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Adewale B, Mogaji H, Balogun J, Balogun E, Olamiju F, Herbert D. Monitoring the Status of Soil-Transmitted Helminthiases in Non-Endemic Implementation Units: A Case Study of Borgu in Northcentral Nigeria. Pathogens 2023; 12:pathogens12030491. [PMID: 36986413 PMCID: PMC10057921 DOI: 10.3390/pathogens12030491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/16/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023] Open
Abstract
Nigeria remains the most endemic country in sub-Saharan Africa (SSA) for soil-transmitted helminthiases (STH). In line with ongoing monitoring plans, we present findings from a recent analysis of STH epidemiological data in Borgu, one of the non-endemic implementation units for STH in the northcentral region of Nigeria. An overall prevalence of 8.8% was recorded for STH infection, which corresponds to a 51.9% decline from the 18.3% reported in 2013. All the infected participants (36 out of 410) had a low intensity of infection. However, more than two-thirds (69%) of the children do not have access to latrine facilities, and 45% of them walk barefoot. Prevalence was significantly associated with community, age, and parental occupation. About 21-25% reduced odds were reported in some of the study communities, and children whose parents were traders had 20 times lower odds of infection compared to those whose parents were farmers. The ongoing preventive chemotherapy program for lymphatic filariasis in the area could be responsible for the huge reduction in prevalence and intensity estimates for STH. It is therefore important to invest in monitoring transmission dynamics in other non-endemic areas to arrest emerging threats through the provision of complementary interventions including WASH facilities and other health educational tools.
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Affiliation(s)
- Babatunde Adewale
- Public Health and Epidemiology Department, Nigerian Institute of Medical Research, Yaba Lagos 101245, Nigeria
| | - Hammed Mogaji
- Parasitology and Epidemiology Unit, Department of Animal and Environmental Biology, Federal University Oye-Ekiti, Oye-Ekiti 371104, Nigeria
- Mission to Save the Helpless, Jos 930001, Nigeria
| | - Joshua Balogun
- Department of Biological Sciences, Federal University Dutse, Dutse 720223, Nigeria
| | - Emmanuel Balogun
- Department of Biochemistry, Ahmadu Bello University, Zaria 810107, Nigeria
| | | | - De'Broski Herbert
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Aung E, Han KT, Gordon CA, Hlaing NN, Aye MM, Htun MW, Wai KT, Myat SM, Thwe TL, Tun A, Wangdi K, Li Y, Williams GM, Clements ACA, Vaz Nery S, McManus DP, Gray DJ. High prevalence of soil-transmitted helminth infections in Myanmar schoolchildren. Infect Dis Poverty 2022; 11:28. [PMID: 35272701 PMCID: PMC8908594 DOI: 10.1186/s40249-022-00952-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background Achieving the elimination of soil-transmitted helminth (STH) infections requires a sufficient understanding of the current epidemiological status of STH endemicity. We aimed to examine the status of STH in Myanmar – a country with the eighth highest STH prevalence in the world, 10 years after instigation of the national deworming programme. Methods In August 2016 we screened for STH infections using Kato Katz (KK) microscopy and real-time PCR (qPCR) in schoolchildren from the Bago Region township of Phyu, a STH sentinel site in Myanmar. Ten schools were randomly selected, and one stool sample each from a total of 264 students was examined. Prevalence and intensity of infection were calculated for each STH. Results High prevalence of STH was identified in the study area with 78.8% of the schoolchildren infected with at least one STH by qPCR, and 33.3% by KK. The most prevalent STH was Trichuris trichiura, diagnosed by both KK (26.1%) and qPCR (67.1%), followed by Ascaris lumbricoides (15.5% KK; 54.9% qPCR). No hookworm infections were identified by KK; however, the qPCR analysis showed a high prevalence of Ancylostoma sp. infection (29.6%) with few Necator americanus (1.1%) infections. Conclusions Despite bi-annual deworming of schoolchildren in the fourth-grade and below, STH prevalence remains stubbornly high. These results informed the expansion of the Myanmar National STH control programme to include all school-aged children by the Ministry of Health and Sports in 2017, however further expansion to the whole community should be considered along with improving sanitation and hygiene measures. This would be augmented by rigorous monitoring and evaluation, including national prevalence surveys.
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Affiliation(s)
- Eindra Aung
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Kay Thwe Han
- Parasitology Research Division, Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Catherine A Gordon
- Infectious Diseases Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | | | - Moe Moe Aye
- Department of Zoology, University of Yangon, Yangon, Myanmar
| | - Myo Win Htun
- Parasitology Research Division, Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Khin Thet Wai
- Parasitology Research Division, Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Su Mon Myat
- Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Thida Lay Thwe
- Department of Zoology, University of Yangon, Yangon, Myanmar
| | - Aung Tun
- Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Kinley Wangdi
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Yuesheng Li
- Infectious Diseases Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Hunan Institute of Parasitic Diseases, World Health Organization Collaborating Centre for Research and Control On Schistosomiasis in Lake Region, Yueyang, China
| | - Gail M Williams
- School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Archie C A Clements
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia.,Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Susana Vaz Nery
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia.,The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Donald P McManus
- Infectious Diseases Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Darren J Gray
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia.
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Htun LL, Rein ST, Win SY, Soe NC, Thein SS, Khaing Y, Thaw YN, Chel HM, Hmoon MM, Bawm S. Occurrence of gastrointestinal helminths and the first molecular detection of Ancylostoma ceylanicum, Trichuris trichiura, and Trichuris vulpis in dogs in Myanmar. Parasitol Res 2021; 120:3619-3624. [PMID: 34417864 DOI: 10.1007/s00436-021-07290-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 08/11/2021] [Indexed: 11/30/2022]
Abstract
Dogs may serve as hosts for a variety of zoonotic or potentially zoonotic helminths, including Ancylostoma ceylanicum and Trichuris species. Cross-sectional study design was used to collect 210 faecal samples of dogs from Nay Pyi Taw area, Myanmar. According to microscopic examination, 180 samples (85.7%) were positive for eight species of gastrointestinal helminths. Among them, positive rates of Ancylostoma species and Trichuris species eggs were observed as 79.0% (166/210) and 11.9% (15/210), respectively. Molecular identification of A. ceylanicum and Trichuris species was confirmed by COX1 gene- and SSU rRNA gene-targeted PCR. Partial sequences of COX1 and SSU rRNA showed 100% identity with A. ceylanicum, Trichuris trichiura, and Trichuris vulpis deposited in GenBank.
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Affiliation(s)
- Lat Lat Htun
- Department of Pharmacology and Parasitology, University of Veterinary Science, Yezin, Nay Pyi Taw, 15013, Myanmar
| | - Sandar Thu Rein
- Department of Pharmacology and Parasitology, University of Veterinary Science, Yezin, Nay Pyi Taw, 15013, Myanmar.,Livestock Breeding and Veterinary Department, Ye-U Township, Myanmar
| | - Shwe Yee Win
- Department of Pharmacology and Parasitology, University of Veterinary Science, Yezin, Nay Pyi Taw, 15013, Myanmar
| | - Nyein Chan Soe
- Department of Pharmacology and Parasitology, University of Veterinary Science, Yezin, Nay Pyi Taw, 15013, Myanmar
| | - Su Su Thein
- Department of Pharmacology and Parasitology, University of Veterinary Science, Yezin, Nay Pyi Taw, 15013, Myanmar
| | - Yadanar Khaing
- Department of International Relations and Information Technology, University of Veterinary Science, Yezin, Nay Pyi Taw, 15013, Myanmar
| | - Yu Nandi Thaw
- Department of Pharmacology and Parasitology, University of Veterinary Science, Yezin, Nay Pyi Taw, 15013, Myanmar
| | - Hla Myet Chel
- Department of Pharmacology and Parasitology, University of Veterinary Science, Yezin, Nay Pyi Taw, 15013, Myanmar
| | - Myint Myint Hmoon
- Department of Pharmacology and Parasitology, University of Veterinary Science, Yezin, Nay Pyi Taw, 15013, Myanmar
| | - Saw Bawm
- Department of International Relations and Information Technology, University of Veterinary Science, Yezin, Nay Pyi Taw, 15013, Myanmar.
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Dunn JC, Papaiakovou M, Han KT, Chooneea D, Bettis AA, Wyine NY, Lwin AMM, Maung NS, Misra R, Littlewood DTJ, Anderson RM. The increased sensitivity of qPCR in comparison to Kato-Katz is required for the accurate assessment of the prevalence of soil-transmitted helminth infection in settings that have received multiple rounds of mass drug administration. Parasit Vectors 2020; 13:324. [PMID: 32580759 PMCID: PMC7315547 DOI: 10.1186/s13071-020-04197-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 06/17/2020] [Indexed: 12/13/2022] Open
Abstract
Background The most commonly used diagnostic tool for soil-transmitted helminths (STH) is the Kato-Katz (KK) thick smear technique. However, numerous studies have suggested that the sensitivity of KK can be problematic, especially in low prevalence and low intensity settings. An emerging alternative is quantitative polymerase chain reaction (qPCR). Methods In this study, both KK and qPCR were conducted on stool samples from 648 participants in an STH epidemiology study conducted in the delta region of Myanmar in June 2016. Results Prevalence of any STH was 20.68% by KK and 45.06% by qPCR. Prevalence of each individual STH was also higher by qPCR than KK, the biggest difference was for hookworm with an approximately 4-fold increase between the two diagnostic techniques. Prevalence of Ancylostoma ceylanicum, a parasite predominately found in dogs, was 4.63%, indicating that there is the possibility of zoonotic transmission in the study setting. In individuals with moderate to high intensity infections there is evidence for a linear relationship between eggs per gram (EPG) of faeces, derived from KK, and DNA copy number, derived from qPCR which is particularly strong for Ascaris lumbricoides. Conclusions The use of qPCR in low prevalence settings is important to accurately assess the epidemiological situation and plan control strategies for the ‘end game’. However, more work is required to accurately assess STH intensity from qPCR results and to reduce the cost of qPCR so that is widely accessible in STH endemic countries.![]()
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Affiliation(s)
- Julia C Dunn
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, W2 1PG, UK. .,London Centre for Neglected Tropical Disease Research, London, UK.
| | - Marina Papaiakovou
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, W2 1PG, UK.,London Centre for Neglected Tropical Disease Research, London, UK.,Department of Life Sciences, Natural History Museum, London, UK
| | - Kay Thwe Han
- Department of Medical Research, Ministry of Health and Sports, Nyapyitaw, Myanmar
| | - Darren Chooneea
- Core Research Laboratories, Natural History Museum, London, UK
| | - Alison A Bettis
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, W2 1PG, UK.,London Centre for Neglected Tropical Disease Research, London, UK
| | - Nay Yee Wyine
- London Centre for Neglected Tropical Disease Research, London, UK
| | - Aye Moe Moe Lwin
- University of Public Health, Myorma Kyaung Street, Yangon, 11131, Myanmar
| | - Nay Soe Maung
- University of Public Health, Myorma Kyaung Street, Yangon, 11131, Myanmar
| | - Raju Misra
- Core Research Laboratories, Natural History Museum, London, UK
| | | | - Roy M Anderson
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, W2 1PG, UK.,London Centre for Neglected Tropical Disease Research, London, UK
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Mogaji HO, Dedeke GA, Bada BS, Bankole S, Adeniji A, Fagbenro MT, Omitola OO, Oluwole AS, Odoemene NS, Abe EM, Mafiana CF, Ekpo UF. Distribution of ascariasis, trichuriasis and hookworm infections in Ogun State, Southwestern Nigeria. PLoS One 2020; 15:e0233423. [PMID: 32511237 PMCID: PMC7279584 DOI: 10.1371/journal.pone.0233423] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/05/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Ascariasis, Trichuriasis and Hookworm infections poses a considerable public health burden in Sub-Saharan Africa, and a sound understanding of their spatial distribution facilitates to better target control interventions. This study, therefore, assessed the prevalence of the trio, and mapped their spatial distribution in the 20 administrative regions of Ogun State, Nigeria. METHODS Parasitological surveys were carried out in 1,499 households across 33 spatially selected communities. Fresh stool samples were collected from 1,027 consenting participants and processed using ether concentration method. The locations of the communities were georeferenced using a GPS device while demographic data were obtained using a standardized form. Data were analysed using SPSS software and visualizations and plotting maps were made in ArcGIS software. RESULTS Findings showed that 19 of the 20 regions were endemic for one or more kind of the three infections, with an aggregated prevalence of 17.2%. Ascariasis was the most frequently observed parasitic infection in 28 communities with a prevalence of 13.6%, followed by hookworm infections with a prevalence of 4.6% while Trichuriasis was the least encountered with a prevalence of 1.7%. The spatial distribution of infections ranges between 5.3-49.2% across the regions. The highest and lowest distribution of overall helminth infections was recorded in Egbado South and Egbado North respectively. Nine regions had infection status between 20.0%-49.2%, while 10 regions had infection status between 5.3%-15.8%. CONCLUSION This study provides epidemiological data on the prevalence and spatial distribution of ascariasis, trichuriasis and hookworm infections which will add to the baseline data and guide the public health officers in providing appropriate control strategies in the endemic communities.
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Affiliation(s)
- Hammed Oladeji Mogaji
- Department of Animal and Environmental Biology, Federal University Oye-Ekiti, Ekiti, Nigeria
| | - Gabriel Adewunmi Dedeke
- Department of Pure and Applied Zoology, Federal University of Agriculture, Abeokuta, Nigeria
| | - Babatunde Saheed Bada
- Department of Environmental Management and Toxicology, Federal University of Agriculture, Abeokuta, Nigeria
| | - Samuel Bankole
- Department of Pure and Applied Zoology, Federal University of Agriculture, Abeokuta, Nigeria
| | - Adejuwon Adeniji
- Department of Pure and Applied Zoology, Federal University of Agriculture, Abeokuta, Nigeria
| | - Mariam Tobi Fagbenro
- Department of Pure and Applied Zoology, Federal University of Agriculture, Abeokuta, Nigeria
| | - Olaitan Olamide Omitola
- Department of Pure and Applied Zoology, Federal University of Agriculture, Abeokuta, Nigeria
| | | | | | - Eniola Micheal Abe
- National Institute of Parasitic Disease and Control, 14 China Centre for Disease Control, Beijing, P.R. China
| | - Chiedu Felix Mafiana
- Directorate for Research and Innovation, National Open University of Nigeria, Abuja, Nigeria
| | - Uwem Friday Ekpo
- Department of Pure and Applied Zoology, Federal University of Agriculture, Abeokuta, Nigeria
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6
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Else KJ, Keiser J, Holland CV, Grencis RK, Sattelle DB, Fujiwara RT, Bueno LL, Asaolu SO, Sowemimo OA, Cooper PJ. Whipworm and roundworm infections. Nat Rev Dis Primers 2020; 6:44. [PMID: 32467581 DOI: 10.1038/s41572-020-0171-3] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2020] [Indexed: 12/26/2022]
Abstract
Trichuriasis and ascariasis are neglected tropical diseases caused by the gastrointestinal dwelling nematodes Trichuris trichiura (a whipworm) and Ascaris lumbricoides (a roundworm), respectively. Both parasites are staggeringly prevalent, particularly in tropical and subtropical areas, and are associated with substantial morbidity. Infection is initiated by ingestion of infective eggs, which hatch in the intestine. Thereafter, T. trichiura larvae moult within intestinal epithelial cells, with adult worms embedded in a partially intracellular niche in the large intestine, whereas A. lumbricoides larvae penetrate the gut mucosa and migrate through the liver and lungs before returning to the lumen of the small intestine, where adult worms dwell. Both species elicit type 2 anti-parasite immunity. Diagnosis is typically based on clinical presentation (gastrointestinal symptoms and inflammation) and the detection of eggs or parasite DNA in the faeces. Prevention and treatment strategies rely on periodic mass drug administration (generally with albendazole or mebendazole) to at-risk populations and improvements in water, sanitation and hygiene. The effectiveness of drug treatment is very high for A. lumbricoides infections, whereas cure rates for T. trichiura infections are low. Novel anthelminthic drugs are needed, together with vaccine development and tools for diagnosis and assessment of parasite control in the field.
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Affiliation(s)
- Kathryn J Else
- Lydia Becker Institute for Immunology and Inflammation, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
| | - Jennifer Keiser
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Celia V Holland
- Department of Zoology, School of Natural Sciences, Trinity College Dublin, Dublin, Ireland
| | - Richard K Grencis
- Lydia Becker Institute for Immunology and Inflammation, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - David B Sattelle
- Centre for Respiratory Biology, UCL Respiratory, Rayne Building, University College London, London, UK
| | - Ricardo T Fujiwara
- Department of Parasitology, Institute of Biological Sciences (ICB), Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Lilian L Bueno
- Department of Parasitology, Institute of Biological Sciences (ICB), Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Samuel O Asaolu
- Department of Zoology, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Oluyomi A Sowemimo
- Department of Zoology, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Philip J Cooper
- Institute of Infection and Immunity, St George's University of London, London, UK.,Facultad de Ciencias Medicas, de la Salud y la Vida, Universidad Internacional del Ecuador, Quito, Ecuador
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Dana D, Vlaminck J, Ayana M, Tadege B, Mekonnen Z, Geldhof P, Levecke B. Evaluation of copromicroscopy and serology to measure the exposure to Ascaris infections across age groups and to assess the impact of 3 years of biannual mass drug administration in Jimma Town, Ethiopia. PLoS Negl Trop Dis 2020; 14:e0008037. [PMID: 32282815 PMCID: PMC7179930 DOI: 10.1371/journal.pntd.0008037] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 04/23/2020] [Accepted: 01/08/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The scientific community has recently summarized the desired characteristics for diagnostic tools across the different phases of a soil-transmitted helminth (STH) mass drug administration (MDA) program. Although serology meets some of the desired criteria, there is a scarcity of data on baseline serological profiles in human populations, both prior to and during MDA programs. METHODS In this study, we compared the copromicroscopic and the serological infection profiles in 600 school-aged children (SAC) and 600 adults at the advent of the MDA program in Jimma Town, Ethiopia. The serological profiles were examined by two ELISAs that measure IgG4 responses to the Ascaris suum haemoglobin antigen (AsHb) and a somatic extract of lung stage larvae (AsLungL3). Three years into the MDA program, we sampled another group of 600 SAC from the same schools to assess the reduction in prevalence and intensity of Ascaris infections measured by copromicroscopy and serology. PRINCIPAL FINDINGS Prior to the start of MDA, copromicroscopy revealed an Ascaris prevalence of 31.0% and a mean fecal egg count of 2,919 eggs per gram (EPG) in SAC. Following three years of biannual treatment, the prevalence reduced to 13.2% (57.8% reduction) and the mean fecal egg count to 1,513 EPG (48.1% reduction). This reduction was also reflected in the serological results. The seroprevalence reduced with 40.9% and 27.4% and the mean optical density ratio reduced with 44.2% and 38.2% as measured by the AsHb or AsLungL3 ELISA respectively. We also showed that, despite a decreasing coproprevalence, seroprevalence to Ascaris increased with age. CONCLUSIONS This study is the first to provide IgG4 response profiles of an endemic population to two different A. suum antigens. The results suggest that exposure to the infectious stages of Ascaris reaches beyond SAC alone. Furthermore, it highlights the possible use of serological assays to monitor changes in STH exposure during MDA programs.
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Affiliation(s)
- Daniel Dana
- School of Laboratory Science, Faculty of Health Science, Institute of Health, Jimma University, Jimma, Ethiopia
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Johnny Vlaminck
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
- * E-mail: (JV); (BL)
| | - Mio Ayana
- School of Laboratory Science, Faculty of Health Science, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Bamlaku Tadege
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
- School of Medicine, Hawassa University, Hawassa, Ethiopia
| | - Zeleke Mekonnen
- School of Laboratory Science, Faculty of Health Science, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Peter Geldhof
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Bruno Levecke
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
- * E-mail: (JV); (BL)
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Kang Y, Kim J. Age-specific risk factors for child anaemia in Myanmar: Analysis from the Demographic and Health Survey 2015-2016. MATERNAL AND CHILD NUTRITION 2019; 15:e12870. [PMID: 31278831 DOI: 10.1111/mcn.12870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/19/2019] [Accepted: 07/03/2019] [Indexed: 01/22/2023]
Abstract
Anaemia is prevalent among preschool-aged children in Myanmar, but few epidemiological studies of anaemia at the national level were reported. Using data from the Myanmar Demographic and Health Survey 2015-2016, we examined risk factors for anaemia at household, maternal, and individual levels for children aged 6-23 months (n = 1,133) and 24-59 months (n = 2,393) separately. Survey design and sampling weights were adjusted for in multivariate regression analyses. The prevalence of anaemia was 77.2% in children aged 6-23 months and 50.8% in those aged 24-59 months. Living in geographic zones other than the hilly zone was associated with a higher odds of anaemia in both age groups (OR = 1.86-2.51 [95% lower limit > 1.0]). Maternal anaemia predicted child anaemia in a dose-response manner in both groups (6-23 months of age, OR = 2.01, 95% CI [1.38, 2.92; mild] and OR = 2.41, 95% CI [1.12, 5.19; moderate]; and 24-59 months of age, OR = 1.42, 95% CI [1.12, 1.81; mild] and OR = 2.92, 95% CI [1.91,4.46; moderate]). A maternal age of 14-24 years (ref: 25-34 years, OR = 1.67, 95% CI [1.06, 2.64]) and maternal tolerant attitude to domestic violence (OR = 1.61, 95% CI [1.13, 2.31]) predicted anaemia in children aged 6-23 months only. Younger child age (OR = 0.97, 95% CI [0.96, 0.98]), stunting (OR = 1.35, 95% CI [1.08, 1.69]) and using unimproved drinking water sources (OR = 1.38, 95% CI [1.10, 1.75]) were associated with anaemia in children aged 24-59 months. Consideration of age-specific risks factors for child anaemia will help in planning anaemia control programmes in Myanmar.
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Affiliation(s)
- Yunhee Kang
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jihye Kim
- Department of Medical Nutrition, Graduate School of East-West Medical Science, Kyung Hee University, Yongin, South Korea
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9
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Dunn JC, Bettis AA, Wyine NY, Lwin AMM, Tun A, Maung NS, Anderson RM. Soil-transmitted helminth reinfection four and six months after mass drug administration: results from the delta region of Myanmar. PLoS Negl Trop Dis 2019; 13:e0006591. [PMID: 30768602 PMCID: PMC6395004 DOI: 10.1371/journal.pntd.0006591] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 02/28/2019] [Accepted: 01/24/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Mass drug administration (MDA), targeted at school-aged children (SAC) is the method recommended by the World Health Organization for the control of morbidity induced by soil-transmitted helminth (STH) infection in endemic countries. However, MDA does not prevent reinfection between treatment rounds and research suggests that only treating SAC will not be sufficient to bring prevalence to low levels and possibly interrupt transmission of STH. In countries with endemic infection, such as Myanmar, the coverage, who is targeted, and rates of reinfection will determine how effective MDA is in suppressing transmission in the long-term. METHODS/PRINCIPAL FINDINGS In this paper, data from an epidemiological study on STH, comprising three surveys conducted between June 2015 and June 2016 in the delta region of Myanmar, are analysed to determine how STH prevalence and intensity in the study community changes over the course of a year, including reinfection after two MDA rounds in which the whole study sample (all age groups, n = 523) were treated with albendazole. Prevalence in the first survey (August 2015) was 27.92% for any STH, 5.54% for Ascaris lumbricoides, 17.02% for Trichuris trichiura and 9.75% for hookworm. Over the year (survey one to survey three), prevalence of any STH decreased by 8.99% (P < 0.001) and mean EPG significantly decreased for T. trichiura (P < 0.01) and hookworm (P < 0.001). Risk ratios (RRs) for a four-month reinfection period (August to December) were statistically significant and were below one, indicating that STH prevalence had not bounced back to the prevalence levels recorded immediately prior to the last round of treatment (any STH RR = 0.67, 95% CI 0.56-0.81; A. lumbricoides RR = 0.31, 95% CI 0.16-0.59; T. trichiura RR = 0.70, 95% CI 0.55-0.88; hookworm RR = 0.69, 95% CI 0.50-0.95). The only statistically significant RR for the six-month reinfection period (December to June) was for A. lumbricoides infection in SAC (RR = 2.67, 95% CI 1.37-5.21). All six-month RRs were significantly higher than four-month RRs (P < 0.05). Evidence of predisposition to infection (low and high), as measured by the Kendall Tau-b statistic, was found for all species overall and within most age groups stratifications, except for hookworm infection in preschool-aged children. CONCLUSIONS/SIGNIFICANCE This study demonstrates that, for certain demographic groups, a six-month gap between MDA in these communities is enough time for STH infection to return to STH prevalence levels recorded immediately before the previous MDA round, and that on average the same individuals are being consistently infected between MDA rounds.
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Affiliation(s)
- Julia C. Dunn
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | - Alison A. Bettis
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | - Nay Yee Wyine
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | | | - Aung Tun
- Ministry of Health and Sports, Nyapyitaw, Myanmar
| | | | - Roy M. Anderson
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
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Aung MPPTHH, Hino A, Oo KM, Win KK, Maruyama H, Htike WW, Nagayasu E. Prevalence and associated risk factors of Strongyloides stercoralis infection in Lower Myanmar. Trop Med Health 2018; 46:43. [PMID: 30598622 PMCID: PMC6299610 DOI: 10.1186/s41182-018-0126-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 12/02/2018] [Indexed: 12/30/2022] Open
Abstract
Background Strongyloidiasis is prevalent in Southeast Asian regions along with other soil-transmitted helminthiases, but only limited present-day data was available for Myanmar. Methods A prevalence survey for Strongyloides stercoralis infection was conducted among villagers in rural areas of three townships located in the Lower Myanmar during 2014–2016 by agar plate culture method in combination with specific identification by molecular assays. Risk factors associated with S. stercoralis infection were assessed by analyzing questionnaires obtained from study participants. Results Strongyloides stercoralis was identified in 40 out of 703 participants (5.7% overall prevalence). The highest prevalence (14.4%) was observed in Htantabin, while other two communities (Thabaung and Thanlyin) had much lower prevalence (2.2 and 2.5%, respectively). Infection was relatively rare (1.2%) in younger generations under 20 years compared to older generations (9.5%). Even in Htantabin, none of the female residents under age 40 (n = 33) had infection. In adult Htantabin residents, those who answered that they do not wear shoes regularly had an elevated risk of infection (odds ratio = 2.50, 95% confidence interval = 1.03–6.08). Conclusions This study showed that there is still an on-going transmission of strongyloidiasis in Lower Myanmar. It is highly desirable that the soil should be free of fecal contamination by improving the management of fecal waste. Meanwhile, health education to promote shoe-wearing would be beneficial to reduce the risk of transmission, especially for those who have frequent and intense contact with soil.
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Affiliation(s)
- Myo Pa Pa Thet Hnin Htwe Aung
- 1Department of Microbiology, University of Medicine 1, No. 245 Myoma Kyaung Street, Lanmadaw Township, Yangon, Myanmar
| | - Akina Hino
- 2Division of Parasitology, Department of Infectious Diseases, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692 Japan
| | - Khine Mar Oo
- 1Department of Microbiology, University of Medicine 1, No. 245 Myoma Kyaung Street, Lanmadaw Township, Yangon, Myanmar
| | - Kyu Kyu Win
- 1Department of Microbiology, University of Medicine 1, No. 245 Myoma Kyaung Street, Lanmadaw Township, Yangon, Myanmar
| | - Haruhiko Maruyama
- 2Division of Parasitology, Department of Infectious Diseases, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692 Japan
| | - Wah Win Htike
- 1Department of Microbiology, University of Medicine 1, No. 245 Myoma Kyaung Street, Lanmadaw Township, Yangon, Myanmar
| | - Eiji Nagayasu
- 2Division of Parasitology, Department of Infectious Diseases, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692 Japan
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Aye NN, Lin Z, Lon KN, Linn NYY, Nwe TW, Mon KM, Ramaiah K, Betts H, Kelly-Hope LA. Mapping and modelling the impact of mass drug adminstration on filariasis prevalence in Myanmar. Infect Dis Poverty 2018; 7:56. [PMID: 29855355 PMCID: PMC5984392 DOI: 10.1186/s40249-018-0420-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 04/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lymphatic filariasis (LF) is endemic in Myanmar and targeted for elimination. To highlight the National Programme to Eliminate Lymphatic Filariasis (NPELF) progress between 2000 and 2014, this paper describes the geographical distribution of LF, the scale-up and impact of mass drug administration (MDA) implementation, and the first evidence of the decline in transmission in five districts. METHODS The LF distribution was determined by mapping historical and baseline prevalence data collected by NPELF. Data on the MDA implementation, reported coverage rates and sentinel site surveillance were summarized. A statistical model was developed from the available prevalence data to predict prevalence at township level by year of measurement. Transmission assessment survey (TAS) methods, measuring antigenemia (Ag) prevalence in children, were used to determine whether prevalence was below a level where recrudescence is unlikely to occur. RESULTS The highest baseline LF prevalence was found in the Central Valley region. The MDA implementation activities scaled up to cover 45 districts, representing the majority of the endemic population, with drug coverage rates ranging from 60.0% to 98.5%. Challenges related to drug supply and local conflict were reported, and interrupted MDA in some districts. Overall, significant reductions in LF prevalence were found, especially after the first 2 to 3 rounds of MDA, which was supported by the corresponding model. The TAS activities in five districts found only two Ag positive children, resulting in all districts passing the critical threshold. CONCLUSION Overall, the Myanmar NPELF has made positive steps forward in the elimination of LF despite several challenges, however, it needs to maintain momentum, drawing on international stakeholder support, to aim towards the national and global goals of elimination.
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Affiliation(s)
- Ni Ni Aye
- Ministry of Health and Sports, Department of Public Health, Nay Pyi Taw, Myanmar
| | - Zaw Lin
- Ministry of Health and Sports, Department of Public Health, Nay Pyi Taw, Myanmar
| | - Khin Nan Lon
- Ministry of Health and Sports, Department of Public Health, Nay Pyi Taw, Myanmar
| | - Nay Yi Yi Linn
- Ministry of Health and Sports, Department of Public Health, Nay Pyi Taw, Myanmar
| | - Thet Wai Nwe
- Ministry of Health and Sports, Department of Public Health, Nay Pyi Taw, Myanmar
| | - Khin Mon Mon
- Ministry of Health and Sports, Department of Public Health, Nay Pyi Taw, Myanmar
| | | | - Hannah Betts
- Department of Parasitology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Louise A. Kelly-Hope
- Department of Parasitology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, UK
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Hu Y, Miller M, Zhang B, Nguyen TT, Nielsen MK, Aroian RV. In vivo and in vitro studies of Cry5B and nicotinic acetylcholine receptor agonist anthelmintics reveal a powerful and unique combination therapy against intestinal nematode parasites. PLoS Negl Trop Dis 2018; 12:e0006506. [PMID: 29775454 PMCID: PMC5979042 DOI: 10.1371/journal.pntd.0006506] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/31/2018] [Accepted: 05/08/2018] [Indexed: 01/21/2023] Open
Abstract
Background The soil-transmitted nematodes (STNs) or helminths (hookworms, whipworms, large roundworms) infect the intestines of ~1.5 billion of the poorest peoples and are leading causes of morbidity worldwide. Only one class of anthelmintic or anti-nematode drugs, the benzimidazoles, is currently used in mass drug administrations, which is a dangerous situation. New anti-nematode drugs are urgently needed. Bacillus thuringiensis crystal protein Cry5B is a powerful, promising new candidate. Drug combinations, when properly made, are ideal for treating infectious diseases. Although there are some clinical trials using drug combinations against STNs, little quantitative and systemic work has been performed to define the characteristics of these combinations in vivo. Methodology/Principal findings Working with the hookworm Ancylostoma ceylanicum-hamster infection system, we establish a laboratory paradigm for studying anti-nematode combinations in vivo using Cry5B and the nicotinic acetylcholine receptor (nAChR) agonists tribendimidine and pyrantel pamoate. We demonstrate that Cry5B strongly synergizes in vivo with both tribendimidine and pyrantel at specific dose ratios against hookworm infections. For example, whereas 1 mg/kg Cry5B and 1 mg/kg tribendimidine individually resulted in only a 0%-6% reduction in hookworm burdens, the combination of the two resulted in a 41% reduction (P = 0.020). Furthermore, when mixed at synergistic ratios, these combinations eradicate hookworm infections at doses where the individual doses do not. Using cyathostomin nematode parasites of horses, we find based on inhibitory concentration 50% values that a strongylid parasite population doubly resistant to nAChR agonists and benzimidazoles is more susceptible or “hypersusceptible” to Cry5B than a cyathostomin population not resistant to nAChR agonists, consistent with previous Caenhorhabditis elegans results. Conclusions/Significance Our study provides a powerful means by which anthelmintic combination therapies can be examined in vivo in the laboratory. In addition, we demonstrate that Cry5B and nAChR agonists have excellent combinatorial properties—Cry5B combined with nAChR agonists gives rise to potent cures that are predicted to be recalcitrant to the development of parasite resistance. These drug combinations highlight bright spots in new anthelmintic development for human and veterinary animal intestinal nematode infections. Intestinal nematodes are roundworm parasites of humans and animals, causing significant morbidity in both. In humans, these parasites are leading causes of morbidity in children, e.g., causing growth stunting, cognitive impairment, and malnutrition. Few drugs are used to treat these parasites in humans and animals and there is increasing evidence that the drugs are losing efficacy and/or have low efficacy. Infectious diseases are best treated with drug combinations and not single drugs. However, there has been little work to characterize in detail how various anti-nematode drugs combine. Here we establish a new laboratory model to study anti-nematode drug combinations using the human hookworm Ancylostoma ceylanicum infection in hamsters. We show that two classes of anti-nematode drugs, Cry5B and the nicotinic acetylcholine receptor agonists tribendimidine and pyrantel, combine (synergize) in a way that is more powerful at specific drug ratios than predicted from their individual impacts. Furthermore, when combined at these ratios, these combinations completely eliminated parasites at doses where normally neither drug has that effect. Horse parasites resistant to pyrantel also appear to be hypersensitive (more sensitive than wild-type parasites) to Cry5B. These characteristics predict that combinations of Cry5B with tribendimidine or pyrantel will be extremely effective therapeutically and relatively recalcitrant to the development of parasite resistance.
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Affiliation(s)
- Yan Hu
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Melanie Miller
- Division of Biological Sciences, University of California, San Diego, La Jolla, CA, United States of America
| | - Bo Zhang
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Thanh-Thanh Nguyen
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Martin K. Nielsen
- Department of Veterinary Science, University of Kentucky, Lexington, KY, United States of America
| | - Raffi V. Aroian
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, MA, United States of America
- * E-mail:
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Suntaravitun P, Dokmaikaw A. Prevalence of Intestinal Parasites and Associated Risk Factors for Infection among Rural Communities of Chachoengsao Province, Thailand. THE KOREAN JOURNAL OF PARASITOLOGY 2018. [PMID: 29529848 PMCID: PMC5858660 DOI: 10.3347/kjp.2018.56.1.33] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Intestinal parasitic infections remain a major public health problem in many parts of Thailand, particularly in rural areas. This study aimed to determine the prevalence of intestinal parasitic infections and associated risk factors among the people living in Huai Sai sub-district, Bang Khla district, Chachoengsao Province, central Thailand. A cross-sectional survey was carried out from June 2017 to August 2017 which included a total of 224 participants. Stool samples were examined using a simple direct smear and formalin ethyl acetate concentration technique. Association between risk factors and intestinal parasitic infections was assessed using multivariate logistic regression analysis. The overall prevalence of intestinal parasitic infections was 16.1%. Soil-transmitted helminth infections (14.3%) were more common than protozoan infections (1.8%). The most common intestinal parasites were hookworms (6.7%) followed by Strongyloides stercoralis, (5.0%), Ascaris lumbricoides (1.3%) and Trichuris trichiura (1.3%). Entamoeba histolytica/dispar (1.0%), Giardia intestinalis (0.4%), and Blastocystis hominis (0.4%) were the protozoans identified. A high prevalence of infections was found in male participants of ≥40 years who raised dogs in the households and did not wear boots while working fields. Multivariate analysis showed a significant association of intestinal parasitic infections with gender with the adjusted odds ratio (OR) of 2.4 and 95% confidence interval (CI) of 1.1–5.2 (P=0.020). The results showed a high prevalence of soil-transmitted helminth infections among adults in rural communities which were particularly apparent regarding the skin-penetrating species of nematodes. A greater focus on intervention is required by improving sanitation and personal hygiene to prevent the spread of intestinal parasitic infections.
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Affiliation(s)
- Pisit Suntaravitun
- Department of Public Health, Faculty of Science and Technology, Rajabhat Rajanagarindra University, Chachoengsao 24000, Thailand
| | - Amornrat Dokmaikaw
- Department of Public Health, Faculty of Science and Technology, Rajabhat Rajanagarindra University, Chachoengsao 24000, Thailand
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