[Some socioeconomic aspects related to intestinal parasitosis and evaluation of an educational intervention in scholars from Estiva Gerbi, SP]

Validation of a documentary on Chagas disease by a population living in an endemic area

Abstract Educational interventions may trigger actions that contribute to prevent parasitic diseases, such as Chagas disease (CD). This study aimed at investigating the impact of an instructional video named “Documentary on Chagas Disease” on knowledge about CD and its vectors displayed by a population that lives in an endemic area in Brazil, so as to validate it as an educational tool. The video was shown to 226 subjects, divided into two groups. Group 1 was composed of users of Basic Health Units (BHU) in Pelotas and Pinheiro Machado, cities located in Rio Grande do Sul (RS) state, Brazil, where CD is endemic. Group 2 consisted of students who attend three public schools located in the rural area in Pinheiro Machado, RS. Two questionnaires with questions about their knowledge about triatomines and CD were applied, before and after the documentary was shown. After the video was shown, there was significant increase in individuals’ knowledge (in both groups) about “kissing bugs”, their notification, the disease and its prevention. Besides, watchers considered that the quality of the material was satisfactory. Since the “Documentary on CD” can be easily accessed on the internet and was effective in teaching the population that lives in endemic areas, its use should be encouraged in places and meetings connected to health that aim at fighting against triatominae and at exposing an updated view of CD.

Prevalence of intestinal parasitic infections in Brazil: a systematic review

INTRODUCTION

Parasitic infections are considered a major public health problem due to their associated morbimortality and negative impact on physical and intellectual development, especially in the at-risk pediatric group. Periodic prophylactic administration of antiparasitic agents against soil-transmitted helminths is recommended by the World Health Organization (WHO) to control parasitic infections and disease burden. We aimed to evaluate the prevalence of intestinal parasitic infections in Brazil.

METHODS

We performed a systematic review by searching the literature found in the PubMed, LILACS, and SciELO databases, followed by a meta-analysis of the proportions from studies published in English, Portuguese, and/or Spanish from January 2000 to May 2018. This systematic review was registered in the PROSPERO database (CRD42018096214).

RESULTS

The prevalence of intestinal parasitic infections (protozoa and/or helminths) in Brazil was 46% (confidence interval: 39-54%), with 99% heterogeneity. Prevalence varied by region: 37%, 51%, 50%, 58%, and 41% in the Southeast, South, Northeast, North, and Central-West regions, respectively. Most studies (32/40) evaluated children (<18 years) and found an average prevalence of 51%. Children also had the highest prevalence in all four regions: Central-West (65%), South (65%), North (58%), Northeast (53%), and Southeast (37%). However, most studies evaluated specific populations, which may have created selection bias. Presumably, this review of intestinal parasitic diseases in Brazil includes the most studies and the largest population ever considered.

CONCLUSIONS

The prevalence of intestinal parasitic infections is high in Brazil, and anthelmintic drugs should be administered periodically as a prophylactic measure, as recommended by the WHO.

Intestinal parasites among employees of restaurants and cafeterias in a city of Brazil

OBJECTIVE

To investigate the frequency of intestinal parasites in employees of restaurants and cafeterias located in the Commercial Center of São Mateus, Espírito Santo, one of the oldest cities of Brazil.

MATERIAL AND METHODS

Between August 2013 and February 2014, 42 fecal samples were collected and analyzed by spontaneous sedimentation method in the Clinical Analysis Laboratory of the Federal University of Espírito Santo, São Mateus Campus.

RESULTS

The results were positive in 19 % of the samples. The commensal Entamoeba coli (75 %) was the most common followed by Entamoeba histolytica/dispar (37.5 %) and Giardia lamblia (12.5 %).

CONCLUSIONS

Implementing health education measures in the city of São Mateus is suggested by providing permanent health education, as well as conducting parasitological examinations. Such actions will contribute to the improvement of health conditions of the population.

DETECTION OF INTESTINAL PARASITES IN THE ENVIRONMENTS OF A PUBLIC SCHOOL IN THE TOWN OF DIAMANTINA , MINAS GERAIS STATE, BRAZIL

Intestinal parasites are a major public health problem in developing countries, most prevalent in areas where sanitation is poor and the population's hygiene is inadequate. They affect people of all ages, although school-age children are the most susceptible. In this study, we investigated the presence of intestinal parasites in the shared environments of a public school in the town of Diamantina, Minas Gerais State. From December 2012 to February 2013, samples were collected for three months (once a month) by using the Graham method (1941), in duplicate, by affixing a 6 x 5 cm clear tape, six times in each collection site, in a space of about 30 cm². Then, each tape was positioned longitudinally on a microscope slide and the identification of the biological forms of the parasites was performed with the aid of a 40X objective from an optical microscope. Eleven sites were selected for sampling. Cysts of Entamoeba coli were the most frequently found in this study (50%), followed by Hymenolepis diminuta eggs (27.6%), Iodamoeba butschllii cysts (5.6%), Ascaris lumbricoides eggs (5.6%), Taenia species eggs (5.6%) and hookworm eggs (5.6%). The highest positivity rates were found in the samples drawn from the cafeteria's eating table. The results have indicated the need to improve the cleaning in the school environments, as well as the development of educational practices that may help in the preservation of public health.

Improving the understanding of schistosomiasis among adolescents in endemic areas in Brazil: A comparison of educational methods

OBJECTIVE

To evaluate the effectiveness of two teaching strategies, both guided by the concept of dialogicity, on adolescents' knowledge about schistosomiasis and adherence to diagnostic fecal testing.

METHODS

Two teaching strategies related to schistosomiasis were developed, an educational video and group conversation, which were tested in two groups of students aged 10-15 years old. Before and after the intervention, a questionnaire was applied to assess participants' knowledge about schistosomiasis and, after the intervention, two fecal samples were requested from each participant. Comparisons were performed by paired t- and McNemar tests.

RESULTS

Both strategies resulted in statistically significant improvements in knowledge between the pre- and post-tests. Students who watched the video had a higher return rate of fecal samples and percentage of correct questionnaire answers, mainly on questions about schistosomiasis infection.

CONCLUSION

Teaching strategies based on dialogue favored the construction of concepts about schistosomiasis that can influence the adoption of positives attitudes related to health.

PRACTICAL IMPLICATIONS

Using teaching strategies based on the concept of dialogicity can favor the increase of knowledge of school age children about schistosomiasis and can influence behavioral change related to health.

Performance of microscopy and ELISA for diagnosing Giardia duodenalis infection in different pediatric groups

Techniques for Giardia diagnosis based on microscopy are usually applied as routine laboratory testing; however, they typically exhibit low sensitivity. This study aimed to evaluate Giardia duodenalis and other intestinal parasitic infections in different pediatric groups, with an emphasis on the comparison of Giardia diagnostic techniques. Feces from 824 children from different groups (diarrheic, malnourished, with cancer and from day care) were examined by microscopy and ELISA for Giardia, Cryptosporidium sp. and Entamoeba histolytica coproantigen detection. Giardia-positive samples from day-care children, identified by either microscopy or ELISA, were further tested by PCR targeting of the β-giardin and Gdh genes. Statistically significant differences (P<0.05) were observed when comparing the frequency of each protozoan among the groups. Giardia duodenalis was more frequent in day-care children and Cryptosporidium sp. in diarrheic and malnourished groups; infections by Entamoeba histolytica were found only in children with diarrhea. Considering positivity for Giardia by at least one method, ELISA was found to be more sensitive than microscopy (97% versus 55%). To examine discrepancies among the diagnostic methods, 71 Giardia-positive stool samples from day-care children were tested by PCR; of these, DNA was amplified from 51 samples (77.4%). Concordance of positivity between microscopy and ELISA was found for 48 samples, with 43 confirmed by PCR. Parasite DNA was amplified from eleven of the 20 Giardia samples (55%) identified only by ELISA. This study shows the higher sensitivity of ELISA over microscopy for Giardia diagnosis when a single sample is analyzed and emphasizes the need for methods based on coproantigen detection to identify this parasite in diarrheic fecal samples.

Comparison between Two Decades of Prevalence of Intestinal Parasitic Diseases and Risk Factors in a Brazilian Urban Centre

Objectives. This study's objective was to compare the prevalence of intestinal parasites and associated risk factors in children in urban communities, in the Brazilian Northeast, between two decades. Methods. This quantitative transversal study consisted of a comparative analysis of two different samples: the first viewing the years 1992-1996 and the other through a coproepidemiological data survey undertaken in 2010-2011. Results. It was evidenced that there was a reduction of intestinal parasites and that there were improvements in the socioenvironmental conditions between the two decades evaluated. It was observed that, in the period 1992-1996, playing out in the streets was associated with a higher risk for acquiring intestinal parasites. Over the 2010-2011 period, the characteristics of more than five residents per household, houses with dirt floors, children who live in homes without piped water, and children who play out in the streets were associated with a higher risk of intestinal parasitic infection. Conclusion. The study showed a reduction of intestinal parasitic diseases to 23.8% in 2010-2011 from 81.3% in 1992-1996 and improvement of the social-sanitary conditions of the population between the decades analyzed.

Parasitoses intestinais: o que a comunidade sabe sobre este tema?

As enteroparasitoses constituem um importante problema de saúde pública, contribuindo para as taxas de morbimortalidade devido a doenças infecto-parasitárias em todo o mundo. Objetivo: conhecer as atitudes e percepções da comunidade a respeito de parasitoses intestinais. Métodos: foi aplicado um questionário semiestruturado a 72 pessoas entre 18 e 70 anos para identificar o que elas conheciam sobre parasitoses intestinais. Resultados: a medida de prevenção mais utilizada foi higiene pessoal (77,7%), e 66,6% dos respondentes concordaram que os vermes contaminam o meio-ambiente. Os sintomas mais citados foram dor de barriga e coceira e 72,2% mencionaram que procuram um médico quando suspeitam de contaminação. Conclusão: os resultados mostram uma forma simplificada de conhecimento, baseada no cotidiano da população, sendo esses achados úteis para o planejamento de futuras campanhas e projetos educacionais.

Frequency of amoebiasis and other intestinal parasitoses in a settlement in Ilhéus City, State of Bahia, Brazil

INTRODUCTION

This study evaluated the frequency of intestinal parasites, emphasizing the identification and differentiation of Entamoeba spp.

METHODS

Multiplex polymerase chain reaction (PCR), coproantigen tests and morphometric analysis were performed for Entamoeba spp. differentiation.

RESULTS

The overall frequency of intestinal parasites was 65%. Entamoeba histolytica was detected by the coproantigen test, and the PCR showed that Entamoeba dispar predominated in the population. In contrast, morphometric analysis was important for identifying Entamoeba hartmanni.

CONCLUSIONS

It is possible to identify the causative agent of amoebiasis and to differentiate this agent from other species by combining techniques.

Update on the mapping of prevalence and intensity of infection for soil-transmitted helminth infections in Latin America and the Caribbean: a call for action

It is estimated that in Latin America and the Caribbean (LAC) at least 13.9 million preschool age and 35.4 million school age children are at risk of infections by soil-transmitted helminths (STH): Ascaris lumbricoides, Trichuris trichiura and hookworms (Necator americanus and Ancylostoma duodenale). Although infections caused by this group of parasites are associated with chronic deleterious effects on nutrition and growth, iron and vitamin A status and cognitive development in children, few countries in the LAC Region have implemented nationwide surveys on prevalence and intensity of infection. The aim of this study was to identify gaps on the mapping of prevalence and intensity of STH infections based on data published between 2000 and 2010 in LAC, and to call for including mapping as part of action plans against these infections. A total of 335 published data points for STH prevalence were found for 18 countries (11.9% data points for preschool age children, 56.7% for school age children and 31.3% for children from 1 to 14 years of age). We found that 62.7% of data points showed prevalence levels above 20%. Data on the intensity of infection were found for seven countries. The analysis also highlights that there is still an important lack of data on prevalence and intensity of infection to determine the burden of disease based on epidemiological surveys, particularly among preschool age children. This situation is a challenge for LAC given that adequate planning of interventions such as deworming requires information on prevalence to determine the frequency of needed anthelmintic drug administration and to conduct monitoring and evaluation of progress in drug coverage.

Soil-transmitted helminths (STH) are part of the group of neglected infectious diseases (NID) in Latin America and the Caribbean (LAC), and are associated with several adverse chronic effects on child health. Although control interventions such as periodic administration of anthelmintic drugs, health education, improved access to safe water and sanitation, among others, are acknowledged to be an important means to reduce morbidity and to achieve control, epidemiological information on prevalence status is lacking at the lowest sub-national administrative levels (municipalities, districts or provinces) in many countries thus hindering decision making regarding not only the treatment, but also the monitoring of progress in deworming coverage, the assessment of epidemiological impact on parasite prevalence and load and, therefore, the achievement of the overall public health goals. Epidemiological surveys can be expensive and require time and effort for their implementation, which could explain the low number of studies published with data on prevalence and intensity of infection in the Americas. The use of alternative methodologies, for instance those based on geographical information systems and remote sensing technologies, or of sentinel surveillance in schools may help countries in the task of collecting information and support the implementation of integrated control programs against STH.

Fatores associados à ocorrência de parasitoses intestinais em uma população de crianças e adolescentes

OBJETIVOS: Analisar a prevalência de infecções por parasitos intestinais em crianças e adolescentes matriculados em escolas de ensino fundamental no município de São João del-Rei, Minas Gerais, e os fatores associados à infecção. MÉTODOS: Estudo epidemiológico seccional, realizado entre março/2008 e julho/2009. Foram realizados exames coproscópicos por sedimentação espontânea e Kato-Katz em 1.172 escolares. Foram ajustados modelos de regressão logística múltipla para o estudo dos fatores associados às infecções em geral e, separadamente, por helmintos e por protozoários. RESULTADOS: A prevalência de infecções foi de 29%, havendo uma variação de 7 a 83%, respectivamente, entre as escolas de menor e maior ocorrência. A presença de instalação sanitária no domicílio foi associada a uma ocorrência menor de helmintos; o aumento na idade dos escolares associou-se a uma maior ocorrência de protozoários e de parasitos em geral; enquanto a presença de filtro de água e a localização do domicílio em área urbana mostraram-se associadas a uma ocorrência menor dos três desfechos analisados. Em todas as regiões, foi registrado o consumo de medicação preventiva contra helmintos. CONCLUSÕES: Desigualdades nas condições de vida tornaram as prevalências diferenciadas entre as regiões do estudo. O estudo ressalta a necessidade de promover o uso de filtros de água nas residências de áreas endêmicas e de avaliar o consumo preventivo de medicamentos anti-helmínticos na dinâmica e na saúde dos indivíduos. Medidas de controle que levem em conta os fatores descritos devem ser prioritárias em nível de Saúde Pública.

[Prevalence and factors associated with geohelminth infections in children living in municipalities with low HDI in North and Northeast Brazil]

Stool surveys were conducted to estimate the prevalence and identify risk factors for geohelminth infections among children in ten Brazilian municipalities with low human development indices (HDI). Socioeconomic and environmental data were obtained from the children's parents or guardians, and stool samples were examined. The proportion of geohelminth infections according to target variables was calculated. Risk factors were evaluated using multilevel logistic regression. Of the 2,523 children, 36.5% were infected with one or more geohelminths (Ascaris lumbricoides, 25.1%; hookworm, 15.3%; Trichuris trichiura, 12.2%). Overall prevalence of geohelminth infections was 45.7% in rural areas and 32.2% in urban areas. Low family income (OR = 1.75; 1.38-2.23), low maternal schooling (OR = 1.69; 1.39-2.06), presence of garbage near the home (OR = 1.50; 1.22-1.84), and number of individuals in the household (OR = 1.41; 1.17-1.71) were associated with infection. In conclusion, geohelminth infections were closely related to socioeconomic conditions, thus emphasizing the importance of targeted public interventions to improve living conditions as part of sustainable prevention.

Prevalence of intestinal parasites versus knowledge, attitudes, and practices of inhabitants of low-income communities of Campos dos Goytacazes, Rio de Janeiro State, Brazil

Intestinal parasites are the causative agents of common infections responsible for significant public health problems in developing countries and generally linked to lack of sanitation, safe water, and improper hygiene. More than two billion people throughout the world live with unrelenting illness due to intestinal parasitic infections (IPIs). The purposes of this study are to assess knowledge, attitudes, and practices on IPIs and investigate the relationship with prevalence of intestinal parasites among a low-income group of inhabitants from two communities of the Travessão District area, Campos dos Goytacazes, north of Rio de Janeiro State, Brazil. The two communities are known as "Parque Santuário," which is an urban slum with miserable living conditions, and "Arraial," where the socioeconomic and educational levels are better, neither having a sanitary infrastructure with an excreta collection system. Questionnaires revealed that both communities had local and specific codification to denominate the intestinal parasites and present correct knowledge on the theme but ignored some aspects of IPI transmission, with the Arraial population being better informed (p < 0.05). The overall prevalence of IPIs in Parque Santuário (49.7%) was greater than in Arraial (27.2%) (p < 0.001; prevalence ratio/95% confidence interval 1.83/1.50-2.23). This study reports the real IPI situation in the Travessão District and also reinforces the need to continue the investigation on the impact of combined prophylactic methods, educational measures, and socioeconomic and sanitary improvements by governmental authorities and the local popular organization.

Enteroparasites and commensals among children in four peripheral districts of Uberlândia, State of Minas Gerais

The aim of this study was to determine the occurrence of intestinal parasites and commensals among children in four peripheral districts located in the northern, southern, eastern and western sectors of Uberlândia, Minas Gerais, using the Baermann methods as modified by Moraes and Lutz. Out of 160 individuals studied, 93 (58.1% CI: 50.4-65.7) were infected, distributed among the sectors as follows: northern (72.5%), southern (47.5%), eastern (57.5%) and western (55%). The positive findings according to age groups were: 0-5 years (26.9%), 5-10 years (21.2%) and 10-15 years (10%). Male children presented 2.7 times higher risk of infection than females did (OR: 2.7; CI: 1052-7001). The parasites and commensals identified were: Giardia lamblia (27.5%), Entamoeba coli (20.6%), Ascaris lumbricoides (14.4%), Enterobius vermicularis (8.8%), Hymenolepis nana (7.5%), Hymenolepis diminuta (5%), hookworms (3.1%), Trichuris trichiura (2.5%), Endolimax nana (2.5%), Entamoeba hartmanni (2.5%), Strongyloides stercoralis (1.3%), Iodamoeba butschlii (1.3%) and Capillaria hepatica (0.6%). The infection rate in these children was high and showed the need to implement prophylactic education programs in the community.

[Evolution of the prevalence of intestinal parasitosis among schoolchildren in Caxias do Sul, RS]

Reports on the prevalence of intestinal parasitosis in Brazil have been local in nature, with descriptions of different populations, which makes comprehensive diagnosis difficult. With the aim of studying the variation in the prevalence of intestinal parasitosis among schoolchildren in Caxias do Sul, Rio Grande do Sul, over a 35-year period, 9,787 parasitological stool tests that had been performed using centrifugal sedimentation were evaluated. There were positive results from 5,655 samples (58%), and the most prevalent infestations were of Ascaris lumbricoides (47%), Trichuris trichiura (36%), Enterobius vermicularis (8%) and the protozoa Giardia lamblia (24%) and Entamoeba coli (20%). The overall prevalence diminished from 89% to 37%, indicating an average decrease of 1.4% per year. Reductions in prevalence were observed for Ascaris lumbricoides (61 to 26%) and Trichuris trichiura (38 to 18%). No significant change was observed for Giardia lamblia. The prevalence of Entamoeba coli increased from 29 to 46%. The decreases in helminth prevalence were probably due to infrastructure improvements and educational actions undertaken in schools.

Prevalence of intestinal parasites in children from public daycare centers in the city of Belo Horizonte, Minas Gerais, Brazil

The objective of this study was to verify the occurrence of intestinal parasites in 3 to 6-year-old children from daycare centers maintained by the municipal government of Belo Horizonte, Minas Gerais, Brazil. Coproparasitological tests performed in 472 children have shown that 24.6% of them had some type of parasites, 6.6% of the children having more than one type. Among protozoa, Entamoeba coli (14.0%) and G. duodenalis (9.5%) were the most prevalent, whereas Ascaris lumbricoides (3.0%) and Trichuris trichiura (1.1%) were the most frequent among the helminths. Thus, we can observe that intestinal parasites still represent a serious public health problem in Belo Horizonte, especially among children and in areas where the socioeconomic conditions are less favorable.

Spatial distribution of enteroparasites among school children from Guarapuava, State of Paraná, Brazil

The most common infections in human beings are caused by intestinal parasites. They can lead to a number of harmful effects, which could include, among others, intestinal obstruction, malnutrition, iron deficiency anemia, diarrhea, and poor absorption. In Brazil, enteroparasites are one of the main public health issues. The present study aims at analyzing the distribution and frequency of enteroparasite occurrence in 635 children from seven community schools in the city of Guarapuava, Paraná (PR). In addition, we used similarity and diversity indices to analyze the parasite community. We found 475 samples with at least one parasite showing that 75.27% of children had enteroparasites. A smaller fraction (26.73%) of children harbored several parasites (multiparasitism), especially Giardia duodenalis (56%), and Ascaris lumbricoides (18%). Statistical analysis showed that three (out of seven) children communities had higher similarity in frequency and amount of parasites. Our results suggest that the children studied were highly infected by enteroparasites. These levels of infestation could be related to several factors, such as climate, social and economic conditions and characteristics of the parasites.