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Legge H, Pullan RL, Sartorius B. Improved household flooring is associated with lower odds of enteric and parasitic infections in low- and middle-income countries: A systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002631. [PMID: 38039279 PMCID: PMC10691699 DOI: 10.1371/journal.pgph.0002631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/27/2023] [Indexed: 12/03/2023]
Abstract
Enteric and parasitic infections such as soil-transmitted helminths cause considerable mortality and morbidity in low- and middle-income settings. Earthen household floors are common in many of these settings and could serve as a reservoir for enteric and parasitic pathogens, which can easily be transmitted to new hosts through direct or indirect contact. We conducted a systematic review and meta-analysis to establish whether and to what extent improved household floors decrease the odds of enteric and parasitic infections among occupants compared with occupants living in households with unimproved floors. Following the PRISMA guidelines, we comprehensively searched four electronic databases for studies in low- and middle-income settings measuring household flooring as an exposure and self-reported diarrhoea or any type of enteric or intestinal-parasitic infection as an outcome. Metadata from eligible studies were extracted and transposed on to a study database before being imported into the R software platform for analysis. Study quality was assessed using an adapted version of the Newcastle-Ottawa Quality Assessment Scale. In total 110 studies were eligible for inclusion in the systematic review, of which 65 were eligible for inclusion in the meta-analysis after applying study quality cut-offs. Random-effects meta-analysis suggested that households with improved floors had 0.75 times (95CI: 0.67-0.83) the odds of infection with any type of enteric or parasitic infection compared with household with unimproved floors. Improved floors gave a pooled protective OR of 0.68 (95CI: 0.58-0.8) for helminthic infections and 0.82 OR (95CI: 0.75-0.9) for bacterial or protozoan infections. Overall study quality was poor and there is an urgent need for high-quality experimental studies investigating this relationship. Nevertheless, this study indicates that household flooring may meaningfully contribute towards a substantial portion of the burden of disease for enteric and parasitic infections in low- and middle-income settings.
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Affiliation(s)
- Hugo Legge
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rachel L. Pullan
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Benn Sartorius
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Department of Health Metric Sciences, University of Washington, Seattle, Washington, United States of America
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Gerber DJF, Dhakal S, Islam MN, Al Kawsar A, Khair MA, Rahman MM, Karim MJ, Rahman MS, Aktaruzzaman MM, Tupps C, Stephens M, Emerson PM, Utzinger J, Vounatsou P. Distribution and treatment needs of soil-transmitted helminthiasis in Bangladesh: A Bayesian geostatistical analysis of 2017-2020 national survey data. PLoS Negl Trop Dis 2023; 17:e0011656. [PMID: 37930980 PMCID: PMC10662736 DOI: 10.1371/journal.pntd.0011656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 11/21/2023] [Accepted: 09/11/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND In Bangladesh, preventive chemotherapy targeting soil-transmitted helminth (STH) infections in school-age children has been implemented since 2008. To evaluate the success of this strategy, surveys were conducted between 2017 and 2020 in 10 out of 64 districts. We estimate the geographic distribution of STH infections by species at high spatial resolution, identify risk factors, and estimate treatment needs at different population subgroups. METHODOLOGY Bayesian geostatistical models were fitted to prevalence data of each STH species. Climatic, environmental, and socioeconomic predictors were extracted from satellite images, open-access, model-based databases, and demographic household surveys, and used to predict the prevalence of infection over a gridded surface at 1 x 1 km spatial resolution across the country, via Bayesian kriging. These estimates were combined with gridded population data to estimate the number of required treatments for different risk groups. PRINCIPAL FINDINGS The population-adjusted prevalence of Ascaris lumbricoides, Trichuris trichiura, and hookworm across all ages is estimated at 9.9% (95% Bayesian credible interval: 8.0-13.0%), 4.3% (3.0-7.3%), and 0.6% (0.4-0.9%), respectively. There were 24 out of 64 districts with an estimated population-adjusted STH infection prevalence above 20%. The proportion of households with improved sanitation showed a statistically important, protective association for both, A. lumbricoides and T. trichiura prevalence. Precipitation in the driest month of the year was negatively associated with A. lumbricoides prevalence. High organic carbon concentration in the soil's fine earth fraction was related to a high hookworm prevalence. Furthermore, we estimated that 30.5 (27.2; 36.0) million dosages of anthelmintic treatments for school-age children were required per year in Bangladesh. CONCLUSIONS/SIGNIFICANCE For each of the STH species, the prevalence was reduced by at least 80% since treatment was scaled up more than a decade ago. The current number of deworming dosages could be reduced by up to 61% if the treatment strategy was adapted to the local prevalence.
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Affiliation(s)
- Daniel J. F. Gerber
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Sanjaya Dhakal
- Children Without Worms, Task Force for Global Health, Decatur, Georgia, United States of America
| | - Md. Nazmul Islam
- Communicable Disease Control Unit, Directorate General of Health Services, Ministry of Health & Family Welfare, Dhaka, Bangladesh
| | - Abdullah Al Kawsar
- Communicable Disease Control Unit, Directorate General of Health Services, Ministry of Health & Family Welfare, Dhaka, Bangladesh
| | - Md. Abul Khair
- Communicable Disease Control Unit, Directorate General of Health Services, Ministry of Health & Family Welfare, Dhaka, Bangladesh
| | - Md. Mujibur Rahman
- Communicable Disease Control Unit, Directorate General of Health Services, Ministry of Health & Family Welfare, Dhaka, Bangladesh
| | - Md. Jahirul Karim
- Communicable Disease Control Unit, Directorate General of Health Services, Ministry of Health & Family Welfare, Dhaka, Bangladesh
| | - Md. Shafiqur Rahman
- Communicable Disease Control Unit, Directorate General of Health Services, Ministry of Health & Family Welfare, Dhaka, Bangladesh
| | - M. M. Aktaruzzaman
- Communicable Disease Control Unit, Directorate General of Health Services, Ministry of Health & Family Welfare, Dhaka, Bangladesh
| | - Cara Tupps
- Children Without Worms, Task Force for Global Health, Decatur, Georgia, United States of America
| | - Mariana Stephens
- Children Without Worms, Task Force for Global Health, Decatur, Georgia, United States of America
| | - Paul M. Emerson
- Children Without Worms, Task Force for Global Health, Decatur, Georgia, United States of America
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Penelope Vounatsou
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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Adhikari S, Hunter E, Vossenberg JVD, Thomas J. A review of latrine front-end characteristics associated with microbial infection risk; reveals a lack of pathogen density data. Int J Hyg Environ Health 2023; 254:114261. [PMID: 37734133 DOI: 10.1016/j.ijheh.2023.114261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/06/2023] [Accepted: 09/09/2023] [Indexed: 09/23/2023]
Abstract
Unsafe sanitation accounts for an estimated 898,000 global deaths annually. The faecal pathogen transmission pathway is complex with several possible routes. Latrine front-end characteristics and usage behaviours are one key transmission pathway for microbial pathogens, however, there has not yet been a synthesis of the available research. This review aims to compare the microbial infection risks with latrine front-end components including any quantified microbial densities within the household latrines. This review was conducted with no restriction on the geographical location of the research. Of 118 studies reviewed, only ten (8%) have quantified the microbial density inside the household latrines compared to 109 (92%) measuring the infection risks. The reported risks were most frequent for specific bacterial (n = 34), and helminths infections (n = 32) compared to diarrhoea (n = 23), combined (n = 15), protozoan (n = 4), and viral (n = 4) infections. The infections risk decreased for using latrines lying at a higher position on the sanitation ladder (for example flush latrines) compared to those lying lower (for example pit latrines). The trend was similar for using floor materials that were easier to clean and less favourable for pathogen survival inside the latrines (for example, concrete as opposed to earth). Faecal coliforms were reported highest on the surface of the squat pan (743 CFU/cm2) of pour-flush latrines and helminths on earth floors of pit latrines (1.5 eggs and larvae per gram of soil). Irrespective of latrine type and its position on the sanitation ladder, a dirty latrine, evidenced by a visible lack of cleanliness, significantly increased the risk for all infections. This study recommends that effective microbial infection risk reduction in latrines can be gained efficiently by ensuring washable surfaces and consistent cleaning practices. Future studies should include more rigorous measurements of microbial densities in various latrine types incorporating the different front-end components and usage behaviours.
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Affiliation(s)
- Sabita Adhikari
- School of Civil Engineering, The University of Sydney, Australia.
| | - Erin Hunter
- Department of Public Health Sciences, College of Behavioural, Social and Health Sciences, Clemson University, United States.
| | - Jack van de Vossenberg
- Water Supply, Sanitation and Environmental Engineering Department, IHE Delft Institute of Water Education, the Netherlands.
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Trend and risk factors of fatal pregnancy termination: A long-term nationwide population-based cross-section survey in Bangladesh. PLoS One 2023; 18:e0263467. [PMID: 36706092 PMCID: PMC9882646 DOI: 10.1371/journal.pone.0263467] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/19/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Pregnant women often experience the fatal outcome of their pregnancy both in developed and impoverished countries. Due to strong health systems and services, factual and historical data are available from developed countries. However, the prevalence trend and risk factors of a fatal termination of pregnancy in developing countries like Bangladesh are still lacking. OBJECTIVE The objective of the current study was to determine the 20 years trend of prevalence and risk factors of fatal pregnancy termination from 1997 to 2018 in Bangladesh. METHOD This study utilised the publicly available seven consecutive cross-data on Bangladesh Demographic and Health Surveys data since 1997 following identical methods among women of reproductive age. Respondent was asked if they had had a fatal pregnancy termination ever. A Generalised Linear model with a log-Poisson link was used to estimate the relative risk of different predictors for four survey time points (1998, 2004, 2011, 2018). RESULTS The proportions of fatal pregnancy termination in urban and rural areas were 24% vs. 19% and 24% vs. 22% in 1997 and 2018, respectively. In multivariable analysis, maternal age 30 years and above and obesity were strongly associated in all survey time points. The richest wealth index had a weak association in 1997 but was strongly associated in 2011 and 2018. A significant modest association with secondary complete education level was only observed in 2018. CONCLUSION The overall proportions of fatal pregnancy termination in Bangladesh remain nearly static; however, its risk factors differed across different survey time points.
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Nath TC, Eom KS, Choe S, Mukutmoni M, Khanum H, Bhuiyan JU, Islam KM, Islam S, Zohra F, Park H, Lee D. An update of intestinal helminth infections among urban slum communities in Bangladesh. IJID REGIONS 2022; 5:1-7. [PMID: 36105668 PMCID: PMC9465421 DOI: 10.1016/j.ijregi.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/24/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022]
Abstract
Parasitic infections remain prevalent in urban slum communities in Bangladesh. School-aged children had a higher infection rate compared with adults. Ascaris lumbricoides was predominant in children, and hookworms were predominant in adults. Rhabditis sp. was observed for the first time in humans in Bangladesh. A significant association was found between free-roaming animals and human parasitic infections.
Aim Methods Results Conclusion
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Affiliation(s)
- Tilak Chandra Nath
- Department of Parasitology, Sylhet Agricultural University, Sylhet, Bangladesh
- International Parasite Resource Bank, Chungbuk National University, Cheongju, South Korea
| | - Keeseon S. Eom
- International Parasite Resource Bank, Chungbuk National University, Cheongju, South Korea
- Department of Parasitology and Parasite Research Centre, School of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Seongjun Choe
- Department of Parasitology and Parasite Research Centre, School of Medicine, Chungbuk National University, Cheongju, South Korea
| | | | - Hamida Khanum
- Department of Zoology, Dhaka University, Dhaka, Bangladesh
| | - Jamal Uddin Bhuiyan
- Department of Parasitology, Sylhet Agricultural University, Sylhet, Bangladesh
| | | | - Saiful Islam
- Department of Parasitology, Sylhet Agricultural University, Sylhet, Bangladesh
| | - Fatematuz Zohra
- Chittagong Veterinary and Animal Sciences University, Khulshi, Bangladesh
| | - Hansol Park
- International Parasite Resource Bank, Chungbuk National University, Cheongju, South Korea
- Corresponding authors at: International Parasite Resource Bank (iPRB), Chungbuk National University, Cheongju, South Korea.
| | - Dongmin Lee
- International Parasite Resource Bank, Chungbuk National University, Cheongju, South Korea
- Department of Parasitology and Parasite Research Centre, School of Medicine, Chungbuk National University, Cheongju, South Korea
- Corresponding authors at: International Parasite Resource Bank (iPRB), Chungbuk National University, Cheongju, South Korea.
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Donkoh ET, Berkoh D, Fosu-Gyasi S, Boadu WIO, Raji AS, Asamoah S, Otabil KB, Otoo JE, Yeboah MT, Aganbire BA, Adobasom-Anane AG, Adams SK, Debrah O. Evidence of reduced academic performance among schoolchildren with helminth infection. Int Health 2022; 15:309-317. [PMID: 35713982 PMCID: PMC9384326 DOI: 10.1093/inthealth/ihac044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/18/2022] [Accepted: 05/24/2022] [Indexed: 11/23/2022] Open
Abstract
Background Soil-transmitted helminths (STHs) pose a formidable health risk to school-age children in resource-limited settings. Unfortunately, mass deworming campaigns have been derailed since the onset of the coronavirus disease 2019 pandemic. The present study assessed the cross-sectional associations between STHs, nutritional status and academic performance of schoolchildren in the Banda District of Ghana. Methods Schoolchildren (5–16 y of age; n=275) were recruited through both school and household visits by community health workers using a multistage cluster sampling technique. In addition to school microscopy, anthropometric records were also taken. Results The prevalence of geohelminthiasis was 40.4% (95% confidence interval 34.6 to 46.2). STHs targeted for elimination by the World Health Organization and national programmes were detected among schoolchildren. Children with intestinal parasite infection (53.7 [standard deviation {SD} 11.5]) had lower mean academic scores compared with uninfected children (59.6 [SD 16.9]) (p=0.034). In multiple regression analysis, intestinal parasite infection status and z-scores for weight-for-age showed a collective significant effect on the academic score (F1117=8.169, p<0.001, R2=0.125). Conclusions Schoolchildren with STHs had poorer academic performance compared with uninfected children, despite their nutritional status. In addition to school feeding programmes, school-based mass drug administration campaigns may be critical for improving learning outcomes in young schoolchildren.
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Affiliation(s)
- Emmanuel T Donkoh
- Screen and Treat Research Group, Center for Research in Applied Biology, University of Energy and Natural Resources, Sunyani, Ghana
| | - Dorice Berkoh
- Screen and Treat Research Group, Center for Research in Applied Biology, University of Energy and Natural Resources, Sunyani, Ghana
| | - Samuel Fosu-Gyasi
- Screen and Treat Research Group, Center for Research in Applied Biology, University of Energy and Natural Resources, Sunyani, Ghana
| | - Wina I Ofori Boadu
- Department of Medical Diagnostics, Faculty of Allied Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Abdul S Raji
- Screen and Treat Research Group, Center for Research in Applied Biology, University of Energy and Natural Resources, Sunyani, Ghana
| | - Samuel Asamoah
- Department of Medical Laboratory Science, University of Energy and Natural Resources, Sunyani, Ghana
| | - Kenneth B Otabil
- Netrodis Research Group, Center for Research in Applied Biology, University of Energy and Natural Resources, Sunyani, Ghana
| | - John E Otoo
- Ghana Health Service, Bono Regional Health Directorate, Sunyani, Ghana
| | - Michael T Yeboah
- Ghana Health Service, Bono Regional Health Directorate, Sunyani, Ghana
| | | | - Austin G Adobasom-Anane
- Screen and Treat Research Group, Center for Research in Applied Biology, University of Energy and Natural Resources, Sunyani, Ghana
| | - Simon K Adams
- Ghana Health Service, Bono Regional Health Directorate, Sunyani, Ghana
| | - Oksana Debrah
- Department of Medical Laboratory Science, University of Cape Coast, Cape Coast, Ghana
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Depriving Out-of-School Children of Deworming Tablets for Soil-Transmitted Helminth Infection in Bangladesh: The Irony of a School-Based Deworming Programme. Trop Med Infect Dis 2022; 7:tropicalmed7030035. [PMID: 35324582 PMCID: PMC8955424 DOI: 10.3390/tropicalmed7030035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/17/2022] Open
Abstract
Since 2008, Bangladesh has had a school-based deworming programme to combat soil-transmitted helminth (STH) infection among school-aged children (SACs). Existing programmes have trouble reaching SACs, especially those out-of-school (OSCs). This study evaluated deworming coverage among school going children (SGCs) and OSCs in two Nilphamari sub-districts. It also evaluated community knowledge on STH control and deworming coverage in both areas for all SACs. Saidpur (intervention) and Kishoregonj (control) sub-districts, in Nilphamari, were surveyed in December 2019. The survey included SACs and their parents. Among SGCs, the intervention group (89.0%) had higher deworming coverage than the control group (75.5%). In the intervention group, 59.9% of OSCs received the deworming tablet versus 24.6% in the control group. Community involvement activities including door-to-door visits, courtyard gatherings, and miking benefited both SACs and their primary caregivers. SACs living in the intervention region, awareness of the last pill distribution date, and caregivers observing BRAC workers in action, were linked to SAC deworming coverage. Re-strategizing the deworming programme to include the OSCs is vital and suggests timely action. Building community awareness and periodic epidemiological assessment can further facilitate an improved drug intake.
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Begum K, Cooper GD, Akhter N, Nahar P, Kasim A, Bentley GR. Early life, life course and gender influences on levels of C-reactive protein among migrant Bangladeshis in the UK. Evol Med Public Health 2022; 10:21-35. [PMID: 35035976 PMCID: PMC8754477 DOI: 10.1093/emph/eoab041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 11/18/2021] [Indexed: 11/14/2022] Open
Abstract
Background and objectives Humans co-evolved with pathogens, especially helminths, that educate the immune system during development and lower inflammatory responses. The absence of such stimuli in industrialized countries is associated with higher baseline levels of C-reactive protein (CRP) among adults who appear at greater risk for inflammatory disorders. This cross-sectional study examined effects of early life development on salivary CRP levels in 452 British-Bangladeshis who spent varying periods growing up in Bangladesh or UK. We also analyzed how gender and central obesity modulate effects on CRP. We hypothesized that: (i) first-generation Bangladeshis with higher childhood exposure to pathogens would have chronically lower CRP levels than second-generation British-Bangladeshis; (ii) effects would be greater with early childhoods in Bangladesh; (iii) effects by gender would differ; and (iv) increasing obesity would mitigate early life effects. Methodology Saliva samples were assayed for CRP using ELISAs, and anthropometric data collected. Participants completed questionnaires about demographic, socioeconomic, lifestyle and health histories. Data were analyzed using multiple linear regression. Results First-generation migrants who spent early childhoods in mostly rural, unhygienic areas, and moved to UK after age 8, had lower salivary CRP compared to the second-generation. Effects differed by gender, while waist circumference predicted higher CRP levels. CRP increased with years in UK, alongside growing obesity. Conclusions and implications Our study supports the hypothesis that pathogen exposure in early life lowers inflammatory responses in adults. However, protective effects differed by gender and can be eroded by growing obesity across the life course which elevates risks for other inflammatory disorders. Lay Summary: Migrants to the UK who spent early childhoods in less hygienic environments in Bangladesh that help to educate their immune systems had lower levels of the inflammatory marker, C-reactive protein (CRP) compared to migrants who grew up in UK. Both gender and increasing obesity were associated with increased levels of CRP.
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Affiliation(s)
- Khurshida Begum
- Department of Anthropology, Durham University, Dawson Building, South Road, Durham DH1 3LE, UK
| | - Gillian D Cooper
- Department of Anthropology, Durham University, Dawson Building, South Road, Durham DH1 3LE, UK
| | - Nasima Akhter
- Department of Anthropology, Durham University, Dawson Building, South Road, Durham DH1 3LE, UK
| | - Papreen Nahar
- Department of Anthropology, Durham University, Dawson Building, South Road, Durham DH1 3LE, UK
- Department of Global Health and Infection, University of Sussex, BSMS Teaching Building, Brighton BN1 9PX, East Sussex, UK
| | - Adetayo Kasim
- Department of Anthropology, Durham University, Dawson Building, South Road, Durham DH1 3LE, UK
- Durham Research Methods Centre, Faculty of Social Sciences & Health, Durham University, Arthur Holmes Building, Durham DH1 3LE, UK
- UCB Pharmaceuticals, 216 Bath Road, Slough SL1 3WE, UK
| | - Gillian R Bentley
- Department of Anthropology, Durham University, Dawson Building, South Road, Durham DH1 3LE, UK
- Corresponding author. Department of Anthropology, Durham University, Dawson Building, South Road, Durham DH1 3LE, UK. Tel: 011 44 191 334 1114; E-mail:
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Ford ND, Bichha RP, Parajuli KR, Paudyal N, Joshi N, Whitehead RD, Chitekwe S, Mei Z, Flores‐Ayala R, Adhikari DP, Rijal S, Jefferds ME. Factors associated with anaemia in a nationally representative sample of nonpregnant women of reproductive age in Nepal. MATERNAL & CHILD NUTRITION 2022; 18 Suppl 1:e12953. [PMID: 32153098 PMCID: PMC8770658 DOI: 10.1111/mcn.12953] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/12/2019] [Accepted: 01/03/2020] [Indexed: 02/06/2023]
Abstract
We used cross-sectional data from the 2016 Nepal National Micronutrient Status Survey to evaluate factors associated with anaemia among a nationally representative sample of nonpregnant women 15- 49 years (n = 1, 918). Haemoglobin, biomarkers of iron status and other micronutrients, infection, inflammation, and blood disorders were assessed from venous blood. Soil-transmitted helminth and Helicobacter pylori infections were assessed from stool. Sociodemographic, household, and health characteristics and diet were ascertained by interview. We conducted bivariate analyses between candidate predictors and anaemia (haemoglobin <12.0 g/ dL, altitude- and smoking-adjusted). Candidate predictors that were significant in bivariate models (P < 0.05) were included in the multivariable logistic regression model, accounting for complex sampling design. Anaemia prevalence was 20.2% (95% confidence interval [CI] [17.6, 22.8]). Associated with reduced anaemia odds were living in the Mountain and Hill ecological zones relative to the Terai (adjusted odds ratio [AOR] 0.35, 95% CI [0.21, 0.60] and AOR 0.41, 95% CI [0.29, 0.59], respectively), recent cough (AOR 0.56, 95% CI [0.38, 0.82]), hormonal contraceptive use (AOR 0.58; 95% CI [0.38, 0.88]), ln ferritin (micrograms per litre; AOR 0.43, 95% CI [0.35, 0.54]), and ln retinol binding protein (micrograms per litre; AOR 0.20, 95% CI [0.11, 0.37]). Residing in a house with an earth floor (AOR 1.74, 95% CI [1.18, 2.56]), glucose-6- phosphate dehydrogenase deficiency (AOR 2.44, 95% CI [1.66, 3.60]), and haemoglobinopathies (AOR 6.15, 95% CI [3.09, 12.26]) were associated with increased anaemia odds. Interventions that improve micronutrient status, ensure access to hormonal birth control, and replace dirt floors to reduce infection risk might help reduce anaemia in this population.
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Affiliation(s)
- Nicole D. Ford
- McKing Consulting CorporationChambleeGeorgiaUSA
- Nutrition Branch, Division of Nutrition, Physical Activity, and ObesityUnited States Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | | | - Naveen Paudyal
- Nutrition SectionUnited Nations Children's FundKathmanduNepal
| | | | - Ralph D. Whitehead
- Nutrition Branch, Division of Nutrition, Physical Activity, and ObesityUnited States Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | - Zuguo Mei
- Nutrition Branch, Division of Nutrition, Physical Activity, and ObesityUnited States Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Rafael Flores‐Ayala
- Nutrition Branch, Division of Nutrition, Physical Activity, and ObesityUnited States Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | - Sanjay Rijal
- Nutrition SectionUnited Nations Children's FundKathmanduNepal
| | - Maria Elena Jefferds
- Nutrition Branch, Division of Nutrition, Physical Activity, and ObesityUnited States Centers for Disease Control and PreventionAtlantaGeorgiaUSA
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Sahiledengle B, Kumie A, Atlaw D, Tekalegn Y, Woldeyohannes D, Zenbaba D, Awoke T. The Role of Household Flooring on Childhood Diarrhea Among Children 0 to 23 Months of Age in Ethiopia: A Nationally Representative Cross-Sectional Study Using a Multi-Level Mixed Effect Analysis. ENVIRONMENTAL HEALTH INSIGHTS 2021; 15:11786302211064423. [PMID: 34924758 PMCID: PMC8671690 DOI: 10.1177/11786302211064423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 11/12/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Household flooring has been associated with diarrhea, but few studies have examined the association between childhood diarrhea and type of household flooring considering the individual and community level characteristics. We aimed to determine if household flooring was associated with childhood diarrhea among children 0 to 23 months of age in Ethiopia. METHODS Data from the fourth round of the Ethiopian Demographic and Health Survey (EDHS) conducted in 2016 is used to carry out the analysis. The EDHS was large, cross-sectional by design and nationally representative. In the current analysis, we included children 0 to 23 months of age (n = 4552) with their mother and 636 community clusters. To get information about the occurrence of diarrhea, mothers/caregivers were asked, "Has (NAME) had diarrhea in the last 2 weeks?" The response to this question was recorded as, "yes" or "no." A multilevel binary logistic regression model was fitted to identify factors associated with childhood diarrhea. RESULTS The overall prevalence of diarrhea among children 0 to 23 months of age in Ethiopia was 15.5% (95% CI [confidence interval] 14.4-16.5). No association was found between childhood diarrhea and type of household flooring (adjusted odds ratio [AOR] 1.05, 95% CI 0.59-1.88). The adjusted odds also showed that the age of the child, having an acute respiratory infection (ARI), and size of the child at birth were associated with diarrhea. CONCLUSION We found no association between childhood diarrhea and the type of household flooring. Further research with strong research design is needed to determine the effect of household flooring on childhood diarrhea.
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Affiliation(s)
- Biniyam Sahiledengle
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Abera Kumie
- Department of Community Health, College of Health Science, Addis Ababa University, Ethiopia
| | - Daniel Atlaw
- Department of Human Anatomy, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Yohannes Tekalegn
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Demelash Woldeyohannes
- Department of Public Health, College of Medicine and Health Science, Wachemo University, Hossana, Ethiopia
| | - Demisu Zenbaba
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Tadesse Awoke
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Maurelli MP, Alves LC, Aggarwal CS, Cociancic P, Levecke B, Cools P, Montresor A, Ianniello D, Gualdieri L, Cringoli G, Rinaldi L. Ascaris lumbricoides eggs or artefacts? A diagnostic conundrum. Parasitology 2021; 148:1554-1559. [PMID: 34250886 PMCID: PMC8564801 DOI: 10.1017/s0031182021001256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/29/2021] [Accepted: 07/04/2021] [Indexed: 11/24/2022]
Abstract
Due to the presence of artefacts in stool samples, the copromicroscopic diagnosis of Ascaris lumbricoides is not always straightforward, particularly in the case of fertilized decorticated eggs. A total of 286 stool samples from 115 schoolchildren in India and 171 adult immigrants in Italy were screened for the presence of A. lumbricoides eggs by both Kato-Katz thick smear and Mini-FLOTAC. If the outer layer of A. lumbricoides eggs was absent, two aliquots of each stool sample were preserved: one for coproculture to identify larvae after development and one to compose a pool of stool for molecular analysis. A total of 64 stool samples (22.4%) were positive for A. lumbricoides using the Kato-Katz thick smear; 36 (56.3%) of these showed mammillated A. lumbricoides eggs, 25 (39.1%) showed elements resembling fertilized decorticated eggs, while three samples (4.7%) showed both mammillated and decorticated eggs. By Mini-FLOTAC, 39 stool samples (13.6%) were positive, while decorticated A. lumbricoides-like eggs were identified as artefacts. These results were confirmed by negative coprocultures and quantitative polymerase chain reaction. Mini-FLOTAC can be used for a reliable diagnosis of A. lumbricoides, thanks to the flotation and translation features which allow a clearer view, resulting in the correct identification of A. lumbricoides eggs.
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Affiliation(s)
- M. P. Maurelli
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, CREMOPAR, WHO Collaborating Centre ITA-116, Naples, Italy
| | - L. C. Alves
- Department of Veterinary Medicine, Federal Rural University of Pernambuco, Recife, Brazil
| | - C. S. Aggarwal
- Division of Parasitic Diseases, National Centre for Disease Control, 22 Shamnath Marg, Delhi, India
| | - P. Cociancic
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, CREMOPAR, WHO Collaborating Centre ITA-116, Naples, Italy
- Centro de Estudios Parasitológicos y de Vectores (CEPAVE-CONICET-UNLP-asociado a CICPBA), La Plata, Buenos Aires, Argentina
| | - B. Levecke
- Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, WHO Collaborating Centre BEL-42, Merelbeke, Belgium
| | - P. Cools
- Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, WHO Collaborating Centre BEL-42, Merelbeke, Belgium
| | - A. Montresor
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - D. Ianniello
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, CREMOPAR, WHO Collaborating Centre ITA-116, Naples, Italy
| | - L. Gualdieri
- Medical Center, Centro per la Tutela della Salute degli Immigrati, Naples, Italy
| | - G. Cringoli
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, CREMOPAR, WHO Collaborating Centre ITA-116, Naples, Italy
| | - L. Rinaldi
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, CREMOPAR, WHO Collaborating Centre ITA-116, Naples, Italy
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Asfaw MA, Hailu C, Beyene TJ. Evaluating Equity and Coverage in Mass Drug Administration for Soil-Transmitted Helminth Infections among School-Age Children in the Hard-to-Reach Setting of Southern Ethiopia. Pediatric Health Med Ther 2021; 12:325-333. [PMID: 34267576 PMCID: PMC8275865 DOI: 10.2147/phmt.s316194] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/17/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Soil-transmitted helminth (STH) infections are prevalent in most developing countries, including Ethiopia, with school-age children (SAC) at high risk of infection. In Ethiopia, despite substantial progress being made on mass drug administration (MDA) coverage for STH infections, its implementation is facing challenges in hard-to-reach areas. This study thus aimed at assessing equity and coverage in MDA and identifying factors associated with drug coverage for STH infections among SAC in the hard-to-reach setting of southern Ethiopia. METHODS A community-based cross-sectional survey was conducted in the North Ari district, South Omo Zone in July 2019. Sample size was estimated following WHO drug-coverage evaluation guidelines. Factors associated with drug uptake for STH infections were identified using multivariate logistic regression. RESULTS Of 956 SAC participating in this study, the overall MDA coverage for STH was found to be 27.5% (95% CI 24.7%-30.5%). The odds of having taken drugs were highest among school-enrolled children and in those who knew the purpose of MDA: about about double their counterparts. In contrast, the odds of drug uptake were lower by 69% among those who had got informed only when the drugs delivered and by 92% among those who needed to travel >30 minutes to reach drug-distribution points than their counterparts. CONCLUSION Achieving effective and equitable MDA coverage is facing serious challenges in the hard-to-reach setting of southern Ethiopia. The very low (27.5%) and inequitable MDA coverage found in this study are associated with school nonenrollment, inaccessibility, and lack of information, awareness, and mobilization. Social mobilization should be scaled up to inform and create awareness in the community ahead of MDA. Further, school-based deworming in settings with low school enrollment needs a modified strategy to reach those in need of drugs.
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Affiliation(s)
- Mekuria Asnakew Asfaw
- Collaborative Research and Training Centre for NTDs, Arba Minch University, Arba Minch, Ethiopia
| | - Chernet Hailu
- Jimma University, Faculty of Public Health, Department of Epidemiology, Jimma, Ethiopia
| | - Tariku J Beyene
- Center for Surgical Outcomes Research, Research Institute at Nationwide Children’s Hospital, Columbus, OH, 43015, USA
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Benjamin-Chung J, Crider YS, Mertens A, Ercumen A, Pickering AJ, Lin A, Steinbaum L, Swarthout J, Rahman M, Parvez SM, Haque R, Njenga SM, Kihara J, Null C, Luby SP, Colford JM, Arnold BF. Household finished flooring and soil-transmitted helminth and Giardia infections among children in rural Bangladesh and Kenya: a prospective cohort study. Lancet Glob Health 2021; 9:e301-e308. [PMID: 33607029 PMCID: PMC7900607 DOI: 10.1016/s2214-109x(20)30523-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/20/2020] [Accepted: 11/30/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Soil-transmitted helminths and Giardia duodenalis are responsible for a large burden of disease globally. In low-resource settings, household finished floors (eg, concrete floors) might reduce transmission of soil-transmitted helminths and G duodenalis. METHODS In a prospective cohort of children nested within two randomised trials in rural Bangladesh and Kenya, we estimated associations between household finished flooring and soil-transmitted helminths and G duodenalis prevalence. In 2015-16, we collected stool samples from children aged 2-16 years in rural Bangladesh and Kenya. We detected soil-transmitted helminth infection using quantitative PCR (qPCR; Bangladesh n=2800; Kenya n=3094), and G duodenalis using qPCR in Bangladesh (n=6894) and ELISA in Kenya (n=8899). We estimated adjusted prevalence ratios (aPRs) using log-linear models adjusted for potential confounders. FINDINGS 7187 (92·2%) of 7795 children in Bangladesh and 9077 (93·7%) of 9686 children in Kenya provided stool specimens that were analysed by qPCR. At enrolment, 691 (10%) households in Bangladesh and 471 (5%) households in Kenya had finished floors. In both countries, household finished flooring was associated with lower Ascaris lumbricoides prevalence (Bangladesh aPR 0·33, 95% CI 0·14-0·78; Kenya 0·62, 0·39-0·98) and any soil-transmitted helminths (Bangladesh 0·73, 0·52-1·01; Kenya 0·57, 0·37-0·88). Household finished floors were also associated with lower Necator americanus prevalence in Bangladesh (0·52, 0·29-0·94) and G duodenalis prevalence in both countries (Bangladesh 0·78, 0·64-0·95; Kenya 0·82, 0·70-0·97). INTERPRETATION In low-resource settings, living in households with finished floors over a 2-year period was associated with lower prevalence of G duodenalis and some soil-transmitted helminths in children. FUNDING Bill & Melinda Gates Foundation and Task Force for Global Health.
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Affiliation(s)
- Jade Benjamin-Chung
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, CA, USA.
| | - Yoshika S Crider
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, CA, USA; Energy & Resources Group, University of California, Berkeley, Berkeley, CA, USA
| | - Andrew Mertens
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Ayse Ercumen
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC, USA
| | - Amy J Pickering
- Civil and Environmental Engineering, Tufts University, Medford, MA, USA
| | - Audrie Lin
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | | | - Jenna Swarthout
- Civil and Environmental Engineering, Tufts University, Medford, MA, USA
| | - Mahbubur Rahman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Sarker M Parvez
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Sammy M Njenga
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Jimmy Kihara
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Clair Null
- Center for International Policy Research and Evaluation, Mathematica Policy Research, Washington, DC, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - John M Colford
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Benjamin F Arnold
- Francis I Proctor Foundation, University of California, San Francisco, CA, USA; Department of Ophthalmology, University of California, San Francisco, CA, USA
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Kurscheid J, Laksono B, Park MJ, Clements ACA, Sadler R, McCarthy JS, Nery SV, Soares-Magalhaes R, Halton K, Hadisaputro S, Richardson A, Indjein L, Wangdi K, Stewart DE, Gray DJ. Epidemiology of soil-transmitted helminth infections in Semarang, Central Java, Indonesia. PLoS Negl Trop Dis 2020; 14:e0008907. [PMID: 33370267 PMCID: PMC7793285 DOI: 10.1371/journal.pntd.0008907] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 01/08/2021] [Accepted: 10/21/2020] [Indexed: 11/18/2022] Open
Abstract
Soil-transmitted helminth (STH) infections are endemic in Indonesia. However, prevalence data for many parts of the country are incomplete. The aim of this study was to determine human STH prevalence and knowledge and practices relating to STH risk behaviour, to provide a current view of the status of STH infection in rural communities in Central Java. A cross-sectional survey of 16 villages was conducted in Semarang, Central Java in 2015. Demographic and household data together with information about knowledge and practices relating to STH and hygiene were elicited through face-to-face interviews. Stool samples were collected and examined using the flotation method. Children (aged 2–12 years) also had their haemoglobin (Hb) levels, height and weight data collected, and BMI estimated. Data were analysed using univariate logistic regression analysis. A total of 6,466 individuals with a mean age of 33.5 years (range: 2–93) from 2,195 households were interviewed. The overall prevalence of STH was 33.8% with Ascaris lumbricoides (roundworm) the predominant nematode identified (prevalence = 26.0%). Hookworm and Trichuris trichiura (whipworm) were found in 7.9% and 1.8% of participants, respectively. Females were at increased odds of infection with A. lumbricoides (adjusted OR 1.14, 95% CI [1.02–1.29], p = 0.02). Adults in age groups 51–60 and over 60 years had the highest odds of being infected with hookworm (adjusted OR 3.01, 95% CI [1.84–4.91], p<0.001 and adjusted OR 3.79, 95% CI [2.30–6.26], p<0.001, respectively) compared to 6–12 year olds. Farmers also had higher odds of being infected with hookworm (adjusted OR 2.36, 95% CI [1.17–4.76], p = 0.02) compared to other occupation categories. Poverty (OR 2.14, 95% CI [1.77–2.58], p<0.001), overcrowding (OR 1.35, 95% CI [1.27–1.44], p<0.001), goat ownership (OR 1.61, 95% CI [1.10–2.41], p = 0.02) and the presence of dry floor space in the home (OR 0.73, 95% CI [0.58–0.91], p = 0.01) were all household factors significantly associated with an increased odds of infection. Infection with STH was not significantly associated with the gastrointestinal illness (p>0.05), BMI or Hb levels; however, one third of all 2–12 year olds surveyed were found to be anaemic (i.e. Hb concentrations below 110g/l or 115g/l for children under 5 and 5 years or older, respectively), with a greater proportion of school-age children at risk. Knowledge and behaviour related to hygiene and gastrointestinal diseases varied widely and were generally not associated with STH infection. The study revealed that STH infection remains endemic in Central Java despite ongoing deworming programs. Current control efforts would benefit from being re-evaluated to determine a more effective way forward. Among the major NTDs, STH are one of the most common disabling chronic infections. Currently available drug treatments, whilst considered safe and generally well tolerated, do not confer protection against new infections. In Indonesia, prevalences of STH of up to 90% have been reported but these estimates are based on data from the 1980s and 90s. More up-to-date STH prevalence estimates are urgently needed to help guide future control efforts. A cross-sectional survey was conducted in rural villages in Semarang, Central Java to determine human STH prevalence and associated risk factors. One-third of all cohort participants were positive for STH with prevalences of 26%, 7.9% and 1.8% identified for Ascaris lumbricoides, hookworm and Trichuris trichiura at 7.9% and 1.8%, respectively. Risk of A. lumbricoides infection was higher for females, whilst farmers and adults over 50 had an increased risk of hookworm infection. Poverty, overcrowding in the home and goat ownership were also associated with an increased risk at the household level. Soil-transmitted helminthiases remains a significant health problem in Central Java, Indonesia, exacerbated by limited knowledge about STH, poor sanitation and hygiene and poverty prevalent in the region. Control efforts would benefit from an integrated approach emphasising WASH, health education and chemotherapy. Further studies investigating environmental contamination with STH in and around homes in endemic areas could provide further insight into links between household factors and STH identified in our study.
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Affiliation(s)
- Johanna Kurscheid
- Department of Global Health, Research School of Population Health, Australian National University, Acton, Australia
- * E-mail:
| | - Budi Laksono
- Yayasan Wahana Bakti Sejatera Foundation (YWBS), Semarang, Indonesia
| | - M. J. Park
- Department of Nursing, College of Nursing, Konyang University, Daejeon, South Korea
| | | | - Ross Sadler
- School of Public Health, Griffith Health, Griffith University, South Brisbane, Australia
| | | | - Susana V. Nery
- Public Health Interventions Group, Kirby Institute, University of New South Wales, Kensington, Australia
| | | | - Kate Halton
- Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | | | - Alice Richardson
- Statistical Consulting Unit, Australian National University, Acton, Australia
| | - Léa Indjein
- School of Veterinary Science, University of Queensland, Gatton, Australia
| | - Kinley Wangdi
- Department of Global Health, Research School of Population Health, Australian National University, Acton, Australia
| | - Donald E. Stewart
- Department of Global Health, Research School of Population Health, Australian National University, Acton, Australia
- School of Medicine, Griffith Health, Griffith University, South Brisbane, Australia
| | - Darren J. Gray
- Department of Global Health, Research School of Population Health, Australian National University, Acton, Australia
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Helminth infections among rural schoolchildren in Southern Ethiopia: A cross-sectional multilevel and zero-inflated regression model. PLoS Negl Trop Dis 2020; 14:e0008002. [PMID: 33351816 PMCID: PMC7755205 DOI: 10.1371/journal.pntd.0008002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 10/20/2020] [Indexed: 11/19/2022] Open
Abstract
Although the prevalence of helminths infection among schoolchildren is known, there has been little progress in the application of count model for modelling the risk factors of helminths egg. Only a few studies applied multilevel analysis to explore the variation in helminths prevalence across schools and classes. This study aimed to assess the prevalence, intensity of helminths infection, and identify risk factors at the individual-, household-, and school-level among schoolchildren in Southern Ethiopia. Using multistage random sampling, we recruited 864 students in the Wonago District. We applied multilevel-logistic and zero-inflated negative binomial regression models (ZINB). Risk factors were concentrated at the individual level; school-level and class-level variables explained less than 5% of the variance. The overall helminths prevalence was 56% (479/850); Trichuris trichiura prevalence was 42.4% (360/850); and Ascaris lumbricoides prevalence was 18.7% (159/850). The rate of any helminths increased among thin children (AOR: 1.73 [95% CI: (1.04, 2.90]), anemic (AOR: 1.45 [95% CI: 1.04, 2.03]), mothers who had no formal education (AOR: 2.08 [95% CI: 1.25, 3.47]), and those in households using open containers for water storage (AOR: 2.06 [95% CI: 1.07, 3.99]). In the ZINB model, A. lumbricoides infection intensity increased with increasing age (AOR: 1.08 [95% CI: 1.01, 1.16]) and unclean fingernails (AOR: 1.47 [95% CI: 1.07, 2.03]). Handwashing with soap (AOR: 0.68 [95% CI: 0.48, 0.95]), de-worming treatment [AOR: 0.57 (95% CI: 0.33, 0.98)], and using water from protected sources [AOR: 0.46 (95% CI: 0.28, 0.77)] were found to be protective against helminths infection. After controlling for clustering effects at the school and class levels and accounting for excess zeros in fecal egg counts, we found an association between helminths infection and the following variables: age, thinness, anemia, unclean fingernails, handwashing, de-worming treatment, mother's education, household water source, and water storage protection. Improving hygiene behavior, providing safe water at school and home, and strengthening de-worming programs is required to improve the health of schoolchildren in rural Gedeo.
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Dhakal S, Karim MJ, Al Kawsar A, Irish J, Rahman M, Tupps C, Kabir A, Imtiaz R. Post-intervention epidemiology of STH in Bangladesh: Data to sustain the gains. PLoS Negl Trop Dis 2020; 14:e0008597. [PMID: 33284834 PMCID: PMC7746288 DOI: 10.1371/journal.pntd.0008597] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/17/2020] [Accepted: 10/23/2020] [Indexed: 11/25/2022] Open
Abstract
In 2008, Bangladesh initiated Preventive Chemotherapy (PCT) for school-age children (SAC) through bi-annual school-based mass drug administration (MDA) to control Soil-Transmitted Helminth (STH) infections. In 2016, the Ministry of Health and Family Welfare’s Program on Lymphatic Filariasis Elimination and STH (ELFSTH) initiated district-level community impact assessments with Children Without Worms (CWW) using standardized, population-based sampling to measure the post-intervention STH burden across all ages (≥ 1 yr) for the three STH species. The Integrated Community-based Survey for Program Monitoring (ICSPM) was developed by CWW and was used to survey 12 districts in Bangladesh from 2017–2020. We excluded the first two district data as piloting caused some sampling errors and combined the individual demographic and parasite-specific characteristics from the subsequent 10 districts, linking them with the laboratory data for collective analysis. Our analysis identified district-specific epidemiologic findings, important for program decisions. Of the 17,874 enrolled individuals, our results are based on 10,824 (61.0%) stool samples. Overall, the prevalence of any STH species was substantially reduced to 14% from 79.8% in 2005. The impact was similar across all ages. STH prevalence was 14% in 10 districts collectively, but remained high in four districts, despite their high reported PCT coverage in previous years. Among all, Bhola district was unique because it was the only district with high T.trichuris prevalence. Bangladesh successfully lowered STH prevalence across all ages despite targeting SAC only. Data from the survey indicate a significant number of adults and pre-school age children (PSAC) were self-deworming with purchased pills. This may account for the flat impact curve across all ages. Overall prevalence varied across surveyed districts, with persistent high transmission in the northeastern districts and a district in the central flood zone, indicating possible service and ecological factors. Discrepancies in the impact between districts highlight the need for district-level data to evaluate program implementation after consistent high PCT coverage. Bangladesh government conducted school-based mass drug administration (MDA) for over 10 years to control soil-transmitted helminth (STH) infections. School-based evaluations of MDA indicate a reduction in STH burden among school-aged children (SAC). To further assess the impact on the community, Children Without Worms and the Ministry of Health and Family Welfare’s Program on Lymphatic Filariasis Elimination and STH (ELFSTH) initiated district-level community impact surveys in 12 districts. We share the results from the latter 10 districts here (the first two pilots were excluded because of possible sampling errors). Our analysis of 10,824 interviews and stool samples from 10 districts showed an estimated 14% of community members infected with at least one species of STH. This finding is substantially lower than the baseline STH prevalence (79.8%) estimated in 2005. Bangladesh’s successful impact was achieved across all ages despite only treating SAC. Deworming source data showed significant numbers of adults and pre-school age children (PSAC) self-dewormed with locally purchased pills. Prevalence varied across the surveyed districts, with persistent high transmission in the northeastern districts and a district in the central flood zone, indicating possible ecological and service factors contributing to persistent infections. Variable impact across districts highlights the need for sub-national level data to evaluate program performance following the consistent high intervention and could be attributable to many additional factors.
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Affiliation(s)
- Sanjaya Dhakal
- Children Without Worms, The Task Force for Global Health, Atlanta, Georgia, United States of America
| | | | - Abdullah Al Kawsar
- Communicable Disease Control, Ministry of Health & Family Welfare, Dhaka, Bangladesh
| | - Jasmine Irish
- Children Without Worms, The Task Force for Global Health, Atlanta, Georgia, United States of America
| | - Mujibur Rahman
- Communicable Disease Control, Ministry of Health & Family Welfare, Dhaka, Bangladesh
| | - Cara Tupps
- Children Without Worms, The Task Force for Global Health, Atlanta, Georgia, United States of America
| | - Ashraful Kabir
- Children Without Worms, The Task Force for Global Health, Atlanta, Georgia, United States of America
| | - Rubina Imtiaz
- Children Without Worms, The Task Force for Global Health, Atlanta, Georgia, United States of America
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Prevalence and Intensity of Intestinal Helminth Infections in Preschool Pupils in Lugari Subcounty, Kakamega County, Kenya. J Parasitol Res 2020; 2020:8871042. [PMID: 33204523 PMCID: PMC7666631 DOI: 10.1155/2020/8871042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/14/2020] [Accepted: 10/22/2020] [Indexed: 12/03/2022] Open
Abstract
Intestinal helminths cause anaemia, malnutrition, indigestion disorders, retarded growth, and low mental abilities in pupils. About 1.5 billion are infected globally. Intestinal helminth infections are caused by Ascaris lumbricoides, Trichuris trichiura, Strongyloides stercoralis, Enterobius vermicularis, Ancylostoma duodenale, and Necator americanus. Lugari Subcounty has poor sanitation and inadequate clean water. This study determined the prevalence of intestinal helminth infections in preschool pupils in Lugari Subcounty. A stratified multistage cluster experimental design was used. Sampling was carried out in four wards: Lumakanda, Lugari, Luandeti, and Chekalini. Preschool pupils of either gender were selected randomly. Written consents and verbal assent were obtained from parents or guardians and preschool pupils, respectively. Questionnaires were administered in order to collect sociodemographic data. Stool samples were collected and tested for the presence of eggs using the standard Kato-Katz technique. Prevalence rate and prevalence ratio were calculated as the percentage of infected preschool pupils among the total number of preschool pupils examined. Preschool pupils positive with helminths were treated freely, and a follow-up screening was conducted three months after treatment. Approval of the study was sought from the Masinde Muliro University of Science and Technology Institutional Ethical Review Board (MMUST IRB). The overall prevalence of intestinal helminths was 12.3%. Only one species, Ascaris lumbricoides, was identified. Statistical tests were carried out at a 5% significance level (p < 0.05, confidence interval (CI) 95%). There was a statistically significant association for prevalence and intensity of intestinal helminths versus factors like school location, knowledge of washing hands before eating, and awareness of washing hands after visiting a toilet. Although this study revealed a low prevalence and light intensity, some factors had significant effects on intestinal helminth infections among the preschool children. Therefore, there is a need to intensify efforts for their intestinal helminth control.
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Hygienic Risk Exposures Across Ethnic Groups in Rural Areas of Guangxi, China: Prevalence, Associated Factors, and Perceptions of Policy. J Racial Ethn Health Disparities 2020; 8:1054-1066. [PMID: 32948950 DOI: 10.1007/s40615-020-00862-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 08/24/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Controlling hygienic risk exposures (HREs) is important for reducing acute respiratory infection or parasitic infection; however, studies across vulnerable ethnicities are limited. This study aimed to identify the prevalence and associated factors of HREs and perception on HRE policies among ethnic groups in Guangxi, China. METHODS A community-based cross-sectional study was conducted in rural areas of Guangxi, China, among Han majority and Zhuang, Yao, Miao, Dong, Mulao, and Maonan minorities. The prevalence of HREs and perceptions concerning the HRE policies were presented using descriptive statistics. Associated factors were analyzed using a logistic regression model, and adjusted prevalence ratios and 95% confidence interval were calculated. RESULTS High prevalence of HREs on hand and soil hygiene were found in all ethnicities. Miao minority had the highest prevalence of HREs, particularly in poor hand washing (74.1%), infrequent nail clipping (90.4%), and outdoor soil contact (92.7%), compared with the others. Prevalence of HREs in some ethnic minority groups were significantly different from those in Han majority after adjusted with other significant factors. Village leaders were more aware of existing national and community regulations related to HREs than household heads. Village leaders and household heads of almost all ethnic groups perceived high policy's compliance in their village or household on avoiding fertilizing with farmyard manure. CONCLUSIONS HREs were prevalent in all ethnic groups, especially in Miao minority. Ethnicity, one of social determinants, was significantly associated with HREs. Raising awareness at both the village and household levels on HREs is needed for all ethnic groups.
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Kim SH, Stothard JR, Rinamalo M, Rainima-Qaniuci M, Talemaitoga N, Kama M, Rafai E, Jang S, Kim JY, Oh YM, Kim EM, Hong ST, Lowry JH, Verweij JJ, Kelly-Hope LA, Choi MH. A first nation-wide assessment of soil-transmitted helminthiasis in Fijian primary schools, and factors associated with the infection, using a lymphatic filariasis transmission assessment survey as surveillance platform. PLoS Negl Trop Dis 2020; 14:e0008511. [PMID: 32976499 PMCID: PMC7518615 DOI: 10.1371/journal.pntd.0008511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/23/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Soil-transmitted helminthiasis (STH) is endemic in Fiji but its prevalence is not known and likely to have changed after a decade of mass drug administration (MDA) for lymphatic filariasis (LF). By linking with LF transmission assessment surveys (LF-TAS), we undertook the first nation-wide assessment of STH in Fijian primary schools, as well as an analysis of factors associated with STH infections. METHODOLOGY/PRINCIPAL FINDINGS A cross-sectional assessment for STH was conducted in all four Divisions of Fiji from 2014 to 2015. In the Western, Central, and Northern Divisions, schools were sub-sampled after LF-TAS, while, in the Eastern Division, schools were selected via simple random sampling. For the diagnosis of STH, stool samples were examined by coproscopy with a single Kato-Katz thick smear (KK) and the formol-ether-acetate concentration technique, except for the samples from the Eastern Division where only KK was used. Mean prevalence of any STH among class 1-2 students at the national level was 10.5% (95% CI: 6.9-15.5). Across the three Divisions via LF-TAS, the prevalence levels for ascariasis were 8.7% (95% CI: 4.3-16.6), hookworm 3.9% (95% CI: 2.3-6.6) and trichuriasis 0%. In the Eastern Division, ascariasis prevalence was 13.3% (95% CI: 6.4-25.6), and hookworm 0.7% (95% CI: 0.2-2.5), with one case of trichuriasis. Among class 3-8 students, ascariasis prevalence was lower. Lower risk of any STH was associated with wearing shoes (adjusted OR 0.54, 95% CI: 0.32-0.90) and having piped water from the Fiji Water Authority at home (adjusted OR 0.48, 95% CI: 0.25-0.92). CONCLUSIONS After a decade of community-based LF-MDA, STH in school-age children in Fiji is now close to 10%, but localities of endemicity remain. Preventive chemotherapy should be maintained in areas with elevated STH prevalence alongside targeted delivery of integrated WASH interventions. LF-TAS has provided an opportunity to develop future public health surveillance platforms.
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Affiliation(s)
- Sung Hye Kim
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - J. Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | | | | | - Mike Kama
- Ministry of Health, Dinem House, Suva, Republic of Fiji
| | - Eric Rafai
- Ministry of Health, Dinem House, Suva, Republic of Fiji
| | - Seoyun Jang
- Department of Tropical Medicine and Parasitology and Institute of Endemic Diseases, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Young Kim
- Department of Tropical Medicine and Parasitology and Institute of Endemic Diseases, Seoul National University College of Medicine, Seoul, Korea
| | - Yoo Min Oh
- Department of Tropical Medicine and Parasitology and Institute of Endemic Diseases, Seoul National University College of Medicine, Seoul, Korea
| | - Eun-Min Kim
- Department of Environmental Medical Biology and Arthropods of Medical Importance Resource Research Bank, Institute of Tropical Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Tae Hong
- Department of Tropical Medicine and Parasitology and Institute of Endemic Diseases, Seoul National University College of Medicine, Seoul, Korea
| | - John H. Lowry
- School of Geography, Earth Science, and Environment, The University of South Pacific, Suva, Republic of Fiji
| | - Jaco J. Verweij
- Laboratory of Medical Microbiology and Immunology, Elisabeth Hospital, Tilburg, The Netherlands
| | - Louise A. Kelly-Hope
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Min-Ho Choi
- Department of Tropical Medicine and Parasitology and Institute of Endemic Diseases, Seoul National University College of Medicine, Seoul, Korea
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Nath TC, Adnan MR, Sultana N, Husna A, Ndossi BA, Kang Y, Bia MM, Choe S, Park H, Lee D, Eamudomkarn C, Jeon HK, Eom KS. Integration of health education intervention to improve the compliance to mass drug administration for soil-transmitted helminths infection in Bangladesh: An implementation research. Parasite Epidemiol Control 2020; 11:e00165. [PMID: 32775707 PMCID: PMC7396901 DOI: 10.1016/j.parepi.2020.e00165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/12/2020] [Accepted: 07/04/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction In Bangladesh, the prevention and control strategy of soil-transmitted helminthiasis (STHs) is based on the mass drug administration (MDA) program. Despite bi-annual MDA since 2008, the reported compliance is still below the target, and the STH prevalence is high in several areas. This study was done to assess the feasibility and barriers of integrating health education (HE) intervention to achieve the target MDA compliance in the local context of Bangladesh. Materials and methods A mixed-method study, utilizing PRISM (Practical Robust Implementation Sustainability Model) framework, was conducted between July 2017 to March 2018 in Dhaka and Sylhet divisions of Bangladesh. A total of 640 school-aged children selected from four different schools were divided into intervention and control groups. Eight focus group discussions (FGDs) and eight in-depth interviews (IDIs) were also conducted among 56 adults, including parents of school-aged children, school teachers, and health officers. Results Quantitative findings revealed that HE intervention had a significant role (P < .05) to improve the mean knowledge score in the intervention group (3.35) compared to the control group (0.29). STH preventive behaviours and MDA participating attitudes were also significantly increased in the intervention group (P < .05) compared to the control group. Some of the major barriers associated with HE integration identified in the qualitative study were budget deficiencies, inadequate training of program implementers, and information gaps. In contrast, the school environment and positive community attitudes were observed as supportive factors for the integration of HE. Conclusion Increased knowledge score and behaviour changes due to HE intervention demonstrated in this study hint that integration of HE with MDA is feasible and can be promising to promote MDA compliance and to reduce STH prevalence in this setting. However, the allocation of adequate budget, as well as coordination and collaboration with local political context, should be addressed for the sustainability of integration.
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Affiliation(s)
- Tilak Chandra Nath
- Department of Parasitology, Parasite Research Center and Parasite Resource Bank, Chungbuk National University, Republic of Korea
- Department of Parasitology, Sylhet Agricultural University, Bangladesh
| | | | - Nazmin Sultana
- Department of Pathology, Sylhet Agricultural University, Bangladesh
| | - Asmaul Husna
- Department of Pathology, Sylhet Agricultural University, Bangladesh
| | - Barakaeli A. Ndossi
- Department of Parasitology, Parasite Research Center and Parasite Resource Bank, Chungbuk National University, Republic of Korea
| | - Yeseul Kang
- Department of Parasitology, Parasite Research Center and Parasite Resource Bank, Chungbuk National University, Republic of Korea
| | - Mohammed Mebarek Bia
- Department of Parasitology, Parasite Research Center and Parasite Resource Bank, Chungbuk National University, Republic of Korea
| | - Seongjun Choe
- Department of Parasitology, Parasite Research Center and Parasite Resource Bank, Chungbuk National University, Republic of Korea
| | - Hansol Park
- Department of Parasitology, Parasite Research Center and Parasite Resource Bank, Chungbuk National University, Republic of Korea
| | - Dongmin Lee
- Department of Parasitology, Parasite Research Center and Parasite Resource Bank, Chungbuk National University, Republic of Korea
| | - Chatanun Eamudomkarn
- Department of Parasitology, Parasite Research Center and Parasite Resource Bank, Chungbuk National University, Republic of Korea
| | - Hyeong-Kyu Jeon
- Department of Parasitology, Parasite Research Center and Parasite Resource Bank, Chungbuk National University, Republic of Korea
| | - Keeseon S. Eom
- Department of Parasitology, Parasite Research Center and Parasite Resource Bank, Chungbuk National University, Republic of Korea
- Corresponding author.
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21
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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: 104] [Impact Index Per Article: 26.0] [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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22
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Benjamin-Chung J, Pilotte N, Ercumen A, Grant JR, Maasch JRMA, Gonzalez AM, Ester AC, Arnold BF, Rahman M, Haque R, Hubbard AE, Luby SP, Williams SA, Colford JM. Comparison of multi-parallel qPCR and double-slide Kato-Katz for detection of soil-transmitted helminth infection among children in rural Bangladesh. PLoS Negl Trop Dis 2020; 14:e0008087. [PMID: 32330127 PMCID: PMC7202662 DOI: 10.1371/journal.pntd.0008087] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/06/2020] [Accepted: 01/24/2020] [Indexed: 01/08/2023] Open
Abstract
There is growing interest in local elimination of soil-transmitted helminth (STH) infection in endemic settings. In such settings, highly sensitive diagnostics are needed to detect STH infection. We compared double-slide Kato-Katz, the most commonly used copromicroscopic detection method, to multi-parallel quantitative polymerase chain reaction (qPCR) in 2,799 stool samples from children aged 2–12 years in a setting in rural Bangladesh with predominantly low STH infection intensity. We estimated the sensitivity and specificity of each diagnostic using Bayesian latent class analysis. Compared to double-slide Kato-Katz, STH prevalence using qPCR was almost 3-fold higher for hookworm species and nearly 2-fold higher for Trichuris trichiura. Ascaris lumbricoides prevalence was lower using qPCR, and 26% of samples classified as A. lumbricoides positive by Kato-Katz were negative by qPCR. Amplicon sequencing of the 18S rDNA from 10 samples confirmed that A. lumbricoides was absent in samples classified as positive by Kato-Katz and negative by qPCR. The sensitivity of Kato-Katz was 49% for A. lumbricoides, 32% for hookworm, and 52% for T. trichiura; the sensitivity of qPCR was 79% for A. lumbricoides, 93% for hookworm, and 90% for T. trichiura. Specificity was ≥ 97% for both tests for all STH except for Kato-Katz for A. lumbricoides (specificity = 68%). There were moderate negative, monotonic correlations between qPCR cycle quantification values and eggs per gram quantified by Kato-Katz. While it is widely assumed that double-slide Kato-Katz has few false positives, our results indicate otherwise and highlight inherent limitations of the Kato-Katz technique. qPCR had higher sensitivity than Kato-Katz in this low intensity infection setting. Soil-transmitted helminth infections (STH) (e.g., Ascaris, hookworm, Trichuris) contribute to a large burden of disease among children in low- and middle-income countries. There is increasing interest in implementing large-scale deworming programs to eliminate STH in certain settings. Efforts to monitor whether local elimination has occurred require sensitive diagnostic tests that will not miss positive cases. Kato-Katz, a microscopy-based diagnostic test, has commonly been used to identify STH eggs in stool, but in settings where infection intensity is low, this method frequently misses positive samples because it requires visual identification of small numbers of eggs, and hookworm eggs may degrade prior to visualization. Quantitative polymerase chain reaction (qPCR) is a molecular diagnostic method for detecting STH. It may detect more low intensity infections than Kato-Katz because it identifies STH DNA in stool; DNA can be detected in very small quantities and is less likely to degrade than STH ova. Thus, qPCR is likely to be more accurate than Kato-Katz. This study compared the performance of double-slide Kato-Katz and qPCR using 2,799 stool samples from children aged 2–12 years in a setting in rural Bangladesh with predominantly low STH infection intensity. qPCR was more sensitive than Kato-Katz for hookworm and Trichuris infections. 26% of samples were classified as Ascaris positive by Kato-Katz and negative by qPCR. DNA sequencing of 10 samples confirmed that Ascaris was absent in samples classified as positive by Kato-Katz and negative by qPCR. We conclude that Kato-Katz likely produced false positive results for Ascaris and that qPCR had a higher sensitivity than double-slide Kato-Katz in this low infection intensity setting.
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Affiliation(s)
- Jade Benjamin-Chung
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
- * E-mail:
| | - Nils Pilotte
- Department of Biological Sciences, Smith College, Northampton, Massachusetts, United States of America
- Molecular and Cellular Biology Program, University of Massachusetts, Amherst, Massachusetts, United States of America
| | - Ayse Ercumen
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, North Carolina, United States of America
| | - Jessica R. Grant
- Department of Biological Sciences, Smith College, Northampton, Massachusetts, United States of America
| | | | - Andrew M. Gonzalez
- Department of Biological Sciences, Smith College, Northampton, Massachusetts, United States of America
| | - Ashanta C. Ester
- Department of Biological Sciences, Smith College, Northampton, Massachusetts, United States of America
| | - Benjamin F. Arnold
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
| | - Mahbubur Rahman
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Rashidul Haque
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Alan E. Hubbard
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
| | - Stephen P. Luby
- Infectious Diseases & Geographic Medicine, Stanford University, Stanford, California, United States of America
| | - Steven A. Williams
- Department of Biological Sciences, Smith College, Northampton, Massachusetts, United States of America
- Molecular and Cellular Biology Program, University of Massachusetts, Amherst, Massachusetts, United States of America
| | - John M. Colford
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, California, United States of America
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Dukpa T, Dorji N, Thinley S, Wangchuk, Tshering K, Gyem K, Wangmo D, Sherpa PL, Dorji T, Montresor A. Soil-Transmitted Helminth infections reduction in Bhutan: A report of 29 years of deworming. PLoS One 2020; 15:e0227273. [PMID: 31899772 PMCID: PMC6941809 DOI: 10.1371/journal.pone.0227273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 12/16/2019] [Indexed: 11/19/2022] Open
Abstract
Soil Transmitted Helminth (STH) infections affect over 1.5 billion people worldwide. Although prevalent in all age groups, school aged children are a high-risk groups for STH infections. In Bhutan, epidemiological data on STH were collected from western Bhutan in 2003, which found a prevalence of 16.5%. However, little evidence is available on the prevalence of infection at national level. Therefore, this study was conducted with the aim to assess the prevalence and intensity of STH infections, and identify significant correlates of STH among students. A school-based survey was conducted in three regions of Bhutan. Two-stage cluster sampling was adopted to select a sample of 1500 students from 24 schools, in equal proportion from three regions of the country. A total of 1456 (97%) students were interviewed and their stool sample examined for the presence of parasites. Mini-FLOTAC technique was used to detect the parasite eggs/ova. The prevalence of any STH infection was 1.4%, with 0.8% Ascaris lumbricoides, 0.5% Trichuris trichiura and 0.2% hookworms. The eastern region had the highest prevalence at 2.3%. Except for one student who had moderate intensity of A. lumbricoides, the rest had light infection. Any STH presence was significantly associated with father's occupation, father's education level, type of house and the flooring of the house in which students reported to live. No significant associations were observed between water, sanitation and hygiene (WASH) variables measured and presence of any STH infection. The prevalence of STH was found to be very low with primarily light intensity in this study. Nonetheless, it was also found that the sanitation situation is not ideal in the country, with several students reporting constant or partial open defecation leading to environmental contamination. Based on this prevalence and in line with the WHO guideline, it is recommended that deworming be reduced to once a year in combination with concerted health education on proper hygiene and sanitation practice.
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Affiliation(s)
- Tshering Dukpa
- Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - Nidup Dorji
- Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - Sangay Thinley
- Comprehensive School Health Programme, Department of Public Health, Ministry of Health, Thimphu, Bhutan
| | - Wangchuk
- Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - Karma Tshering
- Department of Microbioloy, Jigme Dorji Wangchuk National Referral Hospital, Thimphu, Bhutan
| | - Kinley Gyem
- Royal Center for Disease Control, Thimphu Bhutan
| | - Diki Wangmo
- Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - Passang Lhamo Sherpa
- Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - Tshering Dorji
- Laboratory Unit, Trashigang District Hospital, Trashigang, Bhutan
| | - Antonio Montresor
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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Oswald WE, Halliday KE, Mcharo C, Witek-McManus S, Kepha S, Gichuki PM, Cano J, Diaz-Ordaz K, Allen E, Mwandawiro CS, Anderson RM, Brooker SJ, Pullan RL, Njenga SM. Domains of transmission and association of community, school, and household sanitation with soil-transmitted helminth infections among children in coastal Kenya. PLoS Negl Trop Dis 2019; 13:e0007488. [PMID: 31765383 PMCID: PMC6901232 DOI: 10.1371/journal.pntd.0007488] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 12/09/2019] [Accepted: 10/14/2019] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Few studies have simultaneously examined the role of sanitation conditions at the home, school, and community on soil-transmitted helminth (STH) infection. We examined the contribution of each domain that children inhabit (home, village, and school) to STH infection and estimated the association of STH infection with sanitation in each domain. METHODS Using data from 4,104 children from Kwale County, Kenya, who reported attending school, we used logistic regression models with cross-classified random effects to calculate measures of general contextual effects and estimate associations of village sanitation coverage (percentage of households with reported access to sanitation), school sanitation coverage (number of usable toilets per enrolled pupil), and sanitation access at home with STH infection. FINDINGS We found reported use of a sanitation facility by households was associated with reduced prevalence of hookworm infection but not with reduced prevalence of T. trichiura infection. School sanitation coverage > 3 toilets per 100 pupils was associated with lower prevalence of hookworm infection. School sanitation was not associated with T. trichiura infection. Village sanitation coverage > 81% was associated with reduced prevalence of T. trichiura infection, but no protective association was detected for hookworm infection. General contextual effects represented by residual heterogeneity between village and school domains had comparable impact upon likelihood of hookworm and T. trichiura infection as sanitation coverage in either of these domains. CONCLUSION Findings support the importance of providing good sanitation facilities to support mass drug administration in reducing the burden of STH infection in children.
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Affiliation(s)
- William E. Oswald
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Katherine E. Halliday
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Carlos Mcharo
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Stefan Witek-McManus
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Stella Kepha
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
- Pwani University Bioscience Research Centre, Pwani University, Kilifi, Kenya
| | - Paul M. Gichuki
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Jorge Cano
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Karla Diaz-Ordaz
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Elizabeth Allen
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Charles S. Mwandawiro
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Roy M. Anderson
- Faculty of Medicine, Department of Infectious Disease Epidemiology, London Centre for Neglected Tropical Disease Research, School of Public Health, St Mary's Campus, Imperial College London, London, United Kingdom
| | - Simon J. Brooker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rachel L. Pullan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sammy M. Njenga
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
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Takeuchi H, Khan MA, Ahmad SM, Hasan SMT, Alam MJ, Takanashi S, Hore SK, Yeasmin S, Jimba M, Iwata T. Concurrent decreases in the prevalence of wheezing and Ascaris infection among 5-year-old children in rural Bangladesh and their regulatory T cell immunity after the implementation of a national deworming program. Immun Inflamm Dis 2019; 7:160-169. [PMID: 31256445 PMCID: PMC6688081 DOI: 10.1002/iid3.253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 04/16/2019] [Accepted: 04/26/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Epidemiological research on the prevalence of asthma and helminthic infections in various countries has led to the hypothesis that helminthic infections protect against asthma by suppressing the host's immune response. This study was conducted to elucidate whether decreased Ascaris infection following a national deworming program was associated with increased recurrent wheezing among rural Bangladeshi children and to test their anti-inflammatory immunity. METHODS This nested case-control study was conducted from December 2015 to October 2016 in the rural service area of the International Centre for Diarrhoeal Disease Research, Bangladesh. Of the 1800 5-year old children randomly selected for the study, informed consent was obtained from the guardians of 1658 children. Data were collected using a semistructured questionnaire adopted from the International Study of Asthma and Allergies in Childhood and blood samples for the analysis of regulatory T (Treg) cell immune responses and the balance between Th1 and Th2 immunity in Ascaris infections. RESULTS A total of 145 children were found to have wheezing, yielding a prevalence rate of 8.7%, which was significantly lower than the rate found in 2001 (16.2%, P < .001); Ascaris infection also decreased from 2001 to 2016. The 127 wheezing children who agreed to participate further were compared to 114 randomly selected never-wheezing children. Wheezing had a significant positive association with antibiotic use, history of pneumonia, parents' history of asthma, and Ascaris infection; children with Ascaris infection were twice as likely to have wheezing (adjusted odds ratio = 2.31, P = .053). Flow cytometry found no significant differences in the rates of Th1, Th2, and CD4 + CD25 + CD127low cells by the wheezing group. CONCLUSIONS Ascaris infection had a positive rather than a negative association with wheezing and the rates of wheezing and Ascaris infections both decreased from 2001 to 2016. These findings undermines the hypothesis that such infections provide protection against asthma.
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Affiliation(s)
- Haruko Takeuchi
- Department of Community and Global Health, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Md. Alfazal Khan
- Nutrition and Clinical Services DivisionInternational Centre for Diarrhoeal Disease ResearchBangladesh
| | | | - S. M. Tafsir Hasan
- Nutrition and Clinical Services DivisionInternational Centre for Diarrhoeal Disease ResearchBangladesh
| | - Md. Jahangir Alam
- Infectious Diseases DivisionInternational Centre for Diarrhoeal Disease ResearchBangladesh
| | - Sayaka Takanashi
- Department of Developmental Medical Sciences, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Samar Kumar Hore
- Centre for Equity and Health SystemInternational Centre for Diarrhoeal Disease ResearchBangladesh
| | - Sultana Yeasmin
- Infectious Diseases DivisionInternational Centre for Diarrhoeal Disease ResearchBangladesh
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Tsutomu Iwata
- Department of Education for Childcare, Faculty of Child StudiesTokyo Kasei UniversityTokyoJapan
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Vaz Nery S, Pickering AJ, Abate E, Asmare A, Barrett L, Benjamin-Chung J, Bundy DAP, Clasen T, Clements ACA, Colford JM, Ercumen A, Crowley S, Cumming O, Freeman MC, Haque R, Mengistu B, Oswald WE, Pullan RL, Oliveira RG, Einterz Owen K, Walson JL, Youya A, Brooker SJ. The role of water, sanitation and hygiene interventions in reducing soil-transmitted helminths: interpreting the evidence and identifying next steps. Parasit Vectors 2019; 12:273. [PMID: 31138266 PMCID: PMC6540378 DOI: 10.1186/s13071-019-3532-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 05/23/2019] [Indexed: 11/10/2022] Open
Abstract
The transmission soil transmitted helminths (STH) occurs via ingestion of or contact with infective stages present in soil contaminated with human faeces. It follows therefore that efforts to reduce faecal contamination of the environment should help to reduce risk of parasite exposure and improvements in water, sanitation and hygiene (WASH) are seen as essential for the long-term, sustainable control of STH. However, the link between WASH and STH is not always supported by the available evidence from randomised controlled trials, which report mixed effects of WASH intervention on infection risk. This review critically summarises the available trial evidence and offers an interpretation of the observed heterogeneity in findings. The review also discusses the implications of findings for control programmes and highlights three main issues which merit further consideration: intervention design, exposure assessment, and intervention fidelity assessment.
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Affiliation(s)
- Susana Vaz Nery
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Amy J. Pickering
- Department of Civil and Environmental Engineering, Tufts University, Medford, USA
| | - Ebba Abate
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | - Jade Benjamin-Chung
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, CA USA
| | - Donald A. P. Bundy
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Thomas Clasen
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, USA
| | | | - John M. Colford
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, CA USA
| | - Ayse Ercumen
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, CA USA
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC USA
| | | | - Oliver Cumming
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Matthew C. Freeman
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Rashidul Haque
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Birhan Mengistu
- Neglected Tropical Diseases, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - William E. Oswald
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Rachel L. Pullan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Judd L. Walson
- Department of Global Health, University of Washington, Seattle, USA
| | - Ashrafedin Youya
- Environmental Health, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Simon J. Brooker
- Global Health, Bill & Melinda Gates Foundation, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
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Ercumen A, Benjamin-Chung J, Arnold BF, Lin A, Hubbard AE, Stewart C, Rahman Z, Parvez SM, Unicomb L, Rahman M, Haque R, Colford JM, Luby SP. Effects of water, sanitation, handwashing and nutritional interventions on soil-transmitted helminth infections in young children: A cluster-randomized controlled trial in rural Bangladesh. PLoS Negl Trop Dis 2019; 13:e0007323. [PMID: 31050672 PMCID: PMC6519840 DOI: 10.1371/journal.pntd.0007323] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 05/15/2019] [Accepted: 03/22/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Soil transmitted helminths (STH) infect >1.5 billion people. Mass drug administration (MDA) effectively reduces infection; however, there is evidence for rapid reinfection and risk of potential drug resistance. We conducted a randomized controlled trial in Bangladesh (WASH Benefits, NCT01590095) to assess whether water, sanitation, hygiene and nutrition interventions, alone and combined, reduce STH in a setting with ongoing MDA. METHODOLOGY/PRINCIPAL FINDINGS In 2012-2013, we randomized 720 clusters of 5551 pregnant women into water treatment, sanitation, handwashing, combined water+sanitation+handwashing (WSH), nutrition, nutrition+WSH (N+WSH) or control arms. In 2015-2016, we enrolled 7795 children, aged 2-12 years, of 4102 available women for STH follow-up and collected stool from 7187. We enumerated STH infections with Kato-Katz. We estimated intention-to-treat intervention effects on infection prevalence and intensity. Participants and field staff were not blinded; laboratory technicians and data analysts were blinded. Prevalence among controls was 36.8% for A. lumbricoides, 9.2% for hookworm and 7.5% for T. trichiura. Most infections were low-intensity. Compared to controls, the water intervention reduced hookworm by 31% (prevalence ratio [PR] = 0.69 (0.50,0.95), prevalence difference [PD] = -2.83 (-5.16,-0.50)) but did not affect other STH. Sanitation improvements reduced T. trichiura by 29% (PR = 0.71 (0.52,0.98), PD = -2.17 (-4.03,-0.38)), had a similar borderline effect on hookworm and no effect on A. lumbricoides. Handwashing and nutrition interventions did not reduce any STH. WSH and N+WSH reduced hookworm prevalence by 29-33% (WSH: PR = 0.71 (0.52,0.99), PD = -2.63 (-4.95,-0.31); N+WSH: PR = 0.67 (0.50,0.91), PD = -3.00 (-5.14,-0.85)) and marginally reduced A. lumbricoides. Effects on infection intensity were similar. CONCLUSIONS/SIGNIFICANCE In a low-intensity infection setting with MDA, we found modest but sustained hookworm reduction from water treatment and combined WSH interventions. Impacts were more pronounced on STH species with short vs. long-term environmental survival. Our findings suggest possible waterborne transmission for hookworm. Water treatment and sanitation improvements can augment MDA to interrupt STH transmission. TRIAL REGISTRATION NCT01590095.
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Affiliation(s)
- Ayse Ercumen
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC, United States of America
- School of Public Health, University of California Berkeley, Berkeley, CA, United States of America
| | - Jade Benjamin-Chung
- School of Public Health, University of California Berkeley, Berkeley, CA, United States of America
| | - Benjamin F. Arnold
- School of Public Health, University of California Berkeley, Berkeley, CA, United States of America
| | - Audrie Lin
- School of Public Health, University of California Berkeley, Berkeley, CA, United States of America
| | - Alan E. Hubbard
- School of Public Health, University of California Berkeley, Berkeley, CA, United States of America
| | - Christine Stewart
- Department of Nutrition, University of California, Davis, CA, United States of America
| | - Zahidur Rahman
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Sarker Masud Parvez
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Leanne Unicomb
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mahbubur Rahman
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Rashidul Haque
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - John M. Colford
- School of Public Health, University of California Berkeley, Berkeley, CA, United States of America
| | - Stephen P. Luby
- Infectious Diseases & Geographic Medicine, Stanford University, Stanford, CA, United States of America
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Oyebamiji D, Ebisike A, Egede J, Hassan A. Knowledge, attitude and practice with respect to soil contamination by Soil-Transmitted Helminths in Ibadan, Southwestern Nigeria. Parasite Epidemiol Control 2018; 3:e00075. [PMID: 30306146 PMCID: PMC6171486 DOI: 10.1016/j.parepi.2018.e00075] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/18/2018] [Accepted: 09/22/2018] [Indexed: 12/23/2022] Open
Abstract
Ancylostoma duodenale, Necator americanus, Ascaris lumbricoides and Trichuris trichiura, the four major Soil-transmitted helminths (STHs) and also Strongyloides stercoralis infect humans worldwide. Most studies on Soil-transmitted helminths (STHs) carried out in Ibadan were faecal examination based while relatively few soil examination based studies were carried out mostly around school premises using limited number of sampling locations. This study was therefore designed to assess the level of soil contamination with STH and associated risk factors in the eleven local government areas of Ibadan. A total of 1980 soil samples were purposively collected monthly, between January and December 2017, from toilet areas, refuse dump sites, house vicinities, playgrounds, roadsides/walk ways, and examined for the presence of parasite eggs or larvae using automated analysis of light microscopy images by computer. Well-structured questionnaires were administered to 620 consenting participants to obtain information on the Knowledge of STH infections, Attitudes and Practices towards the infections. Data were analyzed using SPSS version 21, Chi-square and ANOVA were used in the analysis at p < 0.05. Out of soil samples examined, 1087 (54.9%) had at least one species of parasite. The prevalence of hookworm was 74.5% followed by 50.2% and 37.2% for Strongyloides species larvae and adult respectively, and 25.1% for Ascaris species. The highest prevalence was observed in the refuse dump (74.2%) followed by toilet area (36.5%) while the lowest was at house vicinities (1.6%). Fifty-seven percent of the respondents use pit latrine while 20.6% still practice open defecation. A high transmission risk was observed as large percentage (66.8%) of the respondents showed inadequate knowledge of how to avoid STH infections. Moreover, 64.0% and 25.2% reported that they often walk barefooted and suck fingers respectively. The high prevalence of parasitic contamination of soil observed in the present study and the high proportion of respondent with inadequate knowledge of how to prevent transmission of STH pose a high risk of re-infections in the study area even after treatment. Therefore there is a need for proper education on parasite transmission in the area.
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Affiliation(s)
- D.A. Oyebamiji
- Parasitology Unit, Department of Zoology, Faculty of Science, University of Ibadan, Oyo State, Nigeria
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Marocco C, Bangert M, Joseph SA, Fitzpatrick C, Montresor A. Preventive chemotherapy in one year reduces by over 80% the number of individuals with soil-transmitted helminthiases causing morbidity: results from meta-analysis. Trans R Soc Trop Med Hyg 2018; 111:12-17. [PMID: 28340144 DOI: 10.1093/trstmh/trx011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/08/2017] [Indexed: 11/13/2022] Open
Abstract
The morbidity due to Ascaris lumbricoides and Trichuris trichiura is caused by infections of moderate and heavy intensity while hookworm infections of all intensities are recognized to cause morbidity. This study aims to evaluate the effect of repeated rounds of preventive chemotherapy on the proportion of soil-transmitted helminth (STH) infections causing morbidity. We identified studies from 17 countries, reporting changes in the proportion of STH infection causing morbidity between baseline and follow-up. In the studies identified, the average proportion of individuals with STH infections of moderate and heavy intensity was of 14% at baseline and was on average reduced to 2% by the intervention (i.e., 85% reduction). There was an average reduction of 73% after the first year of treatment, which reached almost 80% after 5 years and over 95% in 10 years of deworming interventions. The reduction in hookworm prevalence was 57% after 12 months reaching 78% after 5 years. We consider the results presented in this study especially useful for decision makers as it demonstrates the effectiveness of preventive chemotherapy in reducing STH prevalence and morbidity. We encourage the implementation of deworming programs to achieve the goal, set by WHO for 2020, to eliminate STH morbidity in children.
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Affiliation(s)
- Chiara Marocco
- Department of Control of Neglected Tropical Diseases, World Health Organization ,Geneva, Switzerland
| | - Mathieu Bangert
- Department of Control of Neglected Tropical Diseases, World Health Organization ,Geneva, Switzerland
| | - Serene A Joseph
- Department of Control of Neglected Tropical Diseases, World Health Organization,Geneva, Switzerland.,Department of Public Health and Epidemiology, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Christopher Fitzpatrick
- Department of Control of Neglected Tropical Diseases, World Health Organization ,Geneva, Switzerland
| | - Antonio Montresor
- Department of Control of Neglected Tropical Diseases, World Health Organization ,Geneva, Switzerland
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Nath TC, Padmawati RS, Alam MS, Das S, Murhandarwati EH. Elimination of soil-transmitted helminthiasis infection in Bangladesh: Knowledge, attitudes, and practices regarding mass drug administration. JOURNAL OF GLOBAL HEALTH REPORTS 2018. [DOI: 10.29392/joghr.2.e2018001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Nath TC, Padmawati RS, Alam MS, Das S, Murhandarwati EH. Elimination of soil-transmitted helminthiasis infection in Bangladesh: Knowledge, attitudes, and practices regarding mass drug administration. JOURNAL OF GLOBAL HEALTH REPORTS 2018. [DOI: 10.29392/joghr.2.e2018017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Baker JM, Trinies V, Bronzan RN, Dorkenoo AM, Garn JV, Sognikin S, Freeman MC. The associations between water and sanitation and hookworm infection using cross-sectional data from Togo's national deworming program. PLoS Negl Trop Dis 2018; 12:e0006374. [PMID: 29590120 PMCID: PMC5902041 DOI: 10.1371/journal.pntd.0006374] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 04/16/2018] [Accepted: 03/07/2018] [Indexed: 02/04/2023] Open
Abstract
Background Sustainable control of soil-transmitted helminths requires a combination of chemotherapy treatment and environmental interventions, including access to safe drinking water, sufficient water for hygiene, use of clean sanitation facilities, and handwashing (WASH). We quantified associations between home-, school-, and community-level WASH characteristics and hookworm infection—both prevalence and eggs per gram of stool (intensity)—among Togolese school children in the context of community-based chemotherapy treatments administered in the country from 2010 through 2014. Methodology/Principal findings We analyzed data from two surveys conducted by the Togo Ministry of Health: a school-based survey of students aged 6–9 years across Togo conducted in 2009 and a follow-up survey in 2015, after four to five years of preventive chemotherapy. Data were available for 16,473 students attending 1,129 schools in 2009 and for 16,890 students from 1,126 schools in 2015. Between surveys, children in study schools received 0 to 8 rounds of deworming chemotherapy treatments. Few WASH conditions (only unimproved drinking water) were found to be significantly associated with the presence or absence of hookworms in an individual; however, quantitative eggs per gram of feces was associated with availability of unimproved drinking water, availability of improved drinking water either on or off school grounds, having a handwashing station with water available, and access to a sex-separate non-private or private latrine. The association between school WASH conditions and hookworm infection or burden often depended on the 2009 prevalence of infection, as more WASH characteristics were found to be significant predictors of infection among schools with high underlying endemicity of hookworm. Conclusions/Significance Our findings emphasize the complex and often inconsistent or unpredictable relationship between WASH and hookworm. Specifically, we found that while preventive chemotherapy appeared to dramatically reduce hookworm infection, WASH was associated with infection intensity. Preventive chemotherapy plays a critical role in breaking transmission of soil-transmitted helminths but it is likely that sustainable control of soil-transmitted helminths will require environmental improvements such as access to water for hygiene and hygienic sanitation, access to and use of a clean toilet facility, and handwashing with soap at key times (WASH). Here, we report on school-, home- and community-level WASH and the relationship of these characteristics with the prevalence and intensity of hookworm infection, one of the most prevalent soil-transmitted helminths, observed in the context of preventive chemotherapy among Togolese school children. In this large, country-wide assessment, few WASH conditions were found to be significant predictors of the presence or absence of hookworms in an individual, however, intensity of infection was associated with several WASH characteristics. Our analysis emphasizes the complex and often unpredictable role of WASH characteristics on hookworm, particularly relevant for Togolese and other international policy makers aiming to understand the interaction between WASH, preventive chemotherapy and hookworm. Further research taking into account not only WASH conditions but also use of WASH resources and practices would further strengthen our understanding of the interaction between WASH and deworming treatment as effective hookworm control strategies.
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Affiliation(s)
- Julia M. Baker
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Victoria Trinies
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta Georgia, United States of America
| | - Rachel N. Bronzan
- Health and Development International, Newburyport, Massachussetts, United States of America
| | | | - Joshua V. Garn
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta Georgia, United States of America
| | - Sêvi Sognikin
- Ministère de la Santé et de la Protection Sociale, Lomé, Togo
| | - Matthew C. Freeman
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta Georgia, United States of America
- * E-mail:
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Rivero MR, De Angelo C, Nuñez P, Salas M, Motta CE, Chiaretta A, Salomón OD, Liang S. Environmental and socio-demographic individual, family and neighborhood factors associated with children intestinal parasitoses at Iguazú, in the subtropical northern border of Argentina. PLoS Negl Trop Dis 2017; 11:e0006098. [PMID: 29155829 PMCID: PMC5714390 DOI: 10.1371/journal.pntd.0006098] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 12/04/2017] [Accepted: 11/05/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Intestinal parasitoses are a major concern for public health, especially in children from middle and low-income populations of tropical and subtropical areas. We examined the presence and co-infection of parasites in humans as well as parasitic environmental contamination in Puerto Iguazú, Argentina. We explored the environmental and socio-demographic characteristics of the persistence of parasites in children and their environment. METHODOLOGY/PRINCIPAL FINDINGS This cross-section survey was conducted among children population comprised into the area of the public health care centers of Iguazú during June 2013 to May 2016. Copro-parasitological status of 483 asymptomatic children was assessed. Simultaneously, a design-based sampling of 744 soil samples and 530 dog feces was used for characterize the environmental contamination. The 71.5% of these sites were contaminated. Sixteen genera were detected in the environment being hookworms (62.0%) the main pathogens group detected followed by Toxocara spp (16.3%), Trichuris spp (15.2%) and Giardia (6.5%). Total children prevalence raised 58.8%, detecting twelve genera of parasite with Giardia intestinalis as the most prevalent pathogen (29.0%) followed by Enterobius vermicularis (23.0%), Hymenolepis nana (12.4%) and hookworms (4.4%). Through questionnaires and census data, we characterized the socio-demographics conditions at an individual, family and neighborhood levels. A multi-level analysis including environmental contamination data showed that the ´presence of parasites´ was mostly determined by individual (e.g. age, playing habits, previous treatment) and household level (e.g. UBN, WASH, mother's literacy) determinants. Remarkably, to define the level of 'parasite co-infection', besides individual and household characteristics, environmental factors at a neighborhood level were important. CONCLUSION/SIGNIFICANCE Our work represents the major survey of intestinal parasites in human and environmental samples developed in the region. High prevalence was detected in the children population as well as in their environment. This work shows the importance of considering and promoting multi-level actions over the identified determinants to face this public health problem from integrative approaches.
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Affiliation(s)
- Maria Romina Rivero
- Instituto Nacional de Medicina Tropical, INMeT. Ministerio de Salud de la Nación. Puerto Iguazú, Misiones. Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET. Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Carlos De Angelo
- Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET. Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
- Instituto de Biología Subtropical (IBS, UNaM-CONICET). Puerto Iguazú, Misiones. Argentina
- Assoc. Civil Centro de Investigaciones del Bosque Atlántico (CeIBA). Puerto Iguazú, Misiones. Argentina
| | - Pablo Nuñez
- Instituto Nacional de Medicina Tropical, INMeT. Ministerio de Salud de la Nación. Puerto Iguazú, Misiones. Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET. Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Martín Salas
- Instituto Nacional de Medicina Tropical, INMeT. Ministerio de Salud de la Nación. Puerto Iguazú, Misiones. Argentina
| | - Carlos E. Motta
- Departamento de Patología Animal, Facultad de Agronomía y Veterinaria, Universidad Nacional de Rio Cuarto. Rio Cuarto, Córdoba. Argentina
| | - Alicia Chiaretta
- Departamento de Patología Animal, Facultad de Agronomía y Veterinaria, Universidad Nacional de Rio Cuarto. Rio Cuarto, Córdoba. Argentina
| | - Oscar D. Salomón
- Instituto Nacional de Medicina Tropical, INMeT. Ministerio de Salud de la Nación. Puerto Iguazú, Misiones. Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET. Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Song Liang
- Department of Environmental and Global Health, University of Florida, Gainesville, Florida, United States of America
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
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Campbell SJ, Biritwum NK, Woods G, Velleman Y, Fleming F, Stothard JR. Tailoring Water, Sanitation, and Hygiene (WASH) Targets for Soil-Transmitted Helminthiasis and Schistosomiasis Control. Trends Parasitol 2017; 34:53-63. [PMID: 29055522 DOI: 10.1016/j.pt.2017.09.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 09/22/2017] [Accepted: 09/25/2017] [Indexed: 12/17/2022]
Abstract
The World Health Organization's (WHO) 2015-2020 Global Strategy on water, sanitation, and hygiene (WASH) and neglected tropical diseases (NTDs) encourages integration, whilst maintaining existing structured NTD investments, and acceleration towards Sustainable Development Goal (SDG) targets. Accordingly, SDG-associated and WASH-NTD indicators have been developed, commencing important intersectoral dialogue, alongside opportunities for future disease-specific refinements. The rationale for soil-transmitted helminthiasis (STH)- and schistosomiasis-specific WASH considerations, and a traffic-light figure, are presented here to indicate where current international definitions may, or may not, suffice. Certain unique aspects in control dynamics and parasitic lifecycles, however, necessitate additional implementation research with more appropriate measurement indicators developed to record programmatic interventions and to define strategic priorities more effectively.
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Affiliation(s)
- Suzy J Campbell
- Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK; Present address: Deworm the World Initiative, Evidence Action, Brisbane, 4020, Australia.
| | - Nana-Kwadwo Biritwum
- National Neglected Tropical Disease Control Programme, Ghana Health Services, Accra, Ghana
| | | | | | - Fiona Fleming
- Schistosomiasis Control Initiative, Imperial College, London, W2 1PG, UK
| | - J Russell Stothard
- Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
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A´sbjo¨rnsdo´ttir KH, Means AR, Werkman M, Walson JL. Prospects for elimination of soil-transmitted helminths. Curr Opin Infect Dis 2017; 30:482-488. [PMID: 28700363 PMCID: PMC7680933 DOI: 10.1097/qco.0000000000000395] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Soil-transmitted helminths (STH) are endemic in 120 countries and are associated with substantial morbidity and loss of economic productivity. Although current WHO guidelines focus on morbidity control through mass drug administration (MDA), there is global interest in whether a strategy targeting disease elimination might be feasible in some settings. This review summarizes the prospects for switching from control to an elimination strategy. RECENT FINDINGS STH control efforts have reduced the intensity of infections in targeted populations with associated reductions in morbidity. However, adults are not frequently targeted and remain important reservoirs for reinfection of treated children. Recent modeling suggests that transmission interruption may be possible through expanded community-wide delivery of MDA, the feasibility of which has been demonstrated by other programs. However, these models suggest that high levels of coverage and compliance must be achieved. Potential challenges include the risk of prematurely dismantling STH programs and the potential increased risk of antihelminthic resistance. SUMMARY Elimination of STH may offer an opportunity to eliminate substantial STH-related morbidity while reducing resource needs of neglected tropical disease programs. Evidence from large community trials is needed to determine the feasibility of interrupting the transmission of STH in some geographic settings.
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Affiliation(s)
- Kristjana H. A´sbjo¨rnsdo´ttir
- DeWorm3, The Natural History Museum, London, UK
- Department of Global Health, University of Washington, Seattle, Washington, USA and
| | - Arianna R. Means
- DeWorm3, The Natural History Museum, London, UK
- Department of Global Health, University of Washington, Seattle, Washington, USA and
| | - Marleen Werkman
- DeWorm3, The Natural History Museum, London, UK
- Department of Infectious Disease Epidemiology, London Centre for Neglected Tropical Disease Research (LCNTDR), St. Mary’s Campus, Imperial College London, London, UK
| | - Judd L. Walson
- DeWorm3, The Natural History Museum, London, UK
- Department of Global Health, University of Washington, Seattle, Washington, USA and
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The Mini-FLOTAC technique for the diagnosis of helminth and protozoan infections in humans and animals. Nat Protoc 2017; 12:1723-1732. [PMID: 28771238 DOI: 10.1038/nprot.2017.067] [Citation(s) in RCA: 157] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This protocol is an extension to: Nat. Protoc. 5, 503-515 (2010); doi: 10.1038/nprot.2009.235; published online 25 February 2010The FLOTAC is a sensitive, accurate, and precise technique for the diagnosis of protozoan and helminth infections in humans and animals. However, it requires centrifugation, and hence might be out of reach in resource-constrained settings. As an extension of the original FLOTAC protocol, this protocol describes the Mini-FLOTAC technique, a logical evolution of FLOTAC conceived to perform multivalent, qualitative, and quantitative diagnosis of helminth and protozoan infections in human and animal feces, and urine. This has been found to be of most use in the processing of large numbers of samples with rapid laboratory workup, and for veterinary applications directly on-farm. In addition to the Mini-FLOTAC apparatus, we describe the use of the Fill-FLOTAC, a closed system used to facilitate the performance of the first four consecutive steps of the Mini-FLOTAC technique: fecal sample collection and weighing, homogenization, filtration, and filling of the Mini-FLOTAC chambers. Processing of an individual sample using this protocol requires ∼12 min.
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Taiwo OT, Sam-Wobo SO, Idowu OA, Talabi AO, Taiwo AM. Comparative assessment of intestinal helminths prevalence in Water, Sanitation and Hygiene (WASH) intervention and non-intervention communities in Abeokuta, Nigeria. Asian Pac J Trop Biomed 2017. [DOI: 10.1016/j.apjtb.2017.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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