Long Term School Based Deworming against Soil-Transmitted Helminths Also Benefits the Untreated Adult Population: Results from a Community-Wide Cross Sectional Survey

Management of paediatric soil-transmitted helminthiasis in a non-endemic area: experience in a reference international health unit

Soil-transmitted helminth (STH) infections inflict disability worldwide, especially in the poorest communities. Current therapeutic options against STHs show limited efficacy, particularly against Trichuris trichiura. The empirical management of patients coming from high-prevalence areas has been suggested for non-endemic areas. This study aimed to describe the management of STH infections in a non-endemic setting using an individualised approach. We performed a retrospective, descriptive study of all patients up to 16 years of age with STH infections attended at an international health unit in a non-endemic area (2014-2018), including all T. trichiura, Necator americanus, Ancylostoma duodenale, and Ascaris lumbricoides infections diagnosed using a formol-ether concentration technique and direct visualisation. Patients were treated according to current international guidelines. Sixty-one stool samples from 48 patients testing positive for STHs were collected, with 96% (46/48) reporting a previous long-term stay in endemic areas. Cure rates with 3-day benzimidazole regimens were 72% for T. trichiura, 40% for hookworms, and 83% for A. lumbricoides. The results were not influenced by any reinfection risk due to the study being performed in a non-endemic area. Patients coming from STH-endemic areas should be evaluated with appropriate diagnostic tools and followed up until cure control results. Cure rates in our cohort were moderate to low, similar to those published in studies in endemic areas. The efficacy of current treatment options is insufficient to recommend a specific empirical approach in high-income countries' healthcare systems.

Comparison of quantitative polymerase chain reaction, Kato-Katz and circulating cathodic antigen rapid test for the diagnosis of Schistosoma mansoni infection: A cross-sectional study in Kirinyaga County, Kenya

The current standard diagnostic tests for Schistosoma mansoni are the Kato-Katz and circulating cathodic antigen (CCA) techniques. However, these techniques have been documented to have several limitations that have a direct impact on schistosomiasis control programmes. Therefore, there is a need for more sensitive and specific tests for diagnosing schistosomiasis. This study compared the performance of quantitative polymerase chain reaction (qPCR), Kato-Katz, and point-of-care circulating cathodic antigen (POC-CCA) techniques in the diagnosis of S. mansoni infection in the Mwea irrigation scheme, Kirinyaga County in Central Kenya. We carried out a cross-sectional study on 357 individuals residing in four villages in the Mwea irrigation scheme. The participants provided urine and stool samples which were screened for S. mansoni infections using the three techniques. The prevalence of S. mansoni by each technique was calculated and 95% confidence intervals estimated using binomial regression model. Sensitivity and specificity were determined using 2 × 2 contingency tables and compared using the McNemar’s chi-square test. Positive and negative predictive values were also determined using the weighted generalized score chi-square test for paired data. The study showed that the prevalence of S. mansoni was 32.8%, 62.5% and 72.8% using Kato-Katz, POC-CCA and qPCR techniques, respectively. Further, when using Kato-Katz as a gold standard, POC-CCA sensitivity was 78.6% and specificity was 45.4%, while qPCR sensitivity was 97.4% and specificity was 39.2%. When using qPCR as the gold standard, Kato-Katz sensitivity was 43.8% and specificity was 96.9%, while POC-CCA sensitivity was 78.1% and specificity was 79.4%. Finally, when using the averaged results from the three techniques as the gold standard, the sensitivity was 41.6%, 79.4% and 92.5% for Kato-Katz, POC-CCA and qPCR, respectively, with a specificity of 100% for all techniques. Kato-Katz technique showed low sensitivity compared to the POC-CCA and qPCR despite it being the most commonly preferred method of choice to diagnose S. mansoni infections. qPCR showed superior sensitivity followed by POC-CCA, hence it can be used as an alternative or to confirm the results obtained by the Kato-Katz technique.

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Comparison of the performance of Kato-Katz, POC-CCA and qPCR for diagnosis of S. mansoni in Kirinyaga County, Kenya.

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A total of 357 urine and stool samples were tested for S. mansoni infection.

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qPCR estimated the highest prevalence followed by POC-CCA and Kato-Katz.

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qPCR showed a generally high sensitivity and specificity.

Evaluation of School-Based Health Education Intervention on the Incidence of Soil-Transmitted Helminths in Pupils of Rural Communities of Eastern Kogi State, North Central Nigeria

The negative impact of soil-transmitted helminths (STHs) in Nigeria is enormous, and it poses serious public health issues and concerns. This study was undertaken to investigate the impact of health education intervention on reinfection of STHs in pupils of rural schools of Kogi East, North Central Nigeria. A total of 10 schools with the highest prevalence of STHs at baseline were selected from the 45 schools assessed during the baseline survey. These 10 schools were randomly paired into two groups of 5 schools per group. Five schools were dewormed and given health education (DHE) intervention while the other 5 schools were dewormed only (DO) without health education. Reassessment of schools for reinfection was carried out for a period of 12 months. Data obtained were analyzed using descriptive statistics. Student's t-test was used to make comparison between interventions in the incidence of infections. Analysis was carried out at p < 0.05. Reinfection with STHs was observed from the 28th week (7th month) of both interventions with incidence of 0.29 (2 pupils) and 1.00 (7 pupils) in DO and DHE schools, respectively. In the 36th week (9th month), incidence observed in schools given DHE was 0.56 (5 pupils) while incidence of 0.89 (8 pupils) was observed in DO schools, and there was no significant difference (t = -1.000, p = 0.347) between the interventions. At 48th week (12th month), there was no significant difference (t = -0.547, p = 0.599) in incidence between the DHE and DO schools with incidence of 1.00 (12 pupils) and 0.83 (10 pupils), respectively. Hookworms had an incidence of 0.78 (7 pupils) at DHE schools and 0.56 (5 pupils) at DO schools in the 36th week while an incidence of 0.92 (11 pupils) and 0.83 (10 pupils) at DHE and DO schools, respectively, in the 48th week. Ascaris lumbricoides was only observed in DHE schools in a pupil with an incidence of 0.11 (1 pupil) and 0.08 (1 pupil) at 36th and 48th weeks. There was no significant difference in the prevalence of the parasites between DO and DHE intervention groups (p > 0.05). School-based health education intervention had no significant impact on STH incidence in pupils of rural schools in Kogi East. Community-based deworming should be encouraged alongside improvement in the water, sanitation, and hygiene infrastructures and practices at both school and home.