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Wu K, Chen J, Xiao Y, Yan C, Li X, Huang Y, Deng R. Health lifestyles of six Zhiguo ethnic groups in China: a latent class analysis. BMC Public Health 2024; 24:2279. [PMID: 39174913 PMCID: PMC11340163 DOI: 10.1186/s12889-024-19743-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/09/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Zhiguo ethnic groups, commonly known as "the directly-entering-socialism ethnic groups", represent Chinese ethnic minorities who have undergone a unique social development trajectory by transforming directly from primitive societies to the socialist stage. In recent decades, significant lifestyle transformations have occurred among Zhiguo ethnic groups. Understanding their health lifestyles can play a strategic role in China's pursuit of universal health coverage. This study aims to examine patterns of health-related lifestyle among Zhiguo ethnic groups and explore whether sociodemographic features and specific indicators related to health status are associated with particular classes. METHODS A cross-sectional study was conducted in Yunnan Province, China, from July to December 2022. Stratified random sampling method was employed to recruit residents belonging to six Zhiguo ethnic groups aged between 15 and 64. Latent class analysis was performed to identify clusters of health-related behaviors within each ethnic group. Logistic regression was utilized to determine the predictors of health lifestyles. RESULTS A total of 1,588 individuals from the Zhiguo ethnic groups participated in this study. Three latent classes representing prevalent health lifestyles among the Zhiguo ethnic groups were identified: "unhealthy lifestyle" (31.80%), "mixed lifestyle" (57.37%), and "healthy lifestyle" (10.83%). In the overall population, individuals belonging to the "healthy lifestyle" group exhibited a higher likelihood of being non-farmers (OR: 2.300, 95% CI: 1.347-3.927), women (OR: 21.459, 95% CI: 13.678-33.667), married individuals (OR: 1.897, 95% CI: 1.146-3.138), and those residing within a walking distance of less than 15 min from the nearest health facility (OR: 2.133, 95% CI: 1.415-3.215). Conversely, individuals in the age cohorts of 30-39 years (OR: 0.277, 95% CI: 0.137-0.558) and 40-49 years (OR: 0.471, 95% CI: 0.232-0.958) showed a decreased likelihood of adopting a healthy lifestyle. CONCLUSIONS A considerable proportion of the Zhiguo ethnic groups have not adopted healthy lifestyles. Targeted interventions aimed at improving health outcomes within these communities should prioritize addressing the clustering of unfavorable health behaviors, with particular emphasis on single male farmers aged 30-49, and expanding healthcare coverage for individuals residing more than 15 min away from accessible facilities.
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Affiliation(s)
- Kaiwen Wu
- School of Public Health, Kunming Medical University, Kunming, China
- The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jie Chen
- School of Public Health, Kunming Medical University, Kunming, China
| | - Yan Xiao
- Foreign Languages Department, Kunming Medical University, Kunming, China
| | - Chaofang Yan
- School of Public Health, Kunming Medical University, Kunming, China
| | - Xiaoju Li
- School of Public Health, Kunming Medical University, Kunming, China
| | - Yuan Huang
- School of Public Health, Kunming Medical University, Kunming, China.
| | - Rui Deng
- School of Public Health, Kunming Medical University, Kunming, China.
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Viriato de Freitas V, Goulart Madeira N. Effectiveness of a School Intervention Based on Knowledge, Attitude, and Practice of Soil-Transmitted Helminths. Am J Trop Med Hyg 2024; 110:263-269. [PMID: 38190744 PMCID: PMC10859796 DOI: 10.4269/ajtmh.23-0010] [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: 01/04/2023] [Accepted: 10/09/2023] [Indexed: 01/10/2024] Open
Abstract
More than 1.5 billion people are infected by soil-transmitted helminths (STHs) worldwide, comprising one of the world's most serious public health problems. School-age children are the most affected as a result of precarious hygienic habits, especially in economically poor areas that lack appropriate sanitation. Therefore, this study aimed to evaluate a didactic method via a health education approach as a complement to the school curriculum of the sixth-grade students of public schools, distributed among six cities in the state of São Paulo, Brazil. For this, a didactic booklet was elaborated with educational explanatory activities about worms, their life cycle, and how to avoid infections. The intervention was measured by the change caused by knowledge, attitude, and practice (KAP), in students before and after using the notebook, through a questionnaire with high validity and internal consistency. Schools were assigned randomly into intervention and control groups, receiving both the didactic material and the questionnaires, versus the questionnaires only, respectively. The results were submitted to an analysis of covariance that revealed a significant difference pre- and postintervention for knowledge (P < 0.001), with greater means (0.54) compared with the control group (0.44); attitude (P < 0.005), with respective means of 0.56 versus 0.48; and practice (P < 0.001), with means of 0.75 versus 0.57. These findings set the didactic material as a potential tool to complement the school curriculum through KAP without disrupting the teaching system, in addition to assisting teachers in health education at schools aiming to prevent children's infections by STHs.
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Affiliation(s)
- Viviany Viriato de Freitas
- Department of Biodiversity and Biostatistics, Section of Parasitology, Institute of Biosciences, São Paulo State University, Botucatu, Brazil
| | - Newton Goulart Madeira
- Department of Biodiversity and Biostatistics, Section of Parasitology, Institute of Biosciences, São Paulo State University, Botucatu, Brazil
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3
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Nqweniso S, Walter C, du Randt R, Adams L, Beckmann J, Coulibaly JT, Dolley D, Joubert N, Long KZ, Müller I, Nienaber M, Pühse U, Seelig H, Steinmann P, Utzinger J, Gerber M, Lang C. Associations between soil-transmitted helminth infections and physical activity, physical fitness, and cardiovascular disease risk in primary schoolchildren from Gqeberha, South Africa. PLoS Negl Trop Dis 2023; 17:e0011664. [PMID: 37831637 PMCID: PMC10575529 DOI: 10.1371/journal.pntd.0011664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 09/15/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND/AIM School-aged children in low- and middle-income countries carry the highest burden of intestinal helminth infections, such as soil-transmitted helminths (STH). STH infections have been associated with negative consequences for child physical and cognitive development and wellbeing. With the epidemiological transition and rise in cardiovascular disease (CVD), studies have shown that helminth infections may influence glucose metabolism by preventing obesity. Thus, the aim of this study was to determine the association of STH infections in schoolchildren from Gqeberha, focusing on physical activity, physical fitness, and clustered CVD risk score. METHODS This cross-sectional study involved 680 schoolchildren (356 girls and 324 boys; mean age 8.19 years, SD±1.4) from disadvantaged communities in Gqeberha (formerly, Port Elizabeth), South Africa. Stool samples were collected and examined for STH infections using the Kato-Katz method. Physical activity (accelerometer) and physical fitness (grip strength, 20 m shuttle run) were measured using standard procedures. Furthermore, anthropometry, blood pressure, as well as glycated haemoglobin and lipid profile from capillary blood samples were assessed. We employed one-way ANOVAs to identify the associations of STH infections in terms of species and infection intensity with physical activity, physical fitness, and clustered CVD risk score. RESULTS We found a low STH infection prevalence (7.2%) in our study, with participants infected with at least one intestinal helminth species. In comparison to their non-infected peers, children infected with STH had lower mean grip strength scores, but higher mean VO2max estimation and higher levels of MVPA (p < .001). When considering type and intensity of infection, a positive association of A. lumbricoides infection and MVPA was found. In contrast, light T. trichiura-infected children had significantly lower grip strength scores compared to non and heavily-infected children. VO2max and MVPA were positively associated with light T. trichiura infection. No significant association between the clustered CVD risk score and infection with any STH species was evident. CONCLUSIONS STH-infected children had lower grip strength scores than their non-infected peers, yet, achieved higher VO2max and MVPA scores. Our study highlights that the type and intensity of STH infection is relevant in understanding the disease burden of STH infections on children's health. The findings of our study must be interpreted cautiously due to the low infection rate, and more research is needed in samples with higher prevalence rates or case-control designs.
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Affiliation(s)
- Siphesihle Nqweniso
- Department of Human Movement Science, Nelson Mandela University, Gqeberha, South Africa
| | - Cheryl Walter
- Department of Human Movement Science, Nelson Mandela University, Gqeberha, South Africa
| | - Rosa du Randt
- Department of Human Movement Science, Nelson Mandela University, Gqeberha, South Africa
| | - Larissa Adams
- Department of Human Movement Science, Nelson Mandela University, Gqeberha, South Africa
| | - Johanna Beckmann
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Jean T. Coulibaly
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire
| | - Danielle Dolley
- Department of Human Movement Science, Nelson Mandela University, Gqeberha, South Africa
| | - Nandi Joubert
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Kurt Z. Long
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Ivan Müller
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Madeleine Nienaber
- Department of Human Movement Science, Nelson Mandela University, Gqeberha, South Africa
| | - Uwe Pühse
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Harald Seelig
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Christin Lang
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Gassen J, White JD, Peterman JL, Mengelkoch S, Proffitt Leyva RP, Prokosch ML, Eimerbrink MJ, Brice K, Cheek DJ, Boehm GW, Hill SE. Sex differences in the impact of childhood socioeconomic status on immune function. Sci Rep 2021; 11:9827. [PMID: 33972662 PMCID: PMC8110986 DOI: 10.1038/s41598-021-89413-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 04/26/2021] [Indexed: 11/18/2022] Open
Abstract
Early life stress increases one's risk for health problems later in life, and many studies find that these effects are sex-differentiated. Here, we examined relationships between multiple sources of early life stress and adult immune function in humans across several functional assays. Adult participants provided retrospective information about their childhood (a) socioeconomic status, (b) household unpredictability, and (c) exposure to adverse experiences. Participants' peripheral blood mononuclear cells (PBMCs) were then isolated for use in functional assays of immune performance: (a) tumor cell lysis by natural killer cells, (b) phagocytosis of Escherichia coli bioparticles, and (c) mitogen-induced leukocyte proliferation and cytokine release. In men, lower childhood socioeconomic status predicted decrements in immunological performance across functional assays, along with greater spontaneous cytokine release from PBMCs. These changes co-occurred with elevations in plasma testosterone levels. Similar effects were not observed for other sources of stress, nor were they found in women (with the exception of spontaneous cytokine release). These findings provide evidence that low childhood socioeconomic status has a lasting negative impact on multiple aspects of immune function, particularly in men.
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Affiliation(s)
- Jeffrey Gassen
- Department of Anthropology, Baylor University, 1214 S 4th St, Waco, TX, 76706, USA.
| | - Jordon D White
- Yale School of Medicine, Yale University, 333 Cedar St, New Haven, CT, 06510, USA
| | - Julia L Peterman
- Department of Psychology, Texas Christian University, 2955 S University Dr, Fort Worth, TX, 76109, USA
| | - Summer Mengelkoch
- Department of Psychology, Texas Christian University, 2955 S University Dr, Fort Worth, TX, 76109, USA
| | - Randi P Proffitt Leyva
- Department of Psychology, Texas Christian University, 2955 S University Dr, Fort Worth, TX, 76109, USA
| | - Marjorie L Prokosch
- Florida Institute of Built Environment Resilience, University of Florida, 606 SE Depot Ave, Gainesville, FL, 32601, USA
| | - Micah J Eimerbrink
- Department of Psychology, Texas Christian University, 2955 S University Dr, Fort Worth, TX, 76109, USA
| | - Kelly Brice
- Department of Psychology, Texas Christian University, 2955 S University Dr, Fort Worth, TX, 76109, USA
| | - Dennis J Cheek
- Harris College of Nursing and Health Sciences, Texas Christian University, 2800 W Bowie St, Fort Worth, TX, 76109, USA
| | - Gary W Boehm
- Department of Psychology, Texas Christian University, 2955 S University Dr, Fort Worth, TX, 76109, USA
| | - Sarah E Hill
- Department of Psychology, Texas Christian University, 2955 S University Dr, Fort Worth, TX, 76109, USA
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Lee JD, Yen CM, Wang JJ, Lin RJ, Chung LY. A school-based soil-transmitted helminths survey in the Guadalcanal Province, the Solomon Islands. Trop Doct 2020; 51:167-170. [PMID: 33215977 DOI: 10.1177/0049475520970055] [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: 11/17/2022]
Abstract
Infections by soil-transmitted helminths are a major public health problem worldwide, especially among schoolchildren in low-income countries. Little information is described about their prevalence in the Solomon Islands. From 2017 to 2018, a school-based soil-transmitted helminths survey in the Guadalcanal Province was conducted. A total of 454 schoolchildren were selected; the Merthiolate-iodine-formaldehyde concentration and stain was used. The prevalence was 17% of one or more parasites, including hookworm (8.8%), Strongyloides stercoralis (5.7%), Ascaris lumbricoides (4.2%) and Trichuris trichiura (3.5%). STH infection was significantly correlated with parents' occupations, hand washing, shoe wearing as well as gastrointestinal symptoms. To prevent STH transmission for schoolchildren in the Solomon Islands completely, combined preventive strategies seem necessary.
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Affiliation(s)
- June-Der Lee
- PhD, Department of Parasitology and Institute of Medicine, 38023Kaohsiung Medical University, Kaohsiung.,Graduate Institute of Medicine, 38023Kaohsiung Medical University, Kaohsiung.,Department of Medical Research, 89234Kaohsiung Medical University Hospital, Kaohsiung
| | - Chuan-Min Yen
- PhD, Department of Parasitology and Institute of Medicine, 38023Kaohsiung Medical University, Kaohsiung
| | - Jiun-Jye Wang
- PhD, Department of Parasitology and Institute of Medicine, 38023Kaohsiung Medical University, Kaohsiung
| | - Rong-Jyh Lin
- PhD, Department of Parasitology and Institute of Medicine, 38023Kaohsiung Medical University, Kaohsiung
| | - Li-Yu Chung
- PhD, Department of Parasitology and Institute of Medicine, 38023Kaohsiung Medical University, Kaohsiung
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Kumar DS, Kulkarni P, Shabadi N, Gopi A, Mohandas A, Narayana Murthy MR. Geographic information system and foldscope technology in detecting intestinal parasitic infections among school children of South India. J Family Med Prim Care 2020; 9:3623-3629. [PMID: 33102340 PMCID: PMC7567236 DOI: 10.4103/jfmpc.jfmpc_568_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/27/2020] [Accepted: 05/18/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Effective and efficient use of technological advances will ease public health interventions and also help in reaching a larger population. Geographic Information System (GIS) and Foldscope are two such technologies, which have promising utilities in public health. Identifying intestinal parasitic infections early through feasible technologies will help in their effective management. With this objective, this study was conducted to assess the prevalence of intestinal parasitic infections among school children in southern districts of Karnataka, India. METHODS This cross-sectional study was conducted among randomly selected 10 urban, 10 rural, and 5 tribal schools of southern districts of Karnataka. A total of 1052 children studying in these schools were selected. Stool samples were collected and examined under Foldscope for parasitic infestation. The schools where children with worm infestations present were plotted in the GIS map. FINDINGS Among 1052 children included in this study, 139 (13.2%) were found to have an intestinal parasitic infestation. Among these children, 24.6% were in the age group of 5-9 years, 12.2% were males, and 14.4% were females. Urban students had higher odds (2.765) of parasitic infections compared to rural students. Mean age, height, and weight were significantly lesser among subjects with a worm infestation. INTERPRETATION Utility of Foldscope and GIS was found to be feasible and effective in the detection and mapping of parasitic infestations. The prevalence of parasitic infestation was found to be high among urban school children. Age, weight, height, and urban residence were found to be the major predictors of outcome.
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Affiliation(s)
- D Sunil Kumar
- Department of Community Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - Praveen Kulkarni
- Department of Community Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - Nayanabai Shabadi
- Department of Community Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - Arun Gopi
- Department of Community Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - Aparna Mohandas
- Department of Community Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - MR Narayana Murthy
- Department of Community Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
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Gerber M, Ayekoé SA, Beckmann J, Bonfoh B, Coulibaly JT, Daouda D, du Randt R, Finda L, Gall S, Mollel GJ, Lang C, Long KZ, Ludyga S, Masanja H, Müller I, Nqweniso S, Okumu F, Probst-Hensch N, Pühse U, Steinmann P, Traoré SG, Walter C, Utzinger J. Effects of school-based physical activity and multi-micronutrient supplementation intervention on growth, health and well-being of schoolchildren in three African countries: the KaziAfya cluster randomised controlled trial protocol with a 2 × 2 factorial design. Trials 2020; 21:22. [PMID: 31907019 PMCID: PMC6945709 DOI: 10.1186/s13063-019-3883-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 11/05/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In low- and middle-income countries, infectious diseases remain a key public health issue. Additionally, non-communicable diseases are a rapidly growing public health problem that impose a considerable burden on population health. One way to address this dual disease burden, is to incorporate (lifestyle) health promotion measures within the education sector. In the planned study, we will (i) assess and compare physical activity, physical fitness, micronutrient status, body composition, infections with soil-transmitted helminths, Schistosoma mansoni, malaria, inflammatory and cardiovascular health risk markers, cognitive function, health-related quality of life, and sleep in schoolchildren in Côte d'Ivoire, South Africa and Tanzania. We will (ii) determine the bi- and multivariate associations between these variables and (iii) examine the effects of a school-based health intervention that consists of physical activity, multi-micronutrient supplementation, or both. METHODS Assuming that no interaction occurs between the two interventions (physical activity and multi-micronutrient supplementation), the study is designed as a cluster-randomised, placebo-controlled trial with a 2 × 2 factorial design. Data will be obtained at three time points: at baseline and at 9 months and 21 months after the baseline assessment. In each country, 1320 primary schoolchildren from grades 1-4 will be recruited. In each school, classes will be randomly assigned to one of four interventions: (i) physical activity; (ii) multi-micronutrient supplementation; (iii) physical activity plus multi-micronutrient supplementation; and (iv) no intervention, which will serve as the control. A placebo product will be given to all children who do not receive multi-micronutrient supplementation. After obtaining written informed consent from the parents/guardians, the children will be subjected to anthropometric, clinical, parasitological and physiological assessments. Additionally, fitness tests will be performed, and children will be invited to wear an accelerometer device for 7 days to objectively assess their physical activity. Children infected with S. mansoni and soil-transmitted helminths will receive deworming drugs according to national policies. Health and nutrition education will be provided to the whole study population independently of the study arm allocation. DISCUSSION The study builds on the experience and lessons of a previous study conducted in South Africa. It involves three African countries with different social-ecological contexts to investigate whether results are generalisable across the continent. TRIAL REGISTRATION The study was registered on August 9, 2018, with ISRCTN. https://doi.org/10.1186/ISRCTN29534081.
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Affiliation(s)
- Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Serge A. Ayekoé
- Institut National de la Jeunesse et des Sports, Abidjan, Côte d’Ivoire
| | - Johanna Beckmann
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Bassirou Bonfoh
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
| | - Jean T. Coulibaly
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire
| | - Dao Daouda
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
| | - Rosa du Randt
- Nelson Mandela University, Port Elizabeth, South Africa
| | - Lina Finda
- Ifakara Health Institute, Dar es Salaam/Ifakara, Tanzania
| | - Stefanie Gall
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | | | - Christin Lang
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Kurt Z. Long
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sebastian Ludyga
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | | | - Ivan Müller
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | | | - Fredros Okumu
- Ifakara Health Institute, Dar es Salaam/Ifakara, Tanzania
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Uwe Pühse
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sylvain G. Traoré
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
- Unité de Formation et de Recherche des Sciences et Technologies des Aliments, Université Nangui Abrogoua, Abidjan, Côte d’Ivoire
| | - Cheryl Walter
- Nelson Mandela University, Port Elizabeth, South Africa
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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8
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Guan M, Han B. Association between intestinal worm infection and malnutrition among rural children aged 9-11 years old in Guizhou Province, China. BMC Public Health 2019; 19:1204. [PMID: 31477069 PMCID: PMC6719348 DOI: 10.1186/s12889-019-7538-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intestinal worm infection adversely impacted child health and was one of the China's largest health burdens. However, yet little was known about associations between intestinal worm infection and malnutrition in school-aged children in rural China. This study aimed to fill into the gap. METHODS Data were from a survey of children aged 9-11 years old in Guizhou Province, China conducted in June 2013. Considering anemia and low intelligent quotient (IQ) as mediating factors, binomial logistic regression was used to estimate the associations of intestinal worm infection with thinness, underweight, and stunting. Moreover, the associations between socio-demographic factors and malnutrition were also explored. RESULTS Among 2179 children, part of children was infected by intestinal worm (41.85%). Stunting (28%), low memory IQ (87.52%), and low process IQ (62.59%) were highly prevalent in the sample. Socio-demographic factors were associated with thinness, underweight, stunting, low memory IQ, low process IQ, anaemia, and intestinal worm infection. Intestinal worm infection was associated with low IQ, anemia, and stunting. In addition, anemia and low IQ could not confound the other expected associations. CONCLUSION This study demonstrated the association between intestinal worm infections and stunting appeared to be largely mediated via low IQ. The study highlighted the importance of deworming and improving nutrition in the surveyed areas.
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Affiliation(s)
- Ming Guan
- Family Issues Center, Xuchang University, Road Bayi, Xuchang, 88, Henan, China.,School of Business, Xuchang University, Road Bayi, Xuchang, 88, Henan, China
| | - Bingxue Han
- Family Issues Center, Xuchang University, Road Bayi, Xuchang, 88, Henan, China. .,College of Urban and Rural Planning and Gardening, Xuchang University, Road Bayi, Xuchang, 88, Henan, China.
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9
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Müller I, Smith D, Adams L, Aerts A, Damons BP, Degen J, Gall S, Gani Z, Gerber M, Gresse A, van Greunen D, Joubert N, Marais T, Nqweniso S, Probst-Hensch N, du Randt R, Seelig H, Steinmann P, Utzinger J, Wadhwani C, Walter C, Pühse U. Effects of a School-Based Health Intervention Program in Marginalized Communities of Port Elizabeth, South Africa (the KaziBantu Study): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e14097. [PMID: 31298224 PMCID: PMC6657454 DOI: 10.2196/14097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/25/2019] [Accepted: 05/25/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The burden of poverty-related infectious diseases remains high in low- and middle-income countries, while noncommunicable diseases (NCDs) are rapidly gaining importance. To address this dual disease burden, the KaziBantu project aims at improving and promoting health literacy as a means for a healthy and active lifestyle. The project implements a school-based health intervention package consisting of physical education, moving-to-music, and specific health and nutrition education lessons from the KaziKidz toolkit. It is complemented by the KaziHealth workplace health intervention program for teachers. OBJECTIVES The aim of the KaziBantu project is to assess the effect of a school-based health intervention package on risk factors for NCDs, health behaviors, and psychosocial health in primary school children in disadvantaged communities in Port Elizabeth, South Africa. In addition, we aim to test a workplace health intervention for teachers. METHODS A randomized controlled trial (RCT) will be conducted in 8 schools. Approximately 1000 grade 4 to grade 6 school children, aged 9 to 13 years, and approximately 60 teachers will be recruited during a baseline survey in early 2019. For school children, the study is designed as a 36-week, cluster RCT (KaziKidz intervention), whereas for teachers, a 24-week intervention phase (KaziHealth intervention) is planned. The intervention program consists of 3 main components; namely, (1) KaziKidz and KaziHealth teaching material, (2) workshops, and (3) teacher coaches. After randomization, 4 of the 8 schools will receive the education program, whereas the other schools will serve as the control group. Intervention schools will be further randomized to the different combinations of 2 additional intervention components: teacher workshops and teacher coaching. RESULTS This study builds on previous experience and will generate new evidence on health intervention responses to NCD risk factors in school settings as a decision tool for future controlled studies that will enable comparisons among marginalized communities between South African and other African settings. CONCLUSIONS The KaziKidz teaching material is a holistic educational and instructional tool designed for primary school teachers in low-resource settings, which is in line with South Africa's Curriculum and Assessment Policy Statement. The ready-to-use lessons and assessments within KaziKidz should facilitate the use and implementation of the teaching material. Furthermore, the KaziHealth interventions should empower teachers to take care of their health through knowledge gains regarding disease risk factors, physical activity, fitness, psychosocial health, and nutrition indicators. Teachers as role models will be able to promote better health behaviors and encourage a healthy and active lifestyle for children at school. We conjecture that improved health and well-being increase teachers' productivity with trickle-down effects on the children they teach and train. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number (ISRCTN): 18485542; http://www.isrctn.com/ISRCTN18485542. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/14097.
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Affiliation(s)
- Ivan Müller
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | | | - Larissa Adams
- Nelson Mandela University, Port Elizabeth, South Africa
| | - Ann Aerts
- Novartis Foundation, Basel, Switzerland
| | | | - Jan Degen
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Stefanie Gall
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | | | - Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | | | | | - Nandi Joubert
- Nelson Mandela University, Port Elizabeth, South Africa
| | - Tracey Marais
- Nelson Mandela University, Port Elizabeth, South Africa
| | | | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Rosa du Randt
- Nelson Mandela University, Port Elizabeth, South Africa
| | - Harald Seelig
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Cheryl Walter
- Nelson Mandela University, Port Elizabeth, South Africa
| | - Uwe Pühse
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Yang D, Yang Y, Wang Y, Yang Y, Dong S, Chen Y, Jiang Q, Zhou Y. Prevalence and Risk Factors of Ascaris lumbricoides, Trichuris trichiura and Cryptosporidium Infections in Elementary School Children in Southwestern China: A School-Based Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15091809. [PMID: 30135364 PMCID: PMC6165538 DOI: 10.3390/ijerph15091809] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/18/2018] [Accepted: 08/20/2018] [Indexed: 11/16/2022]
Abstract
Background: Intestinal parasitic infections pose great public health challenges in school children in developing countries. The aim of this study was to assess the prevalence of A. lumbricoides, T. trichiura and Cryptosporidium among elementary school children in rural southwestern China. Methods: A school-based cross-sectional study involving 321 elementary school children was conducted in 2014 in the southwest of China. They were invited to provide a stool sample and interviewed about the sanitary situation and hygiene behavior. Stool specimens were examined for A. lumbricoides and T. trichiura using the Kato-Katz fecal thick-smear technique. The presence of Cryptosporidium was determined using a modified acid-fast staining method. Results: The prevalence of infection was 10.0% (95% CI: 6.9–13.8%) for A. lumbricoides, 25.2% (95% CI: 20.6–30.4%) for T. trichiura and 2.4% for (95% CI: 1.1–4.9%) Cryptosporidium. The prevalence of co-infection was 3.7% (95% CI: 1.9–6.4%) for A. lumbricoides/T. trichiura, 0.3% (95% CI: 0–1.7%) for A. lumbricoides/Cryptosporidium and 0.9% (95% CI: 0.2–2.7%) for T. trichiura/Cryptosporidium. Children from households using well or river water were associated with a greater odds of A. lumbricoides infection (aOR = 2.61, 95% CI: 1.12–6.05). Having a household lavatory was associated with a lower odds of T. trichiura infection (aOR = 0.50, 95% CI: 0.30–0.84). Children who had three meals at the school canteen on week days were at a lower risk of Cryptosporidium infection. The use of spring water as a water source was associated with lower odds of any intestinal infection (aOR = 0.56, 95% CI: 0.35–0.91). Conclusions: Our study calls for an intervention program of school-based deworming combined with health education, hygiene promotion and provision of safe water and improved sanitation.
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Affiliation(s)
- Dongjian Yang
- Department of Epidemiology, School of Public Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China.
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Shanghai 200032, China.
- Center for Tropical Disease Research, Fudan University, Shanghai 200032, China.
| | - Ya Yang
- Department of Epidemiology, School of Public Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China.
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Shanghai 200032, China.
- Center for Tropical Disease Research, Fudan University, Shanghai 200032, China.
| | - Yingjian Wang
- Department of Epidemiology, School of Public Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China.
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Shanghai 200032, China.
- Center for Tropical Disease Research, Fudan University, Shanghai 200032, China.
| | - Yu Yang
- Department of Epidemiology, School of Public Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China.
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Shanghai 200032, China.
- Center for Tropical Disease Research, Fudan University, Shanghai 200032, China.
| | - Shurong Dong
- Department of Epidemiology, School of Public Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China.
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Shanghai 200032, China.
- Center for Tropical Disease Research, Fudan University, Shanghai 200032, China.
| | - Yue Chen
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON K1G 5Z3, Canada.
| | - Qingwu Jiang
- Department of Epidemiology, School of Public Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China.
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Shanghai 200032, China.
- Center for Tropical Disease Research, Fudan University, Shanghai 200032, China.
| | - Yibiao Zhou
- Department of Epidemiology, School of Public Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China.
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Shanghai 200032, China.
- Center for Tropical Disease Research, Fudan University, Shanghai 200032, China.
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Diet and hygiene practices influence morbidity in schoolchildren living in Schistosomiasis endemic areas along Lake Victoria in Kenya and Tanzania-A cross-sectional study. PLoS Negl Trop Dis 2018; 12:e0006373. [PMID: 29590175 PMCID: PMC5891076 DOI: 10.1371/journal.pntd.0006373] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 04/09/2018] [Accepted: 03/07/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Since 2011, cohorts of schoolchildren in regions bordering Lake Victoria in Kenya and Tanzania have been investigated for morbidity caused by Schistosoma mansoni infection. Despite being neighbouring countries with similar lifestyles and ecological environments, Tanzanian schoolchildren had lower S. mansoni prevalence and intensity and they were taller and heavier, fewer were wasted and anaemic, and more were physical fit compared to their Kenyan peers. The aim of the present study was to evaluate whether diet and school-related markers of socioeconomic status (SES) could explain differences in morbidity beyond the effect of infection levels. METHODS AND PRINCIPAL FINDINGS Parasitological and morbidity data from surveys in 2013-2014 were compared with information on diet and school-related markers of SES collected in 2015 using questionnaires. A total of 490 schoolchildren (163 Kenyans and 327 Tanzanians) aged 9-11 years provided data. A higher proportion of Tanzanian pupils (69.4%, 95% CI: 64.3-74.5) knew where to wash hands after toilet visits compared to Kenyan pupils (48.5%, 95% CI: 40.9-56.1; P<0.0005). Similar proportions of children in the two countries ate breakfast, lunch and dinner, but the content of the meals differed. At all three meals, a higher proportion (95% CI) of Tanzanian pupils consumed animal proteins (mostly fish proteins) compared to their Kenyan peers (35.0% (28.3-41.7) vs. 0%; P<0.0005 at breakfast; 69.0% (63.9-74.1) vs. 43.6% (35.8-51.4); P<0.0005 at lunch; and 67.2% (62.1-72.3) vs. 53.4% (45.8-61.0); P = 0.003 at dinner). Multivariable analyses investigating risk factors for important morbidity markers among individuals revealed that after controlling for schistosome and malaria infections, eating animal proteins (fish) and knowing where to wash hands after toilet visits were significant predictors for both haemoglobin levels and physical fitness (measured as VO2 max). CONCLUSIONS These results suggest that the differences in morbidity may be affected by factors other than S. mansoni infection alone. Diet and hygiene practice differences were associated with health status of schoolchildren along Lake Victoria in Kenya and Tanzania. TRIAL REGISTRATION Trials Registration numbers: ISRCT 16755535 (Kenya), ISRCT 95819193 (Tanzania).
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12
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Geary DC. Evolution of Human Sex-Specific Cognitive Vulnerabilities. QUARTERLY REVIEW OF BIOLOGY 2017. [DOI: 10.1086/694934] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gall S, Müller I, Walter C, Seelig H, Steenkamp L, Pühse U, du Randt R, Smith D, Adams L, Nqweniso S, Yap P, Ludyga S, Steinmann P, Utzinger J, Gerber M. Associations between selective attention and soil-transmitted helminth infections, socioeconomic status, and physical fitness in disadvantaged children in Port Elizabeth, South Africa: An observational study. PLoS Negl Trop Dis 2017; 11:e0005573. [PMID: 28481890 PMCID: PMC5436891 DOI: 10.1371/journal.pntd.0005573] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 05/18/2017] [Accepted: 04/17/2017] [Indexed: 02/07/2023] Open
Abstract
Background Socioeconomically deprived children are at increased risk of ill-health associated with sedentary behavior, malnutrition, and helminth infection. The resulting reduced physical fitness, growth retardation, and impaired cognitive abilities may impede children’s capacity to pay attention. The present study examines how socioeconomic status (SES), parasitic worm infections, stunting, food insecurity, and physical fitness are associated with selective attention and academic achievement in school-aged children. Methodology The study cohort included 835 children, aged 8–12 years, from eight primary schools in socioeconomically disadvantaged neighborhoods of Port Elizabeth, South Africa. The d2-test was utilized to assess selective attention. This is a paper and pencil letter-cancellation test consisting of randomly mixed letters d and p with one to four single and/or double quotation marks either over and/or under each letter. Children were invited to mark only the letters d that have double quotation marks. Cardiorespiratory fitness was assessed via the 20 m shuttle run test and muscle strength using the grip strength test. The Kato-Katz thick smear technique was employed to detect helminth eggs in stool samples. SES and food insecurity were determined with a pre-tested questionnaire, while end of year school results were used as an indicator of academic achievement. Principal findings Children infected with soil-transmitted helminths had lower selective attention, lower school grades (academic achievement scores), and lower grip strength (all p<0.05). In a multiple regression model, low selective attention was associated with soil-transmitted helminth infection (p<0.05) and low shuttle run performance (p<0.001), whereas higher academic achievement was observed in children without soil-transmitted helminth infection (p<0.001) and with higher shuttle run performance (p<0.05). Conclusions/Significance Soil-transmitted helminth infections and low physical fitness appear to hamper children’s capacity to pay attention and thereby impede their academic performance. Poor academic achievement will make it difficult for children to realize their full potential, perpetuating a vicious cycle of poverty and poor health. Trial registration ClinicalTrials.gov ISRCTN68411960 Children growing up in challenging environments, such as townships in South Africa, are at an increased risk of ill-health associated with sedentary behavior, poor nutrition, growth retardation, and infections with parasitic worms. Negative factors such as limited educational resources, insufficient health care and safety are exacerbating the effects of poverty and, taken together, might cause developmental delays and school failure. A total of 835 school children aged 8–12 years were examined for soil-transmitted helminth infection, physical fitness, selective attention, stunting, household socioeconomic conditions, and food security. Furthermore, children’s academic achievement scores were utilized as a proxy for academic achievement. The multivariate analyses showed that low selective attention was associated with soil-transmitted helminth infection and low shuttle run performance, whereas higher academic achievement was observed in children without soil-transmitted helminth infection and with higher shuttle run performance. Our study suggests that soil-transmitted helminths and low physical fitness hinder children from realizing their full potential.
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Affiliation(s)
- Stefanie Gall
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
- * E-mail:
| | - Ivan Müller
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Cheryl Walter
- Department of Human Movement Science, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
| | - Harald Seelig
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Liana Steenkamp
- Department of Human Movement Science, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
- Department of HIV&AIDS Research, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
| | - Uwe Pühse
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Rosa du Randt
- Department of Human Movement Science, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
| | - Danielle Smith
- Department of Human Movement Science, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
| | - Larissa Adams
- Department of Human Movement Science, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
| | - Siphesihle Nqweniso
- Department of Human Movement Science, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
| | - Peiling Yap
- Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital, Singapore
| | - Sebastian Ludyga
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Geary DC. Evolution of Sex Differences in Trait- and Age-Specific Vulnerabilities. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2016; 11:855-876. [DOI: 10.1177/1745691616650677] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Traits that facilitate competition for reproductive resources or that influence mate choice generally have a heightened sensitivity to stressors. They have evolved to signal resilience to infectious disease and nutritional and social stressors, and they are compromised by exposure to man-made toxins. Although these traits can differ from one species or sex to the next, an understanding of the dynamics of competition and choice can in theory be used to generate a priori predictions about sex-, age-, and trait-specific vulnerabilities for any sexually reproducing species. I provide a review of these dynamics and illustrate associated vulnerabilities in nonhuman species. The age- and sex-specific vulnerability of such traits is then illustrated for stressor-related disruptions of boys’ and girls’ physical growth and play behavior, as well as for aspects of boys’ and girls’ and men’s and women’s personality, language, and spatial abilities. There is much that remains to be determined, but enough is now known to reframe trait sensitivity in ways that will allow scientists and practitioners to better identify and understand vulnerable human traits, and eventually ameliorate or prevent their expression.
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Müller I, Yap P, Steinmann P, Damons BP, Schindler C, Seelig H, Htun NSN, Probst-Hensch N, Gerber M, du Randt R, Pühse U, Walter C, Utzinger J. Intestinal parasites, growth and physical fitness of schoolchildren in poor neighbourhoods of Port Elizabeth, South Africa: a cross-sectional survey. Parasit Vectors 2016; 9:488. [PMID: 27595566 PMCID: PMC5011914 DOI: 10.1186/s13071-016-1761-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 08/16/2016] [Indexed: 12/11/2022] Open
Abstract
Background As traditional lifestyle and diets change with social and economic development, disadvantaged communities in low- and middle-income countries increasingly face a double burden of communicable and non-communicable diseases. We studied the relationship between physical fitness and infections with soil-transmitted helminths (STHs), intestinal protozoa and Helicobacter pylori among schoolchildren in Port Elizabeth, South Africa. Methods We conducted a cross-sectional survey among 1009 children, aged 9 to 12 years, from eight primary schools in socioeconomically disadvantaged neighbourhoods of Port Elizabeth. Physical fitness was determined using field-deployable tests of the Eurofit fitness test battery. Stool samples were analysed with the Kato-Katz thick smear technique to diagnose STHs and with rapid diagnostic tests (RDTs) to detect intestinal protozoa and H. pylori infections. Haemoglobin (Hb) levels were assessed and anthropometric indicators determined. Results Complete data were available for 934 children (92 %). In two schools, high STH prevalences were found (Ascaris lumbricoides 60 and 72 %; Trichuris trichiura 65 % each). For boys and girls co-infected with A. lumbricoides and T. trichiura (n = 155) the maximal oxygen uptake (VO2 max) was estimated to be 50.1 and 47.2 ml kg-1 min-1, compared to 51.5 and 47.4 ml kg-1 min-1 for their non-infected peers (n = 278), respectively. On average, children without helminth infections had greater body mass (P = 0.011), height (P = 0.009) and a higher body mass index (P = 0.024) and were less often stunted (P = 0.006), but not significantly less wasted compared to their peers with a single or dual species infection. Among 9-year-old boys, a negative correlation between helminth infections and VO2 max, grip strength and standing broad jump distance was observed (P = 0.038). The overall mean Hb level was 122.2 g l-1. In the two schools with the highest prevalence of STHs the Hb means were 119.7 and 120.5 g l-1, respectively. Conclusions Intestinal parasite infections appear to have a small but significant negative effect on the physical fitness of infected children, as expressed by their maximal oxygen uptake. We observed a clear impact on anthropometric indicators. Electronic supplementary material The online version of this article (doi:10.1186/s13071-016-1761-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ivan Müller
- Swiss Tropical and Public Health Institute, P.O. Box, , CH-4002, Basel, Switzerland.,University of Basel, P.O. Box, , CH-4003, Basel, Switzerland.,Department of Sport, Exercise and Health, University of Basel, St. Jakobsturm, Birsstrasse 320B, CH-4056, Basel, Switzerland
| | - Peiling Yap
- Swiss Tropical and Public Health Institute, P.O. Box, , CH-4002, Basel, Switzerland.,University of Basel, P.O. Box, , CH-4003, Basel, Switzerland.,Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital, 308433, Singapore, Singapore
| | - Peter Steinmann
- Swiss Tropical and Public Health Institute, P.O. Box, , CH-4002, Basel, Switzerland.,University of Basel, P.O. Box, , CH-4003, Basel, Switzerland
| | - Bruce P Damons
- Faculty of Education, Nelson Mandela Metropolitan University, P.O. Box 77000, Port Elizabeth, 6031, South Africa.,Department of Human Movement Science, Nelson Mandela Metropolitan University, P.O. Box 77000, Port Elizabeth, 6031, South Africa
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, P.O. Box, , CH-4002, Basel, Switzerland.,University of Basel, P.O. Box, , CH-4003, Basel, Switzerland
| | - Harald Seelig
- University of Basel, P.O. Box, , CH-4003, Basel, Switzerland.,Department of Sport, Exercise and Health, University of Basel, St. Jakobsturm, Birsstrasse 320B, CH-4056, Basel, Switzerland
| | - Nan S N Htun
- Swiss Tropical and Public Health Institute, P.O. Box, , CH-4002, Basel, Switzerland.,University of Basel, P.O. Box, , CH-4003, Basel, Switzerland
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, P.O. Box, , CH-4002, Basel, Switzerland.,University of Basel, P.O. Box, , CH-4003, Basel, Switzerland
| | - Markus Gerber
- University of Basel, P.O. Box, , CH-4003, Basel, Switzerland.,Department of Sport, Exercise and Health, University of Basel, St. Jakobsturm, Birsstrasse 320B, CH-4056, Basel, Switzerland
| | - Rosa du Randt
- Department of Human Movement Science, Nelson Mandela Metropolitan University, P.O. Box 77000, Port Elizabeth, 6031, South Africa
| | - Uwe Pühse
- University of Basel, P.O. Box, , CH-4003, Basel, Switzerland.,Department of Sport, Exercise and Health, University of Basel, St. Jakobsturm, Birsstrasse 320B, CH-4056, Basel, Switzerland
| | - Cheryl Walter
- Department of Human Movement Science, Nelson Mandela Metropolitan University, P.O. Box 77000, Port Elizabeth, 6031, South Africa
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, P.O. Box, , CH-4002, Basel, Switzerland. .,University of Basel, P.O. Box, , CH-4003, Basel, Switzerland.
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Campbell SJ, Nery SV, Doi SA, Gray DJ, Soares Magalhães RJ, McCarthy JS, Traub RJ, Andrews RM, Clements ACA. Complexities and Perplexities: A Critical Appraisal of the Evidence for Soil-Transmitted Helminth Infection-Related Morbidity. PLoS Negl Trop Dis 2016; 10:e0004566. [PMID: 27196100 PMCID: PMC4873196 DOI: 10.1371/journal.pntd.0004566] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Soil-transmitted helminths (STH) have acute and chronic manifestations, and can result in lifetime morbidity. Disease burden is difficult to quantify, yet quantitative evidence is required to justify large-scale deworming programmes. A recent Cochrane systematic review, which influences Global Burden of Disease (GBD) estimates for STH, has again called into question the evidence for deworming benefit on morbidity due to STH. In this narrative review, we investigate in detail what the shortfalls in evidence are. METHODOLOGY/PRINCIPAL FINDINGS We systematically reviewed recent literature that used direct measures to investigate morbidity from STH and we critically appraised systematic reviews, particularly the most recent Cochrane systematic review investigating deworming impact on morbidity. We included six systematic reviews and meta-analyses, 36 literature reviews, 44 experimental or observational studies, and five case series. We highlight where evidence is insufficient and where research needs to be directed to strengthen morbidity evidence, ideally to prove benefits of deworming. CONCLUSIONS/SIGNIFICANCE Overall, the Cochrane systematic review and recent studies indicate major shortfalls in evidence for direct morbidity. However, it is questionable whether the systematic review methodology should be applied to STH due to heterogeneity of the prevalence of different species in each setting. Urgent investment in studies powered to detect direct morbidity effects due to STH is required.
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Affiliation(s)
- Suzy J. Campbell
- Research School of Population Health, College of Medicine, Biology, and Environment, The Australian National University, Canberra, Australian Captial Territory, Australia
| | - Susana V. Nery
- Research School of Population Health, College of Medicine, Biology, and Environment, The Australian National University, Canberra, Australian Captial Territory, Australia
| | - Suhail A. Doi
- Research School of Population Health, College of Medicine, Biology, and Environment, The Australian National University, Canberra, Australian Captial Territory, Australia
| | - Darren J. Gray
- Research School of Population Health, College of Medicine, Biology, and Environment, The Australian National University, Canberra, Australian Captial Territory, Australia
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Ricardo J. Soares Magalhães
- Children's Health and Environment Program, Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Queensland, Australia
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - James S. McCarthy
- School of Population Health, University of Queensland, Brisbane, Queensland, Australia
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Rebecca J. Traub
- Faculty of Veterinary and Agricultural Science, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ross M. Andrews
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Archie C. A. Clements
- Research School of Population Health, College of Medicine, Biology, and Environment, The Australian National University, Canberra, Australian Captial Territory, Australia
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Geary DC. Can Neglected Tropical Diseases Compromise Human Wellbeing in Sex-, Age-, and Trait-Specific Ways? PLoS Negl Trop Dis 2016; 10:e0004489. [PMID: 27077746 PMCID: PMC4831682 DOI: 10.1371/journal.pntd.0004489] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Traits that facilitate competition for reproductive resources or that influence mate choice have evolved to signal resilience to infectious disease and other stressors. As a result, the dynamics of competition and choice can, in theory, be used to generate predictions about sex-, age-, and trait-specific vulnerabilities for any sexually reproducing species, including humans. These dynamics and associated vulnerabilities are reviewed for nonhuman species, focusing on traits that are compromised by exposure to parasites. Using the same approach, sex-, age-, and trait-specific vulnerabilities to parasitic disease are illustrated for children's and adolescent's physical growth and fitness. Suggestions are then provided for widening the assessment of human vulnerabilities to include age-appropriate measures of behavioral (e.g., children's play) and cognitive (e.g., language fluency) traits. These are traits that are likely to be compromised by infection in age- and sex-specific ways. Inclusion of these types of measures in studies of neglected tropic diseases has the potential to provide a more nuanced understanding of how these diseases undermine human wellbeing and may provide a useful means to study the efficacy of associated treatments.
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Affiliation(s)
- David C. Geary
- Department of Psychological Sciences, Interdisciplinary Neuroscience, University of Missouri, Columbia, Missouri, United States of America
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Ngui R, Aziz S, Chua KH, Aidil RM, Lee SC, Tan TK, Sani MM, Arine AF, Rohela M, Lim YAL. Patterns and Risk Factors of Soil-Transmitted Helminthiasis Among Orang Asli Subgroups in Peninsular Malaysia. Am J Trop Med Hyg 2015; 93:361-70. [PMID: 26055746 PMCID: PMC4530762 DOI: 10.4269/ajtmh.13-0677] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 01/30/2015] [Indexed: 11/07/2022] Open
Abstract
A cross-sectional study was conducted to provide comprehensive data on the patterns and associated risk factors of soil-transmitted helminth (STH) infections among five Orang Asli subgroups in Peninsular Malaysia. The overall prevalence of STH infections was 59.9% (95% confidence interval [CI] = 56.1-63.7%). Trichuris trichiura (54.3%; 95% CI = 50.4-58.2%) was the predominant species followed by Ascaris lumbricoides (26.7%; 95% CI = 23.3-30.1%) and hookworm (9.1%; 95% CI = 6.9-11.3%). This study showed diversity for STH infections by subgroup with poverty and personal sanitary behavior as important risk factors for infection. Risk profile analyses indicating that Orang Kuala subgroup who has a generally well-developed infrastructure and better quality of life had a low rate of infection. There is a need for poverty reduction and promotion of deworming programs along with mass scale campaigns to create awareness about health and hygiene to reduce STH infections.
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Affiliation(s)
- Romano Ngui
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Geography, Faculty of Arts and Social Sciences, University of Malaya, Kuala Lumpur, Malaysia; Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Orang Asli Development, Ministry of Rural and Regional Development, West Block, Wisma Selangor Dredging, 142-C, Jalan Ampang, Kuala Lumpur, Malaysia
| | - Shafie Aziz
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Geography, Faculty of Arts and Social Sciences, University of Malaya, Kuala Lumpur, Malaysia; Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Orang Asli Development, Ministry of Rural and Regional Development, West Block, Wisma Selangor Dredging, 142-C, Jalan Ampang, Kuala Lumpur, Malaysia
| | - Kek Heng Chua
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Geography, Faculty of Arts and Social Sciences, University of Malaya, Kuala Lumpur, Malaysia; Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Orang Asli Development, Ministry of Rural and Regional Development, West Block, Wisma Selangor Dredging, 142-C, Jalan Ampang, Kuala Lumpur, Malaysia
| | - Roslan Muhammad Aidil
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Geography, Faculty of Arts and Social Sciences, University of Malaya, Kuala Lumpur, Malaysia; Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Orang Asli Development, Ministry of Rural and Regional Development, West Block, Wisma Selangor Dredging, 142-C, Jalan Ampang, Kuala Lumpur, Malaysia
| | - Soo Ching Lee
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Geography, Faculty of Arts and Social Sciences, University of Malaya, Kuala Lumpur, Malaysia; Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Orang Asli Development, Ministry of Rural and Regional Development, West Block, Wisma Selangor Dredging, 142-C, Jalan Ampang, Kuala Lumpur, Malaysia
| | - Tiong Kai Tan
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Geography, Faculty of Arts and Social Sciences, University of Malaya, Kuala Lumpur, Malaysia; Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Orang Asli Development, Ministry of Rural and Regional Development, West Block, Wisma Selangor Dredging, 142-C, Jalan Ampang, Kuala Lumpur, Malaysia
| | - Mistam Mohd Sani
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Geography, Faculty of Arts and Social Sciences, University of Malaya, Kuala Lumpur, Malaysia; Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Orang Asli Development, Ministry of Rural and Regional Development, West Block, Wisma Selangor Dredging, 142-C, Jalan Ampang, Kuala Lumpur, Malaysia
| | - Ahmad Fadzlun Arine
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Geography, Faculty of Arts and Social Sciences, University of Malaya, Kuala Lumpur, Malaysia; Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Orang Asli Development, Ministry of Rural and Regional Development, West Block, Wisma Selangor Dredging, 142-C, Jalan Ampang, Kuala Lumpur, Malaysia
| | - Mahmud Rohela
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Geography, Faculty of Arts and Social Sciences, University of Malaya, Kuala Lumpur, Malaysia; Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Orang Asli Development, Ministry of Rural and Regional Development, West Block, Wisma Selangor Dredging, 142-C, Jalan Ampang, Kuala Lumpur, Malaysia
| | - Yvonne A L Lim
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Geography, Faculty of Arts and Social Sciences, University of Malaya, Kuala Lumpur, Malaysia; Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Orang Asli Development, Ministry of Rural and Regional Development, West Block, Wisma Selangor Dredging, 142-C, Jalan Ampang, Kuala Lumpur, Malaysia
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Steinmann P, Yap P, Utzinger J, Du ZW, Jiang JY, Chen R, Wu FW, Chen JX, Zhou H, Zhou XN. Control of soil-transmitted helminthiasis in Yunnan province, People's Republic of China: experiences and lessons from a 5-year multi-intervention trial. Acta Trop 2015; 141:271-80. [PMID: 25308524 DOI: 10.1016/j.actatropica.2014.10.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 10/01/2014] [Accepted: 10/01/2014] [Indexed: 01/11/2023]
Abstract
The current global strategy for the control of soil-transmitted helminthiasis emphasises periodic administration of anthelminthic drugs to at-risk populations. However, this approach fails to address the root social and ecological causes of soil-transmitted helminthiasis. For sustainable control, it has been suggested that improvements in water, sanitation and hygiene behaviour are required. We designed a 5-year multi-intervention trial in Menghai county, Yunnan province, People's Republic of China. Three different interventions were implemented, each covering a village inhabited by 200-350 people. The interventions consisted of (i) initial health education at study inception and systematic treatment of all individuals aged ≥2 years once every year with a single dose of albendazole; (ii) initial health education and bi-annual albendazole administration; and (iii) bi-annual treatment coupled with latrine construction at family level and regular health education. Interventions were rigorously implemented for 3 years, whilst the follow-up, which included annual albendazole distribution, lasted for 2 more years. Before the third round of treatment, the prevalence of Ascaris lumbricoides was reduced by only 2.8% in the annual treatment arm, whilst bi-annual deworming combined with latrine construction and health education resulted in a prevalence reduction of 53.3% (p<0.001). All three control approaches significantly reduced the prevalence of Trichuris trichiura and hookworm, with the highest reductions achieved when chemotherapy was combined with sanitation and health education. The prevalence of T. trichiura remained at 30% and above regardless of the intervention. Only bi-annual treatment combined with latrine construction and health education significantly impacted on the prevalence of Taenia spp., but none of the interventions significantly reduced the prevalence of Strongyloides stercoralis. Our findings support the notion that in high-endemicity areas, sustainable control of soil-transmitted helminth infections necessitates measures to reduce faecal environmental contamination to complement mass drug administration. However, elimination of soil-transmitted helminthiasis will not be achieved in the short run even with a package of interventions, and probably requires improvements in living conditions, changes in hygiene behaviour and more efficacious anthelminthic drugs and treatment regimens.
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Al-Delaimy AK, Al-Mekhlafi HM, Lim YAL, Nasr NA, Sady H, Atroosh WM, Mahmud R. Developing and evaluating health education learning package (HELP) to control soil-transmitted helminth infections among Orang Asli children in Malaysia. Parasit Vectors 2014; 7:416. [PMID: 25179100 PMCID: PMC4261692 DOI: 10.1186/1756-3305-7-416] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 08/17/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND This study was carried out to develop a health education learning package (HELP) about soil-transmitted helminth (STH) infections, and to evaluate what impact such a package could have in terms of reducing the incidence and intensity of STH infections among Orang Asli schoolchildren in Pahang, Malaysia. METHODS To identify the key risk factors of STH in Orang Asli communities, we applied an extensive mixed methods approach which involved an intensive literature review, as well as community-based discussions with children, their parents, teachers and health personnel, whilst also placing the children under direct observation. To evaluate the package, 317 children from two schools in Lipis, Pahang were screened for STH infections, treated by a 3-day course of albendazole and then followed up over the next 6 months. The knowledge of teachers, parents and children towards STH infections were assessed at baseline and after 3 months. RESULTS The developed package consists of a half day workshop for teachers, a teacher's guide book to STH infections, posters, a comic book, a music video, a puppet show, drawing activities and an aid kit. The package was well-received with effective contributions being made by teachers, children and their parents. The incidence rates of hookworm infection at different assessment points were significantly lower among children in the intervention school compared to those in the control school. Similarly, the intensity of trichuriasis, ascariasis and hookworm infections were found to be significantly lower among children in the HELP group compared to those in the control group (P < 0.05). Moreover, the package significantly improved the knowledge, attitude and practices (KAP) of Orang Asli people and the knowledge of teachers towards STH infections. CONCLUSION A school-based health education learning package (HELP) was developed which displayed a significant impact in terms of reducing the intensity of all three main STH infections, as well as in reducing the prevalence of hookworm infections. Moreover, the knowledge levels of both teachers and the Orang Asli population regarding STH was significantly improved, a fact which greatly helped in attracting community participation and thus raising the general level of awareness regarding these forms of infections.
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Affiliation(s)
| | - Hesham M Al-Mekhlafi
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
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Hürlimann E, Houngbedji CA, N'Dri PB, Bänninger D, Coulibaly JT, Yap P, Silué KD, N'Goran EK, Raso G, Utzinger J. Effect of deworming on school-aged children's physical fitness, cognition and clinical parameters in a malaria-helminth co-endemic area of Côte d'Ivoire. BMC Infect Dis 2014; 14:411. [PMID: 25060173 PMCID: PMC4131038 DOI: 10.1186/1471-2334-14-411] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 07/09/2014] [Indexed: 12/13/2022] Open
Abstract
Background Malaria and helminth infections are thought to negatively affect children’s nutritional status and to impair their physical and cognitive development. Yet, the current evidence-base is weak. The purpose of this study was to determine the effect of deworming against soil-transmitted helminthiasis and schistosomiasis on children’s physical fitness, cognition and clinical parameters in a malaria-helminth co-endemic setting of Côte d’Ivoire. Methods We designed an intervention study with a 5-month follow-up among schoolchildren aged 5–14 years from Niablé, eastern Côte d’Ivoire. In late 2012, a baseline cross-sectional survey was conducted. Finger-prick blood, stool and urine samples were subjected to standardised, quality-controlled techniques for the diagnosis of Plasmodium spp., Schistosoma spp., soil-transmitted helminths and intestinal protozoa infections. Haemoglobin level was determined and anthropometric measurements were taken for appraisal of anaemia and nutritional status. Children underwent memory (digit span) and attention (code transmission) cognitive testing, and their physical fitness and strength were determined (20 m shuttle run, standing broad jump and grip strength test). All children were treated with albendazole (against soil-transmitted helminthiasis) and praziquantel (against schistosomiasis) after the baseline cross-sectional survey and again 2 months later. Five months after the initial deworming, the same battery of clinical, cognitive and physical fitness tests was performed on the same children. Results Lower scores in strength tests were significantly associated with children with harbouring nutritional deficiencies. Surprisingly, boys infected with Schistosoma mansoni achieved longer jumping distances than their non-infected counterparts. Light-intensity infection with S. mansoni was associated with slightly better aerobic capacity. Deworming showed no effect on haemoglobin levels and anaemia, but children with moderate- to heavy-intensity Schistosoma infection at baseline gained weight more pronouncedly than non-infected children. Interestingly, children with soil-transmitted helminth or Schistosoma infection at baseline performed significantly better in the sustained attention test than their non-infected counterparts at the 5-month follow-up. Conclusions This study revealed conflicting results regarding clinical parameters and cognitive behaviour of children after two rounds of deworming. We speculate that potential beneficial effects of deworming are likely to be undermined in areas where malaria is co-endemic and nutritional deficiencies are widespread. Electronic supplementary material The online version of this article (doi:10.1186/1471-2334-14-411) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Giovanna Raso
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
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McManus DP, Bieri FA, Li YS, Williams GM, Yuan LP, Henglin Y, Du ZW, Clements AC, Steinmann P, Raso G, Yap P, Magalhães RJS, Stewart D, Ross AG, Halton K, Zhou XN, Olveda RM, Tallo V, Gray DJ. Health education and the control of intestinal worm infections in China: a new vision. Parasit Vectors 2014; 7:344. [PMID: 25060336 PMCID: PMC4117961 DOI: 10.1186/1756-3305-7-344] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 07/21/2014] [Indexed: 11/23/2022] Open
Abstract
Background The transmission of soil-transmitted helminths (STHs) is associated with poverty, poor hygiene behaviour, lack of clean water and inadequate waste disposal and sanitation. Periodic administration of benzimidazole drugs is the mainstay for global STH control but it does not prevent re-infection, and is unlikely to interrupt transmission as a stand-alone intervention. Findings We reported recently on the development and successful testing in Hunan province, PR China, of a health education package to prevent STH infections in Han Chinese primary school students. We have recently commenced a new trial of the package in the ethnically diverse Xishuangbanna autonomous prefecture in Yunnan province and the approach is also being tested in West Africa, with further expansion into the Philippines in 2015. Conclusions The work in China illustrates well the direct impact that health education can have in improving knowledge and awareness, and in changing hygiene behaviour. Further, it can provide insight into the public health outcomes of a multi-component integrated control program, where health education prevents re-infection and periodic drug treatment reduces prevalence and morbidity.
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Effect of deworming on physical fitness of school-aged children in Yunnan, China: a double-blind, randomized, placebo-controlled trial. PLoS Negl Trop Dis 2014; 8:e2983. [PMID: 25010608 PMCID: PMC4091871 DOI: 10.1371/journal.pntd.0002983] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 05/14/2014] [Indexed: 11/19/2022] Open
Abstract
Background There is considerable debate on the health impacts of soil-transmitted helminth infections. We assessed effects of deworming on physical fitness and strength of children in an area in Yunnan, People's Republic of China, where soil-transmitted helminthiasis is highly endemic. Methodology The double-blind, randomized, placebo-controlled trial was conducted between October 2011 and May 2012. Children, aged 9–12 years, were treated with either triple-dose albendazole or placebo, and monitored for 6 months post-treatment. The Kato-Katz and Baermann techniques were used for the diagnosis of soil-transmitted helminth infections. Physical fitness was assessed with a 20-m shuttle run test, where the maximum aerobic capacity within 1 min of exhaustive exercise (VO2 max estimate) and the number of 20-m laps completed were recorded. Physical strength was determined with grip strength and standing broad jump tests. Body height and weight, the sum of skinfolds, and hemoglobin levels were recorded as secondary outcomes. Principal Findings Children receiving triple-dose albendazole scored slightly higher in the primary and secondary outcomes than placebo recipients, but the difference lacked statistical significance. Trichuris trichiura-infected children had 1.6 ml kg−1 min−1 (P = 0.02) less increase in their VO2 max estimate and completed 4.6 (P = 0.04) fewer 20-m laps than at baseline compared to non-infected peers. Similar trends were detected in the VO2 max estimate and grip strength of children infected with hookworm and Ascaris lumbricoides, respectively. In addition, the increase in the VO2 max estimate from baseline was consistently higher in children with low-intensity T. trichiura and hookworm infections than in their peers with high-intensity infections of all soil-transmitted helminths (range: 1.9–2.1 ml kg−1 min−1; all P<0.05). Conclusions/Significance We found no strong evidence for significant improvements in physical fitness and anthropometric indicators due to deworming over a 6-month follow-up period. However, the negative effect of T. trichiura infections on physical fitness warrants further investigation. Children from the developing world are often burdened with intestinal worms due to poor water supply, sanitation, and hygiene. However, the assessment of the burden due to intestinal worms is difficult, and thus, the benefits of deworming are unclear. In this study, we determined the effect of deworming on the physical fitness and strength of 9- to 12-year-old children in Yunnan, China, where intestinal worms are common. Children were treated with triple-dose albendazole or placebo and monitored over a 6-month period. Stool samples were collected for the diagnosis of intestinal worm infections. Physical fitness was estimated with a 20-m shuttle run test and physical strength was assessed with grip strength and standing broad jump tests. Children receiving triple-dose albendazole scored slightly higher values in the primary and secondary outcomes than those children who were given placebo. However, the differences were not significant. We also found that children infected with intestinal worms performed significantly worse in the physical fitness and strength tests than their non-infected counterparts. In particular, the negative impact of whipworm infection on physical fitness warrants further investigation.
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Parajuli RP, Fujiwara T, Umezaki M, Konishi S, Takane E, Maharjan M, Tachibana K, Jiang HW, Pahari K, Watanabe C. Prevalence and risk factors of soil-transmitted helminth infection in Nepal. Trans R Soc Trop Med Hyg 2014; 108:228-36. [PMID: 24488979 DOI: 10.1093/trstmh/tru013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The purpose of this study is to evaluate the prevalence and intensity and examine the risk factors of soil transmitted helminth (STH; i.e., roundworm [Ascaris lumbricoides], hookworms [Ancylostoma duodenale and Necator americanus], and whipworm [Trichuris trichiura]) infections in Nepal. METHODS Five hundred and ninety-four adults (256 men and 338 women) were selected via convenience sampling from five communities in Nepal. The Kato-Katz method was used to assess the prevalence and intensity of STH infection in this population. RESULTS Prevalence of STH infection ranged from 3.3% in Birendranagar in Chitwan, 3.5% in Kuleshor in Kathmandu, 11.7% in Kanyam in Ilam, 17.0% in Dhikurpokhari in Kaski and 51.4% in Khokana in Lalitpur District [corrected]. Multivariable regression analysis revealed that not using soap for hand-washing was significantly associated with the prevalence and infection intensity of roundworm, hookworms and whipworm. Similarly, not wearing sandals or shoes outside was significantly associated with the prevalence and infection intensity of roundworm and hookworms, but not with infection intensity of whipworm. Literacy, being underweight or overweight, anemia and occupation were not associated with prevalence and intensity of roundworm and hookworms infection, but there was an association between occupation and the prevalence of whipworm infection. CONCLUSION STH infection was associated with individual hygiene behavior, but not with nutritional status or socio-demographic characteristics. Health policy focusing on changing individual hygiene behaviors might be useful in addressing STH infection in Nepal.
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Affiliation(s)
- R P Parajuli
- Department of Human Ecology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
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Yap P, Du ZW, Wu FW, Jiang JY, Chen R, Zhou XN, Hattendorf J, Utzinger J, Steinmann P. Rapid re-infection with soil-transmitted helminths after triple-dose albendazole treatment of school-aged children in Yunnan, People's Republic of China. Am J Trop Med Hyg 2013; 89:23-31. [PMID: 23690551 PMCID: PMC3748482 DOI: 10.4269/ajtmh.13-0009] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 03/27/2013] [Indexed: 01/01/2023] Open
Abstract
Post-treatment soil-transmitted helminth re-infection patterns were studied as part of a randomized controlled trial among school-aged children from an ethnic minority group in Yunnan province, People's Republic of China. Children with a soil-transmitted helminth infection (N = 194) were randomly assigned to triple-dose albendazole or placebo and their infection status monitored over a 6-month period using the Kato-Katz and Baermann techniques. Baseline prevalence of Trichuris trichiura, Ascaris lumbricoides, hookworm, and Strongyloides stercoralis were 94.5%, 93.3%, 61.3%, and 3.1%, respectively, with more than half of the participants harboring triple-species infections. For the intervention group (N = 99), the 1-month post-treatment cure rates were 96.7%, 91.5%, and 19.6% for hookworm, A. lumbricoides, and T. trichiura, respectively. Egg reduction rates were above 88% for all three species. Rapid re-infection with A. lumbricoides was observed: the prevalence 4 and 6 months post-treatment was 75.8% and 83.8%, respectively. Re-infection with hookworm and T. trichiura was considerably slower.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Peter Steinmann
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Helminthiasis Division, Yunnan Institute of Parasitic Diseases, Pu'er, People's Republic of China; Menghai Center for Disease Control and Prevention, Menghai, People's Republic of China; National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, People's Republic of China
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National intestinal helminth survey among schoolchildren in Tajikistan: prevalences, risk factors and perceptions. Acta Trop 2013; 126:93-8. [PMID: 23395878 DOI: 10.1016/j.actatropica.2013.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Revised: 01/27/2013] [Accepted: 01/29/2013] [Indexed: 11/22/2022]
Abstract
Solid evidence regarding the epidemiology of intestinal helminth infections in Tajikistan is currently lacking. As such information is essential for the evidence-based design, implementation and evaluation of control interventions, a national intestinal helminth survey was conducted with the following objectives: (i) to assess the prevalence of intestinal helminth infections among school-aged children nationally and stratified by region; (ii) to identify locally relevant risk factors for infection; and (iii) to better understand the children's knowledge and perception of intestinal helminth infections, and asses their haemoglobin status. Standard field and laboratory procedures including the Kato-Katz thick smear and tape test were employed. Complete data was obtained for 1642 children from 33 randomly selected primary schools from different parts of the country. Across the country, prevalences of E. vermicularis, A. lumbricoides, H. nana and T. trichiura were 26.5%, 16.9%, 15.5% and 2.7% respectively. The prevalence of common soil-transmitted helminth (A. lumbricoides and T. trichiura) infections was 19.4%. No hookworm infections were detected, and prevalences of various infections differed significantly between administrative districts (all P<0.05). Hand washing after toilet usage (OR=0.78; P=0.047) and handling animals (OR=0.66; P=0.009) were identified as significant protective factors against E. vermicularis infections. H. nana infection was associated with a 2.85g/L decrease in haemoglobin levels (P<0.001) despite already low average haemoglobin levels. The proportions of children with knowledge about intestinal helminths and protective hygiene practices varied significantly between regions (both P<0.001). Mass albendazole administration to school-aged children and women of child-bearing age against intestinal helminths has been conducted in Tajikistan in spring 2012, followed by mass albendazole and praziquantel distribution to school-aged children in autumn 2012. In the longer term, an integrated approach including chemotherapy, provision of safe water and proper sanitation as well as targeted health education will be necessary to achieve sustainable control.
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Bustinduy AL, Parraga IM, Thomas CL, Mungai PL, Mutuku F, Muchiri EM, Kitron U, King CH. Impact of polyparasitic infections on anemia and undernutrition among Kenyan children living in a Schistosoma haematobium-endemic area. Am J Trop Med Hyg 2013; 88:433-40. [PMID: 23324217 PMCID: PMC3592521 DOI: 10.4269/ajtmh.12-0552] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 12/12/2012] [Indexed: 11/07/2022] Open
Abstract
We measured prevalence of Schistosoma haematobium, Wuchereria bancrofti, Plasmodium falciparum, hookworm, and other geohelminths among school-aged children in four endemic villages in Kwale County, Kenya and explored the relationship between multiparasite burden, undernutrition, and anemia. In 2009-2010 surveys, cross-sectional data were obtained for 2,030 children 5-18 years old. Infections were most prevalent for S. haematobium (25-62%), hookworm (11-28%), and falciparum malaria (8-24%). Over one-half of children were anemic, with high rates of acute and chronic malnutrition. Associations with infection status showed significant age and sex differences. For boys, young age, low socioeconomic standing (SES), S. haematobium, and/or malaria infections were associated with greater odds of anemia, wasting, and/or stunting; for girls, heavy S. haematobium infection and age were the significant cofactors for anemia, whereas low SES and older age were linked to stunting. The broad overlap of infection-related causes for anemia and malnutrition and the high frequency of polyparasitic infections suggest that there will be significant advantages to integrated parasite control in this area.
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Affiliation(s)
- Amaya L Bustinduy
- CTID Building, Liverpool School of Tropical Medicine, Liverpool, UK.
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Nasr NA, Al-Mekhlafi HM, Ahmed A, Roslan MA, Bulgiba A. Towards an effective control programme of soil-transmitted helminth infections among Orang Asli in rural Malaysia. Part 1: prevalence and associated key factors. Parasit Vectors 2013; 6:27. [PMID: 23356952 PMCID: PMC3564908 DOI: 10.1186/1756-3305-6-27] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 01/24/2013] [Indexed: 11/10/2022] Open
Abstract
Background Despite the continuous efforts to improve the quality of life of Orang Asli (Aborigines) communities, these communities are still plagued with a wide range of health problems including parasitic infections. The first part of this study aimed at determining the prevalence of soil-transmitted helminth (STH) infections and identifying their associated factors among rural Orang Asli children. Methods A cross-sectional study was carried out among 484 Orang Asli children aged ≤ 15 years (235 females and 249 males) belonging to 215 households from 13 villages in Lipis district, Pahang, Malaysia. Faecal samples were collected and examined by using formalin-ether sedimentation, Kato Katz and Harada Mori techniques. Demographic, socioeconomic, environmental and behavioural information were collected by using a pre-tested questionnaire. Results Overall, 78.1% of the children were found to be infected with one or more STH species. The prevalence of trichuriasis, ascariasis and hookworm infections were 71.7%, 37.4% and 17.6%, respectively. Almost all, three quarters and one fifth of trichuriasis, ascariasis and hookworm infections, respectively, were of moderate-to-heavy intensities. Multiple logistic regression analysis showed that age of ≥ 6 years (school-age), using unsafe water supply as a source for drinking water, absence of a toilet in the house, large family size (≥ 7 members), not washing hands before eating, and not washing hands after defecation were the key factors significantly associated with STH among these children. Conclusion This study reveals an alarmingly high prevalence of STH among Orang Asli children and clearly brings out an urgent need to implement school-based de-worming programmes and other control measures like providing a proper sanitation, as well as a treated drinking water supply and proper health education regarding good personal hygiene practices. Such an integrated control program will help significantly in reducing the prevalence and intensity of STH in Orang Asli communities.
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Affiliation(s)
- Nabil A Nasr
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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Nasr NA, Al-Mekhlafi HM, Ahmed A, Roslan MA, Bulgiba A. Towards an effective control programme of soil-transmitted helminth infections among Orang Asli in rural Malaysia. Part 2: Knowledge, attitude, and practices. Parasit Vectors 2013; 6:28. [PMID: 23356968 PMCID: PMC3571980 DOI: 10.1186/1756-3305-6-28] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 01/24/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the first part of this study, we investigated the prevalence and associated key factors of soil-transmitted helminth (STH) infections among Orang Asli children in rural Malaysia; an alarming high prevalence and five key factors significantly associated with infections were reported. Part 2 of this study aims to evaluate the knowledge, attitude and practices (KAP) on STH infections among Orang Asli in Peninsular Malaysia. METHODS A cross-sectional study was carried out among 215 households from 13 villages in Lipis district, Pahang, Malaysia. Demographic and socioeconomic information of the participants and their KAP on STH were collected by using a pre-tested questionnaire. RESULTS Overall, 61.4% of the participants had prior knowledge about intestinal helminths with a lack of knowledge on the transmission (28.8%), signs and symptoms (29.3%) as well as the prevention (16.3%). Half of the respondents considered STH as harmful, while their practices to prevent infections were still inadequate. Significant associations between the KAP and age, gender, educational and employment status, family size, and household monthly income were reported. Moreover, significantly lower prevalence of STH infections was reported among children of respondents who wear shoes/slippers when outside the house (72.8%; 95% CI= 62.6, 80.5 vs 87.0%; 95% CI= 81.4, 91.1), wash their hands before eating (32.4%; 95% CI= 24.3, 42.2 vs 51.4%; 95% CI= 44.7, 60.1), and wash their hands after defecation (47.8%; 95% CI= 35.7, 57.1 vs 69.2%; 95% CI= 63.7, 78.7) as compared to their counterparts. Multiple logistic regression analysis indicated that the educational level of the respondents was the most important factor significantly associated with the KAP on STH among this population. CONCLUSION This study reveals inadequate knowledge, attitude and practices on STH infections among Orang Asli in rural Malaysia. Hence, there is a great need for a proper health education programme and community mobilisation to enhance prevention and instil better knowledge on STH transmission and prevention. This is crucial for an effective and sustainable STH control programme to save the lives and future of the most vulnerable children in rural Malaysia.
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Affiliation(s)
- Nabil A Nasr
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia
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Wang JX, Pan CS, Cui LW. Application of a real-time PCR method for detecting and monitoring hookworm Necator americanus infections in Southern China. Asian Pac J Trop Biomed 2012; 2:925-9. [PMID: 23593570 PMCID: PMC3621466 DOI: 10.1016/s2221-1691(13)60001-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 11/17/2012] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To develop a quantitative PCR method for detecting hookworm infection and quantification. METHODS A real-time PCR method was designed based on the intergenic region II of ribosomal DNA of the hookworm Necator americanus. The detection limit of this method was compared with the microscopy-based Kato-Katz method. The real-time PCR method was used to conduct an epidemiological survey of hookworm infection in southern Fujian Province of China. RESULTS The real-time PCR method was specific for detecting Necator americanus infection, and was more sensitive than conventional PCR or microscopy-based method. A preliminary survey for hookworm infection in villages of Fujian Province confirmed the high prevalence of hookworm infections in the resident populations. In addition, the infection rate in women was significantly higher than that of in men. CONCLUSIONS A real-time PCR method is designed, which has increased detection sensitivity for more accurate epidemiological studies of hookworm infections, especially when intensity of the infection needs to be considered.
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Affiliation(s)
- Jia-Xu Wang
- Department of Microbiology, Xiamen Centre for Disease Control and Prevention, Xiamen 361021, Fujian, China
- School of Life Science, Xiamen University, Xiamen 361005, Fujian, China
| | - Cang-Sang Pan
- School of Life Science, Xiamen University, Xiamen 361005, Fujian, China
| | - Li-Wang Cui
- Department of Entomology, the Pennsylvania State University, 501 ASI Building, University Park, PA 16802, USA
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Yap P, Fürst T, Müller I, Kriemler S, Utzinger J, Steinmann P. Determining soil-transmitted helminth infection status and physical fitness of school-aged children. J Vis Exp 2012:e3966. [PMID: 22951972 DOI: 10.3791/3966] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Soil-transmitted helminth (STH) infections are common. Indeed, more than 1 billion people are affected, mainly in the developing world where poverty prevails and hygiene behavior, water supply, and sanitation are often deficient. Ascaris lumbricoides, Trichuris trichiura, and the two hookworm species, Ancylostoma duodenale and Necator americanus, are the most prevalent STHs. The estimated global burden due to hookworm disease, ascariasis, and trichuriasis is 22.1, 10.5, and 6.4 million disability-adjusted life years (DALYs), respectively. Furthermore, an estimated 30-100 million people are infected with Strongyloides stercoralis, the most neglected STH species of global significance which arguably also causes a considerable public health impact. Multiple-species infections (i.e., different STHs harbored in a single individual) are common, and infections have been linked to lowered productivity and thus economic outlook of developing countries. For the diagnosis of common STHs, the World Health Organization (WHO) recommends the Kato-Katz technique, which is a relatively straightforward method for determining the prevalence and intensity of such infections. It facilitates the detection of parasite eggs that infected subjects pass in their feces. With regard to the diagnosis of S. stercoralis, there is currently no simple and accurate tool available. The Baermann technique is the most widely employed method for its diagnosis. The principle behind the Baermann technique is that active S. stercoralis larvae migrate out of an illuminated fresh fecal sample as the larvae are phototactic. It requires less sophisticated laboratory materials and is less time consuming than culture and immunological methods. Morbidities associated with STH infections range from acute but common symptoms, such as abdominal pain, diarrhea, and pruritus, to chronic symptoms, such as anemia, under- and malnutrition, and cognitive impairment. Since the symptoms are generally unspecific and subtle, they often go unnoticed, are considered a normal condition by affected individuals, or are treated as symptoms of other diseases that might be more common in a given setting. Hence, it is conceivable that the true burden of STH infections is underestimated by assessment tools relying on self-declared signs and symptoms as is usually the case in population-based surveys. In the late 1980s and early 1990s, Stephenson and colleagues highlighted the possibility of STH infections lowering the physical fitness of boys aged 6-12 years. This line of scientific inquiry gained new momentum recently. The 20-meter (m) shuttle run test was developed and validated by Léger et al. and is used worldwide to measure the aerobic fitness of children. The test is easy to standardize and can be performed wherever a 20-m long and flat running course and an audio source are available, making its use attractive in resource-constrained settings. To facilitate and standardize attempts at assessing whether STH infections have an effect on the physical fitness of school-aged children, we present methodologies that diagnose STH infections or measure physical fitness that are simple to execute and yet, provide accurate and reproducible outcomes. This will help to generate new evidence regarding the health impact of STH infections.
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Affiliation(s)
- Peiling Yap
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
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