1371/journal.ppat.1008982] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 02/18/2021] [Accepted: 01/13/2021] [Indexed: 12/28/2022] Open
Abstract
In the absence of efficient alternative strategies, the control of parasitic nematodes, impacting human and animal health, mainly relies on the use of broad-spectrum anthelmintic compounds. Unfortunately, most of these drugs have a limited single-dose efficacy against infections caused by the whipworm, Trichuris. These infections are of both human and veterinary importance. However, in contrast to a wide range of parasitic nematode species, the narrow-spectrum anthelmintic oxantel has a high efficacy on Trichuris spp. Despite this knowledge, the molecular target(s) of oxantel within Trichuris is still unknown. In the distantly related pig roundworm, Ascaris suum, oxantel has a small, but significant effect on the recombinant homomeric Nicotine-sensitive ionotropic acetylcholine receptor (N-AChR) made up of five ACR-16 subunits. Therefore, we hypothesized that in whipworms, a putative homolog of an ACR-16 subunit, can form a functional oxantel-sensitive receptor. Using the pig whipworm T. suis as a model, we identified and cloned a novel ACR-16-like subunit and successfully expressed the corresponding homomeric channel in Xenopus laevis oocytes. Electrophysiological experiments revealed this receptor to have distinctive pharmacological properties with oxantel acting as a full agonist, hence we refer to the receptor as an O-AChR subtype. Pyrantel activated this novel O-AChR subtype moderately, whereas classic nicotinic agonists surprisingly resulted in only minor responses. We observed that the expression of the ACR-16-like subunit in the free-living nematode Caenorhabditis elegans conferred an increased sensitivity to oxantel of recombinant worms. We demonstrated that the novel Tsu-ACR-16-like receptor is indeed a target for oxantel, although other receptors may be involved. These finding brings new insight into the understanding of the high sensitivity of whipworms to oxantel, and highlights the importance of the discovery of additional distinct receptor subunit types within Trichuris that can be used as screening tools to evaluate the effect of new synthetic or natural anthelmintic compounds.
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Affiliation(s)
- Tina V. A. Hansen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg C, Denmark
- INRAE, Université de Tours, ISP, Nouzilly, France
| | - Susanna Cirera
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - Cédric Neveu
- INRAE, Université de Tours, ISP, Nouzilly, France
| | | | | | - Kirstine Calloe
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - Dan A. Klaerke
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - Richard J. Martin
- Department of Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, United States of America
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Risk Factors Associated with Helminthic Intestinal Infection in Lurambi Subcounty, Kakamega, Kenya. J Parasitol Res 2021; 2020:8810519. [PMID: 33489319 PMCID: PMC7790573 DOI: 10.1155/2020/8810519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/01/2020] [Accepted: 12/12/2020] [Indexed: 02/04/2023] Open
Abstract
Background Soil-transmitted helminths (STHs) and schistosome infections have been known to be major causes of morbidity and mortality in sub-Saharan countries. School aged and preschool children are known to be at high risk of infection. Therefore, the aim of this study was to determine the prevalence and risk factors associated with soil-transmitted helminths among school-going children in Lurambi Subcounty, Kakamega, Kenya. Method A cross-sectional study was conducted from Jan 2020 to Feb 2020 among 392 randomly selected primary school-going children aged 5 to 14 years old in six primary schools. Risk factors associated with STH infection were obtained using a structured questionnaire answered by the children's caregivers. Stool samples were examined using the standard quantitative Kato-Katz technique. The data was analyzed using SPSS version 20 and Epi Info version 7.2.3.1. Result A total of 278 children provided stool samples for analysis. The overall prevalence of intestinal helminths was 14.4% (40/278). The prevalence of Ascaris lumbricoides was 11.5% (32/278), 0.4% (1/278) for hookworm, 0.4% (1/278) for Trichuris trichiura, and 2.1% (6/278) for Schistosoma mansoni; coinfection was detected in 0.4% (1/278). The intensity of infection ranged between light and moderate. Significant risk factors for STH infection included failure to wash hands before eating (OR: 3.529; P = 0.041), failure to wash fruits and vegetables before eating (OR: 2.3129; P = 0.005), and not washing hands after soil contact (OR: 2.1529; P = 0.005). Age (Z = 2.4006, P = 0.0164) was a risk factor only for infection with Schistosoma mansoni. Conclusion Preventive chemotherapy and proper hygienic and sanitation practices should be integrated to achieve elimination of STH and Schistosoma mansoni in Lurambi Subcounty and at large in Kenya.
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Keller L, Palmeirim MS, Ame SM, Ali SM, Puchkov M, Huwyler J, Hattendorf J, Keiser J. Efficacy and Safety of Ascending Dosages of Moxidectin and Moxidectin-albendazole Against Trichuris trichiura in Adolescents: A Randomized Controlled Trial. Clin Infect Dis 2021; 70:1193-1201. [PMID: 31044235 DOI: 10.1093/cid/ciz326] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 04/22/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Preventive chemotherapy is the main strategy to control soil-transmitted helminth (STH) infections. Albendazole and mebendazole are ubiquitously used, but they are not sufficiently effective against Trichuris trichiura. Moxidectin might be a useful addition to the small drug armamentarium. However, the optimal dosage of moxidectin alone and in combination with albendazole against T. trichiura and other STHs has not yet been determined. METHODS A Phase II, randomized, placebo-controlled, dose-finding trial was conducted in 2 secondary schools on Pemba Island, Tanzania. Using a computer-generated list, T. trichiura-infected adolescents were randomly assigned to 7 treatment arms: 8, 16, or 24 mg of moxidectin monotherapy; 8, 16, or 24 mg of moxidectin plus 400 mg of albendazole combination therapy; or placebo. The primary outcome was cure rate (CR) against T. trichiura, analyzed 13 to 20 days after treatment by quadruple Kato-Katz thick smears. RESULTS A total of 290 adolescents were enrolled (41 or 42 per arm). CRs against T. trichiura were 43, 46, and 44% for 8, 16, and 24 mg of moxidectin alone, respectively; 60, 62, and 66% for the same moxidectin dosages plus 400 mg of albendazole, respectively; and 12% for placebo. The moxidectin-albendazole arms also revealed higher CRs and egg reduction rates against hookworm than the monotherapy arms. Moxidectin and its combination with albendazole were well tolerated. CONCLUSIONS Moxidectin-albendazole is superior to moxidectin. There is no benefit of using doses above 8 mg, which is the recommended dose for onchocerciasis. The moxidectin-albendazole combination of 8 mg plus 400 mg should be investigated further to develop recommendations for appropriate control of STH infections. CLINICAL TRIALS REGISTRATION NCT03501251.
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Affiliation(s)
- Ladina Keller
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Marta S Palmeirim
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Shaali M Ame
- Public Health Laboratory Ivo de Carneri, Chake Chake, Republic of Tanzania
| | - Said M Ali
- Public Health Laboratory Ivo de Carneri, Chake Chake, Republic of Tanzania
| | - Maxim Puchkov
- Department of Pharmaceutical Sciences, Division of Pharmaceutical Technology, , Basel, Switzerland
| | - Jörg Huwyler
- Department of Pharmaceutical Sciences, Division of Pharmaceutical Technology, , Basel, Switzerland
| | - Jan Hattendorf
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Jennifer Keiser
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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de Castro JC, de Almeida LV, Cardoso MS, Oliveira FMS, Nogueira DS, Reis-Cunha JL, Magalhaes LMD, Zhan B, Bottazzi ME, Hotez PJ, Bueno LL, Bartholomeu DC, Fujiwara RT. Vaccination with chimeric protein induces protection in murine model against ascariasis. Vaccine 2020; 39:394-401. [PMID: 33248854 DOI: 10.1016/j.vaccine.2020.11.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/06/2020] [Accepted: 11/14/2020] [Indexed: 01/30/2023]
Abstract
An estimated 400 million people are infected by parasites of the genus Ascaris and the existing control measures are inefficient. Vaccine development using B cell antigens is a promising strategy for increased protection against this parasite. The present study aimed at developing a chimeric protein capable of conferring protection against infection by Ascaris sp. For this purpose, we performed B-cell epitope predictions on previously described vaccine candidate proteins from Ascaris suum and the corresponding peptides were used to construct a chimeric protein. Female BALB / c mice were immunized subcutaneously in three doses at 10 day intervals with a vaccine formulation comprised of the chimeric protein together with monophosphoryl lipid A (MPLA). Control groups included protein alone, MPLA, or PBS. After challenge infection, animals vaccinated with chimeric protein plus MPLA showed a reduction of 73.54% of larval load in the lung compared to control group animals. Animals immunized with chimeric protein plus MPLA also display higher IgG response and a reduction in lung inflammation. Our study highlights how chimeric proteins containing more than one B cell epitope can enhance immune protection against helminthic infection and offer new approaches to the development of Ascaris vaccines.
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Affiliation(s)
- Joseane C de Castro
- Department of Parasitology, Federal University of Minas Gerais, Av. Antônio Carlos, 6627, Bloco E4, Sala 168, Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - Laila V de Almeida
- Department of Parasitology, Federal University of Minas Gerais, Av. Antônio Carlos, 6627, Bloco E4, Sala 168, Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - Mariana Santos Cardoso
- Department of Parasitology, Federal University of Minas Gerais, Av. Antônio Carlos, 6627, Bloco E4, Sala 168, Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - Fabricio M Silva Oliveira
- Department of Parasitology, Federal University of Minas Gerais, Av. Antônio Carlos, 6627, Bloco E4, Sala 168, Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - Denise S Nogueira
- Department of Parasitology, Federal University of Minas Gerais, Av. Antônio Carlos, 6627, Bloco E4, Sala 168, Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - João Luis Reis-Cunha
- Department of Parasitology, Federal University of Minas Gerais, Av. Antônio Carlos, 6627, Bloco E4, Sala 168, Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - Luisa M D Magalhaes
- Department of Parasitology, Federal University of Minas Gerais, Av. Antônio Carlos, 6627, Bloco E4, Sala 168, Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - Bin Zhan
- National School of Tropical Medicine, Departments of Pediatrics and Molecular Virology & Microbiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX, USA
| | - Maria Elena Bottazzi
- National School of Tropical Medicine, Departments of Pediatrics and Molecular Virology & Microbiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX, USA; Texas Children's Hospital Center for Vaccine Development, Baylor College of Medicine, Houston, TX, USA
| | - Peter J Hotez
- National School of Tropical Medicine, Departments of Pediatrics and Molecular Virology & Microbiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX, USA; Texas Children's Hospital Center for Vaccine Development, Baylor College of Medicine, Houston, TX, USA
| | - Lilian L Bueno
- Department of Parasitology, Federal University of Minas Gerais, Av. Antônio Carlos, 6627, Bloco E4, Sala 168, Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - Daniella Castanheira Bartholomeu
- Department of Parasitology, Federal University of Minas Gerais, Av. Antônio Carlos, 6627, Bloco E4, Sala 168, Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - Ricardo T Fujiwara
- Department of Parasitology, Federal University of Minas Gerais, Av. Antônio Carlos, 6627, Bloco E4, Sala 168, Pampulha, Belo Horizonte, Minas Gerais, Brazil.
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Ulaganeethi R, Rajkumari N, Gururajan A, Gunalan A, Langbang D, Kumar G. Intestinal parasitic infections and its trends: a 5-year findings from a tertiary care centre, Puducherry, South India. J Parasit Dis 2020; 45:400-405. [PMID: 34295039 DOI: 10.1007/s12639-020-01310-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 11/02/2020] [Indexed: 11/30/2022] Open
Abstract
Intestinal parasitic infection (IPI) constitute a global health burden causing clinical morbidity in 450 million people. Many of these are women of reproductive age and children in developing countries. Mass deworming programmes with improvement in lifestyle are likely to reduce the intensity and prevalence of infection over the years. Hence, we aimed to assess the prevalence of intestinal parasitic infections among patients in a tertiary healthcare setting and to examine its time trends. A descriptive cross-sectional study was done using routinely collected data in a tertiary care hospital in South India. Details of examination of stool samples for the presence of intestinal helminth and protozoan ova/cysts, over the period of 5 years (2014-2019) were extracted from laboratory register and hospital information system. The presence of intestinal parasitic infection was determined by stool microscopy (direct wet mount and concentration techniques). Of the total 3267 stool samples, 303 (9.3%) had at least one parasite; 3.9% (93/3267) with helminths and 2.5% (81/3267) Entamoeba and multi-parasitism was seen in 0.14%. Stool samples from more than 18 years age had high positivity rate than others. Majority of the helminth infections were caused by Ascaris (57%) followed by hookworm (42%). Initially IPI which was 10.9% in 2014 declined to 10% in 2016 and attained a peak of 12.4% in 2017 then decreased to 6.7% in 2018. Nearly one out of ten patients had a parasitic infection. Prevalence surveys in the community followed by strengthening the deworming procedures will reduce the burden of IPIs.
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Affiliation(s)
- Revathi Ulaganeethi
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medicine and Research (JIPMER), Puducherry, India
| | - Nonika Rajkumari
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medicine and Research (JIPMER), Puducherry, India
| | - Anusha Gururajan
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medicine and Research (JIPMER), Puducherry, India
| | - Anitha Gunalan
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medicine and Research (JIPMER), Puducherry, India
| | - Dashwa Langbang
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medicine and Research (JIPMER), Puducherry, India
| | - Ganesh Kumar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medicine and Research (JIPMER), Puducherry, India
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Gebreyesus TD, Tadele T, Mekete K, Barry A, Gashaw H, Degefe W, Tadesse BT, Gerba H, Gurumurthy P, Makonnen E, Aklillu E. Prevalence, Intensity, and Correlates of Schistosomiasis and Soil-Transmitted Helminth Infections after Five Rounds of Preventive Chemotherapy among School Children in Southern Ethiopia. Pathogens 2020; 9:E920. [PMID: 33172114 PMCID: PMC7694749 DOI: 10.3390/pathogens9110920] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 01/04/2023] Open
Abstract
Preventive chemotherapy (PC) is a WHO-recommended strategy to control and eliminate schistosomiasis and soil-transmitted helminths (STHs). We assessed the prevalence, intensity, and correlates of schistosomiasis and STH infection after five rounds of PC in southern Ethiopia. A total of 3162 school children from four schools in Wondo Gennet and Hawella Tula districts were screened for Schistosoma mansoni and STHs infection. The overall prevalence of S. mansoni infection was 25.8% (range between schools 11.6% to 54.1%), with light (19.1%), moderate (5.3%), and heavy (1.4%) infection intensities. A total of 61.6% S. mansoni-infected children were STH co-infected. The overall prevalence of STHs infection was 54.7% (range between schools 30.6-71.0%), with moderate-to-heavy intensity infections being 16.3%. Ascaris lumbricoides was the most prevalent 45% (95% CI, 43.5-47) followed by Trichuris trichiura 25.3% (95% CI, 23.8-26.9) and hookworm 6.1% (95% CI, 5.3-7). A total of 33.7% of STHs-infected children had A. lumbricoides and T. trichiura co-infections. S. mansoni infection was significantly associated with school and STHs co-infection (p < 0.001). STH infection was correlated with school and younger age (p < 0.001). Despite repeated PC, S. mansoni and STH infection remain significant health problems, and the WHO target to control schistosomiasis and eliminate STH by 2020 may not be achieved. Intensified control and prevention measures, including drug efficacy surveillance, is recommended.
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Affiliation(s)
- Tigist Dires Gebreyesus
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge,14186 Stockholm, Sweden; (T.D.G.); (A.B.); (B.T.T.)
- Ethiopian Food and Drug Authority, Addis Ababa P.O. Box 5681, Ethiopia; (H.G.); (W.D.); (H.G.)
| | - Tafesse Tadele
- College of Medicine and Health Sciences, Hawassa University, Hawassa P.O. Box 1560, Ethiopia;
| | - Kalkidan Mekete
- Ethiopian Public Health Institute, Addis Ababa P.O. Box 1242, Ethiopia;
| | - Abbie Barry
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge,14186 Stockholm, Sweden; (T.D.G.); (A.B.); (B.T.T.)
| | - Habtamu Gashaw
- Ethiopian Food and Drug Authority, Addis Ababa P.O. Box 5681, Ethiopia; (H.G.); (W.D.); (H.G.)
| | - Workagegnehu Degefe
- Ethiopian Food and Drug Authority, Addis Ababa P.O. Box 5681, Ethiopia; (H.G.); (W.D.); (H.G.)
| | - Birkneh Tilahun Tadesse
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge,14186 Stockholm, Sweden; (T.D.G.); (A.B.); (B.T.T.)
- College of Medicine and Health Sciences, Hawassa University, Hawassa P.O. Box 1560, Ethiopia;
| | - Heran Gerba
- Ethiopian Food and Drug Authority, Addis Ababa P.O. Box 5681, Ethiopia; (H.G.); (W.D.); (H.G.)
| | - Parthasarathi Gurumurthy
- Pharmacovigilance and Clinical Trials, Botswana Medicines Regulatory Authority, Gaborone P.O. Box 505155, Botswana;
| | - Eyasu Makonnen
- Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 9086, Ethiopia;
- Departments of Pharmacology and Clinical Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 9086, Ethiopia
| | - Eleni Aklillu
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge,14186 Stockholm, Sweden; (T.D.G.); (A.B.); (B.T.T.)
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Keller L, Patel C, Welsche S, Schindler T, Hürlimann E, Keiser J. Performance of the Kato-Katz method and real time polymerase chain reaction for the diagnosis of soil-transmitted helminthiasis in the framework of a randomised controlled trial: treatment efficacy and day-to-day variation. Parasit Vectors 2020; 13:517. [PMID: 33059756 PMCID: PMC7558729 DOI: 10.1186/s13071-020-04401-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/09/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Accurate, scalable and sensitive diagnostic tools are crucial in determining prevalence of soil-transmitted helminths (STH), assessing infection intensities and monitoring treatment efficacy. However, assessments on treatment efficacy comparing traditional microscopic to newly emerging molecular approaches such as quantitative Polymerase Chain Reaction (qPCR) are scarce and hampered partly by lack of an established diagnostic gold standard. METHODS We compared the performance of the copromicroscopic Kato-Katz method to qPCR in the framework of a randomized controlled trial on Pemba Island, Tanzania, evaluating treatment efficacy based on cure rates of albendazole monotherapy versus ivermectin-albendazole against Trichuris trichiura and concomitant STH infections. Day-to-day variability of both diagnostic methods was assessed to elucidate reproducibility of test results by analysing two stool samples before and two stool samples after treatment of 160 T. trichiura Kato-Katz positive participants, partially co-infected with Ascaris lumbricoides and hookworm, per treatment arm (n = 320). As negative controls, two faecal samples of 180 Kato-Katz helminth negative participants were analysed. RESULTS Fair to moderate correlation between microscopic egg count and DNA copy number for the different STH species was observed at baseline and follow-up. Results indicated higher sensitivity of qPCR for all three STH species across all time points; however, we found lower test result reproducibility compared to Kato-Katz. When assessed with two samples from consecutive days by qPCR, cure rates were significantly lower for T. trichiura (23.2 vs 46.8%), A. lumbricoides (75.3 vs 100%) and hookworm (52.4 vs 78.3%) in the ivermectin-albendazole treatment arm, when compared to Kato-Katz. CONCLUSIONS qPCR diagnosis showed lower reproducibility of test results compared to Kato-Katz, hence multiple samples per participant should be analysed to achieve a reliable diagnosis of STH infection. Our study confirms that cure rates are overestimated using Kato-Katz alone. Our findings emphasize that standardized and accurate molecular diagnostic tools are urgently needed for future monitoring within STH control and/or elimination programmes.
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Affiliation(s)
- Ladina Keller
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland
- University of Basel, Petersplatz 1, 4051 Basel, Switzerland
| | - Chandni Patel
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland
- University of Basel, Petersplatz 1, 4051 Basel, Switzerland
| | - Sophie Welsche
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland
- University of Basel, Petersplatz 1, 4051 Basel, Switzerland
| | - Tobias Schindler
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland
- University of Basel, Petersplatz 1, 4051 Basel, Switzerland
| | - Eveline Hürlimann
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland
- University of Basel, Petersplatz 1, 4051 Basel, Switzerland
| | - Jennifer Keiser
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland
- University of Basel, Petersplatz 1, 4051 Basel, Switzerland
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Palmeirim MS, Bosch F, Ame SM, Ali SM, Hattendorf J, Keiser J. Efficacy, safety and acceptability of a new chewable formulation versus the solid tablet of mebendazole against hookworm infections in children: An open-label, randomized controlled trial. EClinicalMedicine 2020; 27:100556. [PMID: 33150325 PMCID: PMC7599302 DOI: 10.1016/j.eclinm.2020.100556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Soil-transmitted helminths (STHs) infect almost 1·5 billion people worldwide. The control of STH infections is based on preventive chemotherapy using either albendazole or mebendazole. Before being widely used, a sufficient body of evidence on efficacy, safety and acceptability is warranted for the new chewable child-friendly formulation of mebendazole that was recently developed. METHODS We conducted a randomised controlled superiority trial in four primary schools and kindergartens on Pemba Island, Tanzania. We considered eligible children aged 3 to 12 years with a hookworm infection intensity of at least 50 eggs per gram (EPG) of stool and no chronic diseases. Participants were allocated to treatment arms (ratio 1:1) using a computer generated random sequence. Our primary outcome was geometric mean based egg reduction rate (ERR) against hookworm assessed 14-21 days post-treatment. This trial complete and is registered with ClinicalTrials.gov, number NCT03995680 (June 24, 2019). FINDINGS 397 children were eligible and randomised into the solid (198) or chewable (199) tablet arms, of whom 393 were analysed. We found no significant difference between both formulations in terms of ERR (solid 70·8% versus chewable 68·5%, difference in ERRgeometric mean 2·3%-points, 95% CI -7·8 to 12·6, p = 0.65) and CR (11·2 versus 12·7%, 95% CI -4·9 to 7·9, p = 0.65) against hookworm infections. Adverse events were mild in both treatment arms. INTERPRETATIONS Though we could not demonstrate superiority in terms of efficacy of the new formulation, the difference between arms was small and therefore, the chewable formulation could be safely used as an alternative to swallowable tablets, in particular in young children who may have swallowing difficulties. This might help increase compliance and, consequently, enhance the effect of preventive chemotherapy.
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Affiliation(s)
- Marta S. Palmeirim
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, and University of Basel, P.O. Box, CH-4002, Basel, Switzerland
| | - Felix Bosch
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, and University of Basel, P.O. Box, CH-4002, Basel, Switzerland
| | - Shaali M. Ame
- Public Health Laboratory Ivo de Carneri, Chake, Tanzania
| | - Said M. Ali
- Public Health Laboratory Ivo de Carneri, Chake, Tanzania
| | - Jan Hattendorf
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, and University of Basel, Basel, Switzerland
| | - Jennifer Keiser
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, and University of Basel, P.O. Box, CH-4002, Basel, Switzerland
- Corresponding author.
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Tugwell P, Welch VA, Karunananthan S, Maxwell LJ, Akl EA, Avey MT, Bhutta ZA, Brouwers MC, Clark JP, Cook S, Cuervo LG, Curran JA, Ghogomu ET, Graham IG, Grimshaw JM, Hutton B, Ioannidis JPA, Jordan Z, Jull JE, Kristjansson E, Langlois EV, Little J, Lyddiatt A, Martin JE, Marušić A, Mbuagbaw L, Moher D, Morton RL, Nasser M, Page MJ, Pardo Pardo J, Petkovic J, Petticrew M, Pigott T, Pottie K, Rada G, Rader T, Riddle AY, Rothstein H, Schüneman HJ, Shamseer L, Shea BJ, Simeon R, Siontis KC, Smith M, Soares-Weiser K, Thavorn K, Tovey D, Vachon B, Valentine J, Villemaire R, Walker P, Weeks L, Wells G, Wilson DB, White H. When to replicate systematic reviews of interventions: consensus checklist. BMJ 2020; 370:m2864. [PMID: 32933948 DOI: 10.1136/bmj.m2864] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Peter Tugwell
- Department of Medicine, University of Ottawa, 501 Smyth Road, Room L1227, Ottawa, ON, K1H 8L6, Canada
- Bruyere Research Institute, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Vivian Andrea Welch
- Bruyere Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Sathya Karunananthan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Lara J Maxwell
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Marc T Avey
- Public Health Agency of Canada, Ottawa, ON, Canada
| | | | - Melissa C Brouwers
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Jocalyn P Clark
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Luis Gabriel Cuervo
- Pan American Health Organization (PAHO/WHO), Unit of Health Services and Access, Washington, DC, USA
| | | | | | - Ian G Graham
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Jeremy M Grimshaw
- Department of Medicine, University of Ottawa, 501 Smyth Road, Room L1227, Ottawa, ON, K1H 8L6, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Brian Hutton
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - John P A Ioannidis
- Stanford Prevention Research Center, Department of Medicine and Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | - Zoe Jordan
- JBI, Faculty of Health and Medical Sciences, University of Adelaide, South Australia
| | | | - Elizabeth Kristjansson
- Centre for Research in Educational and Community Services, School of Psychology, Faculty of Social Sciences, Ottawa, ON, Canada
| | - Etienne V Langlois
- World Health Organization, Partnership for Maternal, Newborn, and Child Health (PMNCH), Geneva, Switzerland
| | - Julian Little
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Janet E Martin
- Department of Anesthesia and Perioperative Medicine, and Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Ana Marušić
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
| | - Lawrence Mbuagbaw
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - David Moher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Mona Nasser
- Faculty of Health, University of Plymouth, UK
| | - Matthew J Page
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jordi Pardo Pardo
- Cochrane Musculoskeletal Group, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Mark Petticrew
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Terri Pigott
- College of Education and Human Development, Georgia State University, Atlanta, GA, USA
| | - Kevin Pottie
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Tamara Rader
- Canadian Agency for Drugs and Technologies in Health, Ottawa, ON, Canada
| | | | - Hannah Rothstein
- Narendra Paul Loomba Department of Management, Baruch College, New York, NY, USA
| | - Holger J Schüneman
- Cochrane Canada and McMaster GRADE Centres, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Larissa Shamseer
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Beverley J Shea
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Rosiane Simeon
- Population Health, Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | | | | | | | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Brigitte Vachon
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | | | - Rebecca Villemaire
- Department of Mechanical Engineering, University of Ottawa, Ottawa, ON, Canada
| | | | - Laura Weeks
- Canadian Agency for Drugs and Technologies in Health, Ottawa, ON, Canada
| | - George Wells
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada
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Lo NC, Gupta R, Addiss DG, Bendavid E, Heft-Neal S, Mikhailov A, Montresor A, Mbabazi PS. Comparison of World Health Organization and Demographic and Health Surveys data to estimate sub-national deworming coverage in pre-school aged children. PLoS Negl Trop Dis 2020; 14:e0008551. [PMID: 32804925 PMCID: PMC7462292 DOI: 10.1371/journal.pntd.0008551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 09/01/2020] [Accepted: 07/01/2020] [Indexed: 02/02/2023] Open
Abstract
Background The key metric for monitoring the progress of deworming programs in controlling soil-transmitted helminthiasis (STH) is national drug coverage reported to the World Health Organization (WHO). There is increased interest in utilizing geographically-disaggregated data to estimate sub-national deworming coverage and equity, as well as gender parity. The Demographic and Health Surveys (DHS) offer a potential source of sub-national data. This study aimed to compare deworming coverage routinely reported to WHO and estimated by DHS in pre-school aged children to inform global STH measurement and evaluation. Methodology We compared sub-national deworming coverage in pre-school aged children reported to WHO and estimated by DHS aligned geospatially and temporally. We included data from Burundi (2016–2017), Myanmar (2015–2016), and the Philippines (2017) based on data availability. WHO provided data on the date and sub-national coverage per mass drug administration reported by Ministries of Health. DHS included maternally-reported deworming status within the past 6 months for each child surveyed. We estimated differences in sub-national deworming coverage using WHO and DHS data, and performed sensitivity analyses. Principal findings We compared data on pre-school aged children from 13 of 18 districts in Burundi (N = 6,835 in DHS), 11 of 15 districts in Myanmar (N = 1,462 in DHS) and 16 of 17 districts in the Philippines (N = 7,594 in DHS) following data exclusion. The national deworming coverages estimated by DHS in Burundi, Myanmar, and the Philippines were 75.5% (95% CI: 73.7%-77.7%), 47.0% (95% CI: 42.7%-51.3%), and 48.0% (95% CI: 46.0%-50.0%), respectively. The national deworming coverages reported by WHO in Burundi, Myanmar, and the Philippines were 80.1%, 93.6% and 75.7%, respectively. The mean absolute differences in district-level coverage reported to WHO and estimated by DHS in Burundi, Myanmar, and the Philippines were 9.5%, 41.5%, and 24.6%, respectively. Across countries, coverage reported to WHO was frequently higher than DHS estimates (32 of 40 districts). National deworming coverage from DHS estimates were similar by gender within countries. Conclusions and significance Agreement of deworming coverage reported to WHO and estimated by DHS data was heterogeneous across countries, varying from broadly compatible in Burundi to largely discrepant in Myanmar. DHS data could complement deworming data reported to WHO to improve data monitoring practices and serve as an independent sub-national source of coverage data. Soil-transmitted helminths are parasitic worms that infect an estimated 1 billion people globally, primarily in low- and middle-income countries. One of the main strategies to reduce the prevalence of these parasitic infections is through preventive chemotherapy—the periodic widespread treatment of an entire at-risk population (e.g. children) with albendazole or mebendazole. The World Health Organization (WHO) tracks the progress of mass deworming programs by estimating the national coverage of these programs through aggregation of local health district program reports, which represent the proportion of at-risk people in a country that are reported to have received deworming treatment. In this study, we used an alternative source of data from the Demographic and Health Surveys (DHS) that provides maternally-reported child deworming treatment to estimate coverage in pre-school aged children and was subsequently compared to data reported to WHO. We conducted this comparison of deworming coverage at a sub-national level for three countries with available data: Burundi, Myanmar, and the Philippines. Coverage reported to WHO and estimated by DHS were broadly consistent in Burundi, highly discrepant in Myanmar, and varied in agreement for the Philippines. These differences may be explained by variability in the medication distribution monitoring practices, quality of national validation systems, and mis-reporting due to albendazole receipt through non-STH related public health campaigns (e.g. lymphatic filariasis treatment). This analysis suggests that in specific settings, DHS data can complement deworming coverage data reported to WHO, serving as an independent source of data to improve monitoring and evaluation of deworming programs globally.
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Affiliation(s)
- Nathan C. Lo
- Deparment of Medicine, University of California, San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Ribhav Gupta
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, United States of America
| | - David G. Addiss
- Focus Area for Compassion and Ethics, Task Force for Global Health, Decatur, Georgia, United States of America
| | - Eran Bendavid
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, United States of America
- Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California, United States of America
| | - Sam Heft-Neal
- Center on Food Security and the Environment, Stanford University, Stanford, California, United States of America
| | - Alexei Mikhailov
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Antonio Montresor
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Pamela Sabina Mbabazi
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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Isah AUJ, Ekwunife OI, Ejie IL, Mandrik O. Effects of nutritional supplements on the re-infection rate of soil-transmitted helminths in school-age children: A systematic review and meta-analysis. PLoS One 2020; 15:e0237112. [PMID: 32790693 PMCID: PMC7425883 DOI: 10.1371/journal.pone.0237112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/20/2020] [Indexed: 11/18/2022] Open
Abstract
Background The effect of nutritional supplements on the re-infection rate of species-specific soil-transmitted helminth infections in school-aged children remains complex and available evidence on the subject matter has not been synthesized. Methods The review included randomised controlled trials (RCTs) and cluster RCTs investigating food supplements on school-aged children between the age of 4–17 years. A search for RCTs was conducted on eight databases from inception to 12th June 2019. Cochrane Risk of Bias tool was used to assess the risk of bias in all included studies. Meta-analysis and narrative synthesis were conducted to describe and analyze the results of the review. Outcomes were summarized using the mean difference or standardized mean difference where appropriate. Results The search produced 1,816 records. Six studies met the inclusion criteria (five individually RCTs and one cluster RCT). Four studies reported data on all three STH species, while one study only reported data on Ascaris lumbricoides infections and the last study reported data on only hookworm infections. Overall, the risk of bias in four individual studies was low across most domains. Nutritional supplementation failed to statistically reduce the re-infection rates of the three STH species. The effect of nutritional supplements on measures of physical wellbeing in school-aged children could not be determined. Conclusions The findings from this systematic review suggest that nutritional supplements for treatment of STH in children should not be encouraged unless better evidence emerges. Conclusion of earlier reviews on general populations may not necessarily apply to children since children possibly have a higher re-infection rate.
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Affiliation(s)
- Aisha Ummi Jibrin Isah
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, United Kingdom
| | - Obinna Ikechukwu Ekwunife
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Nigeria
- * E-mail:
| | - Izuchukwu Loveth Ejie
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Nigeria
| | - Olena Mandrik
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, United Kingdom
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Li Q, Li S, Liu X, He Z, Wang T, Xu Y, Guan H, Chen R, Qi S, Wang F. FecalNet: Automated detection of visible components in human feces using deep learning. Med Phys 2020; 47:4212-4222. [PMID: 32583463 DOI: 10.1002/mp.14352] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To automate the detection and identification of visible components in feces for early diagnosis of gastrointestinal diseases, we propose FecalNet, a method using multiple deep neural networks. METHODS FecalNet uses the ResNet152 residual network to extract and learn the characteristics of visible components in fecal microscopic images, acquire feature maps in combination with the feature pyramid network, apply the full convolutional network to classify and locate the fecal components, and implement the improved focal loss function to reoptimize the classification results. This allowed the complete automation of the detection and identification of the visible components in feces. RESULTS We validated this method using a fecal database of 1,122 patients. The results indicated a mean average precision (mAP) of 92.16% and an average recall (AR) of 93.56%. The average precision (AP) and AR of erythrocyte, leukocyte, intestinal mucosal epithelial cells, hookworm eggs, ascarid eggs, and whipworm eggs were 92.82% and 93.38%, 93.99% and 96.11%, 90.71% and 92.41%, 89.95% and 93.88%, 96.90% and 91.21%, and 88.61% and 94.37%, respectively. The average times required by the GPU and the CPU to analyze a fecal microscopic image are approximately 0.14 and 1.02 s, respectively. CONCLUSION FecalNet can automate the detection and identification of visible components in feces. It also provides a detection and identification framework for detecting several other types of cells in clinical practice.
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Affiliation(s)
- Qiaoliang Li
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Department of Biomedical Engineering, School of Medicine, Shenzhen University, Xueyuan Avenue, Nanshan District, Shenzhen, 518071, China
| | - Shiyu Li
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Department of Biomedical Engineering, School of Medicine, Shenzhen University, Xueyuan Avenue, Nanshan District, Shenzhen, 518071, China
| | - Xinyu Liu
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Department of Biomedical Engineering, School of Medicine, Shenzhen University, Xueyuan Avenue, Nanshan District, Shenzhen, 518071, China
| | - Zhuoying He
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Department of Biomedical Engineering, School of Medicine, Shenzhen University, Xueyuan Avenue, Nanshan District, Shenzhen, 518071, China
| | - Tao Wang
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Department of Biomedical Engineering, School of Medicine, Shenzhen University, Xueyuan Avenue, Nanshan District, Shenzhen, 518071, China
| | - Ying Xu
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Department of Biomedical Engineering, School of Medicine, Shenzhen University, Xueyuan Avenue, Nanshan District, Shenzhen, 518071, China
| | - Huimin Guan
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Department of Biomedical Engineering, School of Medicine, Shenzhen University, Xueyuan Avenue, Nanshan District, Shenzhen, 518071, China
| | - Runmin Chen
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Department of Biomedical Engineering, School of Medicine, Shenzhen University, Xueyuan Avenue, Nanshan District, Shenzhen, 518071, China
| | - Suwen Qi
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Department of Biomedical Engineering, School of Medicine, Shenzhen University, Xueyuan Avenue, Nanshan District, Shenzhen, 518071, China
| | - Feng Wang
- Department of Clinical Laboratory, Shenzhen Baoan Women's and Children's Hospital, Shenzhen, 518071, China
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Mationg MLS, Williams GM, Tallo VL, Olveda RM, Aung E, Alday P, Reñosa MD, Daga CM, Landicho J, Demonteverde MP, Santos ED, Bravo TA, Angly Bieri FA, Li Y, Clements ACA, Steinmann P, Halton K, Stewart DE, McManus DP, Gray DJ. Determining the Impact of a School-Based Health Education Package for Prevention of Intestinal Worm Infections in the Philippines: Protocol for a Cluster Randomized Intervention Trial. JMIR Res Protoc 2020; 9:e18419. [PMID: 32584263 PMCID: PMC7381005 DOI: 10.2196/18419] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 01/16/2023] Open
Abstract
Background Repeated mass drug administration (MDA) of antihelminthics to at-risk populations is still the main strategy for the control of soil-transmitted helminth (STH) infections. However, MDA, as a stand-alone intervention, does not prevent reinfection. Accordingly, complementary measures to prevent STH reinfection, such as health education and improved sanitation, as part of an integrated control approach, are required to augment the effectiveness of MDA for optimal efficiency and sustainability. Objective The aim of this study is to determine the impact and generalizability of a school-based health education package entitled The Magic Glasses for STH prevention in the Philippines. Methods We conducted a cluster randomized controlled intervention trial, involving 2020 schoolchildren aged 9-10 years, in 40 schools in Laguna Province, Philippines, to evaluate the impact of the school-based health education package for the prevention of STHs. The trial was conducted over the course of 1 year (June 2016 to July 2017). A total of 20 schools were randomly assigned to the intervention arm, in which The Magic Glasses Philippines health education package was delivered with the standard health education activities endorsed by the Philippines Department of Health (DOH) and the Department of Education (DepEd). The other 20 schools comprised the control arm of the study, where the DOH/DepEd’s standard health education activities were done. At baseline, parasitological assessments and a knowledge, attitude, and practice survey were carried out in all schools. In addition, height, weight, and hemoglobin levels were obtained from each child (after parental consent), and their school attendance and academic performance in English and mathematics were accessed from the school records. The baseline and 2 follow-up surveys were completed using the same study measurements and quality-control assessments. Results Key results from this cluster randomized intervention trial will shed light on the impact that The Magic Glasses health education package will have against STH infections in schoolchildren in the province of Laguna, located on the Island of Luzon, in the Calabarzon Region of the Philippines. Conclusions The results of the trial will be used to assess the generalizability of the impact of The Magic Glasses health education package in different epidemiological and cultural settings, providing evidence for translation of this health education package into public health policy and practice in the Asian region and beyond. Trial Registration Australian New Zealand Clinical Trials Registry number ACTRN12616000508471; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368849 International Registered Report Identifier (IRRID) DERR1-10.2196/18419
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Affiliation(s)
- Mary Lorraine S Mationg
- Research School of Population Heath, The Australian National University, Canberra, Australia.,Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Gail M Williams
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Veronica L Tallo
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Remigio M Olveda
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Eindra Aung
- Research School of Population Heath, The Australian National University, Canberra, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Portia Alday
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Mark Donald Reñosa
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Chona Mae Daga
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Jhoys Landicho
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Maria Paz Demonteverde
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Eunice Dianne Santos
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Thea Andrea Bravo
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Franziska A Angly Bieri
- Research School of Population Heath, The Australian National University, Canberra, Australia
| | - Yuesheng Li
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Hunan Institute of Parasitic Diseases, World Health Organization Collaborating Centre for Research and Control on Schistosomiasis in Lake Region, Yueyang, China
| | | | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Kate Halton
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Donald E Stewart
- Research School of Population Heath, The Australian National University, Canberra, Australia.,School of Medicine, Griffith University, Brisbane, Australia
| | - Donald P McManus
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Darren J Gray
- Research School of Population Heath, The Australian National University, Canberra, Australia
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Abebaw A, Alemu G, Ayehu A. Prevalence of intestinal parasites and associated factors among children from child centres in Bahir Dar city, northwest Ethiopia. Trop Doct 2020; 50:194-198. [PMID: 32380905 DOI: 10.1177/0049475520920161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Data concerning the burden of parasites among populations living in overcrowded circumstances have paramount importance for the success of interventions aimed at eliminating such disease. A cross-sectional study was therefore conducted from February to May 2019 among 217 children at child centres in Bahir Dar city. Data were collected using a structured questionnaire and stool samples were processed for parasitological investigation.A total of 53 (24.4%) children were infected with at least a single species of intestinal parasite. Giardia lamblia (7.8%) was the most frequent, followed by Hymenolepis nana (6%). Children with untrimmed fingernails (adjusted odds ratio [AOR] = 2.422, P = 0.027) were significantly more prone to infection. Similarly, children with no habit of hand washing after soil contact (AOR = 2.752, P = 0.014) or after defecation (AOR = 3.087, P = 0.026) were significantly associated with parasitic infection. The prevalence of intestinal parasites at child centres in Bahir Dar is of public health importance; therefore, control programmes should target these children.
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Affiliation(s)
- Aynework Abebaw
- Department of Medical Laboratory Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getaneh Alemu
- Department of Medical Laboratory Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Animen Ayehu
- Department of Medical Laboratory Science, Bahir Dar University, Bahir Dar, Ethiopia
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Cunningham LJ, Campbell SJ, Armoo S, Koukounari A, Watson V, Selormey P, Stothard JR, Idun B, Asiedu M, Ashong Y, Adams ER, Osei-Atweneboana MY. Assessing expanded community wide treatment for schistosomiasis: Baseline infection status and self-reported risk factors in three communities from the Greater Accra region, Ghana. PLoS Negl Trop Dis 2020; 14:e0007973. [PMID: 32339185 PMCID: PMC7205311 DOI: 10.1371/journal.pntd.0007973] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 05/07/2020] [Accepted: 12/05/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This paper reports on the baseline prevalence and associated risk factor findings of a pilot, longitudinal study exploring community-wide treatment of schistosomiasis and soil-transmitted helminthiasis, using albendazole plus praziquantel in the Greater Accra region of Ghana. METHOD From three communities, at least, 658 individuals were enrolled into the study via random household selection. Prevalence and intensity of schistosomiasis and STH infection were determined from stool and urine samples with a questionnaire being administered in order to explore other morbidities and risk factors. Factor analysis of household demographic variables was undertaken to generate a socioeconomic score; this was then further categorised into tertiles. Proportional-odds cumulative logit generalised estimating equation (GEE) models were used to investigate categorical ordinal intensity of infection associations with morbidity. Separately, logistic GEE models were used to investigate risk factor associations with infection prevalence. RESULTS Both Schistosoma haematobium and S. mansoni were prevalent in the three communities, with the prevalence of S. haematobium ranging from 3.3% (24/679; 95% CI = 1.9-4.7) to 19% (114/632; 95% CI = 15.8-22.2) and S. mansoni ranging from 30% (202/679; 95% CI = 26.5-33.5) to 78.3% (409/536; 95% CI = 74.7-81.9). The total prevalence of STH across all three sites was negligible at 1.3% (24/1847; 95% CI = 0.8-1.9) comprising mainly hookworm (10/1847). Multivariable statistical models indicated males to be 2.3 (95% CI = 1.7-3.3) times more likely to have a high intensity S. mansoni infection and 1.5 (95% CI = 1.1-2) times more likely to have a high intensity of S. haematobium infection compared to females. There was no significant difference in the likelihood of infection with S. mansoni between adults and school age children (SAC), however S. haematobium infections were found to be 2.5 (95% CI = 1.8-3.5) times more likely to occur in school age children than in adults. Multivariable statistical models (adjusted for age and sex) indicated an association between schistosomiasis and a number of self-reported morbidity indicators (notably diarrhoea and blood in stool and urine). Low socio-economic status was also associated with SCH infection (OR: 2; 95% CI = 1.3-3.2). CONCLUSION The communities targeted by this study showed a range of Schistosoma prevalence's of infection, from hypo-endemic through to meso-endemic and hyper-endemic. The prevalence of SCH across the different age groups in the study locations highlights the large number of individuals currently being left out of the standard morbidity control method of annual treatment of the SAC.
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Affiliation(s)
- Lucas J. Cunningham
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Samuel Armoo
- Department of Biomedical and Public Health Research, Council for Scientific and Industrial Research—Water Research Institute, Council Close, Accra, Ghana
| | - Artemis Koukounari
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, United Kingdom
| | - Victoria Watson
- Department of Biostatistics, University of Liverpool, Liverpool, United Kingdom
| | - Pamela Selormey
- Department of Biomedical and Public Health Research, Council for Scientific and Industrial Research—Water Research Institute, Council Close, Accra, Ghana
| | - J. Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Bright Idun
- Department of Biomedical and Public Health Research, Council for Scientific and Industrial Research—Water Research Institute, Council Close, Accra, Ghana
| | - Manfred Asiedu
- Department of Biomedical and Public Health Research, Council for Scientific and Industrial Research—Water Research Institute, Council Close, Accra, Ghana
| | - Yvonne Ashong
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Emily R. Adams
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Mike Yaw Osei-Atweneboana
- Department of Biomedical and Public Health Research, Council for Scientific and Industrial Research—Water Research Institute, Council Close, Accra, Ghana
- * E-mail:
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Abstract
BACKGROUND Ascaris lumbricoides is a common infection, and mainly affects children living in low-income areas. Water and sanitation improvement, health education, and drug treatment may help break the cycle of transmission, and effective drugs will reduce morbidity. OBJECTIVES To compare the efficacy and safety of anthelmintic drugs (albendazole, mebendazole, ivermectin) for treating people with Ascaris infection. SEARCH METHODS We searched the Cochrane Infectious Disease Group Specialized Register, CENTRAL, MEDLINE, Embase, LILACS, three other databases, and reference lists of included studies, without language restrictions, up to 4 July 2019. SELECTION CRITERIA Randomized controlled trials (RCT) that compared albendazole, mebendazole, and ivermectin in children and adults with confirmed Ascaris infection. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion, assessed risk of bias, and extracted data from the included trials. A third review author checked the quality of data extraction. We used the Cochrane 'Risk of bias' assessment tool to determine the risk of bias in included trials. We used risk ratios (RRs) with 95% confidence intervals (CIs) to compare dichotomous outcomes in treatment and control groups. We used the fixed-effect model for studies with low heterogeneity and the random-effects model for studies with moderate to high heterogeneity. We assessed the certainty of the evidence using the GRADE approach. We used the control rate average to provide illustrative cure rates in the comparison groups. MAIN RESULTS We included 30 parallel-group RCTs, which enrolled 6442 participants from 17 countries across Africa, Asia, Central America and the Caribbean, and South America. Participants were from 28 days to 82 years of age, recruited from school, communities, and health facilities. Twenty studies were funded or co-funded by manufacturers, while 10 studies were independent of manufacturer funding. Twenty-two trials had a high risk of bias for one or two domains (blinding, incomplete outcome data, selective reporting). Single dose of albendazole (four trials), mebendazole (three trials) or ivermectin (one trial) was compared to placebo. Parasitological cure at 14 to 60 days was high in all the studies (illustrative cure of 93.0% in the anthelmintic group and 16.1% in the placebo group; RR 6.29, 95% CI 3.91 to 10.12; 8 trials, 1578 participants; moderate-certainty evidence). Single dose of albendazole is as effective as multiple doses of albendazole (illustrative cure of 93.2% with single dose, 94.3% with multiple doses; RR 0.98, 95% CI 0.92 to 1.05; 3 trials, 307 participants; high-certainty evidence); or as single dose of mebendazole (illustrative cure of 98.0% with albendazole, 96.9% with mebendazole; RR 1.01, 95% CI 1.00 to 1.02; 6 trials, 2131 participants; high-certainty evidence). Studies did not detect a difference between a single dose of albendazole and a single dose of ivermectin (cure rates of 87.8% with albendazole, 90.2% with ivermectin; RR 0.99, 95% CI 0.91 to 1.08; 3 trials, 519 participants; moderate-certainty evidence). Across all the studies, failure after single dose of albendazole ranged from 0.0% to 30.3%, mebendazole from 0.0% to 22.2%, and ivermectin from 0.0% to 21.6%. The egg reduction rate (ERR) measured up to 60 days after the treatment was high in all treated groups, regardless of the anthelmintic used (range 96% to 100%). It was not possible to evaluate parasitological cure by classes of infection intensity. No included trials reported complication or serious adverse events. Other adverse events were apparently similar among the compared anthelmintic groups (moderate- to low-certainty evidence). The most commonly reported other adverse events were nausea, vomiting, abdominal pain, diarrhoea, headache, and fever. AUTHORS' CONCLUSIONS Single-dose of albendazole, mebendazole, and ivermectin all appeared effective against Ascaris lumbricoides infection, yielding high parasitological cure and large reductions in eggs excreted, with no differences detected between them. The drugs appear to be safe to treat children and adults with confirmed Ascaris infection. There is little to choose between drugs and regimens in terms of cure or adverse events.
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Affiliation(s)
- Lucieni O Conterno
- State University of Campinas (UNICAMP)Medical School, Department of Internal Medicine, Infectious Diseases DivisionRua Tessália Vieira de Camargo, 126Cidade Universitária "Zeferino Vaz"CampinasSão PauloBrazil13083‐887
| | - Marilia D Turchi
- Federal University of GoiasDepartment of Public Health, Institute of Tropical Pathology and Public HealthRua Amorinopolis QdR2 Lt13 Residencial GoiasAlphaville FlamboyantGoianiaGoiasBrazil74884‐540
| | - Ione Corrêa
- Botucatu Medical School, UNESP ‐ Univ Estadual PaulistaDepartment of NursingDistrito de Rubião Júnior, s/nBotucatuSão PauloBrazil18603‐970
| | - Ricardo Augusto Monteiro de Barros Almeida
- Botucatu Medical School, UNESP ‐ Univ Estadual PaulistaDepartment of Tropical Diseases and Imaging DiagnosisAv. Prof. Montenegro, s/nDistrito de Rubiao JrBotucatuSao PauloBrazil18618‐970
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Liu M, Panda SK, Luyten W. Plant-Based Natural Products for the Discovery and Development of Novel Anthelmintics against Nematodes. Biomolecules 2020; 10:biom10030426. [PMID: 32182910 PMCID: PMC7175113 DOI: 10.3390/biom10030426] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 12/11/2022] Open
Abstract
Intestinal parasitic nematodes infect approximately two billion people worldwide. In the absence of vaccines for human intestinal nematodes, control of infections currently relies mainly on chemotherapy, but resistance is an increasing problem. Thus, there is an urgent need for the discovery and development of new anthelmintic drugs, especially ones with novel mechanisms of action. Medicinal plants hold great promise as a source of effective treatments, including anthelmintic therapy. They have been used traditionally for centuries and are mostly safe (if not, their toxicity is well-known). However, in most medicinal plants the compounds active against nematodes have not been identified thus far. The free-living nematode C. elegans was demonstrated to be an excellent model system for the discovery of new anthelmintics and for characterizing their mechanism of action or resistance. The compounds discussed in this review are of botanical origin and were published since 2002. Most of them need further studies of their toxicity, mechanisms and structure-activity relationship to assess more fully their potential as drugs.
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