Intestinal parasitic infections and risk factors: a cross-sectional survey of some school children in a suburb in Accra, Ghana

Malaria, gastrointestinal parasite infection and nutritional status among febrile children In Accra, Ghana

Introduction

Malaria and intestinal parasite infection are common in developing countries. These Parasites causes anaemia and malnutrition mostly in children. For this reason, it is important to study these infections and their effects in order to monitor interventions to control them. This study aims to determine prevalence of malaria and intestinal parasite infections and their association with nutritional status among febrile children in Accra, Ghana.

Methods

The study was conducted among febrile children aged 6 months to 5 years attending three health facilities in Accra from May to October, 2022. A total of 315 children were selected for the study. Anthropometric measurement was done for each participant. Blood and stool samples were collected for investigation. Thick and thin blood smears stained with 10% Giemsa were prepared and examined for Plasmodium parasite using microscopy. Stool samples were processed using direct wet mount and formalin-ether concentration method and examined for intestinal parasites using microscopy. Haemoglobin concentration was measured using automatic haematology analyzer.

Results

A total of 24% (76/315) were positive for malaria. Plasmodium falciparum accounted for 77.6% (59/76) of parasitaemia, whereas Plasmodium malariae was 22.4% (17/76). Prevalence of intestinal parasite infection was 10.7% (34/315). Giardia lamblia accounted for 17/315 (5.3%) of the entire children, followed by Ascaris lumbricoides 8/315 (2.5%), Hookworm 6/315 (1.9%) and Trichuris trichiura 3/315 (0.9%). A total of 15/315 (5%) of the participants had co-infection of malaria and intestinal parasite infection. Prevalence of anaemia, malnutrition, stunting, wasting and underweight were (72%), (30.7%), (16.2%), (24.4%) and (57.1%) respectively. Malaria was significantly associated with anaemia (p = 0.000) and underweight (p = 0.013). Ascaris lumbricoides was significantly associated with wasting (p = 0.010). Giardia lamblia was significantly association with malnutrition (p = 0.000) and Stunting (p = 0.000), whereas Hookworm was found to be significantly associated with anaemia (p = 0.021).

Conclusion

Prevalence of IPI in this study was less than previously reported, most likely due to regular deworming of most of the children. However, Malaria and intestinal parasitic infection were significantly associated with anaemia and malnutrition including wasting, stunting, and underweight.

Prevalence and Associated Risk Factors of Human Intestinal Helminths Parasitic Infections in Ethiopia: A Systematic Review and Meta-Analysis

Background

Intestinal helminth infections are still public health problems in tropical and subtropical countries including Ethiopia. This review and meta-analysis aimed to produce the pooled prevalence and associated risk factors of human intestinal helminth parasitic infections (HIHPIs) in Ethiopia.

Methods

Articles written in English were searched from online databases. Sixty-seven studies were included. Meta-analysis was computed using STATA version 14.

Result

The pooled prevalence of HIHPIs was (33.35%, 95% CI: 28.85%, 37.86%). Ascaris lumbricoides (10.84%, 95% CI: 9.34, 12.34), hookworm spp. (8.89%, 95% CI: 7.75, 10.04), Schistosoma mansoni (4.22%, 95% CI: 3.64, 4.81), Trichuris trichiura (2.51%, 95% CI: 2.17, 2.86), Hymenolepis nana (2.29%, 95% CI: 1.96, 2.63), Taenia species (1.01%, 95% CI: 0.80, 1.22), Strongyloides stercoralis (1.17%, 95% CI: 0.92, 1.41), and Enterobius vermicularis(0.71%, 95% CI: 0.52, 0.90) were recorded. Handwashing before food (OR: 5.22,95% CI: 3.49, 6.94), handwashing after toilet (OR: 3.03, 95%; CI: 1.01, 5.05), age (OR: 1.66, 95% CL. 1.09, 2.23), open defecation (OR: 2.42, 95% CI: 1.60, 3.24), eating raw and unwashed vegetables/fruits (OR: 1.98, 95%; CI: 1.30, 2.66), maternal education (OR: 1.81, 95% CI: 0.91, 2.72), family income (OR: 2.00, 95% CI: 0.87, 3.31), source of drinking water (OR: 3.12, 95% CI: 1.96, 4.27), swimming/contact with river water (OR: 1.90, 95% CI: 1.11, 2.69), barefoot (OR: 3.28, 95% CI: 1.67, 4.88), playing with soil (OR: 2.64, 95% CI: 1.40, 3.88), and family size (OR: 3.75, 95% CI: 2.03, 5.46) were factors associated with HIHPIs in Ethiopia. High heterogeneity of the prevalence of HIHPIs was observed among the studies within and among regions (I2 > 99.6% and P ≤ 0.001).

Conclusion

HIHPIs in Ethiopia were significantly high. Therefore, special attention should be given by all stakeholders to minimize HIHPIs in Ethiopia.

Nutritional and health status of a cohort of school-age children born to mothers treated for severe acute malnutrition in their childhood in The Democratic Republic of Congo

Background

Malnutrition is a public health problem, but outside the theoretical framework, little is known about the concrete intergenerational effects of malnutrition.

Objective

The objective of this study is to compare the nutritional status and health indicators of school children born to mothers who were treated for severe acute malnutrition (SAM).

Methodology

The study took place in Miti-Murhesa health zone in the Democratic Republic of Congo. This is a cohort study assessing the nutritional and health status of school children born to mothers who had been treated for SAM, based on WHZ or edema, in Lwiro hospital between 1988–2002 compared to children born to mothers who were not exposed to SAM. Stunting and thinness were evaluated by Height for Age Z-score (HAZ) and Body Mass Index by Age criteria (BMIAZ) respectively. On admission, blood samples were taken to assess anemia, HIV serology, hemogram and others biological indicators. Stool’s examinations were conducted by using Olympus optical microscope. Parametric and non-parametric tests were applied to compare the different variables in two groups.

Results

We identified 106 children aged 5–16 years (103 exposed and 58 unexposed) and we received 83.5% and 91.4% children respectively for anthropometric parameters. The mean of age was 7.9 ± 2.4 year in exposed group and 7.4 ± 2.1 year in unexposed group (p = 0.26). The prevalence of stunting was 68.3% in the exposed group and 67.3% in the unexposed group (p = 0.90). The prevalence of thinness was 12.8% in the exposed group and 9.6% in the unexposed group (p = 0.57). The biological profile (glycemia, urea, creatinine and hemogram) and the prevalence of intestinal parasites were similar in the two groups.

Conclusion

In this sample, in a malnutrition-endemic area, there was no statistically significant difference in nutrition and health indicators between school children born to mothers exposed to SAM and their community controls.

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

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

Cross-Sectional Study on Assessment of Frequency of Intestinal Helminth Infections and Its Related Risk Factors among School Children from Adola Town, Ethiopia

The three main intestinal helminth infections (IHIs), ascariasis, trichuriasis, and hookworm, are common clinical disorders worldwide. These IHIs are more prevalent in tropics and subtropical countries especially in developing countries like sub-Saharan Africa responsible for morbidity, mortality, and physical as well as intellectual growth retardation in children. In Ethiopia, the burden of IHIs appears in all ages mainly due to factors like lack of education, low socio-economic status, and inadequate supply of drugs and proper awareness. The present study was carried out to access the prevalence of intestinal helminth infections and associated risk factors among school children in Adola town from Guji Zone, Oromia, Ethiopia, from August 2019 to December 2019. 404 stool samples were collected in a clean, dry, screw-capped, and wide-mouthed plastic container, fixed with 10% formal-saline solution, and transported to the Adola Hospital laboratory for further microscopic analysis by wet mount following formal ether concentration technique. Data were analyzed using SPSS version 20 by binary logistic regression model using odd ratio with 95% CI. The overall prevalence of IHIs among school children was found to be 33.91% (137/404). Rate of double infection was noted to be 2.72% (11/404). Most dominant species was Ascaris lumbricoides (8.9%) followed by Hymenolepis nana (7.7%), Taenia saginata (5.4%), hookworm (4.7%), Trichuris trichiura (2.5%), Schistosoma mansoni (2.2%), Enterobius vermicularis (1.7%), and Strongyloides stercoralis (0.7%), respectively. Highest prevalence was observed in male students (39.6%) compared to female students (28.8%) (P < 0.05). The prevalence of IHIs among school children in the age group of 6-10, 11-15, 16-20, and above 20 was 49.6%, 35.8%, 10.9%, and 3.6%, respectively (P < 0.05). IHI was significantly associated with some of the risk factors such as gender, educational level of students', toilet usage habit, habit of hand washing, hand washing habit before feeding and after defecation, purpose of hand washing, and awareness to intestinal helminths (P < 0.05). In the study area, the prevalence of IHIs is moderately high and represents a public health problem in the school children. Therefore, all stakeholders should pay attention to raise awareness about health education programs such as proper personal hygiene, environmental sanitation, improving the quality of drinking water, and treatment to reduce the consequences of intestinal helminths.

Prevalence of intestinal protozoan parasites among school children in africa: A systematic review and meta-analysis

Introduction

Parasitic infections, especially intestinal protozoan parasites (IPPs) remain a significant public health issue in Africa, where many conditions favour the transmission and children are the primary victims. This systematic review and meta-analysis was carried out with the objective of assessing the prevalence of IPPs among school children in Africa.

Methods

Relevant studies published between January 2000 and December 2020 were identified by systematic online search on PubMed, Web of Science, Embase and Scopus databases without language restriction. Pooled prevalence was estimated using a random-effects model. Heterogeneity of studies were assessed using Cochrane Q test and I² test, while publication bias was evaluated using Egger’s test.

Results

Of the 1,645 articles identified through our searches, 46 cross-sectional studies matched our inclusion criteria, reported data from 29,968 school children of Africa. The pooled prevalence of intestinal protozoan parasites amongst African school children was 25.8% (95% CI: 21.2%-30.3%) with E. histolytica/ dispar (13.3%; 95% CI: 10.9%-15.9%) and Giardia spp. (12%; 95% CI: 9.8%-14.3%) were the most predominant pathogenic parasites amongst the study participants. While E. coli was the most common non-pathogenic protozoa (17.1%; 95% CI: 10.9%-23.2%).

Conclusions

This study revealed a relatively high prevalence of IPPs in school children, especially in northern and western Africa. Thus, poverty reduction, improvement of sanitation and hygiene and attention to preventive control measures will be the key to reducing protozoan parasite transmission.

Pathogenic intestinal protozoan parasites (IPPs) remain a major public health concern. Studies have documented that, the prevalence rates of protozoan infections are quite high in developing regions, particularly Africa and children are the primary victims. Despite numerous studies have been conducted on IPPs in school children in African countries, data on the burden of these infections in African school children have not yet been synthesised. This systematic review and meta-analysis was conducted to provide continent-wide prevalence of IPPs amongst African school children. Our study found that about 25.8% of the children had one or more species of intestinal protozoan parasites in their faecal specimens. E. histolytica/ dispar and Giardia spp. were the most predominant parasites amongst the study participants. The relatively high prevalence estimate of IPPs amongst African children and the considerable variation in the disease prevalence over the years, between and within countries and regions clearly indicates the needs to improve sanitation and hygiene, paying more attention to preventive control measures as well as poverty reduction which are the key to reducing protozoan parasite transmission.

Association between allergic sensitization and intestinal parasite infection in schoolchildren in Gqeberha, South Africa

Background

Inconsistent data exist regarding the influence of parasitic infection on the prevalence of allergic sensitization and disorders.

Objective

To investigate the impact of geohelminth and protozoan infections on sensitization patterns and allergic symptoms of children living in low‐income communities in Gqeberha, South Africa.

Methods

In a cross‐sectional study, 587 schoolchildren aged 8–12 years were recruited in June 2016 and screened for reactivity to common allergens by skin prick tests (SPTs) and for parasitic infections by stool examination. Additionally, questionnaires were completed to record allergic symptoms the children may have experienced.

Results

Positive SPTs were found in 237/587 children (40.4%), and about one‐third of whom were polysensitized. Sensitizations were most frequently detected against the house dust mites (HDM) Dermatophagoides spp. (31.9%) and Blomia tropicalis (21.0%). Infections with geohelminths (Ascaris lumbricoides, Trichuris trichiura) were found in 26.8% and protozoan infections (Giardia intestinalis, Cryptosporidia spp.) in 13.9% of study participants. Mixed logistic regression analyses revealed negative associations between parasite infection and sensitization to Blomia tropicalis (OR: 0.54, 95% CI 0.33–0.89) and to Dermatophagoides spp. (OR 0.65, 95% CI 0.43–0.96), and between protozoan infection and allergic sensitization to any aeroallergen, although these associations were not significant when adjusted for false discovery. Geohelminth infection and intensity of geohelminth infection were both associated with reduced risk of polysensitization (OR 0.41, 95% CI 0.21–0.86), and this association remained significant with adjustment for false discovery. Reported respiratory symptoms were associated with HDM sensitization (ORs from 1.54 to 2.48), but not with parasite infection.

Conclusions and clinical relevance

Our data suggest that geohelminth infection and high geohelminth infection intensity are associated with a reduced risk of polysensitization.

Benefits and Risks of Smallholder Livestock Production on Child Nutrition in Low- and Middle-Income Countries

Livestock production may improve nutritional outcomes of pregnant women and children by increasing household income, availability of nutrient-dense foods, and women's empowerment. Nevertheless, the relationship is complex, and the nutritional status of children may be impaired by presence of or proximity to livestock and their pathogens. In this paper, we review the benefits and risks of livestock production on child nutrition. Evidence supports the nutritional benefits of livestock farming through income, production, and women's empowerment. Increasing animal source food consumption requires a combination of efforts, including improved animal management so that herd size is adequate to meet household income needs and consumption and addressing sociocultural and gendered norms. Evidence supports the inclusion of behavior change communication strategies into livestock production interventions to facilitate the sustainability of nutritional benefits over time, particularly interventions that engage women and foster dimensions of women's empowerment. In evaluating the risks of livestock production, evidence indicates that a broad range of enteric pathogens may chronically infect the intestines of children and, in combination with dietary deficits, may cause environmental enteric dysfunction (EED), a chronic inflammation of the gut. Some of the most important pathogens associated with EED are zoonotic in nature with livestock as their main reservoir. Very few studies have aimed to understand which livestock species contribute most to colonization with these pathogens, or how to reduce transmission. Control at the point of exposure has been investigated in a few studies, but much less effort has been spent on improving animal husbandry practices, which may have additional benefits. There is an urgent need for dedicated and long-term research to understand which livestock species contribute most to exposure of young children to zoonotic enteric pathogens, to test the potential of a wide range of intervention methods, to assess their effectiveness in randomized trials, and to assure their broad adaptation and sustainability. This review highlights the benefits and risks of livestock production on child nutrition. In addition to identifying research gaps, findings support inclusion of poor gut health as an immediate determinant of child undernutrition, expanding the established UNICEF framework which includes only inadequate diet and disease.

Prevalence of intestinal parasitic infections and their associated risk factors among preschool and school children in Egypt

Intestinal parasitic infections (IPIs) are among the major public health problems globally, particularly in developing countries like Egypt. This study aimed to evaluate prevalence and risk factors associated with IPIs among preschool and school children in Egypt. A cross-sectional study was conducted on 996 randomly selected preschool and school-aged children in Gharbia governorate during January to April 2018. Stool specimens were examined for the presence of the parasite by direct smear and the formol-ether concentration methods. The overall prevalence of IPIs was 46.2%. Entamoeba histolytica and Ascaris lumbricoides were the most predominant parasites (12.7% per each). This is followed by Enterobius vermicularis (8.6%), Giardia lamblia (7.1%), Cryptosporidium parvum (1.5%), Heterophyes heterophyes (1.4%), Hymenolepis nana (0.7%), Hookworms (0.6%), Fasciola hepatica (0.5%) and Dipylidium caninum (0.4%). Infected children with no symptoms (26.8%) were significantly (P < 0.001) more frequent than those with medical complaint (19.4%). Socio-demographic predictors of IPIs were preschool age (OR = 4.9; P < 0.001; 95%CI 3.3-7.3), living in rural dwellings (OR = 1.96; P < 0.001; 95%CI 1.5-2.5), and belonging to a low-income family (OR = 4.7; P < 0.001; 95%CI 2.3-9.3). The absence of safe drinking water, lack of hand washing (after soil contact, or before meals, or after toilet usage), and eating unwashed vegetables were risk factors for IPIs in the study region (OR = 1.3-6.9, P < 0.001 -P = 0.05). Higher odds for exposure to potential zoonotic parasites were evident in children with pets in their homes for G. lambia and D. caninum (OR = 2.1-8.3; P = 0.02 -P = 0.04), children having household reared ruminants for C. parvum (OR = 10.4; P < 0.001), and children that play with stray animals for E. histolytica and Hookworm (OR = 1.8-6.3; P = 0.04 -P = 0.05)compared to other children with no animal contact. The present study highlights the importance of periodic screening and treatment of IPIs in children, deworming companion animals, and public education for effective prevention of IPIs in children in Egypt.

Asymptomatic Intestinal Parasitic Infestations among Children Under Five Years in Selected Communities in the Ho Municipality, Ghana

Background

The study investigated intestinal parasitic infestations (IPIs) and possible risk factors associated with asymptomatic children under five (5) years in five (5) selected communities in the Ho Municipality.

Methods

The study design was cross- sectional, with a simple random sampling technique involving 150 asymptomatic children under 5 years from 5 selected communities (Klave, Hoe, Freetown, Dave and Godokpe) in the Ho Municipality. A questionnaire was used to obtain socio-demographics and other relevant parameters. Direct wet preparation, formol-ether concentration and Modified ZN staining techniques were used for the identification of intestinal parasites from participants' stool samples. The Fisher's exact test and binary logistic regression analysis were used to determine the difference in IPIs proportions and assess the risk factors associated with IPIs respectively.

Results

The overall IPIs cases was 14% (21/150). Cryptosporidium spp was most predominant [5.3% (8/150)], followed by Entamoeba spp [3.3% (5/150)], Cyclospora cayetenensis [2.7% (4/150)], Ascaris lumbricoides [1.3% (2/150)], Giardia lamblia [0.7% (1/150)] and Strongyloides stercoralis [0.7% (1/150)]. Children in rural communities (23.4%) recorded significantly higher case rate compared to those in urban communities (9.8%0), (p=0.04). Lower educational attainment of mother [OR=0.55, 95% CI (0.37 – 0.83), p-value = 0.015] and residence in rural communities [OR = 0.53, 95% CI (0.33–0.88)], p-value = 0.025] were significantly associated with IPIs.

Conclusion

Asymptomatic IPIs are quite prevalent among children under 5 years in the Ho Municipality. The study thus recommends active sensitization programs for parents/guardians on preventive measures and school health programs should be instituted in rural communities.

Human Intestinal Parasites: Prevalence and Associated Risk Factors among Grade School Children in Maksegnit, Northwest Ethiopia

This study was aimed to assess the prevalence and associated risk factors of intestinal parasitic infections in grade school children in Maksegnit, Northwest Ethiopia. Five species of intestinal parasites were identified with an overall prevalence of 155 (40.4%). Among these, Ascaris lumbricoides 122 (31.8%) and Entamoeba histolytica 18 (4.7%) were predominant. Of the total 155 (40.4%) positive individuals, 149 (39%) had a single infection and the rest 6 (1.6%) had double parasitic infections. Of the different variables assessed, age, gender, shoe wearing, and eating raw or undercooked vegetables were not significantly associated with the prevalence of intestinal parasites (P > 0.05). However, a statistically significant association (P < 0.05) was observed between infected children and variables including defecation habit (AOR = 0.216), cleanliness of fingernails (AOR = 0.146), drinking river water (AOR = 0.124), and hand washing habit after defecation (AOR = 0.236) (P < 0.05). Regular deworming, education on personal hygiene, and environmental sanitation to both students and their parents shall be implemented to reduce the prevalence rate of intestinal parasitic infections in the study area.

Physician Perception and Diagnosis of Intestinal Parasitic Infections among Patients with Gastrointestinal Symptoms in Ghana

This study evaluated physicians' perception and diagnosis of intestinal parasitic infections (IPI) in patients with gastrointestinal (GI) symptoms. This cross-sectional survey used a Google form questionnaire distributed online. Demographic and clinical practice information was solicited, including if “IPI was considered as a diagnosis in the last patient seen,” “if stool investigation was requested among the last patients seen,” and physicians' perception of the burden of IPI in the country. Using Pearson chi-square and multivariate logistic regression analysis, we tested the significance of the associations of the job cadre of the physicians and their perception of the IPI burden with consideration of IPI as a diagnosis in the last patient seen, request for stool investigation in the last patient seen, and overall frequency of the request for stool investigation. Ultimately, 184 physicians responded. The majority agreed to “often seeing patients with GI symptoms” (156, 84.7%), “not considering IPI among the last patient seen” (106, 57.6%), and “not requesting stool investigation among the last patient seen with symptoms” (136, 73.9%). House officers (81, 44.2%) constituted the highest proportion of physicians who considered IPI as a diagnosis among the last patient seen (39, 48.1%, p = 0.05). Most physicians (138, 75%) considered IPI as a burden in Ghana. They constituted significant proportions of the physicians who considered IPI as a diagnosis among their last patients seen (65, 83.3%, p = 0.02) and were twice more likely to consider IPI as a diagnosis among the last patients seen than their colleagues who did not consider IPI as a burden in Ghana (AOR 2.26, p = 0.04). The consideration of IPI as a diagnosis among patients with GI symptoms and request for stool investigations was low among physicians in this study. Further engagements with physicians in Ghana are needed to help improve their diagnosis of IPI in patients with GI symptoms.

A cross-sectional survey on parasitic infections in schoolchildren in a rural Tanzanian community

Infectious diseases remain the leading cause of death in children in low- and middle-income countries. Infection with helminths and intestinal protozoa cause considerable morbidity. The aim of this study was to assess the health status of schoolchildren in nine villages of the Kilombero district in Tanzania. We conducted a cross-sectional survey and subjected 427 children aged 6-12 years to standardized diagnostic tests. We found that 15% of children were infected with Entamoeba histolytica/Entamoeba dispar/Entamoeba moshkovskii, 12% with Schistosoma mansoni, and 5% with Plasmodium falciparum. The most common soil-transmitted helminth species was Trichuris trichiura (7%). Strongyloides stercoralis, Schistosoma haematobium, Giardia intestinalis and lymphatic filariasis were rare. Having a latrine inside the house was associated with a lower odds of parasite infections (odds ratio (OR) 0.51, 95% confidence interval (CI) 0.27-0.96, p = 0.04). Children from households with goats were at higher odds of E. histolytica/E. dispar/E. moshkovskii infection (OR 3.03, 95%%CI 1.29-7.10, p = 0.01).When compared to a cross-sectional survey conducted in the same district in the 1980s, there seems to have been a substantial reduction in the prevalence and intensity of parasitic infections, except for T. trichiura, which showed a similar prevalence. Our data suggest that the general development, coupled with infectious disease control programmes improved children's health markedly. However, continued efforts to control parasitic diseases, including new approaches of drug combinations, stronger intersectoral collaboration, rigorous surveillance and public health responses tailored to the local settings are needed to move from control to elimination.

Strongyloidiasis in Africa: Systematic Review and Meta-Analysis on Prevalence, Diagnostic Methods, and Study Settings

BACKGROUND

Strongyloidiasis is an intestinal parasitic infection mainly caused by Strongyloides stercoralis. Although it is a predominant parasite in tropics and subtropics where sanitation and hygiene are poorly practiced, the true prevalence of strongyloidiasis is not known due to low-sensitivity diagnostic methods.

OBJECTIVE

This systematic review and meta-analysis is aimed at determining the pooled prevalence of strongyloidiasis in African countries, stratified by diagnostic methods, study settings, and patients.

METHODS

Cross-sectional studies on strongyloidiasis published in African countries from the year 2008 up to 2018 in PubMed and Google Scholar databases and which reported at least one Strongyloides spp. infection were included. Identification and screening of eligible articles were also done. Articles whose focus was on strongyloidiasis in animals, soil, and foreigners infected by Strongyloides spp. in Africa were excluded. The random effects model was used to calculate the pooled prevalence of strongyloidiasis across African countries as well as by diagnostic methods and study settings. The heterogeneity between studies was also computed.

RESULT

A total of 82 studies were included. The overall pooled prevalence of strongyloidiasis was 2.7%. By individual techniques, the pooled prevalence of strongyloidiasis was 0.4%, 1.0%, 3.4%, 9.3%, 9.6%, and 19.4% by the respective direct saline microscopy, Kato-Katz, formol ether concentration, polymerase chain reaction, Baermann concentration, and culture diagnostic techniques. The prevalence rates of strongyloidiasis among rural community, school, and health institution studies were 6.8%, 6.4%, and 0.9%, respectively. The variation on the effect size comparing African countries, diagnostic methods, study settings, and patients was significant (P ≤ 0.001).

CONCLUSIONS

This review shows that strongyloidiasis is overlooked and its prevalence is estimated to be low in Africa due to the use of diagnostic methods with low sensitivity. Therefore, there is a need for using a combination of appropriate diagnostic methods to approach the actual strongyloidiasis rates in Africa.

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

INTRODUCTION

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

AREAS COVERED

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

EXPERT OPINION

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

Prevalence and Determinants of Intestinal Parasitic Infections among Pregnant Women Receiving Antenatal Care in Kasoa Polyclinic, Ghana

Background

Intestinal parasitic infections affect pregnant women worldwide. The infection has been implicated in causing life-threatening conditions in both gravid women and their developing foetus. Sub-Saharan Africa is known to harbor the greatest proportion of intestinal parasitic infections largely due to socioeconomic and environmental factors. In Kasoa, Southern Ghana, there is paucity of data on the prevalence and associated factors of intestinal parasitic infections among pregnant women.

Objective

The aim of the study was to determine the prevalence of intestinal parasitic infections and associated factors among pregnant women attending antenatal care in Kasoa Polyclinic.

Methods

A hospital based analytical cross-sectional study was carried out among three hundred (300) conveniently sampled pregnant women receiving antenatal care services at the Kasoa Polyclinic. Structured questionnaires were administered to the study participants to assess sociodemographic and other possible factors. Stool samples were collected from each pregnant woman and examined for the presence of intestinal parasites by microscopy using direct wet mount as well as formol-ether sedimentation techniques.

Results

Overall prevalence of intestinal parasites was 14.3% (95% CI 11–19%). Entamoeba histolytica (5.0%) was the most predominant parasite species identified followed by Ascaris lumbricoides (4.3%), Giardia lamblia (2.3%), Trichuris trichiura (1.3%), Schistosoma mansoni (0.3%), Hookworm (0.3%), Hymenolepis nana (0.3%), and Isospora belli (0.3%). Age > 30 years (AOR = 0.17, 95% CI = 0.06–0.48; p=0.001), multigravidity (AOR = 0.43, 95% CI = 0.19–0.97; p=0.043), and 2^nd and 3^rd trimesters (AOR = 4.73, 95% CI = 1.36–16.49; p=0.015) were independently associated with intestinal parasitic infections among pregnant women.

Conclusions

A prevalence of 14.3% pregnant women compared to previous studies in Ghana is relatively low. It however suggests that intestinal parasitic infection is still a problem. The major factors noted were age, gravidity, and gestational age. Routine stool examination and provision of public health education are recommended to prevent infection of pregnant mothers and their unborn babies.

Intestinal parasites and HIV in Ethiopian tuberclosis patients: A systematic review and meta-analysis

BACKGROUND

The distribution of intestinal parasites among patients with tuberculosis in Ethiopia is not well understood.

OBJECTIVE

This systematic review and meta-analysis was designed to determine the pooled national prevalence of intestinal parasites and its association with HIV among patients with tuberculosis in Ethiopia.

METHODS

Original articles were searched in PubMed, Google Scholar, EMBASE, World Health Organization's HINARI portal, and supplemented by the hand searching of cross-references. Data were extracted using a standard data extraction checklist. Random-effects model was used to estimate the pooled prevalence of intestinal parasites and odds ratio of the association. The I 2 statistic was utilized to quantify statistical heterogeneity across studies. Funnel plot asymmetry and Egger regression tests were used to check for publication bias. The analysis was done by STATA version 14 for Windows.

RESULTS

Of 725 identified studies, 12 articles were eligible for inclusion in the final analysis. The pooled national prevalence of intestinal parasites among patients with tuberculosis in Ethiopia was 36.1% (95% CI, 22.1-50.1; I 2 = 98.7%). Subgroup analysis based on study design indicated that the prevalence of intestinal parasite among case-control studies was 41.69% (95% CI, 28.6-54.8; I 2 = 95.1%). The odds of intestinal parasites among patients with tuberculosis-HIV coinfection was not significantly different compared with patients with tuberculosis without HIV/AIDS (odds ratio = 0.99; 95% CI, 0.7-4.7; P = 0.96).

CONCLUSIONS

In Ethiopia, at least 1 out of 3 patients with tuberculosis have an intestinal parasite. These findings suggest a need of more attention on increasing screening tuberculosis patients for intestinal parasites and deworming interventions. (Curr Ther Res Clin Exp. 2020; 81:XXX-XXX).

Prevalence of intestinal parasitosis and associated risk factors among school children of Saptari district, Nepal: a cross-sectional study

BACKGROUND

Intestinal parasitosis, caused by both helminths and protozoans, are among the most prevalent infections, especially in developing countries. Enteric parasites continue to be a major cause of parasitic diseases which is the most common among street and school going children with poor sanitation. This cross-sectional study was carried out to determine the prevalence and potential risk factors of intestinal parasitosis among school going children of two schools of Saptari district of southern Nepal. Stool samples were collected in a clean, dry, screw-capped, and wide-mouthed plastic container, fixed with 10% formal-saline solution, and transported to the laboratory for further microscopic analysis by following concentration technique.

RESULTS

Out of the 285 stool samples analysed, 94 (33%) were positive for the parasitosis. Presence of intestinal parasites was marginally more in rural school (44.6%) than in urban (30%) (P < 0.05). Giardia lamblia was highly prevalent (15.4%) followed by Entamoeba histolytica-like (7.7%), E. coli (7%), Ascaris lumbricoides (1.8%), and Hymenolepis nana (1.08%), respectively. Children of the age group 11-15 years were highly affected (44.2%) compared to younger age groups. The findings of intestinal parasitosis in the study population were statistically significant with family income, hand-washing habit, type of drinking water, and availability of a toilet facility at home (P < 0.05). Over 85% of infection was associated with parasitosis that indicated mainly waterborne infection rather than soil-borne helminths.

CONCLUSIONS

Poor hygiene measures and farming occupation are identified as major risk factors of parasitic infections, so sanitation especially focusing on safe drinking water along with multi intervention strategies must be emphasized in the Saptari district of Nepal to reduce the burden of parasitic diseases in school children.

High prevalence of intestinal helminthic infection among children under 5 years in a rural Ghanaian community: an urgent call for attention

Intestinal parasitic infections presents a significant public health concern in developing countries. The study determined the prevalence of intestinal parasitic infection of children under 5 years. A cross-sectional prospective study was conducted at Dodi Papase, a town in the Kadjebi district of the Oti region of Ghana. Stool samples were collected from 152 children under 5 years and examined for the presence of intestinal parasites using Kato-Katz technique. Additionally, venous blood samples were collected from participants into EDTA tubes and analyzed for their hemoglobin concentration using the Sysmex XS-500i automated hematology analyzer All laboratory analyses were done at the Ho Teaching Hospital Laboratory. Overall prevalence of intestinal helminthic infections was 44.08% (67/152). Ascaris lumbricoides, Trichuris trichiura and Hookworm recorded 20.39%, 10.53% and 13.16% prevalence respectively. Children aged 4 years recorded the highest prevalence of intestinal parasitic infections vis-à-vis 50.00% A. lumbricoides and 37.50% Hookworm while children below age 2 years recorded the lowest. T. trichiura infection was highest among children below age 2 years (44.44%) and lowest among children aged 4 years. This study recorded an overall parasitic infections of 44.08%. This therefore calls for periodic screening, anti-helminthic treatment of these children as well as intensified education on attitudinal/behavioral change on improved personal and environmental hygiene in order to help control the menace of intestinal parasitic infections.

Prevalence of Intestinal Parasites in a Low-Income Texas Community

Strongyloidiasis affects an estimated hundreds of millions of people worldwide, with infection possibly persisting for life without appropriate therapy because of the helminth's unique autoinfection cycle. Like other soil-transmitted helminths, because of the environmental conditions required for the life cycle of Strongyloides stercoralis, this parasite is endemic to tropical, subtropical, and temperate countries and areas with inadequate sanitation infrastructure. Given continued poverty and that nearly one in five American homes are lacking proper sanitation systems, many U.S. regions are at risk for intestinal parasites. A central Texas community was chosen as the study site, given previous reports of widespread sanitation failure, degree of poverty, and community willingness to participate. A total of 92 households were surveyed and residents tested for nine intestinal parasites using a multi-parallel quantitative real-time polymerase chain reaction and ELISA serology. From 43 stool samples, 27 (62.8%) tested positive for Blastocystis spp. and one (2.3%) for Giardia lamblia. From 97 serum samples, Strongyloides serology detected 16 (16.5%) positive individuals. These high rates of heterokont and helminthic laboratory findings in a peri-urban central Texas community suggest several key policy implications, including that strongyloidiasis should be added to the Texas notifiable conditions list, that clinical suspicion for this infection should be heightened in the region, and that residents without access to functioning and sustainable sanitation infrastructure should be provided that access as a basic human right and to promote public health.

Prevalence and associated risk factors of intestinal helminthic infections in children from Lorestan province, Western Iran

BACKGROUND

Intestinal helminthic infections are among the most important global socioeconomic and health problems. This study aimed to estimate the frequency of intestinal parasites in 366 children aged 2 to 15 years referred to the main pediatric health center of Lorestan Province, Iran.

METHODS

Microscopic analysis was performed on 366 stool samples. We applied direct smear, scotch tape, and formol-ether methods. Moreover, a questionnaire was filled in by parents or guardians of the children.

RESULTS

The results showed that 36 children (9.8%) were infected with at least one or more intestinal parasites. The most prevalent parasites were Enterobius vermicularis (6.8%), Hymenolepis nana (1.9%), and Ascaris lumbricoides (0.55%), in the order of their appearance. Statistical analysis showed that several risk factors were significantly associated with the prevalence intestinal helminthic parasites, including male sex (OR = 2.9; 95% CI: 1.2-6.2; p < 0.05), residing in rural regions (OR = 4.2; 95% CI: 2.1-10.6; p < 0.001), no handwashing habit before eating (OR = 5.2; 95% CI: 2.2-12.5; p < 0.001), and consuming raw or unwashed vegetables and fruits (OR = 4.8; 95% CI: 2.3-11.2; p < 0.001).

CONCLUSION

The present study showed a high overall frequency of intestinal helminthic infections among the children in Lorestan province, Iran. The results of the risk factor analysis suggest that improving environmental hygiene and health education would be important for effective control of intestinal parasitic infections.

Soil transmitted helminth infections in Ghana: a ten year review

For more than a decade, intervention programs have been instituted in Ghana to combat soil transmitted helminth (STHs) infections. Knowledge of the trend of the infection in the country is needed for evaluation and modification of existing control programs to achieve national targets. The objective of this review is to examine the pattern of soil transmitted infections in Ghana between 2009-2018. We searched and reviewed published literature on soil transmitted helminths in Ghana in PubMed, Medline, Google Scholar and Institutional Repositories of Kwame Nkrumah University of Science and Technology, University of Ghana, University of Cape Coast, and University for Development Studies-Tamale. We observed paucity of research work on STHs in Ghana over the period of this review. Twenty-nine studies consisting of 24 published works in peer reviewed journals and five graduate theses were included in the study. Hookworm was the most prevalent of STHs recorded followed by roundworm, threadworm, and whipworm. Pinworm was very rarely reported. These infections were reported from different regions and ecological zones of the country and among children, pregnant women, farmers, food vendors, children in orphanage home and psychiatric institution. Although there is some downward trend over the period, soil transmitted helminths are still prevalent in Ghana. This is an indication of some hope of eventual control and elimination of these diseases in the country if control measures are optimised. Further research particularly population studies into soil transmitted helminths in Ghana is needed.

Epidemiology of intestinal parasitic infections in preschool and school-aged Ethiopian children: a systematic review and meta-analysis

BACKGROUND

Numerous studies have been carried out on assessing the prevalence of intestinal parasites infections (IPIs) amongpreschool and school-age children in Ethiopia, but there is lack of study systematically gathered and analyzedinformation for policymakers. Therefore, the aim of this systematic review and meta-analysis was to provide a summary on prevalence, geographical distribution and trends of IPIs among preschool and school-age childrenin Ethiopia.

METHODS

The search were carried out in Medline via PubMed, Scopus, Science Direct, Web of Science, and Google Scholar from 1996to July2019 for studies describing prevalence of IPIs among preschooland school-age children. We conducted meta-regression to understand the trends and the source of heterogeneity and pooled the prevalence using 'metaprop' command using STATA software version 14.

RESULTS

Eighty-three(83) studies examining 56,786 fecal specimens were included. The prevalence of IPIs was 48%(95%CI: 42 to 53%) and showedsignificantly decreasing trends 17% (95% CI: 2.5 to 32%) for each consecutive 6 years) and was similar in males and females. The pooled prevalence in years 1997-2002, 2003-2008, 2009-2014 and > 2014 was 71% (95% CI: 57 to 86%), 42% (95% CI: 27 to 56%), 48% (95% CI: 40 to 56%) and 42% (95% CI: 34 to 49%), respectively. Poly-parasitism was observed in 16% (95% CI: 13 to 19%,) of the cases.

CONCLUSION

Intestinal parasite infections are highly prevalent among preschool and school-age children and well distributed across the regional states of Ethiopia. Southern and Amhara regional states carry the highest burden. We observed significant decreasing trends in prevalence of IPIs among preschool and school-ageEthiopian children over the last two decades. Therefore, this study is important to locate the geographical distribution and identified high risk areas that should be prioritized further interventions, which complement global efforts towards elimination of IPIs infections by 2020.

"Enterocytozoon bieneusi and Cryptosporidium: a cross-sectional study conducted throughout Thailand"

BACKGROUND

Enterocytozoon bieneusi and Cryptosporidium spp. are prevalent zoonotic parasites associated with a high burden among children. To date only limited molecular epidemiological data on E. bieneusi and Cryptosporidium spp. in humans living in Thailand has been published.

METHODS

PCR-based tools were used to detect and characterize E. bieneusi and Cryptosporidium spp. The internal transcribed spacer (ITS) region of the rRNA gene was used to investigate E. bieneusi, and the small subunit (SSU) rRNA gene was used to investigate Cryptosporidium spp., and 697 fecal samples from villagers and school children in rural areas in Thailand were analyzed.

RESULTS

The infection rates were 2.15% (15/697) for E. bieneusi and 0.14% (1/697) for Cryptosporidium spp. The prevalence of E. bieneusi was significantly high in Loei province. Sequence analysis indicated that the Cryptosporidium isolate was C. parvum. Nine E. bieneusi genotypes were identified, EbpC, Peru12, TMH6, TMH3, TMH7, H, D, and two novel genotypes TMLH1 and TMLH2. E. bieneusi prevalence was significantly higher in male participants than in female participants, and in children aged 3-15 years than in participants aged > 15 years.

CONCLUSIONS

The prevalence, genotypes, and zoonotic potential of E. bieneusi were found to vary significantly high even in one country. Transmission routes and key animal carriers of E. bieneusi may be associated with differences in hygiene, sanitation, and cultural behaviors. Further molecular studies including longitudinal studies will be required to unveil epidemiological characteristics of these opportunistic intestinal protozoa in all over the countries.

Prevalence and factors associated with intestinal parasites among under-five children attending Woreta Health Center, Northwest Ethiopia

BACKGROUND

Environmental, social, geographical, and other factors could affect the distribution of intestinal parasites. Parasitic infections would impose on health and social problems like mal-absorption, diarrhea, impaired work capacity, and reduced growth rate. However, there is a scarcity of information regarding the prevalence of intestinal parasites and associated factors in the study area.

METHODS

Institution based cross-sectional study was conducted among 310 study participants from April-May, 2017. Study participants were selected using a systematic random sampling technique. EPI Info version 7 and SPSS version 20 were used to enter and analyze the data. Both bivariate and multivariate logistic regression analyses were computed. In multivariate analysis, variables with P-value < 0.05 were considered statistically significant.

RESULTS

In this study, the mean age of participants was 29.25 Months. The overall prevalence of intestinal parasites was 18.7% (95% CI = 14.4-23.3). Children who rarely feed fresh meal (AOR = 7.74, 95% CI: 1.61, 7.84), Children whose nails were sometimes trimmed (AOR = 3.41, 95% CI: 2.20-10.28), children who had no clean playing ground (AOR = 2.43, 95% CI: 1.25-5.18), and children who had open defecation of the family (AOR = 3.40, 95% CI: 1.27-10.86) were significantly associated with intestinal parasitic infections. Among the intestinal parasites, 31(53.5%) were G.lamblia (Giardia lamblia) and 21(36.2%) were E. histolytica/E. dispar/E. moshkovskii.

CONCLUSION

In this study, the prevalence of intestinal parasites was found low compared with the WHO annual or biannual population prevalence and treatment. However, strengthening of health education about food, personal and environmental hygiene of both children and mothers/guardians is crucial to limit the transmission. Besides, improving mothers/guardian awareness about the mode of intestinal parasites transmission is necessary.