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Means AR, Ásbjörnsdóttir KH, Sharrock KC, Galagan SR, Aruldas K, Avokpaho E, Chabi F, Halliday KE, Houngbegnon P, Israel GJ, Kaliappan SP, Kennedy D, Legge H, Oswald WE, Palanisamy G, Rogers E, Timothy J, Pearman E, Ramesh RM, Simwanza J, Sheik-Abdullah JF, Sheikh M, Togbevi CI, Witek-McManus S, Pullan RL, Bailey R, Kalua K, Ibikounlé M, Luty AJF, Ajjampur SSR, Walson JL. Coverage of community-wide mass drug administration platforms for soil-transmitted helminths in Benin, India, and Malawi: findings from the DeWorm3 project. Infect Dis Poverty 2024; 13:72. [PMID: 39380086 PMCID: PMC11460046 DOI: 10.1186/s40249-024-01241-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 09/12/2024] [Indexed: 10/10/2024] Open
Abstract
BACKGROUND Soil-transmitted helminths (STH) affect approximately 1.5 billion people globally. The current STH control strategy is annual or twice-annual preventive chemotherapy, typically school-based deworming targeting children and women of reproductive age. Mathematical modeling suggests that it may be possible to interrupt STH transmission through high-coverage community-wide mass drug administration (cMDA). DeWorm3 is a cluster randomized trial testing cMDA for prevalence reduction and transmission interruption. The purpose of this study is to describe coverage of cMDA in study clusters over time and correlates of coverage at individual and cluster levels. METHODS From 2018-2020, DeWorm3 delivered six rounds of cMDA with 400 mg albendazole at sites in Benin, India, and Malawi. We report coverage, treatment uptake, and directly observed therapy across all rounds. Factors associated with coverage at the cluster level were identified using binomial generalized estimating equations, while factors associated with non-treatment at the individual level were identified using binomial mixed-effects models. RESULTS Coverage was high across all clusters and rounds, exceeding the WHO target of 75% in all sites and across all rounds (78% to 95%); cluster-level coverage tended to increase over time. Younger, unmarried, and migratory adults were more likely to be untreated at all sites; adult males were more likely to be untreated in Benin and Malawi. Among children, girls were more likely to be untreated, as were non-school-attending and migratory children. Higher adult education was associated with greater odds of non-treatment among adults, but lower odds among children in the household. Belonging to a less wealthy or minority language-speaking household was associated with non-treatment among both adults and children. CONCLUSIONS It is possible to deliver community-wide MDA with high coverage. Unique individual and community-level factors influence treatment across settings, and these may be addressed through targeted programming. TRIAL REGISTRATION Field Studies on the Feasibility of Interrupting the Transmission of Soil-transmitted Helminths (STH), NCT03014167.
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Affiliation(s)
- Arianna Rubin Means
- Department of Global Health, University of Washington, Seattle, Washington, USA.
- The DeWorm3 Project, University of Washington, Seattle, Washington, USA.
| | - Kristjana Hrönn Ásbjörnsdóttir
- Centre of Public Health Sciences, University of Iceland, Reykjavík, Iceland
- The DeWorm3 Project, University of Washington, Seattle, Washington, USA
| | - Katherine C Sharrock
- Department of Global Health, University of Washington, Seattle, Washington, USA
- The DeWorm3 Project, University of Washington, Seattle, Washington, USA
| | - Sean R Galagan
- Department of Global Health, University of Washington, Seattle, Washington, USA
- The DeWorm3 Project, University of Washington, Seattle, Washington, USA
| | - Kumudha Aruldas
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | | | - Félicien Chabi
- Institut de Recherche Clinique du Bénin, Abomey-Calavi, Bénin
| | - Katherine E Halliday
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Gideon John Israel
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | | | - David Kennedy
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Hugo Legge
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - William E Oswald
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Global Health Division, International Development Group, Research Triangle Institute (RTI) International, Research Triangle Park, NC, USA
| | - Gokila Palanisamy
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Elliott Rogers
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Division of Medicine, University College London, London, UK
| | - Joseph Timothy
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Emily Pearman
- The DeWorm3 Project, University of Washington, Seattle, Washington, USA
| | - Rohan Michael Ramesh
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - James Simwanza
- Blantyre Institute for Community Outreach, Lions Sight First Eye Hospital, Blantyre, Malawi
| | - Jasmine Farzana Sheik-Abdullah
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Mariyam Sheikh
- Department of Global Health, University of Washington, Seattle, Washington, USA
- The DeWorm3 Project, University of Washington, Seattle, Washington, USA
| | | | - Stefan Witek-McManus
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rachel L Pullan
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Robin Bailey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Blantyre Institute for Community Outreach, Lions Sight First Eye Hospital, Blantyre, Malawi
| | - Khumbo Kalua
- Blantyre Institute for Community Outreach, Lions Sight First Eye Hospital, Blantyre, Malawi
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Moudachirou Ibikounlé
- Institut de Recherche Clinique du Bénin, Abomey-Calavi, Bénin
- Tropical Infectious Diseases Research Center (TIDRC)Université d'Abomey-Calavi, Abomey-Calavi, Bénin
| | - Adrian J F Luty
- Université Paris Cité, Institut de Recherche pour le Développement, MERIT, Paris, F-75006, France
| | - Sitara S R Ajjampur
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Judd L Walson
- The DeWorm3 Project, University of Washington, Seattle, Washington, USA
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Gilmour B, Wangdi K, Restrepo AC, Tsheten T, Kelly M, Clements A, Gray D, Lau C, Espino FE, Daga C, Mapalo V, Vaz Nery S, Bartlett A, Gebreyohannes EA, Alene KA. Protocol for spatial prediction of soil transmitted helminth prevalence in the Western Pacific region using a meta-analytical approach. Syst Rev 2024; 13:55. [PMID: 38321560 PMCID: PMC10845450 DOI: 10.1186/s13643-024-02469-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 01/25/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Soil transmitted helminth (STH) infections are estimated to impact 24% of the world's population and are responsible for chronic and debilitating morbidity. Disadvantaged communities are among the worst affected and are further marginalized as infection prevalence fuels the poverty cycle. Ambitious targets have been set to eliminate STH infections, but accurate epidemiological data will be required to inform appropriate interventions. This paper details the protocol for an analysis that aims to produce spatial prediction mapping of STH prevalence in the Western Pacific Region (WPR). METHODS The protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol (PRISMA-P) guidelines. The study design will combine the principles of systematic review, meta-analysis, and geospatial analysis. Systematic searches will be undertaken in PubMed, Scopus, ProQuest, Embase, and Web of Science for studies undertaken post 2000, to identify surveys that enable the prevalence of human STH infection within the WPR to be calculated. Covariate data for multivariable analysis will be obtained from publicly accessible sources. Survey data will be geolocated, and STH prevalence and covariates will be linked to produce a spatially referenced dataset for analysis. Bayesian model-based geostatistics will be used to generate spatially continuous estimates of STH prevalence mapped to a resolution of 1 km2. A separate geospatial model will be constructed for each STH species. Predictions of prevalence will be made for unsampled locations and maps will be overlaid for each STH species to obtain co-endemicity maps. DISCUSSION This protocol facilitates study replication and may be applied to other infectious diseases or alternate geographies. Results of the subsequent analysis will identify geographies with high STH prevalence's and can be used to inform resource allocation in combating this neglected tropical disease. TRIAL REGISTRATION Open Science Framework: osf.io/qmxcj.
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Affiliation(s)
- Beth Gilmour
- School of Population Health, Faculty of Health Sciences, Curtin University, Kent St, Bentley WA, Western Australia, 6102, Australia.
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, West Perth, Western Australia, Australia.
| | | | | | | | | | - Archie Clements
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, West Perth, Western Australia, Australia
- Queen's University, Belfast, Northern Ireland
| | - Darren Gray
- Australia National University, Canberra, Australia
| | - Colleen Lau
- The University of Queensland, Brisbane, Australia
| | | | - Chona Daga
- Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | - Vanessa Mapalo
- Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | - Susana Vaz Nery
- The Kirby Institute, University of New South Wales, Kensington, Australia
| | - Adam Bartlett
- The Kirby Institute, University of New South Wales, Kensington, Australia
| | | | - Kefyalew Addis Alene
- School of Population Health, Faculty of Health Sciences, Curtin University, Kent St, Bentley WA, Western Australia, 6102, Australia
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, West Perth, Western Australia, Australia
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Means AR, List K, Roll A, Gwayi-Chore MC, Dolley S, Schünemann HJ, Norman TC, Walson JL. Participatory development of a target policy profile to support soil-transmitted helminth elimination. FRONTIERS IN HEALTH SERVICES 2024; 3:1310694. [PMID: 38313331 PMCID: PMC10836137 DOI: 10.3389/frhs.2023.1310694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/21/2023] [Indexed: 02/06/2024]
Abstract
Introduction Soil-transmitted helminths (STH) are parasitic worms that infect nearly a quarter of the world's population, particularly those living in communities without access to adequate water, sanitation, and housing. Emerging evidence suggests that it may be possible to interrupt transmission of STH by deworming individuals of all ages via community-wide MDA (cMDA), as opposed to only treating children and other focal populations. Transitioning from a policy of STH control to STH elimination in targeted areas would require a fundamental shift in STH policy and programming. This policy change would require updated guidance to support countries as they adapt their current approaches for STH surveillance, supply chain management, community mobilization, and core programmatic activities in pursuit of STH elimination. There is an opportunity to engage with key stakeholders, such as program implementers and implementation partners, to understand what evidence they need to confidently adopt a new policy guideline and to deliver guideline adherent management at scale. Methods We aimed to engage with STH stakeholders to develop a Target Policy Profile (TPoP), a single document that describes optimal characteristics and evidence requirements that STH stakeholders prioritized in future potential STH transmission interruption efforts. Steps in TPoP development included a scoping review and key informant interviews (KIIs), which were used to design a two-stage Delphi technique to identify and verify TPoP components. Results The scoping review resulted in 25 articles, and 8 experts participated in KII's. Twenty respondents completed the first Delphi survey and 10 respondents completed the second. This systematic effort resulted in a net of 3 key information domains (background/context, clinical considerations, and implementation considerations) encompassing 24 evidence categories (examples include evidence regarding safety and adverse events, implementation feasibility, or evidence dissemination). For each evidence category, STH stakeholders reviewed, endorsed, or revised a range of options for how the evidence could be presented. Discussion This information can be used by guideline committees or global policy makers prior to convening guideline advisory groups. The TPoP tool may also speed the process of stakeholder consensus building around guidelines, accelerating progress towards implementing evidence-based policy at scale.
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Affiliation(s)
- Arianna Rubin Means
- Department of Global Health, University of Washington, Seattle, WA, United States
- The DeWorm3 Project, University of Washington, Seattle, WA, United States
| | - Kellie List
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Amy Roll
- Department of Global Health, University of Washington, Seattle, WA, United States
- The DeWorm3 Project, University of Washington, Seattle, WA, United States
| | - Marie-Claire Gwayi-Chore
- Department of Global Health, University of Washington, Seattle, WA, United States
- The DeWorm3 Project, University of Washington, Seattle, WA, United States
| | - Shawn Dolley
- Open Global Health, Arlington, VA, United States
| | - Holger J. Schünemann
- Departmentof Health Research Methods, Evidence, and Impact, and of Medicine, McMaster University, Hamilton, ON, Canada
- McMaster GRADE Centre & Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Thea C. Norman
- Bill & Melinda Gates Foundation, Seattle, WA, United States
| | - Judd L. Walson
- Department of Global Health, University of Washington, Seattle, WA, United States
- The DeWorm3 Project, University of Washington, Seattle, WA, United States
- Departments of Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle, WA, United States
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Ellwanger JH, Ziliotto M, Kulmann-Leal B, Chies JAB. Iron deficiency and soil-transmitted helminth infection: classic and neglected connections. Parasitol Res 2022; 121:3381-3392. [PMID: 36258094 DOI: 10.1007/s00436-022-07697-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/14/2022] [Indexed: 10/24/2022]
Abstract
Beyond participating in the oxygen transport by red blood cells, iron is an essential micronutrient and contributes to different physiological pathways and processes, such as cell proliferation, DNA repair, and other homeostatic functions. Iron deficiency affects millions of people, especially children and pregnant women. The consequences of iron deficiency are diverse, including inadequate child development, impaired cognition, and reduced productivity. Several factors contribute to iron deficiency, such as iron-poor diet, genetic factors, and infection with soil-transmitted helminths (STHs), especially roundworms (Ascaris lumbricoides), hookworms (Necator americanus and Ancylostoma duodenale), and whipworms (Trichuris trichiura). This review updates and summarizes the role of STHs as drivers of iron deficiency. Also, the poorly explored connections between STH infection, geophagia (a pica manifestation), immune response, and iron deficiency are discussed, highlighting how iron deficiency may act as a risk factor for infections by STHs, in addition to being a consequence of intestinal parasitic infections. Finally, strategies for control and management of iron deficiency and STH infection are described.
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Affiliation(s)
- Joel Henrique Ellwanger
- Laboratory of Immunobiology and Immunogenetics (Prédio 43323, Laboratório 212), Department of Genetics, Postgraduate Program in Genetics and Molecular Biology (PPGBM), Instituto de Biociências, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Bento Gonçalves, 9500, Campus do Vale, Rio Grande do Sul, Porto Alegre, Brazil.
| | - Marina Ziliotto
- Laboratory of Immunobiology and Immunogenetics (Prédio 43323, Laboratório 212), Department of Genetics, Postgraduate Program in Genetics and Molecular Biology (PPGBM), Instituto de Biociências, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Bento Gonçalves, 9500, Campus do Vale, Rio Grande do Sul, Porto Alegre, Brazil
| | - Bruna Kulmann-Leal
- Laboratory of Immunobiology and Immunogenetics (Prédio 43323, Laboratório 212), Department of Genetics, Postgraduate Program in Genetics and Molecular Biology (PPGBM), Instituto de Biociências, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Bento Gonçalves, 9500, Campus do Vale, Rio Grande do Sul, Porto Alegre, Brazil
| | - José Artur Bogo Chies
- Laboratory of Immunobiology and Immunogenetics (Prédio 43323, Laboratório 212), Department of Genetics, Postgraduate Program in Genetics and Molecular Biology (PPGBM), Instituto de Biociências, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Bento Gonçalves, 9500, Campus do Vale, Rio Grande do Sul, Porto Alegre, Brazil
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Saboyá-Díaz MI, Carey Angeles CA, Avellaneda Yajahuanca RDS, Meléndez Ruíz SK, Cabrera R, Honorio Morales HA, Pachas PE, Guardo M, Renneker KK, Muñoz BE, West SK. Associated factors of the co-occurrence of trachoma and soil-transmitted helminthiases in children 1 to 9 years old in rural communities of the Amazon basin in Loreto Department, Peru: Results from a population-based survey. PLoS Negl Trop Dis 2022; 16:e0010532. [PMID: 35877683 PMCID: PMC9312473 DOI: 10.1371/journal.pntd.0010532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 05/24/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is evidence of the occurrence of trachoma in Peru, and studies have shown that soil-transmitted helminthiases (STH) are affecting rural communities in the Amazon basin in Loreto Department. This study was done to estimate trachoma prevalence, STH prevalence, and the associated factors for both diseases in children aged 1-9 years in rural communities of Peru. METHODOLOGY A population-based cross-sectional survey was carried out in rural communities of Loreto. A standardized survey questionnaire with individual and household risk factors related to both diseases was used. Ocular examination was done for all participants aged one year and above, and eye swab samples were collected from children with follicular trachoma (TF). Anthropometric measurements, stool samples for STH, and blood samples for hemoglobin measurement were taken from children. PRINCIPAL FINDINGS TF prevalence was 7.74% (95% CI 5.08-11.63%), STH prevalence was 49.49% (95% CI 25.00-52.43%), and prevalence of co-occurrence of both diseases was 5.06% (95% CI 2.80-8.98%) in children aged 1-9 years. Being at age 3-8 years old (AOR = 6.76; 95% CI 1.346-33.947), have an unclean face (AOR = 24.64; 95% CI 6.787-89.444), and having been dewormed in the last six months (AOR = 2.47; 95% CI 1.106-5.514), were risk factors of TF. Being a female (AOR = 0.22; 95% CI 0.103-0.457) was associated with decreased odds of TF. Having been dewormed in the last six months (AOR = 0.30; 95% CI 0.139-0.628) was a preventative factor for STH. Risk factors for children with both diseases mirrored the findings for risk factors for individual diseases. CONCLUSIONS Neglected tropical diseases and associated risk factors overlap in communities living in vulnerable conditions in the Amazon basin of Peru. These findings support the need to implement integrated interventions, including mass drug administration, water, sanitation, and hygiene for both diseases in the study area.
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Affiliation(s)
- Martha Idalí Saboyá-Díaz
- Communicable Diseases and Environmental Determinants of Health Department, Pan American Health Organization, Washington, District of Columbia, United States of America
| | | | | | | | | | | | - Paul E. Pachas
- National Center of Public Health, National Institute of Health of Peru, Lima, Peru
| | - Monica Guardo
- Health Surveillance, Disease Prevention, and Control, Pan American Health Organization, Guatemala City, Guatemala
| | - Kristen K. Renneker
- International Trachoma Initiative, The Task Force for Global Health, Decatur, Georgia, United States of America
| | - Beatriz E. Muñoz
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Sheila K. West
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America
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Ganguly S, Barkataki S, Sanga P, Boopathi K, Kanagasabai K, Devika S, Karmakar S, Chowdhury P, Sarkar R, Raj D, James L, Dutta S, Campbell SJ, Murhekar M. Epidemiology of Soil-Transmitted Helminth Infections among Primary School Children in the States of Chhattisgarh, Telangana, and Tripura, India, 2015-2016. Am J Trop Med Hyg 2022; 107:tpmd211185. [PMID: 35576946 PMCID: PMC9294677 DOI: 10.4269/ajtmh.21-1185] [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: 11/13/2021] [Accepted: 02/09/2022] [Indexed: 11/19/2022] Open
Abstract
Soil-transmitted helminth (STH) infections are highly prevalent in many developing countries, affecting the poorest and most deprived communities. We conducted school-based surveys among children studying in first to fifth standard in government schools in the Indian States of Chhattisgarh, Telangana, and Tripura to estimate the prevalence and intensity of STH infections during November 2015 and January 2016. We adopted a two-stage cluster sampling design, with a random selection of districts within each agro-climatic zone in the first stage. In the second stage, government primary schools were selected by probability proportional to size method from the selected districts. We collected information about demographic details, water, sanitation, and hygiene (WASH) characteristics and stool samples from the school children. Stool samples were tested using Kato-Katz method. Stool samples from 3,313 school children (Chhattisgarh: 1,442, Telangana: 1,443, and Tripura: 428) were examined. The overall prevalence of any STH infection was 80.2% (95% confidence interval [CI]: 73.3-85.7) in Chhattisgarh, 60.7% (95% CI: 53.8-67.2) in Telangana, and 59.8% (95% CI: 49.0-69.7) in Tripura. Ascaris lumbricoides was the most prevalent STH infection in all three states. Most of the STH infections were of light intensity. Our study findings indicate that STH infections were highly prevalent among the school children in Chhattisgarh, Telangana, and Tripura, indicating the need for strengthening STH control program in these states. The prevalence estimates from the survey would serve as a baseline for documenting the impact of the National Deworming Day programs in these states.
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Affiliation(s)
- Sandipan Ganguly
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | | | - K. Boopathi
- ICMR-National Institute of Epidemiology, Chennai, India
| | | | | | - Sumallya Karmakar
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Punam Chowdhury
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Rituparna Sarkar
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Dibyendu Raj
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | - Shanta Dutta
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Suzy J. Campbell
- Deworm the World Initiative, Evidence Action, Brisbane, Australia
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Mationg MLS, Williams GM, Tallo VL, Olveda RM, Aung E, Alday P, Reñosa MD, Daga CM, Landicho J, Demonteverde MP, Santos ED, Bravo TA, Bieri FA, Li Y, Clements ACA, Steinmann P, Halton K, Stewart DE, McManus DP, Gray DJ. Soil-transmitted helminth infections and nutritional indices among Filipino schoolchildren. PLoS Negl Trop Dis 2021; 15:e0010008. [PMID: 34936644 PMCID: PMC8694453 DOI: 10.1371/journal.pntd.0010008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/19/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Soil-transmitted helminth (STH) infections are still prevalent among schoolchildren in the Philippines. We evaluated the risk factors associated with STH and the relationship between STH and nutritional indices among schoolchildren aged 9-10 years in Laguna province, the Philippines. METHODS We used the baseline data from 40 schools enrolled in a randomised controlled trial of the Magic Glasses Philippines health education package. Data on demographic and socio-economic variables, and STH related knowledge, attitudes and practices, were obtained through a questionnaire. Stool samples were collected and assessed for STH egg presence using the Kato-Katz technique. Haemoglobin levels and height and weight of study participants were also determined. The generalized estimating equations approach was used to construct logistic regression models to assess STH-associated risk factors, and the association between any STH infection and anaemia, child stunting, wasting and being underweight. The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12616000508471). FINDINGS Among 1,689 schoolchildren, the prevalence of any STH was 23%. The prevalence of anaemia, stunting, being underweight and wasting was 13%, 20.2%, 19% and 9.5%, respectively. Age, socio-economic status, rural/urban classification of schools and knowledge of STH were significant risk factors for acquiring a STH infection. Moreover, infections with any STH were significantly associated with stunting (P = <0.001) and being underweight (P = <0.003), but not wasting (P = 0.375) or anaemia (P = 0.462) after controlling for confounding covariates. CONCLUSION The study findings emphasise the need for sustainable deworming in tandem with other measures such as the provision of health education, improvements in sanitation and hygiene, and nutritional programs in order to control STH infections and improve morbidity outcomes in schoolchildren. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN12616000508471).
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Affiliation(s)
- Mary Lorraine S. Mationg
- Research School of Population Heath, The Australian National University, Canberra, Australia
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Gail M. Williams
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Veronica L. Tallo
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Remigio M. Olveda
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Eindra Aung
- Research School of Population Heath, The Australian National University, Canberra, Australia
- St Vincent’s Clinical School, University of New South Wales, Sydney, Australia
| | - Portia Alday
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Mark Donald Reñosa
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Chona Mae Daga
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Jhoys Landicho
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Maria Paz Demonteverde
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Eunice Diane Santos
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Thea Andrea Bravo
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Franziska Angly Bieri
- Research School of Population Heath, The Australian National University, Canberra, Australia
| | - Yuesheng Li
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, Australia
- Hunan Institute of Parasitic Diseases, World Health Organization Collaborating Centre for Research and Control on Schistosomiasis in Lake Region, Yueyang, China
| | | | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Kate Halton
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Donald E. Stewart
- Research School of Population Heath, The Australian National University, Canberra, Australia
- School of Medicine, Griffith University, Brisbane, Australia
| | - Donald P. McManus
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Darren J. Gray
- Research School of Population Heath, The Australian National University, Canberra, Australia
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8
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Gilmour B, Alene KA, Clements ACA. The prevalence of soil transmitted helminth infections in minority indigenous populations of South-East Asia and the Western Pacific Region: A systematic review and meta-analysis. PLoS Negl Trop Dis 2021; 15:e0009890. [PMID: 34758024 PMCID: PMC8580241 DOI: 10.1371/journal.pntd.0009890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/09/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Soil transmitted helminth (STH) infections cause one of the most prevalent diseases in man. STHs disproportionately impact socio-economically disadvantaged communities including minority indigenous populations. This systematic review aimed to quantify the prevalence of STH infection within minority indigenous populations of the South-East Asia and Western Pacific Regions. METHODS The systematic review was conducted in accordance with The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines following a published protocol. A random effects meta-analysis was used to estimate the pooled prevalence of STH infection, and meta-regression analysis was used to quantify associations with study characteristics. Where comparative data were available, sub-group analysis was conducted to evaluate the risk of STH infection in minority indigenous people relative to other population groups. The heterogeneity between studies was evaluated visually using Forest plots and was assessed quantitatively by the index of heterogeneity (I2) and Cochran Q-statistics. RESULTS From 1,366 unique studies that were identified, 81 were included in the final analysis. The pooled prevalence of infection within minority indigenous populations was 61.4% (95% CI 50.8, 71.4) for overall STH infection; 32.3% (95% CI 25.7, 39.3) for Ascaris.lumbricoides; 43.6% (95% CI 32.6, 54.8) for Trichuris.trichiura; 19.9% (95% CI 15.7, 24.5) for hookworm and 6.3% (95% CI 3.2, 10.2) for Strongyloides.stercoralis. A significant increase in T. trichiura prevalence was observed over time. The stratified analysis showed that the prevalence of infection for STH overall and for each STH species were not significantly different in minority indigenous participants compared to other populations groups. CONCLUSION The prevalence of STH infection is high within minority indigenous populations across countries at very different levels of socio-economic development. The increasing prevalence of T. trichiura calls for the implementation of more effective therapies and control strategies.
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Affiliation(s)
- Beth Gilmour
- Faculty of Health Sciences, Curtin University, Western Australia, Australia
| | - Kefyalew Addis Alene
- Faculty of Health Sciences, Curtin University, Western Australia, Australia
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Archie C. A. Clements
- Faculty of Health Sciences, Curtin University, Western Australia, Australia
- Telethon Kids Institute, Nedlands, WA, Australia
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9
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Gilmour B, Alene KA, Clarke NE, Clements ACA. The prevalence of tuberculosis, malaria and soil-transmitted helminth infection in minority indigenous people of Southeast Asia and the Western Pacific: protocol for a systematic review and meta-analysis. Syst Rev 2021; 10:203. [PMID: 34246316 PMCID: PMC8271287 DOI: 10.1186/s13643-021-01753-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 06/25/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Infectious diseases such as tuberculosis (TB), malaria and soil-transmitted helminthiasis continue to impose a significant global health burden and socio-economic impact. Globally, minority indigenous people are disproportionately affected by poverty and are shown to experience a disparate burden of disease and poorer health outcomes than the comparative majority population. Despite these inequalities, countries rarely systematically compile epidemiological data disaggregated by ethnicity to enable the extent of the differential to be quantified. METHODS The systematic review will be reported in accordance with The Preferred Reporting Items for Systematic Review and Meta- Analyses (PRISMA) guidelines. Systematic searches will be conducted in EMBASE, Medline, Scopus and Web of Science for studies reporting data which enable the prevalence of TB, malaria, and/or soil-transmitted helminth (STH) infections amongst minority indigenous populations within the Southeast Asia Region (SEAR) and Western Pacific Region (WPR) to be calculated. Where studies provide data on disease prevalence for both minority indigenous and other populations within the same study, a comparative analysis will be undertaken. In addition to a narrative synthesis, where sufficient data are available, a random-effects meta-analysis will be conducted to obtain a pooled estimate value for each disease/infection by country and mortality stratum. Heterogeneity between studies will be examined using the Cochran's Q test and quantitatively measured by the index of heterogeneity squared (I2) statistics. The methodological quality of the included studies will be assessed using a modified Newcastle-Ottawa Scale. DISCUSSION This systematic review aims to analyse the available data on the prevalence of TB, malaria and STH infections within minority indigenous populations of the SEAR and WPR. REGISTRATION Open Science Framework registration: osf.io/m6sqc.
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Affiliation(s)
- Beth Gilmour
- Faculty of Health Sciences, Curtin University, Western Australia, Australia
| | - Kefyalew Addis Alene
- Faculty of Health Sciences, Curtin University, Western Australia, Australia
- Telethon Kids Institute, West Perth, WA Australia
| | - Naomi E. Clarke
- Research School of Population Health, Australian National University, Canberra, ACT Australia
| | - Archie C. A. Clements
- Faculty of Health Sciences, Curtin University, Western Australia, Australia
- Telethon Kids Institute, West Perth, WA Australia
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10
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The role of diagnostic technologies to measure progress toward WHO 2030 targets for soil-transmitted helminth control programs. PLoS Negl Trop Dis 2021; 15:e0009422. [PMID: 34081694 PMCID: PMC8174700 DOI: 10.1371/journal.pntd.0009422] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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11
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Campillo JT, Chabot EB, Awaca-Uvon NP, Tambwe JP, Kuyangisa-Simuna G, Boussinesq M, Chesnais CB, Pion SD. Effect of Lymphatic Filariasis and Hookworm Infection on Pregnancy Course and Outcome in Women Living in the Democratic Republic of the Congo. Am J Trop Med Hyg 2021; 104:2074-2081. [PMID: 33939636 PMCID: PMC8176502 DOI: 10.4269/ajtmh.20-1422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/29/2021] [Indexed: 11/26/2022] Open
Abstract
Little is known about the effect of helminth infections on the natural gynecological and pregnancy course. Our goal was to assess the relationship between Wuchereria bancrofti and hookworm (HW) infections with pregnancy course and outcome in a group of 82 women living in a rural area of the Democratic Republic of the Congo. Demographics and information on gynecological and obstetrical histories were collected retrospectively with standardized questionnaires. Wuchereria bancrofti and HW infections were diagnosed using a filarial antigen-detection test and the Kato-Katz method, respectively. Analyses consisted of multivariable logistic regressions adjusting for age, number of deliveries, and history of anthelmintic treatment (HAHT). The median age of study participants was 35 (interquartile range [IQR]: 30-44) years, and the median number of deliveries was five (IQR: 3-7). Wuchereria bancrofti and HW infection rates were 44.5% and 43.3%, respectively. Filarial antigenemia and HW infection were not significantly associated with the number of deliveries. The proportions of women with a history of pregnancy resulting in neonatal death, miscarriage, premature birth, and postpartum hemorrhage were 56%, 44%, 23%, and 36%, respectively. History of pregnancy associated with neonatal death was less frequent in women with HAHT, tended to be more frequent in women with filarial antigenemia, and was not associated with HW infection. None of the three other pregnancy events studied (miscarriage, premature birth, and postpartum hemorrhage) were associated with filarial antigenemia or HW infection. The positive association found between HAHT and lower risk of neonatal death warrants investigation in larger groups of women.
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Affiliation(s)
- Jérémy T Campillo
- 1UMI 233, Institut de Recherche pour le Développement (IRD), INSERM Unité 1175 and University of Montpellier, Montpellier, France
| | - Emmanuel B Chabot
- 1UMI 233, Institut de Recherche pour le Développement (IRD), INSERM Unité 1175 and University of Montpellier, Montpellier, France
- 2UMR1027, Institut National de la Santé et de la Recherche Nationale (Inserm) and University of Toulouse, Toulouse, France
| | - Naomi-Pitchouna Awaca-Uvon
- 3Programme National de Lutte contre les Maladies Tropicales Négligées à Chimiothérapie Préventive, Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo
| | - Jean-Paul Tambwe
- 3Programme National de Lutte contre les Maladies Tropicales Négligées à Chimiothérapie Préventive, Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo
| | - Godefroy Kuyangisa-Simuna
- 3Programme National de Lutte contre les Maladies Tropicales Négligées à Chimiothérapie Préventive, Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo
| | - Michel Boussinesq
- 1UMI 233, Institut de Recherche pour le Développement (IRD), INSERM Unité 1175 and University of Montpellier, Montpellier, France
| | - Cédric B Chesnais
- 1UMI 233, Institut de Recherche pour le Développement (IRD), INSERM Unité 1175 and University of Montpellier, Montpellier, France
| | - Sébastien D Pion
- 1UMI 233, Institut de Recherche pour le Développement (IRD), INSERM Unité 1175 and University of Montpellier, Montpellier, France
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12
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Malizia V, Giardina F, Vegvari C, Bajaj S, McRae-McKee K, Anderson RM, de Vlas SJ, Coffeng LE. Modelling the impact of COVID-19-related control programme interruptions on progress towards the WHO 2030 target for soil-transmitted helminths. Trans R Soc Trop Med Hyg 2021; 115:253-260. [PMID: 33313897 PMCID: PMC7798673 DOI: 10.1093/trstmh/traa156] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/21/2020] [Accepted: 11/23/2020] [Indexed: 12/21/2022] Open
Abstract
Background On 1 April 2020, the WHO recommended an interruption of all activities for the control of neglected tropical diseases, including soil-transmitted helminths (STH), in response to the COVID-19 pandemic. This paper investigates the impact of this disruption on the progress towards the WHO 2030 target for STH. Methods We used two stochastic individual-based models to simulate the impact of missing one or more preventive chemotherapy (PC) rounds in different endemicity settings. We also investigated the extent to which this impact can be lessened by mitigation strategies, such as semiannual or community-wide PC. Results Both models show that without a mitigation strategy, control programmes will catch up by 2030, assuming that coverage is maintained. The catch-up time can be up to 4.5 y after the start of the interruption. Mitigation strategies may reduce this time by up to 2 y and increase the probability of achieving the 2030 target. Conclusions Although a PC interruption will only temporarily impact the progress towards the WHO 2030 target, programmes are encouraged to restart as soon as possible to minimise the impact on morbidity. The implementation of suitable mitigation strategies can turn the interruption into an opportunity to accelerate progress towards reaching the target.
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Affiliation(s)
- Veronica Malizia
- Departmen t of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Federica Giardina
- Departmen t of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Carolin Vegvari
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.,Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Sumali Bajaj
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.,Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Kevin McRae-McKee
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.,Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Roy M Anderson
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.,Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.,The DeWorm3 Project, Natural History Museum, London, UK
| | - Sake J de Vlas
- Departmen t of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Luc E Coffeng
- Departmen t of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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13
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Aboikoni A, Allaire M, Louvel D, Blanchet D, Dao T, Carod JF, Demar M. Prevalence of intestinal parasite among patients attending two hospitals in French Guiana: A 6-year retrospective study. PLoS Negl Trop Dis 2021; 15:e0009087. [PMID: 33544715 PMCID: PMC7891781 DOI: 10.1371/journal.pntd.0009087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 02/18/2021] [Accepted: 12/18/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Intestinal parasitic diseases are a global health problem. Due to its equatorial climate, vast territory with isolated areas and the precariousness of its population, intestinal parasitosis is considered to be a major issue in French Guiana but only few data are available and these mainly focus on specific population. We aimed at determining the parasitic index and at describing the characteristics of these infections in order to develop preventive strategies. Material and methods We retrospectively analysed all the parasitological samples recorded in the register of the two main laboratories of French Guiana between 2011 and 2016. The parasitic index was the percentage of parasitised patients in comparison with the total number of subjects studied. A patient who underwent several positive parasitological examinations was considered only once in the analysis at the time of the first sampling. Results A total of 15,220 parasitological samples of 9,555 patients were analysed and 2,916 were positive in 1,521 patients. The average infestation rate and parasitic index were 19.2% and 16.0%, respectively. The parasitic index remained stable between 2011 (18.2%) and 2016 (18.3%). The patients were mainly men (66.4%), with a median age of 33.0 years (26.3% of patients were under 18 years of age) and lived mainly in the Central Agglomeration (48.2%) and in West Guiana (37.4%). Hookworms were the most common parasite (25.2%) followed by Entamoeba coli (13.3%), Strongyloides stercoralis (10.9%) and Giardia intestinalis (10.8%). Among the infected patients, 31.0% presented mixed infections and 67.5% of them had at least one pathogenic parasite. The patients aged from 0 to 18 years presented significantly more polyparasitism (30.9%) than monoparasitism (24.3%, p<0.001). Ancylostoma sp and Strongyloides stercoralis were mainly diagnosed during the rainy season (59.5% and 64.7% respectively), in men (78.6% and 81.1% respectively) and in patients aged from 18 to 65 years (86.6% and 76.6% respectively) whereas, Giardia intestinalis infected mostly children under 5 years (59.5%) of age. Conclusion Although it may not be representative of the entire Guyanese population, the parasitic index remained high and stable from 2011 and 2016 and it justifies the need for an active prevention program as it was already done in the other French overseas departments such as Martinique and Guadeloupe. Intestinal parasitic diseases are a global public health problem which mostly affect developing countries where adequate water and sanitation facilities are lacking. Due to its equatorial climate, vast territory with isolated areas and the precariousness of its population, intestinal parasitosis is considered to be a major issue in French Guiana and came to be frequently detected during hospitalisations. However, only few data are available and no integrated control programs have been conducted. This is the first study that has been exploring and reporting epidemiological data on intestinal parasitic infections in French Guiana covering much of the territory. This work reports an average parasitic index of 16.0%, which was stable between 2011 (18.2%) and 2016 (18.3%) with a majority of Ancylostoma sp, Strongyloides stercoralis and Giardia intestinalis. Although it may not be representative of the entire Guyanese population, the parasitic index remained high and stable from 2011 to 2016 and it justifies the need for an active prevention program as it was already done in the other French overseas departments such as Martinique and Guadeloupe.
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Affiliation(s)
- Alolia Aboikoni
- Service d’Hépato-gastroentérologie et de nutrition, CHU Côte de Nacre, Caen-France
- * E-mail:
| | - Manon Allaire
- Service d’Hépato-gastroentérologie et de nutrition, CHU Côte de Nacre, Caen-France
- Centre de Recherche sur l’Inflammation,UMR 1149, INSERM, Université Paris-Diderot, ERL CNRS 8252, Paris-France
| | - Dominique Louvel
- Service de d’Hépato-gastroentérologie, Centre Hospitalier de Cayenne, Cayenne, Guyane française
| | - Denis Blanchet
- Laboratoire Hospitalo-Universitaire de Parasitologie Mycologie, Centre Hospitalier de Cayenne, Cayenne, Guyane française
| | - Thong Dao
- Service d’Hépato-gastroentérologie et de nutrition, CHU Côte de Nacre, Caen-France
| | - Jean-François Carod
- Service de biologie, CH Ouest Guyanais, Saint Laurent du Maroni, Guyane française
| | - Magalie Demar
- Laboratoire Hospitalo-Universitaire de Parasitologie Mycologie, Centre Hospitalier de Cayenne, Cayenne, Guyane française
- Ecosystème amazonien et pathologie tropicale, EA 3593, EPaT, Université de Guyane, Cayenne, Guyane française
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14
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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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15
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Ness TE, Agrawal V, Bedard K, Ouellette L, Erickson TA, Hotez P, Weatherhead JE. Maternal Hookworm Infection and Its Effects on Maternal Health: A Systematic Review and Meta-Analysis. Am J Trop Med Hyg 2020; 103:1958-1968. [PMID: 32840198 DOI: 10.4269/ajtmh.20-0503] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Hookworm is an intestinal parasite that infects nearly 230 million people, with another 5.1 billion at risk, especially in poverty-stricken tropical and subtropical regions. Pregnancy is an especially vulnerable time for hookworm infection because of its effect on both maternal and subsequently fetal health. A systematic review and meta-analysis was conducted. The meta-analysis was performed on the association between maternal hookworm and maternal anemia, as well as maternal hookworm coinfection with malaria. The prevalence of hookworm ranged from 1% to 78% in pregnant women, whereas malaria prevalence ranged from 11% to 81%. Pregnant women with hookworm infection were more likely to have anemia (combined odds ratio [cOR] 2.55 [2.20, 2.96], P < 0.001). In addition, pregnant woman with hookworm were more likely to have malaria coinfection (cOR 1.60 [1.38, 1.86], P < 0.001). Other effects on maternal and child health were investigated and summarized without systematic review or meta-analysis because of the limited study numbers. Despite current deworming recommendations in pregnant women, heavy hookworm burden, coinfection with malaria, and subsequent anemia persist. Although this is likely due, in part, to a lack of implementation of preventive chemotherapy, additional interventions such as health education, proper waste management, or linking malaria and soil-transmitted helminth treatment and prevention programs may also be needed. Further investigations on maternal-child outcomes as a result of hookworm infection during pregnancy will highlight public health interventional targets to reduce morbidity in pregnant women and children globally.
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Affiliation(s)
- Tara E Ness
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Vedika Agrawal
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Kathryn Bedard
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | - Timothy A Erickson
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Peter Hotez
- Department of Biology, Baylor University, Waco, Texas.,Hagler Institute for Advanced Study at Texas A&M University, College Station, Texas.,National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas.,Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Jill E Weatherhead
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas.,Department of Medicine, Baylor College of Medicine, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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16
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Okoyo C, Campbell SJ, Williams K, Simiyu E, Owaga C, Mwandawiro C. Prevalence, intensity and associated risk factors of soil-transmitted helminth and schistosome infections in Kenya: Impact assessment after five rounds of mass drug administration in Kenya. PLoS Negl Trop Dis 2020; 14:e0008604. [PMID: 33027264 PMCID: PMC7540847 DOI: 10.1371/journal.pntd.0008604] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 07/15/2020] [Indexed: 12/23/2022] Open
Abstract
Background In Kenya, over five million school age children (SAC) are estimated to be at risk of parasitic worms causing soil-transmitted helminthiasis (STH) and schistosomiasis. As such, the Government of Kenya launched a National School Based Deworming (NSBD) program in 2012 targeting the at-risk SAC living in endemic regions, with the aim of reducing infections prevalence to a level where they no longer constitute a public health problem. The impact of the program has been consistently monitored from 2012 to 2017 through a robust and extensive monitoring and evaluation (M&E) program. The aim of the current study was to evaluate the parasitological outcomes and additionally investigate water, sanitation and hygiene (WASH) related factors associated with infection prevalence after five rounds of mass drug administration (MDA), to inform the program’s next steps. Materials and methods We utilized a cross-sectional design in a representative, stratified, two-stage sample of school children across six regions in Kenya. A sample size of 100 schools with approximately 108 children per school was purposively selected based on the Year 5 STH infection endemicity prior to the survey. Stool samples were examined for the presence of STH and Schistosoma mansoni eggs using double-slide Kato-Katz technique, urine samples were processed using urine filtration technique for the presence of S. haematobium eggs. Survey questionnaires were administered to all the participating children to collect information on their demographic and individual, household and school level WASH characteristics. Principal findings Overall, STH prevalence was 12.9% (95%CI: 10.4–16.1) with species prevalence of 9.7% (95%CI: 7.5–12.6) for Ascaris lumbricoides, 3.6% (95%CI: 2.2–5.8) for Trichuris trichiura and 1.0% (95%CI: 0.6–1.5) for hookworm. S. mansoni prevalence was 2.2% (95%CI: 1.2–4.3) and S. haematobium prevalence was 0.3% (95%CI: 0.1–1.0). All the infections showed significant prevalence reductions when compared with the baseline prevalence, except S. mansoni. From multivariable analysis, increased odds of any STH infections were associated with not wearing shoes, adjusted odds ratio (aOR) = 1.36 (95%CI: 1.09–1.69); p = 0.007; high number of household members, aOR = 1.21 (95%CI: 1.04–1.41); p = 0.015; and school absenteeism of more than two days, aOR = 1.33 (95%CI: 1.01–1.80); p = 0.045. Further, children below five years had up to four times higher odds of getting STH infections, aOR = 4.68 (95%CI: 1.49–14.73); p = 0.008. However, no significant factors were identified for schistosomiasis, probably due to low prevalence levels affecting performance of statistical analysis. Conclusions After five rounds of MDA, the program shows low prevalence of STH and schistosomiasis, however, not to a level where the infections are not a public health problem. With considerable inter-county infection prevalence heterogeneity, the program should adopt future MDA frequencies based on the county’s infection prevalence status. Further, the program should encourage interventions aimed at improving coverage among preschool age children and improving WASH practices as long-term infection control strategies. This paper presents the findings of an evaluation survey conducted in Year 6 of the Kenya National School-Based Deworming (NSBD) Program, following five years (2012–2017) of prior baseline and subsequent impact monitoring. The survey was conducted in 20 counties, covering six regions in Kenya. The survey showed continued and considerable reductions in prevalence over time, with most marked decline for hookworm, followed by Ascaris lumbricoides. Overall, the mass drug administration (MDA) program has driven both STH and schistosomiasis prevalence to relatively low levels, however not to a point where they no longer constitute a public health problem in Kenya. For these neglected tropical diseases (NTDs), and STH in particular, there are relatively few published examples of programmatic impact assessments enabling refined decisions regarding helminth control strategies. Kenya’s experiences in implementing, monitoring, and evaluating a high-coverage NSBD program are a continuing and increasingly important success story for the country, which provides learnings of importance for the international community.
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Affiliation(s)
- Collins Okoyo
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
- School of Mathematics, College of Biological and Physical Sciences, University of Nairobi, Nairobi, Kenya
- * E-mail: ,
| | - Suzy J. Campbell
- Deworm the World, Evidence Action, Washington DC, United States of America
| | | | - Elses Simiyu
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | | | - Charles Mwandawiro
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
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Gutman JR, Lucchi NW, Cantey PT, Steinhardt LC, Samuels AM, Kamb ML, Kapella BK, McElroy PD, Udhayakumar V, Lindblade KA. Malaria and Parasitic Neglected Tropical Diseases: Potential Syndemics with COVID-19? Am J Trop Med Hyg 2020; 103:572-577. [PMID: 32484155 PMCID: PMC7410484 DOI: 10.4269/ajtmh.20-0516] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/26/2020] [Indexed: 12/21/2022] Open
Abstract
The COVID-19 pandemic, caused by SARS-CoV-2, have surpassed 5 million cases globally. Current models suggest that low- and middle-income countries (LMICs) will have a similar incidence but substantially lower mortality rate than high-income countries. However, malaria and neglected tropical diseases (NTDs) are prevalent in LMICs, and coinfections are likely. Both malaria and parasitic NTDs can alter immunologic responses to other infectious agents. Malaria can induce a cytokine storm and pro-coagulant state similar to that seen in severe COVID-19. Consequently, coinfections with malaria parasites and SARS-CoV-2 could result in substantially worse outcomes than mono-infections with either pathogen, and could shift the age pattern of severe COVID-19 to younger age-groups. Enhancing surveillance platforms could provide signals that indicate whether malaria, NTDs, and COVID-19 are syndemics (synergistic epidemics). Based on the prevalence of malaria and NTDs in specific localities, efforts to characterize COVID-19 in LMICs could be expanded by adding testing for malaria and NTDs. Such additional testing would allow the determination of the rates of coinfection and comparison of severity of outcomes by infection status, greatly improving the understanding of the epidemiology of COVID-19 in LMICs and potentially helping to mitigate its impact.
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Affiliation(s)
- Julie R. Gutman
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Naomi W. Lucchi
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Paul T. Cantey
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Laura C. Steinhardt
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Aaron M. Samuels
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Mary L. Kamb
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Bryan K. Kapella
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
- U.S. President’s Malaria Initiative, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Peter D. McElroy
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Venkatachalam Udhayakumar
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Kim A. Lindblade
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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Gildner TE, Cepon-Robins TJ, Liebert MA, Urlacher SS, Schrock JM, Harrington CJ, Madimenos FC, Snodgrass JJ, Sugiyama LS. Market integration and soil-transmitted helminth infection among the Shuar of Amazonian Ecuador. PLoS One 2020; 15:e0236924. [PMID: 32735608 PMCID: PMC7394393 DOI: 10.1371/journal.pone.0236924] [Citation(s) in RCA: 8] [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: 11/19/2019] [Accepted: 07/17/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Soil-transmitted helminth (STH) infections have many negative health outcomes (e.g., diarrhea, nutritional deficiencies) that can also exacerbate poverty. These infections are generally highest among low-income populations, many of which are also undergoing market integration (MI; increased participation in a market-based economy). Yet the direct impact of MI-related social and environmental changes on STH infection patterns is poorly understood, making it unclear which lifestyle factors should be targeted to better control disease spread. This cross-sectional study examines if household infrastructure associated with greater MI is associated with lower STH burdens among Indigenous Ecuadorian Shuar. METHODS Kato-Katz fecal smears were used to determine STH infection status and intensity (n = 620 participants; 308 females, 312 males, aged 6 months-86 years); Ascaris lumbricoides (ascarid) and Trichuris trichiura (whipworm) were the primary infection types detected. Structured interviews assessing lifestyle patterns (e.g., measures of household infrastructure) measured participant MI. Multilevel regression analyses and zero-inflated negative binomial regression models tested associations between MI measures and STH infection status or intensity, controlling for individual and community characteristics. RESULTS Participants residing in more market-integrated households exhibited lower infection rates and intensities than those in less market integrated households. Parasite infection status and T. trichiura infection intensity were lower among participants living in houses with wood floors than those with dirt floors, while individuals using well or piped water from a spring exhibited lower A. lumbricoides infection intensities compared to those using river or stream water. Unexpectedly, latrine type was not significantly related to STH infection status or intensity. These results suggest that sources of exposure differ between the two helminth species. CONCLUSIONS This study documents associations between household measures and STH infection among an Indigenous population undergoing rapid MI. These findings can help healthcare programs better target interventions and reduce STH exposure among at-risk populations.
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Affiliation(s)
- Theresa E. Gildner
- Department of Anthropology, Dartmouth College, Hanover, New Hampshire, United States of America
| | - Tara J. Cepon-Robins
- Department of Anthropology, University of Colorado, Colorado Springs, Colorado, United States of America
| | - Melissa A. Liebert
- Department of Anthropology, Northern Arizona University, Flagstaff, Arizona, United States of America
| | - Samuel S. Urlacher
- Department of Anthropology, Baylor University, Waco, Texas, United States of America
| | - Joshua M. Schrock
- Department of Anthropology, University of Oregon, Eugene, Oregon, United States of America
| | | | - Felicia C. Madimenos
- Department of Anthropology, Queens College (CUNY), Flushing, New York, United States of America
| | - J. Josh Snodgrass
- Department of Anthropology, University of Oregon, Eugene, Oregon, United States of America
- Center for Global Health, University of Oregon, Eugene, Oregon, United States of America
| | - Lawrence S. Sugiyama
- Department of Anthropology, University of Oregon, Eugene, Oregon, United States of America
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Boyko RH, Marie Harrison L, Humphries D, Galvani AP, Townsend JP, Otchere J, Wilson MD, Cappello M. Dogs and pigs are transport hosts of Necator americanus: Molecular evidence for a zoonotic mechanism of human hookworm transmission in Ghana. Zoonoses Public Health 2020; 67:474-483. [PMID: 32529782 DOI: 10.1111/zph.12708] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/20/2020] [Accepted: 03/22/2020] [Indexed: 01/27/2023]
Abstract
Hookworm infection (Necator americanus and Ancylostoma spp) causes significant morbidity in resource-limited countries. Dog and pig ownership is associated with human infection, although the mechanism through which animals increase risk remains unknown. We first confirmed this association in Kintampo North, Ghana, using a retrospective analysis and serology, followed by a prospective molecular study of animal faeces. As a proxy of exposure to dog faeces, we analysed immunoreactivity of human serum to the zoonotic nematode Toxocara canis. Anti-Toxocara antibodies were present in 62% of samples (n = 89), and reactivity was associated with dog ownership. A subsequent prospective study revealed that 43% of dog and 56% of pig faecal samples contained hookworm eggs by microscopy. PCR analysis confirmed the presence of N. americanus DNA in 47% of samples from dogs and 56% pig samples. Nematode larvae were successfully cultured from samples collected from 36 dogs and seven pigs. These results demonstrate that dogs and pigs have a likely role in the transmission of N. americanus in endemic communities.
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Affiliation(s)
| | | | | | | | | | - Joseph Otchere
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Michael D Wilson
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
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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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Abstract
BACKGROUND Ascaris lumbricoides is a common infection, and mainly affects children living in low-income areas. Water and sanitation improvement, health education, and drug treatment may help break the cycle of transmission, and effective drugs will reduce morbidity. OBJECTIVES To compare the efficacy and safety of anthelmintic drugs (albendazole, mebendazole, ivermectin) for treating people with Ascaris infection. SEARCH METHODS We searched the Cochrane Infectious Disease Group Specialized Register, CENTRAL, MEDLINE, Embase, LILACS, three other databases, and reference lists of included studies, without language restrictions, up to 4 July 2019. SELECTION CRITERIA Randomized controlled trials (RCT) that compared albendazole, mebendazole, and ivermectin in children and adults with confirmed Ascaris infection. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion, assessed risk of bias, and extracted data from the included trials. A third review author checked the quality of data extraction. We used the Cochrane 'Risk of bias' assessment tool to determine the risk of bias in included trials. We used risk ratios (RRs) with 95% confidence intervals (CIs) to compare dichotomous outcomes in treatment and control groups. We used the fixed-effect model for studies with low heterogeneity and the random-effects model for studies with moderate to high heterogeneity. We assessed the certainty of the evidence using the GRADE approach. We used the control rate average to provide illustrative cure rates in the comparison groups. MAIN RESULTS We included 30 parallel-group RCTs, which enrolled 6442 participants from 17 countries across Africa, Asia, Central America and the Caribbean, and South America. Participants were from 28 days to 82 years of age, recruited from school, communities, and health facilities. Twenty studies were funded or co-funded by manufacturers, while 10 studies were independent of manufacturer funding. Twenty-two trials had a high risk of bias for one or two domains (blinding, incomplete outcome data, selective reporting). Single dose of albendazole (four trials), mebendazole (three trials) or ivermectin (one trial) was compared to placebo. Parasitological cure at 14 to 60 days was high in all the studies (illustrative cure of 93.0% in the anthelmintic group and 16.1% in the placebo group; RR 6.29, 95% CI 3.91 to 10.12; 8 trials, 1578 participants; moderate-certainty evidence). Single dose of albendazole is as effective as multiple doses of albendazole (illustrative cure of 93.2% with single dose, 94.3% with multiple doses; RR 0.98, 95% CI 0.92 to 1.05; 3 trials, 307 participants; high-certainty evidence); or as single dose of mebendazole (illustrative cure of 98.0% with albendazole, 96.9% with mebendazole; RR 1.01, 95% CI 1.00 to 1.02; 6 trials, 2131 participants; high-certainty evidence). Studies did not detect a difference between a single dose of albendazole and a single dose of ivermectin (cure rates of 87.8% with albendazole, 90.2% with ivermectin; RR 0.99, 95% CI 0.91 to 1.08; 3 trials, 519 participants; moderate-certainty evidence). Across all the studies, failure after single dose of albendazole ranged from 0.0% to 30.3%, mebendazole from 0.0% to 22.2%, and ivermectin from 0.0% to 21.6%. The egg reduction rate (ERR) measured up to 60 days after the treatment was high in all treated groups, regardless of the anthelmintic used (range 96% to 100%). It was not possible to evaluate parasitological cure by classes of infection intensity. No included trials reported complication or serious adverse events. Other adverse events were apparently similar among the compared anthelmintic groups (moderate- to low-certainty evidence). The most commonly reported other adverse events were nausea, vomiting, abdominal pain, diarrhoea, headache, and fever. AUTHORS' CONCLUSIONS Single-dose of albendazole, mebendazole, and ivermectin all appeared effective against Ascaris lumbricoides infection, yielding high parasitological cure and large reductions in eggs excreted, with no differences detected between them. The drugs appear to be safe to treat children and adults with confirmed Ascaris infection. There is little to choose between drugs and regimens in terms of cure or adverse events.
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Affiliation(s)
- Lucieni O Conterno
- State University of Campinas (UNICAMP)Medical School, Department of Internal Medicine, Infectious Diseases DivisionRua Tessália Vieira de Camargo, 126Cidade Universitária "Zeferino Vaz"CampinasSão PauloBrazil13083‐887
| | - Marilia D Turchi
- Federal University of GoiasDepartment of Public Health, Institute of Tropical Pathology and Public HealthRua Amorinopolis QdR2 Lt13 Residencial GoiasAlphaville FlamboyantGoianiaGoiasBrazil74884‐540
| | - Ione Corrêa
- Botucatu Medical School, UNESP ‐ Univ Estadual PaulistaDepartment of NursingDistrito de Rubião Júnior, s/nBotucatuSão PauloBrazil18603‐970
| | - Ricardo Augusto Monteiro de Barros Almeida
- Botucatu Medical School, UNESP ‐ Univ Estadual PaulistaDepartment of Tropical Diseases and Imaging DiagnosisAv. Prof. Montenegro, s/nDistrito de Rubiao JrBotucatuSao PauloBrazil18618‐970
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Cunningham LJ, Campbell SJ, Armoo S, Koukounari A, Watson V, Selormey P, Stothard JR, Idun B, Asiedu M, Ashong Y, Adams ER, Osei-Atweneboana MY. Assessing expanded community wide treatment for schistosomiasis: Baseline infection status and self-reported risk factors in three communities from the Greater Accra region, Ghana. PLoS Negl Trop Dis 2020; 14:e0007973. [PMID: 32339185 PMCID: PMC7205311 DOI: 10.1371/journal.pntd.0007973] [Citation(s) in RCA: 4] [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: 05/24/2019] [Revised: 05/07/2020] [Accepted: 12/05/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This paper reports on the baseline prevalence and associated risk factor findings of a pilot, longitudinal study exploring community-wide treatment of schistosomiasis and soil-transmitted helminthiasis, using albendazole plus praziquantel in the Greater Accra region of Ghana. METHOD From three communities, at least, 658 individuals were enrolled into the study via random household selection. Prevalence and intensity of schistosomiasis and STH infection were determined from stool and urine samples with a questionnaire being administered in order to explore other morbidities and risk factors. Factor analysis of household demographic variables was undertaken to generate a socioeconomic score; this was then further categorised into tertiles. Proportional-odds cumulative logit generalised estimating equation (GEE) models were used to investigate categorical ordinal intensity of infection associations with morbidity. Separately, logistic GEE models were used to investigate risk factor associations with infection prevalence. RESULTS Both Schistosoma haematobium and S. mansoni were prevalent in the three communities, with the prevalence of S. haematobium ranging from 3.3% (24/679; 95% CI = 1.9-4.7) to 19% (114/632; 95% CI = 15.8-22.2) and S. mansoni ranging from 30% (202/679; 95% CI = 26.5-33.5) to 78.3% (409/536; 95% CI = 74.7-81.9). The total prevalence of STH across all three sites was negligible at 1.3% (24/1847; 95% CI = 0.8-1.9) comprising mainly hookworm (10/1847). Multivariable statistical models indicated males to be 2.3 (95% CI = 1.7-3.3) times more likely to have a high intensity S. mansoni infection and 1.5 (95% CI = 1.1-2) times more likely to have a high intensity of S. haematobium infection compared to females. There was no significant difference in the likelihood of infection with S. mansoni between adults and school age children (SAC), however S. haematobium infections were found to be 2.5 (95% CI = 1.8-3.5) times more likely to occur in school age children than in adults. Multivariable statistical models (adjusted for age and sex) indicated an association between schistosomiasis and a number of self-reported morbidity indicators (notably diarrhoea and blood in stool and urine). Low socio-economic status was also associated with SCH infection (OR: 2; 95% CI = 1.3-3.2). CONCLUSION The communities targeted by this study showed a range of Schistosoma prevalence's of infection, from hypo-endemic through to meso-endemic and hyper-endemic. The prevalence of SCH across the different age groups in the study locations highlights the large number of individuals currently being left out of the standard morbidity control method of annual treatment of the SAC.
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Affiliation(s)
- Lucas J. Cunningham
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Samuel Armoo
- Department of Biomedical and Public Health Research, Council for Scientific and Industrial Research—Water Research Institute, Council Close, Accra, Ghana
| | - Artemis Koukounari
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, United Kingdom
| | - Victoria Watson
- Department of Biostatistics, University of Liverpool, Liverpool, United Kingdom
| | - Pamela Selormey
- Department of Biomedical and Public Health Research, Council for Scientific and Industrial Research—Water Research Institute, Council Close, Accra, Ghana
| | - J. Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Bright Idun
- Department of Biomedical and Public Health Research, Council for Scientific and Industrial Research—Water Research Institute, Council Close, Accra, Ghana
| | - Manfred Asiedu
- Department of Biomedical and Public Health Research, Council for Scientific and Industrial Research—Water Research Institute, Council Close, Accra, Ghana
| | - Yvonne Ashong
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Emily R. Adams
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Mike Yaw Osei-Atweneboana
- Department of Biomedical and Public Health Research, Council for Scientific and Industrial Research—Water Research Institute, Council Close, Accra, Ghana
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Disturbance in human gut microbiota networks by parasites and its implications in the incidence of depression. Sci Rep 2020; 10:3680. [PMID: 32111922 PMCID: PMC7048763 DOI: 10.1038/s41598-020-60562-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 02/10/2020] [Indexed: 01/02/2023] Open
Abstract
If you think you are in control of your behavior, think again. Evidence suggests that behavioral modifications, as development and persistence of depression, maybe the consequence of a complex network of communication between macro and micro-organisms capable of modifying the physiological axis of the host. Some parasites cause significant nutritional deficiencies for the host and impair the effectiveness of cognitive processes such as memory, teaching or non-verbal intelligence. Bacterial communities mediate the establishment of parasites and vice versa but this complexity approach remains little explored. We study the gut microbiota-parasite interactions using novel techniques of network analysis using data of individuals from two indigenous communities in Guerrero, Mexico. Our results suggest that Ascaris lumbricoides induce a gut microbiota perturbation affecting its network properties and also subnetworks of key species related to depression, translating in a loss of emergence. Studying these network properties changes is particularly important because recent research has shown that human health is characterized by a dynamic trade-off between emergence and self-organization, called criticality. Emergence allows the systems to generate novel information meanwhile self-organization is related to the system's order and structure. In this way, the loss of emergence means a depart from criticality and ultimately loss of health.
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Scotti R, Southern S, Boinett C, Jenkins TP, Cortés A, Cantacessi C. MICHELINdb: a web-based tool for mining of helminth-microbiota interaction datasets, and a meta-analysis of current research. MICROBIOME 2020; 8:10. [PMID: 32008578 PMCID: PMC6996195 DOI: 10.1186/s40168-019-0782-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 12/27/2019] [Indexed: 05/02/2023]
Abstract
BACKGROUND The complex network of interactions occurring between gastrointestinal (GI) and extra-intestinal (EI) parasitic helminths of humans and animals and the resident gut microbial flora is attracting increasing attention from biomedical researchers, because of the likely implications for the pathophysiology of helminth infection and disease. Nevertheless, the vast heterogeneity of study designs and microbial community profiling strategies, and of bioinformatic and biostatistical approaches for analyses of metagenomic sequence datasets hinder the identification of bacterial targets for follow-up experimental investigations of helminth-microbiota cross-talk. Furthermore, comparative analyses of published datasets are made difficult by the unavailability of a unique repository for metagenomic sequence data and associated metadata linked to studies aimed to explore potential changes in the composition of the vertebrate gut microbiota in response to GI and/or EI helminth infections. RESULTS Here, we undertake a meta-analysis of available metagenomic sequence data linked to published studies on helminth-microbiota cross-talk in humans and veterinary species using a single bioinformatic pipeline, and introduce the 'MICrobiome HELminth INteractions database' (MICHELINdb), an online resource for mining of published sequence datasets, and corresponding metadata, generated in these investigations. CONCLUSIONS By increasing data accessibility, we aim to provide the scientific community with a platform to identify gut microbial populations with potential roles in the pathophysiology of helminth disease and parasite-mediated suppression of host inflammatory responses, and facilitate the design of experiments aimed to disentangle the cause(s) and effect(s) of helminth-microbiota relationships. Video abstract.
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Affiliation(s)
- Riccardo Scotti
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 0ES, UK
- Present address: Quadram Institute Bioscience, Norwich Research Park, Norwich, UK
| | - Stuart Southern
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 0ES, UK
| | - Christine Boinett
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 0ES, UK
| | - Timothy P Jenkins
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 0ES, UK
| | - Alba Cortés
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 0ES, UK
| | - Cinzia Cantacessi
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 0ES, UK.
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25
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Vaz Nery S, Traub RJ, McCarthy JS, Clarke NE, Amaral S, Llewellyn S, Weking E, Richardson A, Campbell SJ, Gray DJ, Vallely AJ, Williams GM, Andrews RM, Clements ACA. WASH for WORMS: A Cluster-Randomized Controlled Trial of the Impact of a Community Integrated Water, Sanitation, and Hygiene and Deworming Intervention on Soil-Transmitted Helminth Infections. Am J Trop Med Hyg 2020; 100:750-761. [PMID: 30628573 DOI: 10.4269/ajtmh.18-0705] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Water, sanitation, and hygiene (WASH) interventions have been proposed as an important complement to deworming programs for sustainable control of soil-transmitted helminth (STH) infections. We aimed to determine whether a community-based WASH program had additional benefits in reducing STH infections compared with community deworming alone. We conducted the WASH for WORMS cluster-randomized controlled trial in 18 rural communities in Timor-Leste. Intervention communities received a WASH intervention that provided access to an improved water source, promoted improved household sanitation, and encouraged handwashing with soap. All eligible community members in intervention and control arms received albendazole every 6 months for 2 years. The primary outcomes were infection with each STH, measured using multiplex real-time quantitative polymerase chain reaction. We compared outcomes between study arms using generalized linear mixed models, accounting for clustering at community, household, and individual levels. At study completion, the integrated WASH and deworming intervention did not have an effect on infection with Ascaris spp. (relative risk [RR] 2.87, 95% confidence interval [CI]: 0.66-12.48, P = 0.159) or Necator americanus (RR 0.99, 95% CI: 0.52-1.89, P = 0.987), compared with deworming alone. At the last follow-up, open defecation was practiced by 66.1% (95% CI: 54.2-80.2) of respondents in the control arm versus 40.2% (95% CI: 25.3-52.6) of respondents in the intervention arm (P = 0.005). We found no evidence that the WASH intervention resulted in additional reductions in STH infections beyond that achieved with deworming alone over the 2-year trial period. The role of WASH on STH infections over a longer period of time and in the absence of deworming remains to be determined.
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Affiliation(s)
- Susana Vaz Nery
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia.,Research School of Population Health, Australian National University, Canberra, Australia
| | - Rebecca J Traub
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, Australia
| | - James S McCarthy
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Naomi E Clarke
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Salvador Amaral
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Stacey Llewellyn
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | - Alice Richardson
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Suzy J Campbell
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Darren J Gray
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Andrew J Vallely
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
| | - Gail M Williams
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia.,Research School of Population Health, Australian National University, Canberra, Australia
| | - Archie C A Clements
- Faculty of Health Sciences, Curtin University, Perth, Australia.,Research School of Population Health, Australian National University, Canberra, Australia
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26
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Orr AR, Quagraine JE, Suwondo P, George S, Harrison LM, Dornas FP, Evans B, Caccone A, Humphries D, Wilson MD, Cappello M. Genetic Markers of Benzimidazole Resistance among Human Hookworms ( Necator americanus) in Kintampo North Municipality, Ghana. Am J Trop Med Hyg 2019; 100:351-356. [PMID: 30734697 DOI: 10.4269/ajtmh.18-0727] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Hookworm infection causes anemia, malnutrition, and growth delay, especially in children living in sub-Saharan Africa. The World Health Organization recommends periodic mass drug administration (MDA) of anthelminthics to school-age children (SAC) as a means of reducing morbidity. Recently, questions have been raised about the effectiveness of MDA as a global control strategy for hookworms and other soil-transmitted helminths (STHs). Genomic DNA was extracted from Necator americanus hookworm eggs isolated from SAC enrolled in a cross-sectional study of STH epidemiology and deworming response in Kintampo North Municipality, Ghana. A polymerase chain reaction (PCR) assay was then used to identify single-nucleotide polymorphisms (SNPs) associated with benzimidazole resistance within the N. americanus β-tubulin gene. Both F167Y and F200Y resistance-associated SNPs were detected in hookworm samples from infected study subjects. Furthermore, the ratios of resistant to wild-type SNP at these two loci were increased in posttreatment samples from subjects who were not cured by albendazole, suggesting that deworming drug exposure may enrich resistance-associated mutations. A previously unreported association between F200Y and a third resistance-associated SNP, E198A, was identified by sequencing of F200Y amplicons. These data confirm that markers of benzimidazole resistance are circulating among hookworms in central Ghana, with unknown potential to impact the effectiveness and sustainability of chemotherapeutic approaches to disease transmission and control.
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Affiliation(s)
- Ambrose R Orr
- Yale Partnerships for Global Health, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Josephine E Quagraine
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana.,Yale Partnerships for Global Health, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Peter Suwondo
- Yale Partnerships for Global Health, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Santosh George
- Yale Partnerships for Global Health, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Lisa M Harrison
- Yale Partnerships for Global Health, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Fabio Pio Dornas
- Yale Partnerships for Global Health, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Benjamin Evans
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, Connecticut
| | - Adalgisa Caccone
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, Connecticut
| | - Debbie Humphries
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Michael D Wilson
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Michael Cappello
- Yale Partnerships for Global Health, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
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Insights from quantitative analysis and mathematical modelling on the proposed WHO 2030 goals for soil-transmitted helminths. Gates Open Res 2019; 3:1632. [PMID: 31819925 PMCID: PMC6869437 DOI: 10.12688/gatesopenres.13077.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2019] [Indexed: 12/20/2022] Open
Abstract
Soil-transmitted helminths (STHs) are a group of parasitic worms that infect humans, causing a wide spectrum of disease, notably anaemia, growth retardation, and delayed cognitive development. The three main STHs are
Ascaris lumbricoides,
Trichuris trichiura and hookworm (
Necator americanus and
Ancylostoma duodenale). Approximately 1.5 billion people are infected with STHs worldwide. The World Health Organization goal for 2030 is morbidity control, defined as reaching <2% prevalence of medium-to-high intensity infections in preschool-age children and school-age children (SAC). Treatment guidelines for achieving this goal have been recommended. The Neglected Tropical Diseases Modelling Consortium has developed mathematical and statistical models to quantify, predict, and evaluate the impact of control measures on STHs. These models show that the morbidity target can be achieved following current guidelines in moderate prevalence settings (20-50% in SAC). In high prevalence settings, semi-annual preventive chemotherapy (PC) ideally including adults, or at least women of reproductive age, is required. For
T. trichiura, dual therapy with albendazole and ivermectin is required. In general, stopping PC is not possible without infection resurgence, unless effective measures for improved access to water, hygiene, and sanitation have been implemented, or elimination of transmission has been achieved. Current diagnostic methods are based on egg counts in stool samples, but these are known to have poor sensitivity at low prevalence levels. A target threshold for novel, more sensitive diagnostics should be defined relative to currently preferred diagnostics (Kato-Katz). Our analyses identify the extent of systematic non-access to treatment and the individual patterns of compliance over multiple rounds of treatment as the biggest unknowns and the main impediment to reaching the target. Moreover, the link between morbidity and infection intensity has not been fully elucidated. By providing more insights on all the above, we aim to inform discussions on the goals and treatment guidelines for STHs.
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Welch VA, Ghogomu E, Hossain A, Riddle A, Gaffey M, Arora P, Dewidar O, Salam R, Cousens S, Black R, Hollingsworth TD, Horton S, Tugwell P, Bundy D, Castro MC, Elliott A, Friis H, Le HT, Liu C, Rousham EK, Rohner F, King C, Sartono E, Supali T, Steinmann P, Webb E, Wieringa F, Winnichagoon P, Yazdanbakhsh M, Bhutta ZA, Wells G. Mass deworming for improving health and cognition of children in endemic helminth areas: A systematic review and individual participant data network meta-analysis. CAMPBELL SYSTEMATIC REVIEWS 2019; 15:e1058. [PMID: 37131850 PMCID: PMC8356492 DOI: 10.1002/cl2.1058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background Soil transmitted (or intestinal) helminths and schistosomes affect millions of children worldwide. Objectives To use individual participant data network meta-analysis (NMA) to explore the effects of different types and frequency of deworming drugs on anaemia, cognition and growth across potential effect modifiers. Search Methods We developed a search strategy with an information scientist to search MEDLINE, CINAHL, LILACS, Embase, the Cochrane Library, Econlit, Internet Documents in Economics Access Service (IDEAS), Public Affairs Information Service (PAIS), Social Services Abstracts, Global Health CABI and CAB Abstracts up to March 27, 2018. We also searched grey literature, websites, contacted authors and screened references of relevant systematic reviews. Selection Criteria We included randomised and quasirandomised deworming trials in children for deworming compared to placebo or other interventions with data on baseline infection. Data Collection and Analysis We conducted NMA with individual participant data (IPD), using a frequentist approach for random-effects NMA. The covariates were: age, sex, weight, height, haemoglobin and infection intensity. The effect estimate chosen was the mean difference for the continuous outcome of interest. Results We received data from 19 randomized controlled trials with 31,945 participants. Overall risk of bias was low. There were no statistically significant subgroup effects across any of the potential effect modifiers. However, analyses showed that there may be greater effects on weight for moderate to heavily infected children (very low certainty evidence). Authors' Conclusions This analysis reinforces the case against mass deworming at a population-level, finding little effect on nutritional status or cognition. However, children with heavier intensity infections may benefit more. We urge the global community to adopt calls to make data available in open repositories to facilitate IPD analyses such as this, which aim to assess effects for the most vulnerable individuals.
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Affiliation(s)
- Vivian A. Welch
- Centre for Global HealthBruyère Research InstituteOttawaOntarioCanada
- School of EpidemiologyPublic Health and Preventive Medicine, University of OttawaOttawaOntarioCanada
| | | | - Alomgir Hossain
- Cardiovascular Research MethodsUniversity of Ottawa Heart InstituteOttawaOntarioCanada
| | - Alison Riddle
- School of EpidemiologyPublic Health and Preventive Medicine, University of OttawaOttawaOntarioCanada
| | - Michelle Gaffey
- Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
| | - Paul Arora
- Public Health Agency of Canada in the National Public Health Laboratory and Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Omar Dewidar
- Bruyère Research InstituteUniversity of OttawaOttawaOntarioCanada
| | - Rehana Salam
- South Australian Health and Medical Research InstituteUniversity of AdelaideAdelaideAustralia
| | - Simon Cousens
- London School of Hygiene and Tropical Medicine (LSHTM)LondonUK
| | - Robert Black
- Department of International HealthJohns Hopkins School of Hygiene and Public HealthBaltimoreMaryland
| | - T. Déirdre Hollingsworth
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of MedicineUniversity of OxfordOxfordUK
| | - Sue Horton
- School of Public Health and Health SystemsUniversity of WaterlooWaterlooOntarioCanada
| | - Peter Tugwell
- School of EpidemiologyPublic Health and Preventive Medicine, University of OttawaOttawaOntarioCanada
- Center for Global Health, WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health EquityBruyère Research InstituteOttawaOntarioCanada
| | | | | | - Alison Elliott
- Medical Research Council/Uganda Virus Research InstituteLondon School of Hygiene and Tropical Medicine Uganda Research UnitEntebbeUganda
| | - Henrik Friis
- Department of Human NutritionUniversity of CopenhagenFrederiksbergDenmark
| | - Huong T. Le
- Institute for Preventive Medicine and Public HealthHanoi Medical UniversityHanoiVietnam
| | - Chengfang Liu
- School of Advanced Agricultural Sciences (SAAS)China Center for Agricultural Policy (CCAP), Peking UniversityBeijingChina
| | - Emily K. Rousham
- School of Sport, Exercise and Health SciencesLoughborough UniversityLeicestershireUK
| | | | - Charles King
- Department of PediatricsUniversity of CaliforniaLa JollaCalifornia
| | - Erliyani Sartono
- Department of ParasitologyLeiden University Medical CenterLeidenThe Netherlands
| | - Taniawati Supali
- Department Parasitology, Faculty of MedicineUniversitas IndonesiaJakartaIndonesia
| | - Peter Steinmann
- Swiss Tropical and Public Health InstituteUniversity of BaselBaselSwitzerland
| | - Emily Webb
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - Franck Wieringa
- UMR204 NutripassInstitute de Recherche pour le DéveloppementMontpellierFrance
| | - Pattanee Winnichagoon
- Community/International Nutrition, Institute of NutritionMahidol UniversityNakhon PathomThailand
| | - Maria Yazdanbakhsh
- Department of ParasitologyLeiden University Medical CenterLeidenThe Netherlands
| | - Zulfiqar A. Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Center of Excellence in Women and Child HealthAga Khan UniversityKarachiPakistan
| | - George Wells
- Cardiovascular Research MethodsUniversity of Ottawa Heart InstituteOttawaOntarioCanada
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29
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Farrell SH, Coffeng LE, Truscott JE, Werkman M, Toor J, de Vlas SJ, Anderson RM. Investigating the Effectiveness of Current and Modified World Health Organization Guidelines for the Control of Soil-Transmitted Helminth Infections. Clin Infect Dis 2019; 66:S253-S259. [PMID: 29860285 PMCID: PMC5982801 DOI: 10.1093/cid/ciy002] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Considerable efforts have been made to better understand the effectiveness of large-scale preventive chemotherapy therapy for the control of morbidity caused by infection with soil-transmitted helminths (STHs): Ascaris lumbricoides, Trichuris trichiura, and the 2 hookworm species, Necator americanus and Ancylostoma duodenale. Current World Health Organization (WHO) guidelines for STH control include mass drug administration (MDA) programs based on prevalence measurements, aiming at reducing morbidity in pre–school-aged children (pre-SAC) and school-aged children (SAC) by lowering the prevalence of moderate- to heavy-intensity infections to <1%. Methods We project the likely impact of following the current WHO guidelines and assess whether the WHO morbidity goals will be achieved across a range of transmission settings. We also investigate modifications that could be made to the current WHO treatment guidelines, and project their potential impacts in achieving morbidity and transmission control. Results While the standard guidelines are sufficient at low transmission levels, community-wide treatment (ie, involving pre-SAC, SAC, and adults) is essential if WHO morbidity goals are to be met in moderate- to high-transmission settings. Moreover, removing the recommendation of decreasing the treatment frequency at midline (5–6 years after the start of MDA) further improves the likelihood of achieving morbidity control in SAC. Conclusions We meld analyses based on 2 mathematical models of parasite transmission and control by MDA for the dominant STH species, to generate a unified treatment approach applicable across all settings, regardless of which STH infection is most common. We recommend clearly defined changes to the current WHO guidelines.
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Affiliation(s)
- Sam H Farrell
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College London, United Kingdom
| | - Luc E Coffeng
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - James E Truscott
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College London, United Kingdom.,DeWorm3 Project, Natural History Museum of London, United Kingdom
| | - Marleen Werkman
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College London, United Kingdom.,DeWorm3 Project, Natural History Museum of London, United Kingdom
| | - Jaspreet Toor
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College London, United Kingdom
| | - Sake J de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Roy M Anderson
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College London, United Kingdom.,DeWorm3 Project, Natural History Museum of London, United Kingdom
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30
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Insights from quantitative analysis and mathematical modelling on the proposed WHO 2030 goals for soil-transmitted helminths. Gates Open Res 2019; 3:1632. [DOI: 10.12688/gatesopenres.13077.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2019] [Indexed: 11/20/2022] Open
Abstract
Soil-transmitted helminths (STHs) are a group of parasitic worms that infect humans, causing a wide spectrum of disease, notably anaemia, growth retardation, and delayed cognitive development. The three main STHs are Ascaris lumbricoides, Trichuris trichiura and hookworm (Necator americanus and Ancylostoma duodenale). Approximately 1.5 billion people are infected with STHs worldwide. The World Health Organization goal for 2030 is morbidity control, defined as reaching <2% prevalence of medium-to-high intensity infections in preschool-age children and school-age children (SAC). Treatment guidelines for achieving this goal have been recommended. The Neglected Tropical Diseases Modelling Consortium has developed mathematical and statistical models to quantify, predict, and evaluate the impact of control measures on STHs. These models show that the morbidity target can be achieved following current guidelines in moderate prevalence settings (20-50% in SAC). In high prevalence settings, semi-annual preventive chemotherapy (PC) ideally including adults, or at least women of reproductive age, is required. For T. trichiura, dual therapy with albendazole and ivermectin is required. In general, stopping PC is not possible without infection resurgence, unless effective measures for improved access to water, hygiene, and sanitation have been implemented, or elimination of transmission has been achieved. Current diagnostic methods are based on egg counts in stool samples, but these are known to have poor sensitivity at low prevalence levels. A target threshold for novel, more sensitive diagnostics should be defined relative to currently preferred diagnostics (Kato-Katz). Our analyses identify the extent of systematic non-access to treatment and the individual patterns of compliance over multiple rounds of treatment as the biggest unknowns and the main impediment to reaching the target. Moreover, the link between morbidity and infection intensity has not been fully elucidated. By providing more insights on all the above, we aim to inform discussions on the goals and treatment guidelines for STHs.
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31
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The benefits of mass deworming on health outcomes: new evidence synthesis, the debate persists. LANCET GLOBAL HEALTH 2019; 5:e4-e5. [PMID: 27955787 DOI: 10.1016/s2214-109x(16)30333-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 11/08/2016] [Indexed: 12/30/2022]
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Effects of single and integrated water, sanitation, handwashing, and nutrition interventions on child soil-transmitted helminth and Giardia infections: A cluster-randomized controlled trial in rural Kenya. PLoS Med 2019; 16:e1002841. [PMID: 31242190 PMCID: PMC6594579 DOI: 10.1371/journal.pmed.1002841] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 05/28/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Helminth and protozoan infections affect more than 1 billion children globally. Improving water quality, sanitation, handwashing, and nutrition could be more sustainable control strategies for parasite infections than mass drug administration, while providing other quality of life benefits. METHODS AND FINDINGS We enrolled geographic clusters of pregnant women in rural western Kenya into a cluster-randomized controlled trial (ClinicalTrials.gov NCT01704105) that tested 6 interventions: water treatment, improved sanitation, handwashing with soap, combined water treatment, sanitation, and handwashing (WSH), improved nutrition, and combined WSH and nutrition (WSHN). We assessed intervention effects on parasite infections by measuring Ascaris lumbricoides, Trichuris trichiura, hookworm, and Giardia duodenalis among children born to the enrolled pregnant women (index children) and their older siblings. After 2 years of intervention exposure, we collected stool specimens from 9,077 total children aged 2 to 15 years in 622 clusters, including 2,346 children in an active control group (received household visits but no interventions), 1,117 in the water treatment arm, 1,160 in the sanitation arm, 1,141 in the handwashing arm, 1,064 in the WSH arm, 1,072 in the nutrition arm, and 1,177 in the WSHN arm. In the control group, 23% of children were infected with A. lumbricoides, 1% with T. trichiura, 2% with hookworm, and 39% with G. duodenalis. The analysis included 4,928 index children (median age in years: 2) and 4,149 older siblings (median age in years: 5); study households had an average of 5 people, <10% had electricity access, and >90% had dirt floors. Compared to the control group, Ascaris infection prevalence was lower in the water treatment arm (prevalence ratio [PR]: 0.82 [95% CI 0.67, 1.00], p = 0.056), the WSH arm (PR: 0.78 [95% CI 0.63, 0.96], p = 0.021), and the WSHN arm (PR: 0.78 [95% CI 0.64, 0.96], p = 0.017). We did not observe differences in Ascaris infection prevalence between the control group and the arms with the individual interventions sanitation (PR: 0.89 [95% CI 0.73, 1.08], p = 0.228), handwashing (PR: 0.89 [95% CI 0.73, 1.09], p = 0.277), or nutrition (PR: 86 [95% CI 0.71, 1.05], p = 0.148). Integrating nutrition with WSH did not provide additional benefit. Trichuris and hookworm were rarely detected, resulting in imprecise effect estimates. No intervention reduced Giardia. Reanalysis of stool samples by quantitative polymerase chain reaction confirmed the reductions in Ascaris infections measured by microscopy in the WSH and WSHN groups. Trial limitations included imperfect uptake of targeted intervention behaviors, limited power to detect effects on rare parasite infections, and that it was not feasible to blind participants and sample collectors to treatment status. However, lab technicians and data analysts were blinded to treatment status. The trial was funded by the Bill & Melinda Gates Foundation and the United States Agency for International Development. CONCLUSIONS Integration of improved water quality, sanitation, and handwashing could contribute to sustainable control strategies for Ascaris infections, particularly in similar settings with recent or ongoing deworming programs. Combining nutrition with WSH did not provide further benefits, and water treatment alone was similarly effective to integrated WSH. Our findings provide new evidence that drinking water should be given increased attention as a transmission pathway for Ascaris. TRIAL REGISTRATION ClinicalTrials.gov NCT01704105.
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33
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Stewart CP, Dewey KG, Lin A, Pickering AJ, Byrd KA, Jannat K, Ali S, Rao G, Dentz HN, Kiprotich M, Arnold CD, Arnold BF, Allen LH, Shahab-Ferdows S, Ercumen A, Grembi JA, Naser AM, Rahman M, Unicomb L, Colford JM, Luby SP, Null C. Effects of lipid-based nutrient supplements and infant and young child feeding counseling with or without improved water, sanitation, and hygiene (WASH) on anemia and micronutrient status: results from 2 cluster-randomized trials in Kenya and Bangladesh. Am J Clin Nutr 2019; 109:148-164. [PMID: 30624600 PMCID: PMC6358037 DOI: 10.1093/ajcn/nqy239] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 08/14/2018] [Indexed: 12/24/2022] Open
Abstract
Background Anemia in young children is a global health problem. Risk factors include poor nutrient intake and poor water quality, sanitation, or hygiene. Objective We evaluated the effects of water quality, sanitation, handwashing, and nutrition interventions on micronutrient status and anemia among children in rural Kenya and Bangladesh. Design We nested substudies within 2 cluster-randomized controlled trials enrolling pregnant women and following their children for 2 y. These substudies included 4 groups: water, sanitation, and handwashing (WSH); nutrition (N), including lipid-based nutrient supplements (LNSs; ages 6-24 mo) and infant and young child feeding (IYCF) counseling; WSH+N; and control. Hemoglobin and micronutrient biomarkers were measured after 2 y of intervention and compared between groups using generalized linear models with robust SEs. Results In Kenya, 699 children were assessed at a mean ± SD age of 22.1 ± 1.8 mo, and in Bangladesh 1470 participants were measured at a mean ± SD age of 28.0 ± 1.9 mo. The control group anemia prevalences were 48.8% in Kenya and 17.4% in Bangladesh. There was a lower prevalence of anemia in the 2 N intervention groups in both Kenya [N: 36.2%; prevalence ratio (PR): 0.74; 95% CI: 0.58, 0.94; WSH+N: 27.3%; PR: 0.56; 95% CI: 0.42, 0.75] and Bangladesh (N: 8.7%; PR: 0.50; 95% CI: 0.32, 0.78; WSH+N: 7.9%, PR: 0.46; 95% CI: 0.29, 0.73). In both trials, the 2 N groups also had significantly lower prevalences of iron deficiency, iron deficiency anemia, and low vitamin B-12 and, in Kenya, a lower prevalence of folate and vitamin A deficiencies. In Bangladesh, the WSH group had a lower prevalence of anemia (12.8%; PR: 0.74; 95% CI: 0.54, 1.00) than the control group, whereas in Kenya, the WSH+N group had a lower prevalence of anemia than did the N group (PR: 0.75; 95% CI: 0.53, 1.07), but this was not significant (P = 0.102). Conclusions IYCF counseling with LNSs reduced the risks of anemia, iron deficiency, and low vitamin B-12. Effects on folate and vitamin A varied between studies. Improvements in WSH also reduced the risk of anemia in Bangladesh but did not provide added benefit over the nutrition-specific intervention. These trials were registered at clinicaltrials.gov as NCT01590095 (Bangladesh) and NCT01704105 (Kenya).
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Affiliation(s)
- Christine P Stewart
- Department of Nutrition, University of California, Davis, Davis, CA,Address correspondence to CPS (e-mail: )
| | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, Davis, CA
| | - Audrie Lin
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA
| | - Amy J Pickering
- Department of Civil and Environmental Engineering,Present address for AJP: Department of Civil and Environmental Engineering, Tufts University, 200 College Avenue, Medford, MA 02155
| | - Kendra A Byrd
- Department of Nutrition, University of California, Davis, Davis, CA
| | - Kaniz Jannat
- International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shahjahan Ali
- International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Gouthami Rao
- Innovations for Poverty Action, Nairobi, Kenya,Present address for GR: Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, CDC, 1600 Clifton Road, Atlanta, GA 30329
| | - Holly N Dentz
- Department of Nutrition, University of California, Davis, Davis, CA,Innovations for Poverty Action, Nairobi, Kenya
| | - Marion Kiprotich
- Innovations for Poverty Action, Nairobi, Kenya,Present address for MK: One Acre Fund, Nairobi, Kenya
| | - Charles D Arnold
- Department of Nutrition, University of California, Davis, Davis, CA
| | - Benjamin F Arnold
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA
| | - Lindsay H Allen
- USDA, Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA
| | | | - Ayse Ercumen
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA
| | | | - Abu Mohd Naser
- International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mahbubur Rahman
- International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Leanne Unicomb
- International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - John M Colford
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA
| | - Clair Null
- Innovations for Poverty Action, Nairobi, Kenya,Present address for CN: Mathmatica Policy Research, 1100 First Street, NE, 12th Floor, Washington, DC 20002
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Debaveye S, Gonzalez Torres CV, De Smedt D, Heirman B, Kavanagh S, Dewulf J. The public health benefit and burden of mass drug administration programs in Vietnamese schoolchildren: Impact of mebendazole. PLoS Negl Trop Dis 2018; 12:e0006954. [PMID: 30419030 PMCID: PMC6258429 DOI: 10.1371/journal.pntd.0006954] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 11/26/2018] [Accepted: 10/29/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Mass anthelmintic drug administration is recommended in developing countries to address infection by soil-transmitted helminthiases (STH). We quantified the public health benefit of treatment with mebendazole in eight million Vietnamese children aged 5-14 years from 2006 to 2011. This was compared to the environmental impact of the pharmaceutical supply chain of mebendazole, as the resource use and emissions associated with pharmaceutical production can be associated with a public health burden, e.g. through emissions of fine particulate matter. METHODOLOGY Through Markov modelling the disability due to STH was quantified for hookworm, Ascaris lumbricoides and Trichuris trichiura. For each worm type, four levels of intensity of infection were included: none, light, medium and heavy. The treatment effect on patients was quantified in Disability-Adjusted Life Years (DALYs). The public health burden induced by the pharmaceutical supply chain of mebendazole was quantified in DALYs through Life Cycle Assessment. PRINCIPAL FINDINGS Compared to 'no treatment', the modelled results of five-year treatment averted 116,587 DALYs (68% reduction) for the three worms combined and largely driven by A. lumbricoides. The main change in DALYs occurred in the first year of treatment, after which the results stabilized. The public health burden associated with the pharmaceutical supply chain was 6 DALYs. CONCLUSIONS The public health benefit of the Mass Drug Administration (MDA) averted substantially more DALYs than those induced by the pharmaceutical supply chain. These results were verified in a sensitivity analysis. The starting prevalence for each worm was the most sensitive model parameter. This methodology is useful for policymakers interested in a holistic approach towards the public health performance of MDA programs, enveloping both the treatment benefit received by the patient and the public health burden associated with the resource consumption and environmental emissions of the pharmaceutical production and supply chain.
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Affiliation(s)
- Sam Debaveye
- Department of Green Chemistry and Technology, Ghent University, Campus Coupure, Ghent, Belgium
| | | | - Delphine De Smedt
- Department of Public Health, Ghent University, Campus UZ, Ghent, Belgium
| | - Bert Heirman
- Johnson & Johnson EHS&S, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Shane Kavanagh
- Health Economics, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Jo Dewulf
- Department of Green Chemistry and Technology, Ghent University, Campus Coupure, Ghent, Belgium
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Blouin B, Casapía M, Joseph L, Kaufman JS, Larson C, Gyorkos TW. The effect of cumulative soil-transmitted helminth infections over time on child development: a 4-year longitudinal cohort study in preschool children using Bayesian methods to adjust for exposure misclassification. Int J Epidemiol 2018; 47:1180-1194. [PMID: 30010794 PMCID: PMC6124617 DOI: 10.1093/ije/dyy142] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2018] [Indexed: 11/12/2022] Open
Abstract
Background Limited research has documented an association between soil-transmitted helminth (STH) infections and child development. This has recently been identified as an important knowledge gap. Methods A longitudinal cohort study was conducted in Iquitos, Peru, between September 2011 and July 2016. A cohort of 880 children, recruited at 1 year of age, was followed up to 5 years. STH infection was measured annually and child development was measured with the Wechsler Preschool and Primary Scale of Intelligence III (WPPSI-III) at 5 years. Linear-regression models were used to investigate the effect of the number of detected STH infections between 1 and 5 years of age on WPPSI-III scores at 5 years of age. Bayesian latent class analysis was used to adjust for exposure misclassification. Results A total of 781 (88.8%) children were included in the analysis. In multivariable analysis, adjusted for STH misclassification, increasing numbers of Ascaris, Trichuris, hookworm and any STH infections were associated with lower WPPSI-III scores. Among the largest observed effects were those for the effect of Ascaris infection on verbal IQ scores [difference in IQ (95% CrI) for two, three, and four or five detected infections compared with zero or one infection: -8.27 (-13.85, -3.10), -6.69 (-12.05, -2.05) and -5.06 (-10.75, 0.05), respectively]. Misclassification of STH infection generally led to a bias towards the null. Conclusions These results document an association between STH infection and child development. The results highlight the importance of adjusting for STH misclassification; however, future research is needed to accurately determine the sensitivity of STH diagnostic techniques. STH control in preschool children may contribute to lowering the disease burden associated with poor child development.
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Affiliation(s)
- Brittany Blouin
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | | | - Lawrence Joseph
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Jay S Kaufman
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Charles Larson
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Theresa W Gyorkos
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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Woode ME, Khan JAM, Thomson R, Niessen LW. Equity and efficiency in the scaled-up implementation of integrated neglected tropical disease control: the health economics protocol of the COUNTDOWN multicountry observational study in Ghana, Cameroon and Liberia. BMJ Open 2018; 8:e020113. [PMID: 29961005 PMCID: PMC6042538 DOI: 10.1136/bmjopen-2017-020113] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 04/06/2018] [Accepted: 04/24/2018] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Worldwide, millions of individuals are affected by neglected tropical diseases (NTDs). They are frequently the poorest and most marginalised members of society. Their living conditions, among other things, make them susceptible to such diseases. Historically, several large-scale treatment programmes providing mass drug administrations (MDAs) were carried out per single disease but over the last decade there has been an increasing trend towards co-implementation of MDA activities given the resources used for such programmes are often the same. The COUNTDOWN multicountry studies focus on scaled-up implementation of integrated control strategies against four diseases: lymphatic filariasis, onchocerciasis, schistosomiasis and soil-transmitted helminthiasis. The objective of the COUNTDOWN economic study is to assess the multicountry implementation of control interventions in terms of equity, impact and efficiency. METHODS The health economic study uses different analytical methods to assess the relationship between NTDs and poverty and the cost-effectiveness of different large-scale intervention options. Regression analysis will be used to study the determinants of NTD occurrence, the impact of NTDs on poverty, factors that hinder access to MDAs and the effect of NTDs on quality-of-life of those affected, including disability. Cost-effectiveness analyses of various integration methods will be performed using health economic modelling to estimate the cost and programme impact of different integration options. Here, cost-effectiveness ratios will be calculated, including multivariate sensitivity analyses, using Bayesian analysis. ETHICS AND DISSEMINATION Ethics approval has been received both at the Liverpool School of Tropical Medicine and in all participating countries. Results of the various substudies will be presented for publication in peer-reviewed journals. STUDY DATES 1 July 2016 to 30 June-October 2019.
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Affiliation(s)
- Maame Esi Woode
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jahangir A M Khan
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Rachael Thomson
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Louis Wilhelmus Niessen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Centre for Applied Health Research and Delivery, Liverpool School of Tropical Medicine, Liverpool, UK
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, USA
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Vaz Nery S, Qi J, Llewellyn S, Clarke NE, Traub R, Gray DJ, Vallely AJ, Williams GM, Andrews RM, McCarthy JS, Clements ACA. Use of quantitative PCR to assess the efficacy of albendazole against Necator americanus and Ascaris spp. in Manufahi District, Timor-Leste. Parasit Vectors 2018; 11:373. [PMID: 29954461 PMCID: PMC6025744 DOI: 10.1186/s13071-018-2838-0] [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: 10/02/2017] [Accepted: 04/09/2018] [Indexed: 11/21/2022] Open
Abstract
Background Soil-transmitted helminths (STHs) including Ascaris lumbricoides, Necator americanus, Ancylostoma spp. and Trichuris trichiura are cause of significant global morbidity. To mitigate their disease burden, at-risk groups in endemic regions receive periodic mass drug administration using anthelmintics, most commonly albendazole and mebendazole. Assessing the efficacy of anthelmintic drugs is important for confirming that these regimens are working effectively and that drug resistance has not emerged. In this study we aimed to characterise the therapeutic efficacy of albendazole against Ascaris spp. and N. americanus in Timor-Leste, using a quantitative polymerase chain reaction (qPCR) method for parasite detection and quantification. Results A total of 314 participants from 8 communities in Timor-Leste provided stool samples before and 10–14 days after the administration of a single 400 mg dose of albendazole. Helminth infection status and infection intensity (measured in Ct-values and relative fluorescence units) were determined using qPCR. Efficacy was determined by examining the cure rates and infection intensity reduction rates. Albendazole was found to be highly efficacious against Ascaris spp., with a cure rate of 91.4% (95% CI: 85.9–95.2%) and infection intensity reduction rate of 95.6% (95% CI: 88.3–100%). The drug was less efficacious against N. americanus with a cure rate of 58.3% (95% CI: 51.4–64.9%) and infection intensity reduction rate of 88.9% (95% CI: 84.0–97.0%). Conclusions The observed cure rates and infection intensity reduction rates obtained for Ascaris spp. and to a lower extent N. americanus, demonstrate the continued efficacy of albendazole against these species and its utility as a mass chemotherapy agent in Timor-Leste. Furthermore, this study demonstrates the usefulness of qPCR as a method to measure the efficacy of anthelminthic drugs. Additional research is necessary to translate Ct-values into eggs per gram in a systematic way. Trial registration Australian and New Zealand Clinical Trials Registry 12614000680662 (registered 27 June 2014).
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Affiliation(s)
- Susana Vaz Nery
- Research School of Population Health, Australian National University, 62 Mills Rd, Canberra, 2601, ACT, Australia. .,Present Address: Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, 2052, NSW, Australia.
| | - Jessica Qi
- Medical School, Australian National University, Building 42, Canberra, ACT, 2601, Australia
| | - Stacey Llewellyn
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, 300 Herston Rd, Brisbane, QLD 4006, Australia
| | - Naomi E Clarke
- Research School of Population Health, Australian National University, 62 Mills Rd, Canberra, 2601, ACT, Australia
| | - Rebecca Traub
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, 3052, Australia
| | - Darren J Gray
- Research School of Population Health, Australian National University, 62 Mills Rd, Canberra, 2601, ACT, Australia
| | - Andrew J Vallely
- Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, 2052, NSW, Australia
| | - Gail M Williams
- School of Public Health, The University of Queensland, Corner of Herston Road and Wyndham Street, Brisbane, QLD 4006, Australia
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT 0811, Australia
| | - James S McCarthy
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, 300 Herston Rd, Brisbane, QLD 4006, Australia
| | - Archie C A Clements
- Research School of Population Health, Australian National University, 62 Mills Rd, Canberra, 2601, ACT, Australia
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Vaz Nery S, Bennett I, Clarke NE, Lin A, Rahman Z, Rahman M, Clements ACA. Characterisation of environmental enteropathy biomarkers and associated risk factors in children in the context of a WASH trial in Timor-Leste. Int J Hyg Environ Health 2018; 221:901-906. [PMID: 29891218 DOI: 10.1016/j.ijheh.2018.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/23/2018] [Accepted: 05/28/2018] [Indexed: 01/24/2023]
Abstract
Environmental enteropathy (EE) is characterised by subclinical inflammation and hyperpermeability of the small intestine, hypothesised to be caused by recurrent ingestion of faecal bacteria. It has been suggested that EE may be a contributor to malnutrition and growth delays seen in children living in unsanitary conditions. We measured putative faecal EE markers myeloperoxidase (MPO) (ng/mL) and alpha-1-antitrypsin (AAT) (mg/g) in stool samples collected from 133 children aged 1-5 years in 16 communities enrolled in the WASH for WORMS randomised controlled trial in Timor-Leste. Samples were collected two years after a community-wide water, sanitation and hygiene (WASH) intervention that was integrated with regular deworming. Mixed effects multivariable linear regression models were used to examine the impact of the study intervention and of various WASH and infection-related factors on EE biomarkers. Children who lived in communities that received both the WASH intervention and deworming had similar AAT values as those who lived in communities that received only deworming (regression coefficient -0.14, p = 0.583), but they had a trend towards lower MPO values (coeff -0.51, p = 0.055). Younger children showed significantly higher MPO levels (coeff: -0.29, p = 0.002). No WASH variables or parasitic infections were associated with AAT levels. Household water being stored in covered containers was associated with lower MPO levels (coeff -1.75, p = 0.046). We found little evidence that a community-based WASH intervention had an impact on EE over a two-year period.
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Affiliation(s)
- Susana Vaz Nery
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia.
| | - Isaac Bennett
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Naomi E Clarke
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Audrie Lin
- Division of Epidemiology, School of Public Health, University of California, Berkeley, California, USA
| | - Ziaur Rahman
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Mahbubur Rahman
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Archie C A Clements
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
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Sanya RE, Nkurunungi G, Andia Biraro I, Mpairwe H, Elliott AM. A life without worms. Trans R Soc Trop Med Hyg 2018; 111:3-11. [PMID: 28340138 PMCID: PMC5412073 DOI: 10.1093/trstmh/trx010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 02/27/2017] [Indexed: 12/14/2022] Open
Abstract
Worms have co-evolved with humans over millions of years. To survive, they manipulate host systems by modulating immune responses so that they cause (in the majority of hosts) relatively subtle harm. Anthelminthic treatment has been promoted as a measure for averting worm specific pathology and to mitigate subtle morbidities which may include effects on anaemia, growth, cognitive function and economic activity. With our changing environment marked by rapid population growth, urbanisation, better hygiene practices and anthelminthic treatment, there has been a decline in worm infections and other infectious diseases and a rise in non-communicable diseases such as allergy, diabetes and cardiovascular disease. This review reflects upon our age-old interaction with worms, and the broader ramifications of life without worms for vaccine responses and susceptibility to other infections, and for allergy-related and metabolic disease. We touch upon the controversy around the benefits of mass drug administration for the more-subtle morbidities that have been associated with worm infections and then focus our attention on broader, additional aspects of life without worms, which may be either beneficial or detrimental.
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Affiliation(s)
- Richard E Sanya
- MRC/UVRI Uganda Research Unit, Uganda Virus Research Institute, P.O. Box 49, Entebbe, Uganda.,College of Health Sciences, Makerere University, Kampala, Uganda
| | - Gyaviira Nkurunungi
- MRC/UVRI Uganda Research Unit, Uganda Virus Research Institute, P.O. Box 49, Entebbe, Uganda.,Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | | | - Harriet Mpairwe
- MRC/UVRI Uganda Research Unit, Uganda Virus Research Institute, P.O. Box 49, Entebbe, Uganda
| | - Alison M Elliott
- MRC/UVRI Uganda Research Unit, Uganda Virus Research Institute, P.O. Box 49, Entebbe, Uganda.,Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Pabalan N, Singian E, Tabangay L, Jarjanazi H, Boivin MJ, Ezeamama AE. Soil-transmitted helminth infection, loss of education and cognitive impairment in school-aged children: A systematic review and meta-analysis. PLoS Negl Trop Dis 2018; 12:e0005523. [PMID: 29329288 PMCID: PMC5766095 DOI: 10.1371/journal.pntd.0005523] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 10/01/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Evidence of an adverse influence of soil transmitted helminth (STH) infections on cognitive function and educational loss is equivocal. Prior meta-analyses have focused on randomized controlled trials only and have not sufficiently explored the potential for disparate influence of STH infection by cognitive domain. We re-examine the hypothesis that STH infection is associated with cognitive deficit and educational loss using data from all primary epidemiologic studies published between 1992 and 2016. METHODS Medline, Biosis and Web of Science were searched for original studies published in the English language. Cognitive function was defined in four domains (learning, memory, reaction time and innate intelligence) and educational loss in two domains (attendance and scholastic achievement). Pooled effect across studies were calculated as standardized mean differences (SMD) to compare cognitive and educational measures for STH infected/non-dewormed children versus STH uninfected /dewormed children using Review Manager 5.3. Sub-group analyses were implemented by study design, risk of bias (ROB) and co-prevalence of Schistosoma species infection. Influential studies were excluded in sensitivity analysis to examine stability of pooled estimates. FINDINGS We included 36 studies of 12,920 children. STH infected/non-dewormed children had small to moderate deficits in three domains-learning, memory and intelligence (SMD: -0.44 to -0.27, P<0.01-0.03) compared to STH-uninfected/dewormed children. There were no differences by infection/treatment status for reaction time, school attendance and scholastic achievement (SMD: -0.26 to -0.16, P = 0.06-0.19). Heterogeneity of the pooled effects in all six domains was high (P<0.01; I2 = 66-99%). Application of outlier treatment reduced heterogeneity in learning domain (P = 0.12; I2 = 33%) and strengthened STH-related associations in all domains but intelligence (SMD: -0.20, P = 0.09). Results varied by study design and ROB. Among experimental intervention studies, there was no association between STH treatment and educational loss/performance in tests of memory, reaction time and innate intelligence (SMD: -0.27 to 0.17, P = 0.18-0.69). Infection-related deficits in learning persisted within design/ROB levels (SMD: -0.37 to -52, P<0.01) except for pre-vs post intervention design (n = 3 studies, SMD = -0.43, P = 0.47). Deficits in memory, reaction time and innate intelligence persisted within observational studies (SMD: -0.23 to -0.38, all P<0.01) and high ROB strata (SMD:-0.37 to -0.83, P = 0.07 to <0.01). Further, in Schistosoma infection co-prevalent settings, associations were generally stronger and statistically robust for STH-related deficits in learning, memory and reaction time tests(SMD:-0.36 to -0.55, P = 0.003-0.02). STH-related deficits in school attendance and scholastic achievement was noted in low (SMD:-0.57, P = 0.05) and high ROB strata respectively. INTERPRETATION We provide evidence of superior performance in five of six educational and cognitive domains assessed for STH uninfected/dewormed versus STH infected/not-dewormed school-aged children from helminth endemic regions. Cautious interpretation is warranted due to high ROB in some of the primary literature and high between study variability in most domains. Notwithstanding, this synthesis provides empirical support for a cognitive and educational benefit of deworming. The benefit of deworming will be enhanced by strategically employing, integrated interventions. Thus, multi-pronged inter-sectoral strategies that holistically address the environmental and structural roots of child cognitive impairment and educational loss in the developing world may be needed to fully realize the benefit of mass deworming programs.
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Affiliation(s)
- Noel Pabalan
- Center for Research and Development, Angeles University Foundation, Angeles City, Philippines
| | - Eloisa Singian
- Department of Medical Technology, College of Allied Medical Professions, Angeles University Foundation, Angeles, Philippines
| | - Lani Tabangay
- Department of Biological Sciences, Angeles University Foundation, Angeles City, Philippines
| | - Hamdi Jarjanazi
- Environmental Monitoring and Reporting Branch, Biomonitoring Unit, Ontario Ministry of the Environment and Climate Change, Toronto, Ontario, Canada
| | - Michael J. Boivin
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, United States of America
| | - Amara E. Ezeamama
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, United States of America
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Welch V, Ghogomu E, Hossain A, Arora P, Cousens S, Gaffey M, Riddle A, Salam R, Tugwell P, Bhutta Z, Wells GA. PROTOCOL: Mass deworming for improving health and cognition of children in endemic helminth areas: a systematic review and individual participant data network meta-analysis. CAMPBELL SYSTEMATIC REVIEWS 2018; 14:1-46. [PMID: 37131362 PMCID: PMC8428007 DOI: 10.1002/cl2.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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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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43
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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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Hill LJ, Williams AC. Meat Intake and the Dose of Vitamin B 3 - Nicotinamide: Cause of the Causes of Disease Transitions, Health Divides, and Health Futures? Int J Tryptophan Res 2017; 10:1178646917704662. [PMID: 28579801 PMCID: PMC5419340 DOI: 10.1177/1178646917704662] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/15/2017] [Indexed: 12/26/2022] Open
Abstract
Meat and vitamin B3 - nicotinamide - intake was high during hunter-gatherer times. Intake then fell and variances increased during and after the Neolithic agricultural revolution. Health, height, and IQ deteriorated. Low dietary doses are buffered by 'welcoming' gut symbionts and tuberculosis that can supply nicotinamide, but this co-evolved homeostatic metagenomic strategy risks dysbioses and impaired resistance to pathogens. Vitamin B3 deficiency may now be common among the poor billions on a low-meat diet. Disease transitions to non-communicable inflammatory disorders (but longer lives) may be driven by positive 'meat transitions'. High doses of nicotinamide lead to reduced regulatory T cells and immune intolerance. Loss of no longer needed symbiotic 'old friends' compounds immunological over-reactivity to cause allergic and auto-immune diseases. Inhibition of nicotinamide adenine dinucleotide consumers and loss of methyl groups or production of toxins may cause cancers, metabolic toxicity, or neurodegeneration. An optimal dosage of vitamin B3 could lead to better health, but such a preventive approach needs more equitable meat distribution. Some people may require personalised doses depending on genetic make-up or, temporarily, when under stress.
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Affiliation(s)
- Lisa J Hill
- Neuroscience and Ophthalmology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Adrian C Williams
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Campbell SJ, Nery SV, D’Este CA, Gray DJ, McCarthy JS, Traub RJ, Andrews RM, Llewellyn S, Vallely AJ, Williams GM, Clements ACA. Investigations into the association between soil-transmitted helminth infections, haemoglobin and child development indices in Manufahi District, Timor-Leste. Parasit Vectors 2017; 10:192. [PMID: 28424091 PMCID: PMC5395746 DOI: 10.1186/s13071-017-2084-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 03/09/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Timor-Leste has a high prevalence of soil-transmitted helminth (STH) infections. High proportions of the population have been reported as being anaemic, and extremely high proportions of children as stunted or wasted. There have been no published analyses of the contributions of STH to these morbidity outcomes in Timor-Leste. METHODS Using baseline cross-sectional data from 24 communities (18 communities enrolled in a cluster randomised controlled trial, and identically-collected data from six additional communities), analyses of the association between STH infections and community haemoglobin and child development indices were undertaken. Stool samples were assessed for STH using qPCR and participant haemoglobin, heights and weights were measured. Questionnaires were administered to collect demographic and socioeconomic data. Intensity of infection was categorised using correlational analysis between qPCR quantification cycle values and eggs per gram of faeces equivalents, with algorithms generated from seeding experiments. Mixed-effects logistic and multinomial regression were used to assess the association between STH infection intensity classes and anaemia, and child stunting, wasting and underweight. RESULTS Very high stunting (60%), underweight (60%), and wasting (20%) in children, but low anaemia prevalence (15%), were found in the study communities. STH were not significantly associated with morbidity outcomes. Male children and those in the poorest socioeconomic quintile were significantly more likely to be moderately and severely stunted. Male children were significantly more likely than female children to be severely underweight. Increasing age was also a risk factor for being underweight. Few risk factors emerged for wasting in these analyses. CONCLUSIONS According to World Health Organization international reference standards, levels of child morbidity in this population constitute a public health emergency, although the international reference standards need to be critically evaluated for their applicability in Timor-Leste. Strategies to improve child development and morbidity outcomes, for example via nutrition and iron supplementation programmes, are recommended for these communities. Despite the apparent lack of an association from STH in driving anaemia, stunting, wasting and underweight, high endemicity suggests a need for STH control strategies. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12614000680662 ; retrospectively registered.
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Affiliation(s)
- Suzy J. Campbell
- Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, 62 Mills Rd, Acton, ACT 2601 Australia
| | - Susana V. Nery
- Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, 62 Mills Rd, Acton, ACT 2601 Australia
| | - Catherine A. D’Este
- Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, 62 Mills Rd, Acton, ACT 2601 Australia
| | - Darren J. Gray
- Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, 62 Mills Rd, Acton, ACT 2601 Australia
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, 300 Herston Rd, Brisbane, QLD 4006 Australia
- School of Public Health, University of Queensland, Herston Rd, Brisbane, QLD 4006 Australia
| | - James S. McCarthy
- School of Public Health, University of Queensland, Herston Rd, Brisbane, QLD 4006 Australia
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, 300 Herston Rd, Brisbane, QLD 4006 Australia
| | - Rebecca J. Traub
- Faculty of Veterinary and Agricultural Science, The University of Melbourne, Parkville, VIC 3010 Australia
| | - Ross M. Andrews
- Menzies School of Health Research, Charles Darwin University, Ellengowan Dr, Casuarina, NT 0810 Australia
| | - Stacey Llewellyn
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, 300 Herston Rd, Brisbane, QLD 4006 Australia
| | - Andrew J. Vallely
- Kirby Institute, University of New South Wales, Wallace Wurth Building, High St, Kensington, NSW 2052 Australia
| | - Gail M. Williams
- School of Public Health, University of Queensland, Herston Rd, Brisbane, QLD 4006 Australia
| | - Archie C. A. Clements
- Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, 62 Mills Rd, Acton, ACT 2601 Australia
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Medley GF, Turner HC, Baggaley RF, Holland C, Hollingsworth TD. The Role of More Sensitive Helminth Diagnostics in Mass Drug Administration Campaigns: Elimination and Health Impacts. ADVANCES IN PARASITOLOGY 2016; 94:343-392. [PMID: 27756457 DOI: 10.1016/bs.apar.2016.08.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Diagnostics play a crucial role in determining treatment protocols and evaluating success of mass drug administration (MDA) programmes used to control soil-transmitted helminths (STHs). The current diagnostic, Kato-Katz, relies on inexpensive, reusable materials and can be used in the field, but only trained microscopists can read slides. This diagnostic always underestimates the true prevalence of infection, and the accuracy worsens as the true prevalence falls. We investigate how more sensitive diagnostics would impact on the management and life cycle of MDA programmes, including number of mass treatment rounds, health impact, number of unnecessary treatments and probability of elimination. We use an individual-based model of STH transmission within the current World Health Organization (WHO) treatment guidelines which records individual disability-adjusted life years (DALY) lost. We focus on Ascaris lumbricoides due to the availability of high-quality data on existing diagnostics. We show that the effect of improving the sensitivity of diagnostics is principally determined by the precontrol prevalence in the community. Communities at low true prevalence (<30%) and high true prevalence (>70%) do not benefit greatly from improved diagnostics. Communities with intermediate prevalence benefit greatly from increased chemotherapy application, both in terms of reduced DALY loss and increased probability of elimination. Our results suggest that programmes should be extended beyond school-age children, especially in high prevalence communities. Finally, we argue against using apparent or measured prevalence as an uncorrected proxy for true prevalence.
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Affiliation(s)
- G F Medley
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - H C Turner
- Imperial College London, London, United Kingdom
| | - R F Baggaley
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - C Holland
- Trinity College Dublin, Dublin, Ireland
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