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Viriato de Freitas V, Goulart Madeira N. Effectiveness of a School Intervention Based on Knowledge, Attitude, and Practice of Soil-Transmitted Helminths. Am J Trop Med Hyg 2024; 110:263-269. [PMID: 38190744 PMCID: PMC10859796 DOI: 10.4269/ajtmh.23-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 10/09/2023] [Indexed: 01/10/2024] Open
Abstract
More than 1.5 billion people are infected by soil-transmitted helminths (STHs) worldwide, comprising one of the world's most serious public health problems. School-age children are the most affected as a result of precarious hygienic habits, especially in economically poor areas that lack appropriate sanitation. Therefore, this study aimed to evaluate a didactic method via a health education approach as a complement to the school curriculum of the sixth-grade students of public schools, distributed among six cities in the state of São Paulo, Brazil. For this, a didactic booklet was elaborated with educational explanatory activities about worms, their life cycle, and how to avoid infections. The intervention was measured by the change caused by knowledge, attitude, and practice (KAP), in students before and after using the notebook, through a questionnaire with high validity and internal consistency. Schools were assigned randomly into intervention and control groups, receiving both the didactic material and the questionnaires, versus the questionnaires only, respectively. The results were submitted to an analysis of covariance that revealed a significant difference pre- and postintervention for knowledge (P < 0.001), with greater means (0.54) compared with the control group (0.44); attitude (P < 0.005), with respective means of 0.56 versus 0.48; and practice (P < 0.001), with means of 0.75 versus 0.57. These findings set the didactic material as a potential tool to complement the school curriculum through KAP without disrupting the teaching system, in addition to assisting teachers in health education at schools aiming to prevent children's infections by STHs.
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Affiliation(s)
- Viviany Viriato de Freitas
- Department of Biodiversity and Biostatistics, Section of Parasitology, Institute of Biosciences, São Paulo State University, Botucatu, Brazil
| | - Newton Goulart Madeira
- Department of Biodiversity and Biostatistics, Section of Parasitology, Institute of Biosciences, São Paulo State University, Botucatu, Brazil
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Zurc J, Laaksonen C. Effectiveness of Health Promotion Interventions in Primary Schools-A Mixed Methods Literature Review. Healthcare (Basel) 2023; 11:1817. [PMID: 37444651 DOI: 10.3390/healthcare11131817] [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: 03/05/2023] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
School-based health promotion interventions (HPIs) are commonly used in schools, but scientific evidence about the structures of effective interventions is lacking. Therefore, we conducted a mixed methods systematic literature review to recognize the HPI structures related to their effectiveness. Based on the inclusion criteria, 49 articles were selected for the literature review. The articles, published in 2011-2022, described 46 different school-based interventions conducted in 20 different countries. The average duration of the interventions was 12 months, and they were implemented mostly with an RCT study design (61.2%) and by targeting children (69.4%). Three main groups of interventions were identified and explained: (1) extensive and long-term interventions; (2) school policy-changing interventions; and (3) highly effective interventions. Effective school-based HPIs included multiple target groups, multiple providers with external experts, and an efficient duration and timing of follow-ups. The implications for educational research and school practice are presented. Evidence on the effectiveness of health-related interventions is still lacking and needs to be addressed in further studies.
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Affiliation(s)
- Joca Zurc
- Department of Pedagogy, Faculty of Arts, University of Maribor, 2000 Maribor, Slovenia
| | - Camilla Laaksonen
- Faculty of Health and Well-Being, Turku University of Applied Sciences, 20520 Turku, Finland
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Saboyá-Díaz MI, Carey Angeles CA, Avellaneda Yajahuanca RDS, Meléndez Ruíz SK, Cabrera R, Honorio Morales HA, Pachas PE, Guardo M, Renneker KK, Muñoz BE, West SK. Associated factors of the co-occurrence of trachoma and soil-transmitted helminthiases in children 1 to 9 years old in rural communities of the Amazon basin in Loreto Department, Peru: Results from a population-based survey. PLoS Negl Trop Dis 2022; 16:e0010532. [PMID: 35877683 PMCID: PMC9312473 DOI: 10.1371/journal.pntd.0010532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 05/24/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is evidence of the occurrence of trachoma in Peru, and studies have shown that soil-transmitted helminthiases (STH) are affecting rural communities in the Amazon basin in Loreto Department. This study was done to estimate trachoma prevalence, STH prevalence, and the associated factors for both diseases in children aged 1-9 years in rural communities of Peru. METHODOLOGY A population-based cross-sectional survey was carried out in rural communities of Loreto. A standardized survey questionnaire with individual and household risk factors related to both diseases was used. Ocular examination was done for all participants aged one year and above, and eye swab samples were collected from children with follicular trachoma (TF). Anthropometric measurements, stool samples for STH, and blood samples for hemoglobin measurement were taken from children. PRINCIPAL FINDINGS TF prevalence was 7.74% (95% CI 5.08-11.63%), STH prevalence was 49.49% (95% CI 25.00-52.43%), and prevalence of co-occurrence of both diseases was 5.06% (95% CI 2.80-8.98%) in children aged 1-9 years. Being at age 3-8 years old (AOR = 6.76; 95% CI 1.346-33.947), have an unclean face (AOR = 24.64; 95% CI 6.787-89.444), and having been dewormed in the last six months (AOR = 2.47; 95% CI 1.106-5.514), were risk factors of TF. Being a female (AOR = 0.22; 95% CI 0.103-0.457) was associated with decreased odds of TF. Having been dewormed in the last six months (AOR = 0.30; 95% CI 0.139-0.628) was a preventative factor for STH. Risk factors for children with both diseases mirrored the findings for risk factors for individual diseases. CONCLUSIONS Neglected tropical diseases and associated risk factors overlap in communities living in vulnerable conditions in the Amazon basin of Peru. These findings support the need to implement integrated interventions, including mass drug administration, water, sanitation, and hygiene for both diseases in the study area.
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Affiliation(s)
- Martha Idalí Saboyá-Díaz
- Communicable Diseases and Environmental Determinants of Health Department, Pan American Health Organization, Washington, District of Columbia, United States of America
| | | | | | | | | | | | - Paul E. Pachas
- National Center of Public Health, National Institute of Health of Peru, Lima, Peru
| | - Monica Guardo
- Health Surveillance, Disease Prevention, and Control, Pan American Health Organization, Guatemala City, Guatemala
| | - Kristen K. Renneker
- International Trachoma Initiative, The Task Force for Global Health, Decatur, Georgia, United States of America
| | - Beatriz E. Muñoz
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Sheila K. West
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America
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Naqvi FA, Das JK, Salam RA, Raza SF, Lassi ZS, Bhutta ZA. Interventions for Neglected Tropical Diseases Among Children and Adolescents: A Meta-analysis. Pediatrics 2022; 149:186947. [PMID: 35503336 DOI: 10.1542/peds.2021-053852e] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Neglected tropical diseases (NTDs) are a group of communicable diseases affecting the poorest populations around the world. OBJECTIVE To assess the effectiveness of interventions, including mass drug administration (MDA), water, sanitation, and hygiene (WASH), vector control, health education, and micronutrients supplementation, for NTDs among children and adolescents. METHODS We conducted a literature search on the Cochrane Controlled Trials Register, Medline, and other databases until December 2020. We included randomized controlled trials and quasi-experimental studies conducted among children and adolescents. Two authors independently screened studies for relevance. Two authors independently extracted data, assessed the risk of bias, performed metaanalysis, and rated the quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation. RESULTS We included 155 studies (231 articles) involving 262 299 participants. For soil-transmitted helminthiasis, MDA may reduce the prevalence of Ascaris, Trichuris, and hookworm by 58%, 36%, and 57%, respectively. We are uncertain of the effect of health education, WASH, and iron supplementation on soil-transmitted helminthiasis prevalence. For Schistosomiasis, health education probably reduces the intensity and prevalence of S. mansoni, whereas micronutrient supplementation may reduce anemia prevalence and the infection intensity of S. hematobium compared with no supplementation. We are uncertain of the effect of MDA and vector control on Schistosomiasis outcomes. For trachoma, health education probably reduces the prevalence of active Trachoma, whereas we are uncertain of the effect of MDA, WASH, and vector control on Trachoma outcomes. There is limited data on the effectiveness of interventions for NTDs targeting children and adolescents. CONCLUSION Future studies are needed to evaluate the relative effectiveness and cost-effectiveness of various interventions specifically targeting children and adolescents.
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Affiliation(s)
- Fatima Abbas Naqvi
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Jai K Das
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Rehana A Salam
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Syeda Fatima Raza
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Zohra S Lassi
- Robinson Research Institute, the University of Adelaide, Adelaide, Australia.,Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Zulfiqar A Bhutta
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan.,Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
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Okoyo C, Campbell SJ, Williams K, Simiyu E, Owaga C, Mwandawiro C. Prevalence, intensity and associated risk factors of soil-transmitted helminth and schistosome infections in Kenya: Impact assessment after five rounds of mass drug administration in Kenya. PLoS Negl Trop Dis 2020; 14:e0008604. [PMID: 33027264 PMCID: PMC7540847 DOI: 10.1371/journal.pntd.0008604] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 07/15/2020] [Indexed: 12/23/2022] Open
Abstract
Background In Kenya, over five million school age children (SAC) are estimated to be at risk of parasitic worms causing soil-transmitted helminthiasis (STH) and schistosomiasis. As such, the Government of Kenya launched a National School Based Deworming (NSBD) program in 2012 targeting the at-risk SAC living in endemic regions, with the aim of reducing infections prevalence to a level where they no longer constitute a public health problem. The impact of the program has been consistently monitored from 2012 to 2017 through a robust and extensive monitoring and evaluation (M&E) program. The aim of the current study was to evaluate the parasitological outcomes and additionally investigate water, sanitation and hygiene (WASH) related factors associated with infection prevalence after five rounds of mass drug administration (MDA), to inform the program’s next steps. Materials and methods We utilized a cross-sectional design in a representative, stratified, two-stage sample of school children across six regions in Kenya. A sample size of 100 schools with approximately 108 children per school was purposively selected based on the Year 5 STH infection endemicity prior to the survey. Stool samples were examined for the presence of STH and Schistosoma mansoni eggs using double-slide Kato-Katz technique, urine samples were processed using urine filtration technique for the presence of S. haematobium eggs. Survey questionnaires were administered to all the participating children to collect information on their demographic and individual, household and school level WASH characteristics. Principal findings Overall, STH prevalence was 12.9% (95%CI: 10.4–16.1) with species prevalence of 9.7% (95%CI: 7.5–12.6) for Ascaris lumbricoides, 3.6% (95%CI: 2.2–5.8) for Trichuris trichiura and 1.0% (95%CI: 0.6–1.5) for hookworm. S. mansoni prevalence was 2.2% (95%CI: 1.2–4.3) and S. haematobium prevalence was 0.3% (95%CI: 0.1–1.0). All the infections showed significant prevalence reductions when compared with the baseline prevalence, except S. mansoni. From multivariable analysis, increased odds of any STH infections were associated with not wearing shoes, adjusted odds ratio (aOR) = 1.36 (95%CI: 1.09–1.69); p = 0.007; high number of household members, aOR = 1.21 (95%CI: 1.04–1.41); p = 0.015; and school absenteeism of more than two days, aOR = 1.33 (95%CI: 1.01–1.80); p = 0.045. Further, children below five years had up to four times higher odds of getting STH infections, aOR = 4.68 (95%CI: 1.49–14.73); p = 0.008. However, no significant factors were identified for schistosomiasis, probably due to low prevalence levels affecting performance of statistical analysis. Conclusions After five rounds of MDA, the program shows low prevalence of STH and schistosomiasis, however, not to a level where the infections are not a public health problem. With considerable inter-county infection prevalence heterogeneity, the program should adopt future MDA frequencies based on the county’s infection prevalence status. Further, the program should encourage interventions aimed at improving coverage among preschool age children and improving WASH practices as long-term infection control strategies. This paper presents the findings of an evaluation survey conducted in Year 6 of the Kenya National School-Based Deworming (NSBD) Program, following five years (2012–2017) of prior baseline and subsequent impact monitoring. The survey was conducted in 20 counties, covering six regions in Kenya. The survey showed continued and considerable reductions in prevalence over time, with most marked decline for hookworm, followed by Ascaris lumbricoides. Overall, the mass drug administration (MDA) program has driven both STH and schistosomiasis prevalence to relatively low levels, however not to a point where they no longer constitute a public health problem in Kenya. For these neglected tropical diseases (NTDs), and STH in particular, there are relatively few published examples of programmatic impact assessments enabling refined decisions regarding helminth control strategies. Kenya’s experiences in implementing, monitoring, and evaluating a high-coverage NSBD program are a continuing and increasingly important success story for the country, which provides learnings of importance for the international community.
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Affiliation(s)
- Collins Okoyo
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
- School of Mathematics, College of Biological and Physical Sciences, University of Nairobi, Nairobi, Kenya
- * E-mail: ,
| | - Suzy J. Campbell
- Deworm the World, Evidence Action, Washington DC, United States of America
| | | | - Elses Simiyu
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | | | - Charles Mwandawiro
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
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Pabalan N, Singian E, Tabangay L, Jarjanazi H, Boivin MJ, Ezeamama AE. Soil-transmitted helminth infection, loss of education and cognitive impairment in school-aged children: A systematic review and meta-analysis. PLoS Negl Trop Dis 2018; 12:e0005523. [PMID: 29329288 PMCID: PMC5766095 DOI: 10.1371/journal.pntd.0005523] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 10/01/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Evidence of an adverse influence of soil transmitted helminth (STH) infections on cognitive function and educational loss is equivocal. Prior meta-analyses have focused on randomized controlled trials only and have not sufficiently explored the potential for disparate influence of STH infection by cognitive domain. We re-examine the hypothesis that STH infection is associated with cognitive deficit and educational loss using data from all primary epidemiologic studies published between 1992 and 2016. METHODS Medline, Biosis and Web of Science were searched for original studies published in the English language. Cognitive function was defined in four domains (learning, memory, reaction time and innate intelligence) and educational loss in two domains (attendance and scholastic achievement). Pooled effect across studies were calculated as standardized mean differences (SMD) to compare cognitive and educational measures for STH infected/non-dewormed children versus STH uninfected /dewormed children using Review Manager 5.3. Sub-group analyses were implemented by study design, risk of bias (ROB) and co-prevalence of Schistosoma species infection. Influential studies were excluded in sensitivity analysis to examine stability of pooled estimates. FINDINGS We included 36 studies of 12,920 children. STH infected/non-dewormed children had small to moderate deficits in three domains-learning, memory and intelligence (SMD: -0.44 to -0.27, P<0.01-0.03) compared to STH-uninfected/dewormed children. There were no differences by infection/treatment status for reaction time, school attendance and scholastic achievement (SMD: -0.26 to -0.16, P = 0.06-0.19). Heterogeneity of the pooled effects in all six domains was high (P<0.01; I2 = 66-99%). Application of outlier treatment reduced heterogeneity in learning domain (P = 0.12; I2 = 33%) and strengthened STH-related associations in all domains but intelligence (SMD: -0.20, P = 0.09). Results varied by study design and ROB. Among experimental intervention studies, there was no association between STH treatment and educational loss/performance in tests of memory, reaction time and innate intelligence (SMD: -0.27 to 0.17, P = 0.18-0.69). Infection-related deficits in learning persisted within design/ROB levels (SMD: -0.37 to -52, P<0.01) except for pre-vs post intervention design (n = 3 studies, SMD = -0.43, P = 0.47). Deficits in memory, reaction time and innate intelligence persisted within observational studies (SMD: -0.23 to -0.38, all P<0.01) and high ROB strata (SMD:-0.37 to -0.83, P = 0.07 to <0.01). Further, in Schistosoma infection co-prevalent settings, associations were generally stronger and statistically robust for STH-related deficits in learning, memory and reaction time tests(SMD:-0.36 to -0.55, P = 0.003-0.02). STH-related deficits in school attendance and scholastic achievement was noted in low (SMD:-0.57, P = 0.05) and high ROB strata respectively. INTERPRETATION We provide evidence of superior performance in five of six educational and cognitive domains assessed for STH uninfected/dewormed versus STH infected/not-dewormed school-aged children from helminth endemic regions. Cautious interpretation is warranted due to high ROB in some of the primary literature and high between study variability in most domains. Notwithstanding, this synthesis provides empirical support for a cognitive and educational benefit of deworming. The benefit of deworming will be enhanced by strategically employing, integrated interventions. Thus, multi-pronged inter-sectoral strategies that holistically address the environmental and structural roots of child cognitive impairment and educational loss in the developing world may be needed to fully realize the benefit of mass deworming programs.
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Affiliation(s)
- Noel Pabalan
- Center for Research and Development, Angeles University Foundation, Angeles City, Philippines
| | - Eloisa Singian
- Department of Medical Technology, College of Allied Medical Professions, Angeles University Foundation, Angeles, Philippines
| | - Lani Tabangay
- Department of Biological Sciences, Angeles University Foundation, Angeles City, Philippines
| | - Hamdi Jarjanazi
- Environmental Monitoring and Reporting Branch, Biomonitoring Unit, Ontario Ministry of the Environment and Climate Change, Toronto, Ontario, Canada
| | - Michael J. Boivin
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, United States of America
| | - Amara E. Ezeamama
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, United States of America
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Gyang VP, Chuang TW, Liao CW, Lee YL, Akinwale OP, Orok A, Ajibaye O, Babasola AJ, Cheng PC, Chou CM, Huang YC, Sonko P, Fan CK. Intestinal parasitic infections: Current status and associated risk factors among school aged children in an archetypal African urban slum in Nigeria. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 52:106-113. [PMID: 28711437 DOI: 10.1016/j.jmii.2016.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 08/08/2016] [Accepted: 09/28/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND/PURPOSE Intestinal parasitic infections (IPIs) among school aged children (SAC) in Nigeria remains endemic, hence the need for regular surveillance to attract the attention of policy makers. This cross-sectional study investigated the current prevalence and factors associated with intestinal parasitic infections among school aged children in an urban slum of Lagos City, Nigeria. METHODS Single stool samples from 384 school aged children (188 boys and 196 girls) were examined by employing Merthiolate-iodine-formaldehyde concentration (MIFC) and Kato-Katz methods. Demographic characteristics and risk factors were obtained by questionnaires investigation. RESULTS The overall prevalence was 86.2% in school children, out of them 39.1% had polyparasitism. IPIs showed the highest to the lowest prevalence of 62% (238/384), 25% (97/384), 12.3% (47/384), 11.8% (45/384), 9.9% (38/384), 8.4% (32/384), 3.4% (13/384), and 0.5% (2/384) found in Ascaris lumbricoides, Entamoeba histolytica/dispar, Giardia duodenalis, Endolimax nana, Entamoeba coli, Trichuris trichiura, Blastocystis hominis, and hookworm infections, respectively. MIFC technique showed superiority to Kato-Katz technique in the detection of IPIs (p < 0.0001). Drinking untreated water was a significant risk factor for these school aged children in acquiring protozoan infections after multivariate adjustment (OR = 1.86, 95% CI = 1.08-3.20, p = 0.02). CONCLUSION Intestinal parasitic infections are very severe among school aged children in the urban slums, thus regular mass de-worming programs, health education, and the provision of safe drinking water is recommended to combat IPIs among the school aged children.
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Affiliation(s)
- Vincent P Gyang
- Public Health Division, Molecular Parasitology Research Laboratory, Nigerian Institute of Medical Research, Yaba, Lagos State, Nigeria
| | - Ting-Wu Chuang
- Department of Molecular Parasitology and Tropical Diseases, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chien-Wei Liao
- Department of Molecular Parasitology and Tropical Diseases, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yueh-Lun Lee
- Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Olaoluwa P Akinwale
- Public Health Division, Molecular Parasitology Research Laboratory, Nigerian Institute of Medical Research, Yaba, Lagos State, Nigeria
| | - Akwaowo Orok
- Biochemistry and Nutrition Division, Nigerian Institute of Medical Research, Yaba, Lagos State, Nigeria
| | - Olusola Ajibaye
- Biochemistry and Nutrition Division, Nigerian Institute of Medical Research, Yaba, Lagos State, Nigeria
| | - Ajayi J Babasola
- Science Laboratory Department, Ogun State Institute of Technology, Igbesa, Ogun state, Nigeria
| | - Po-Ching Cheng
- Department of Molecular Parasitology and Tropical Diseases, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chia-Mei Chou
- Department of Molecular Parasitology and Tropical Diseases, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ying-Chieh Huang
- Department of Molecular Parasitology and Tropical Diseases, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Pasaiko Sonko
- Department of Molecular Parasitology and Tropical Diseases, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chia-Kwung Fan
- Department of Molecular Parasitology and Tropical Diseases, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan; Master Program in Global Health and Development, College of Public Health, Taipei Medical University, Taipei, Taiwan.
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Governance, organization, accountability and sustainability of a region-wide school-based deworming program in Loreto, Peru. Acta Trop 2016; 159:219-26. [PMID: 27048990 DOI: 10.1016/j.actatropica.2016.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/21/2016] [Accepted: 04/01/2016] [Indexed: 11/23/2022]
Abstract
Chau Cuica was the name given by the regional government of Loreto in Peru for its school-based deworming program which was initiated in 2012 with a donation of mebendazole from an international non-governmental organization. Embedded in the program from the start was a sentinel surveillance component which consisted of 16 sentinel schools representing Loreto's seven provinces. Coverage rates varied between 35% and 61% over the first two years of the program (and seven deworming cycles). Initial prevalences of soil-transmitted helminth infections were high, with 82.4% of schoolchildren having at least one infection and prevalences of both Ascaris lumbricoides and Trichuris trichiura infections both exceeding 60%. After two years, these prevalences had dropped to 56% for any STH infection, 38% for A. lumbricoides and 34% for T. trichiura. Importantly, the proportions of children with moderate and heavy infections also dropped. Both the regional Ministry of Health and the Ministry of Education were jointly charged to implement this deworming program. The program's costs were estimated to be approximately 22 cents (USD) per child per deworming cycle. The responsibility for the surveillance component was initially undertaken by research partners from a local NGO and a Canadian university, which transferred gradually over the course of the deworming program to being entirely the responsibility of the Ministry of Health. This regional deworming program may serve as a model for other jurisdictions that are planning a school-based deworming program with an integrated surveillance component to monitor impact.
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Campbell SJ, Nery SV, Doi SA, Gray DJ, Soares Magalhães RJ, McCarthy JS, Traub RJ, Andrews RM, Clements ACA. Complexities and Perplexities: A Critical Appraisal of the Evidence for Soil-Transmitted Helminth Infection-Related Morbidity. PLoS Negl Trop Dis 2016; 10:e0004566. [PMID: 27196100 PMCID: PMC4873196 DOI: 10.1371/journal.pntd.0004566] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Soil-transmitted helminths (STH) have acute and chronic manifestations, and can result in lifetime morbidity. Disease burden is difficult to quantify, yet quantitative evidence is required to justify large-scale deworming programmes. A recent Cochrane systematic review, which influences Global Burden of Disease (GBD) estimates for STH, has again called into question the evidence for deworming benefit on morbidity due to STH. In this narrative review, we investigate in detail what the shortfalls in evidence are. METHODOLOGY/PRINCIPAL FINDINGS We systematically reviewed recent literature that used direct measures to investigate morbidity from STH and we critically appraised systematic reviews, particularly the most recent Cochrane systematic review investigating deworming impact on morbidity. We included six systematic reviews and meta-analyses, 36 literature reviews, 44 experimental or observational studies, and five case series. We highlight where evidence is insufficient and where research needs to be directed to strengthen morbidity evidence, ideally to prove benefits of deworming. CONCLUSIONS/SIGNIFICANCE Overall, the Cochrane systematic review and recent studies indicate major shortfalls in evidence for direct morbidity. However, it is questionable whether the systematic review methodology should be applied to STH due to heterogeneity of the prevalence of different species in each setting. Urgent investment in studies powered to detect direct morbidity effects due to STH is required.
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Affiliation(s)
- Suzy J. Campbell
- Research School of Population Health, College of Medicine, Biology, and Environment, The Australian National University, Canberra, Australian Captial Territory, Australia
| | - Susana V. Nery
- Research School of Population Health, College of Medicine, Biology, and Environment, The Australian National University, Canberra, Australian Captial Territory, Australia
| | - Suhail A. Doi
- Research School of Population Health, College of Medicine, Biology, and Environment, The Australian National University, Canberra, Australian Captial Territory, Australia
| | - Darren J. Gray
- Research School of Population Health, College of Medicine, Biology, and Environment, The Australian National University, Canberra, Australian Captial Territory, Australia
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Ricardo J. Soares Magalhães
- Children's Health and Environment Program, Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Queensland, Australia
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - James S. McCarthy
- School of Population Health, University of Queensland, Brisbane, Queensland, Australia
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Rebecca J. Traub
- Faculty of Veterinary and Agricultural Science, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ross M. Andrews
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Archie C. A. Clements
- Research School of Population Health, College of Medicine, Biology, and Environment, The Australian National University, Canberra, Australian Captial Territory, Australia
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10
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Campbell SJ, Nery SV, McCarthy JS, Gray DJ, Soares Magalhães RJ, Clements ACA. A Critical Appraisal of Control Strategies for Soil-Transmitted Helminths. Trends Parasitol 2016; 32:97-107. [PMID: 26795294 DOI: 10.1016/j.pt.2015.10.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/10/2015] [Accepted: 10/13/2015] [Indexed: 12/29/2022]
Abstract
Interventions that lead to reductions in soil-transmitted helminths (STHs) include chemotherapy with anthelmintic drugs and improvements in water, sanitation, and hygiene (WASH). In this opinion article we aim to determine the evidence for optimal approaches for STH control. First we explore the evidence for the above interventions. We then appraise two integration strategies: current chemotherapy-oriented integrated neglected tropical disease (NTD) control and expanded 'multicomponent integration', which includes integrated chemotherapy, WASH, and other intervention strategies. While multicomponent integrated control may be an effective approach to sustainably reduce STH transmission, there is a need for evidence to prove the feasibility of this approach.
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Affiliation(s)
- Suzy J Campbell
- Research School of Population Health, College of Medicine, Biology, and Environment, The Australian National University, Canberra, Australia.
| | - Susana V Nery
- Research School of Population Health, College of Medicine, Biology, and Environment, The Australian National University, Canberra, Australia
| | - James S McCarthy
- QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Public Health, University of Queensland, Brisbane, Australia
| | - Darren J Gray
- Research School of Population Health, College of Medicine, Biology, and Environment, The Australian National University, Canberra, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Ricardo J Soares Magalhães
- Children's Health and Environment Program, Queensland Children's Medical Research Institute, University of Queensland, Brisbane, Australia; School of Veterinary Science, University of Queensland, Gatton, Australia
| | - Archie C A Clements
- Research School of Population Health, College of Medicine, Biology, and Environment, The Australian National University, Canberra, Australia
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11
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Neves ÉTB, Firmino RT, de França Perazzo M, Gomes MC, Martins CC, Paiva SM, Granville-Garcia AF. Absenteeism among preschool children due to oral problems. J Public Health (Oxf) 2015. [DOI: 10.1007/s10389-015-0697-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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