Parasitic Infections among Children under Five Years in Senegal: Prevalence and Effect on Anaemia and Nutritional Status

Magnitude and Determinants of Intestinal Parasites among Children under Five in Ethiopia During 2010-2023: A Systematic Review and Meta-Analysis

Background: Intestinal parasitic infection (IPI) poses a serious public health threat across the globe, particularly in children in low- and middle-income countries like Ethiopia. This study was to provide pooled estimates for the individually available data on IPI and its predictors among children under five in Ethiopia. Methods: Cochrane's Q, I2, sensitivity analysis, funnel plot, Begg's, and Egger's regression tests were used to check heterogeneity and publication bias. A random-effects model was used to calculate the pooled burden of IPI among children under five. Results: The pooled prevalence of IPI among children under five was 28.27% (95% CI = 20.52-36.03%). Of these, single and mixed infections contribute to 28.02% and 0.25%. Intestinal parasites were significantly associated with eating raw fruits and vegetables [AO = 3.21, 95% CI = 1.11, 5.31]. Conclusion: Under the present scenario, the IPI ranges from 17.78 to 40.05%, and the IPI is higher in community-based studies of children under five.

Ownership of small livestock species, but not aggregate livestock, is associated with an increased risk of anemia among children in Ethiopia: A propensity score matching analysis

Consumption of animal source foods, through livestock production, improves children's growth and micronutrient status. However, research on the relationship between livestock ownership and childhood anemia has produced conflicting results. The current study used robust analytical approaches to examine the effect of household livestock ownership on children's anemia using the most recent secondary data from the national demographic and health survey. We followed a 1:1 closest neighborhood propensity score matching analysis. A propensity score was generated using the binary logistic regression model to compute the probability of owning livestock. From a total of 18,008 households enrolled in the latest Ethiopian Demographic and Health Survey (EDHS 2016), data of 721 index children aged 6-59 months from households owning livestock were matched with a comparable number (721) of children from households without livestock. The paired and independent t-test, matched relative risk (RR), and standardized mean differences were used to compare the distributions of hemoglobin concentration and anemia risks between treatment and control groups. Anemia was found in more than half (54.1% and 58.8%) of children aged 6-59 months from livestock-owning and nonowning families, respectively (p > .05). Aggregate ownership of livestock was not associated with hemoglobin concentration or anemia status (RR = 0.95, 95% confidence interval [95% CI] [0.87-1.04]). Species-wise, poultry was associated with a lower (RR = 0.88, 95% CI [0.84-0.95]) anemia risk, while ownership of goat/sheep was associated with higher (RR = 1.10, 95% CI [1.03-1.17]) risk. In conclusion, ownership of small livestock species (sheep/goats and poultry), but not aggregate livestock ownership, was associated with the risk of anemia among children in Ethiopia. Therefore, agriculture-sensitive nutrition, with a One Health lens approach, is recommended to mitigate the high burden of anemia among children in Ethiopia. In the future, a well-controlled interventional study with more extended periods may be required to fully understand the effects of livestock production and highlight the differences seen across livestock species.

Prevalence and Associated Risk Factors of Endoparasites among Under-Five Children in Debre Tabor Comprehensive Specialized Hospital, Debre Tabor, Northwest Ethiopia: A Cross-Sectional Study

Many endoparasites are still considered neglected tropical illnesses. The term “endoparasites” refers to infections caused by both helminths and protozoa. In many places in Ethiopia, particularly Debre Tabor, epidemiological data on the prevalence and associated variables of endoparasites among under-five children is unavailable. Thus, the aim of this study was to gather baseline data on the prevalence of endoparasites and their associated variables among under-five children who visited the Debre Tabor comprehensive specialized hospital in Northwest Ethiopia. A hospital-based quantitative cross-sectional study was used. The study was carried out from May 1 to November 30, 2021. Study participants were selected by a systematic sampling technique. The stool specimen was examined for the presence of different stages of intestinal parasites (adult, trophozoite, larvae, cysts, and ova) using direct wet mount, modified formal-ether sedimentation, and modified Ziehl–Neelsen methods. The IBM SPSS statistical package (version 23) was used to enter and analyze the collected data. The data was summarized using frequency tables and a bar chart. The adjusted odds ratio and $p$ value <0.05 were used to declare the final association. In the present study, a total of 258 under-five children and their mothers/guardians were involved in the study, with a response rate of 100%. More than half of the respondents, 137 (53.10%), were females, and 159 (61.63%) were in the age group of 24 to 59 months. The overall prevalence of one or more endoparasites among under-five children was 45 (17.44%). Multivariate logistic regression analysis showed that health supervision, child food freshness, regular trimming of fingernails, and children’s playground cleanliness were significantly associated with childhood endoparasites. The present study demonstrated a higher prevalence of endoparasites among under-five children. Health supervision, child food freshness, regular trimming of fingernails, and children’s playground cleanliness were significantly associated with endoparasites. Thus, strengthening health education about food, personal, and environmental hygiene for both children and their mothers/guardians is crucial.

Intestinal Parasite Infections and Associated Risk Factors among Pre-School Aged Children in Kibera Informal Settlement, Nairobi, Kenya

BACKGROUND

Infections with intestinal parasites are a major public health problem in children in developing countries like Kenya. School going children are considered at most risk and are included in school-based de-worming program. Less focus is given to pre-school children and information is scarce about intestinal parasitosis among this age group. In this study, we determined the prevalence and intensity of protozoa and helminth infections, and associated risk factors in an informal settlement.

METHODS

A community based cross-sectional study was conducted from October 2016 to January 2017 among 406 children aged 2-5 years in Kibera informal settlements in Nairobi County, Kenya. Structured interviewer-administered questionnaire was used to collect sociodemographic information and data on associated factors. Stool samples were examined microscopically using formal ether concentration, iodine wet mounting, modified Ziehl-Neelsen staining, and Kato-Katz methods. Multivariable logistic regression analysis was used to identify risk factors associated with intestinal parasites.

RESULTS

The overall prevalence of any helminth and protozoa infections was 13.1% 53/406) and 22.4% (91/406) respectively. The predominant parasites were Giardia lamblia (13.8%), Ascaris lumbricoides (11.3%), Entamoeba histolytica/dispar (9.4%), Trichuris trichiura (3.9%), Entamoeba coli (1.5%) and hookworm (0.2%). Prevalence of co-infection with any helminths or protozoan was 2.7%. About 10.8% (44/406) and 20.7% (84/406) children were infected with single species of helminth and protozoan parasites. All helminth infections were light, with a mean intensity of 592 egg per gram. Intensity of any protozoan infections was heavy 62.6% (57/406). Dirt floors in the household (aOR = 2.22, p = .046), dirty toilets (aOR = 2.33, p=.014), water from communal taps (aOR = 0.27, p=.019), parent's education level (aOR=0.27, p=.032) and parent's earning (aOR =3.34, p=.007) were factors significantly associated with intestinal parasites.

CONCLUSION

The study found both helminth and protozoan parasites to be prevalent among pre-school aged children in Kibera. Intervention measures including education on the improvement of hygiene and health, socio-economic conditions, sanitation, and provision of safe drinking water could reduce the prevalence of these infections.

Anemia and intestinal parasites in farmers and family members and sheep in two agro-ecological zones in Senegal

The burden of anemia in Senegal is high, particularly in children and women in rural households. The main objectives of the study reported here were (i) to measure and compare the prevalence of anemia and intestinal parasitic infections in farmers and family members and sheep in two agro-ecological zones in Senegal and (ii) to examine the association between anemia and age or sex in farmers and family members. The study was conducted in Mpal (250 km from Dakar, the capital city) and Diawara (700 km from Dakar, a remote location near the Malian border). In humans, the prevalence of anemia was higher in Diawara (64/86 = 74%), compared to Mpal (13/29 = 45%) (p < 0.01). Using logistic regression, the odds of anemia were 20.3, 5.7, and 3.2 times higher in children 1–4 years old, children 5–12 years-old, and teenagers 13–19 years old, respectively, compared to adults 20–60 years old, after controlling for study site and sex (p < 0.05). In Diawara, the odds of anemia were 2.9 times higher in women, compared to men, after controlling for age (p = 0.06). The prevalence of intestinal parasites (Giardia sp.) was the same (7%) at both locations. In sheep, the prevalence of low packed cell volume (PCV) and low body condition was higher in Diawara (48/60 = 60% and 11/60 = 18%, respectively), compared to Mpal (23/46 = 50% and 0/46 = 0%, respectively) (p < 0.05). Clinical anemia was associated (p < 0.01) with low PCV and a positive diagnosis of H. contortus. Overall, the prevalence of anemia was higher in farmers and family members and owned sheep in Diawara. In addition, anemia was more common in children and women, an indication that intra-household food allocation may be regulated in favor of men and older age groups. The consequences of livestock affected with anemia and undernutrition can be significant. High morbidity and mortality in livestock can lead to low household income, inadequate household access to and individual consumption of animal source foods, and subsequent risk of anemia in children and women in rural households in Senegal.

Estimating Annual Fluctuations in Malaria Transmission Intensity and in the Use of Malaria Control Interventions in Five Sub-Saharan African Countries

RTS,S/AS01E malaria vaccine safety, effectiveness, and impact will be assessed in pre- and post-vaccine introduction studies, comparing the occurrence of malaria cases and adverse events in vaccinated versus unvaccinated children. Because those comparisons may be confounded by potential year-to-year fluctuations in malaria transmission intensity and malaria control intervention usage, the latter should be carefully monitored to adequately adjust the analyses. This observational cross-sectional study is assessing Plasmodium falciparum parasite prevalence (PfPR) and malaria control intervention usage over nine annual surveys performed at peak parasite transmission. Plasmodium falciparum parasite prevalence was measured by microscopy and nucleic acid amplification test (quantitative PCR) in parallel in all participants, and defined as the proportion of infected participants among participants tested. Results of surveys 1 (S1) and 2 (S2), conducted in five sub-Saharan African countries, including some participating in the Malaria Vaccine Implementation Programme (MVIP), are reported herein; 4,208 and 4,199 children were, respectively, included in the analyses. Plasmodium falciparum parasite prevalence estimated using microscopy varied between study sites in both surveys, with the lowest prevalence in Senegalese sites and the highest in Burkina Faso. In sites located in the MVIP areas (Kintampo and Kombewa), PfPR in children aged 6 months to 4 years ranged from 24.8% to 27.3%, depending on the study site and the survey. Overall, 89.5% and 86.4% of children used a bednet in S1 and S2, of whom 68.7% and 77.9% used impregnated bednets. No major difference was observed between the two surveys in terms of PfPR or use of malaria control interventions.

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

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

Drivers of stunting reduction in Senegal: a country case study

BACKGROUND

Senegal has been an exemplar country in the West African region, reducing child stunting prevalence by 17.9% from 1992 to 2017.

OBJECTIVES

In this study, we aimed to conduct a systematic in-depth assessment of factors at the national, community, household, and individual levels to determine the key enablers of Senegal's success in reducing stunting in children <5 y old between 1992/93 and 2017.

METHODS

A mixed methods approach was implemented, comprising quantitative data analysis, a systematic literature review, creation of a timeline of nutrition-related programs, and qualitative interviews with national and regional stakeholders and mothers in communities. Demographic and Health Surveys and Multiple Indicator Cluster Surveys were used to explore stunting inequalities and factors related to the change in height-for-age z-score (HAZ) using difference-in-difference linear regression and the Oaxaca-Blinder decomposition method.

RESULTS

Population-wide gains in average child HAZ and stunting prevalence have occurred from 1992/93 to 2017. Stunting prevalence reduction varied by geographical region and prevalence gaps were reduced slightly between wealth quintiles, maternal education groups, and urban compared with rural residence. Statistical determinants of change included improvements in maternal and newborn health (27.8%), economic improvement (19.5%), increases in parental education (14.9%), and better piped water access (8.1%). Key effective nutrition programs used a community-based approach, including the Community Nutrition Program and the Nutrition Enhancement Program. Stakeholders felt sustained political will and multisectoral collaboration along with improvements in poverty, women's education, hygiene practices, and accessibility to health services at the community level reduced the burden of stunting.

CONCLUSIONS

Senegal's success in the stunting decline is largely attributed to the country's political stability, the government's prioritization of nutrition and execution of nutrition efforts using a multisectoral approach, improvements in the availability of health services and maternal education, access to piped water and sanitation facilities, and poverty reduction. Further efforts in the health, water and sanitation, and agriculture sectors will support continued success.

Magnitude, Severity, and Associated Factors of Anemia among Under-Five Children Attending Hawassa University Teaching and Referral Hospital, Hawassa, Southern Ethiopia, 2016

Background

Anemia is a widespread public health problem associated with increased risk of morbidity and mortality. Infants, under-5-year-old children, and pregnant women have greater susceptibility to anemia. The magnitude and associated risk factors for anemia vary in different settings. The study aimed to assess the magnitude, severity, and associated factors of anemia at Hawassa University Teaching and Referral hospital, Hawassa, southern Ethiopia.

Methods

In a hospital-based cross-sectional study, a total of 422 under-five children were included. Sociodemographic data and other predisposing factors were collected by structured questionnaire. Venous blood samples were collected and analyzed for hemoglobin determination using a Cell-Dyn 1800 automated analyzer. Stool samples were collected and processed using direct wet mount and formol-ether concentration method to detect intestinal parasites. Data were entered and analyzed using SPSS version 20 statistical packages. Binary and multiple logistic regressions were computed to assess factors associated with anemia. p value less than 0.05 was taken as statistically significant.

Result

The overall prevalence of anemia was found to be 41.7%. The mean hemoglobin level was 10.59 g/dl. Anemia was of mild, moderate, and severe type in 6.6%, 19%, and 16.1% of the children, respectively. Children in the age group 6-23 months (AOR = 2.04 (95% CI: 1.13, 3.69)), and mothers having no formal education (AOR = 1.73 (95% CI: 0.99, 3.02)) were identified as associated factors for anemia.

Conclusion

The prevalence of anemia among the study subjects was 41.7% indicative of the fact that anemia is an important public health problem. It was associated with the child's age, residence, mother's education level, and intestinal parasite (Ascaris lumbricoides). It clearly indicates that there should be well integrated public health interventions to improve the health status that needs to be prioritized to prevent anemia among children under five years of age.

Concentration of soil-transmitted helminth eggs in sludge from South Africa and Senegal: A probabilistic estimation of infection risks associated with agricultural application

The use of sludge in agriculture has been encouraged as a means of increasing soil nutrient content and improving the water holding capacity. On the negative side, major public health concerns with sludge application prevail, mainly due to the high concentration of pathogenic microorganisms. Soil-transmitted helminths (STHs) are of major health concern in this regard, especially in endemic regions, mainly due to the high environmental resistant of the eggs combined with a low infectious dose. In this study the concentration of STH eggs in two months dried sludge from Durban, South Africa and Dakar, Senegal was determined and compared. Sampling was carried out from January to October 2016 and in September 2016 for Dakar. Ascaris spp, hookworm, Trichuris spp, Taenia spp and Toxocara spp were the commonly recorded STH eggs. STH egg concentrations were higher in Dakar than in Durban, with viable STH egg concentrations exceeding both local and international guidelines. Due to the high concentration of viable STH eggs, risks of Ascaris spp infection was very high for farmers applying this sludge on their farms in both Durban (7.9 × 10-1 (±1.7 × 10-2)) and Dakar (9.9 × 10-1 (±1.3 × 10-5)). Consumption of lettuce grown on sludge amended soil will result in probable infections but harvest after 30 days between sludge application and harvest in Durban gave median probability infection risks with a risk level similar to the WHO tolerable risk value (10-4). This time period need to be prolonged to harvest in Dakar to 40 days to reduce the risks of infection to the tolerable risks values. Further treatment of the sludge either through composting or drying for longer periods of time is thus recommended from a public health perspective.

Performance of Real-Time Polymerase Chain Reaction Assays for the Detection of 20 Gastrointestinal Parasites in Clinical Samples from Senegal

Gastrointestinal parasite infections represent one of the biggest public health problems in the world. Therefore, appropriate innovative tools are needed for assessing interventions to control these infections. This study aims to compare the performance of real-time polymerase chain reaction (PCR) assays to microscopic examination for detection of intestinal parasites. A direct microscopic examination and stool concentration was performed on 98 stool samples from patients attending Senegalese hospitals. Negative microscopic control samples were also collected in Nice and Marseille (France). Species-specific primers/probes were used to detect 20 common gastrointestinal protozoans and helminths. Positive frequency and the sensitivity of each real-time PCR assay were compared with conventional microscopic examination. Real-time PCR was positive in 72 of 98 samples (73.5%), whereas microscopic examination was positive in 37 (37.7%) samples (P < 0.001). The real-time PCR assays were more sensitive than microscopy, with 57.4% (31/54) versus 18.5% (10/54), respectively, in the detection of parasites in asymptomatic patients (P < 0.05). In terms of polyparasitism, there were more coinfections detected by real-time PCR assays compared with microscopic methods (25.5% versus 3.06%). In comparison to parasite prevalence on individual samples, the results showed a perfect agreement (100%) between the two techniques for seven species, whereas discrepancies were observed for the others (agreement percentage varying from 64.2% to 98.9%). Real-time PCR appeared to be superior to microscopic examination for the detection of parasites in stool samples. This assay will be useful in diagnostic laboratories and in the field for evaluating the efficacy of mass drug administration programs.

An epidemiological study to assess Plasmodium falciparum parasite prevalence and malaria control measures in Burkina Faso and Senegal

Background

Malariometric information is needed to decide how to introduce malaria vaccines and evaluate their impact in sub-Saharan African countries.

Methods

This cross-sectional study (NCT01954264) was conducted between October and November, 2013, corresponding to the high malaria transmission season, in four sites with Health and Demographic Surveillance Systems (DSS) [two sites with moderate-to-high malaria endemicity in Burkina Faso (Nouna and Saponé) and two sites with low malaria endemicity in Senegal (Keur Socé and Niakhar)]. Children (N = 2421) were randomly selected from the DSS lists of the study sites and were stratified into two age groups (6 months–4 years and 5–9 years). A blood sample was collected from each child to evaluate parasite prevalence of Plasmodium falciparum and other Plasmodium species and gametocyte density by microscopy, and rapid diagnosis test in the event of fever within 24 h. Case report forms were used to evaluate malaria control measures and other factors.

Results

Plasmodium falciparum was identified in 707 (29.2%) children, with a higher prevalence in Burkina Faso than Senegal (57.5 vs 0.9% of children). In Burkina Faso, prevalence was 57.7% in Nouna and 41.9% in Saponé in the 6 months–4 years age group, and 75.4% in Nouna and 70.1% in Saponé in the 5–9 years age group. Infections with other Plasmodium species were rare and only detected in Burkina Faso. While mosquito nets were used by 88.6–97.0 and 64.7–80.2% of children in Burkina Faso and Senegal, other malaria control measures evaluated at individual level were uncommon. In Burkina Faso, exploratory analyses suggested that use of malaria treatment or any other medication within 14 days, and use of insecticide spray within 7 days decreased the prevalence of malaria infection; older age, rural residence, natural floor, grass/palm roof, and unavailability of electricity in the house were factors associated with increased malaria occurrence.

Conclusions

Plasmodium falciparum infection prevalence in children younger than 10 years was 57.5% in Burkina Faso and 0.9% in Senegal, and variability was observed, among others, by age, study site and malaria control measures.

Prevalence and factors associated with anaemia among children aged 6 to 59 months in Namutumba district, Uganda: a cross- sectional study

Background

Anaemia is one of the major causes of death among children under five years in Africa, with a prevalence of 64.6% among pre-school children. In 2014, we conducted a cross-sectional study in Namutumba district in East-central Uganda to determine the prevalence and factors associated with anaemia among children aged 6 to 59 months.

Methods

We conducted a household survey in 376 randomly selected households. One child aged 6 to 59 months was randomly sampled from each selected household. A structured questionnaire administered to an adult caregiver was used to collect household data. Blood was collected by finger or heel prick to estimate the haemoglobin level using a portable haemocue analyser. Anthropometric data including age, weight and height was collected for each child. A modified poisson regression model was used to determine the correlates of anaemia, prevalence ratios and their 95% confidence intervals (CI).

Results

The prevalence of anaemia was high (58.8%) and was highest among children aged 12 to 23 months (68.5%) and males (61.3%). About 27.7% children were stunted. Children aged 6–11 and 12–23 months were more likely to be anaemic (APR = 1.12; 95% CI: 1.05–1.19 and APR = 1.12; 95% CI: 1.00–1.24 respectively), Resident of Magada and Namutumba (urban areas) were less likely to be anaemic (APR = 0.89; 95% CI: 0.87–0.91and APR = 0.86; 95% CI: 0. 85–0.88 respectively). Children of caretakers of a big family size (seven or more children) and with any formal education were less likely to be anaemic (APR = 0.94; 95% CI: 0.89–0.99 and APR = 0.93; 95% CI: 0.87–0.99). Stunting (HAZ scores) was a predictor of anaemia (APR = 1.07; 95% CI: 1.02–1.12).

Conclusion

Anaemia is highly prevalent among children and there is need to invest in measures to prevent anaemia, especially among children in the rural areas.