Parasitic Infections in Children with Disability in Resource Poor Settings: The Research Gaps.

The burden of parasitic infections among children with disability in resource-poor settings has not been summarised through a focused review. Here, we have summarised the key studies reporting the burden of parasitic infections among children without and with a disability. In most instances, among children without disability, Giardia or soil-transmitted helminths dominate the epidemiology, while among disabled individuals, enteric protozoa are the predominant parasites to be reported in both resource-rich and resource-poor countries. Cryptosporidium is generally the leading protozoan to be detected among these populations but all other parasites have been detected in varying frequencies. There is a paucity of data on the precise epidemiology of parasitic infections in children with disability. A large-scale epidemiological study, using modern genomic methodology, is a research priority.

Improved methods to capture the total societal benefits of zoonotic disease control: Demonstrating the cost-effectiveness of an integrated control programme for Taenia solium, soil transmitted helminths and classical swine fever in northern Lao PDR.

BACKGROUND: Control and elimination of zoonotic diseases requires robust information about their effect on both human and livestock health in order to enable policy formulation and the allocation of resources. This study aimed to evaluate the cost-effectiveness of controlling Taenia solium taeniasis/cysticercosis in both humans and pigs, and soil-transmitted helminths (STH) in humans by integrating their control to on-going human and animal health control programmes in northern Lao People's Democratic Republic. METHOD: A cross-sectional study was carried out in 49 households, focusing on the prevalence of T. solium taenias/cysticercosis and soil transmitted helminths before and after a twelve month intervention. The village data was collected using a semi-structured questionnaire through a door-to-door survey. The village data was then projected to the wider northern Lao PDR population using stochastic modelling and cost-effectiveness ratio (after aggregating the net cost to capture both human and animal health parameters) and GDP per capita as a threshold, to determine the cost-effectiveness of the integrated control of T. solium taeniasis/ cysticercosis and STH, assuming linear scaling out of the intervention. The zoonotic DALY (zDALY) approach was also used as an alternative method of estimating the cost-effectiveness ratio of controlling T. solium taeniasis/cysticercosis in humans and pigs. FINDINGS: Using cost-effectiveness analysis after aggregating the net cost and control of T. solium taeniasis/cysticercosis alone as the base case, the study found that simultaneous control of T. solium taeniasis/cysticercosis in humans and pigs, STH in humans and Classical Swine Fever (CSF) in pigs was USD 14 per DALY averted and USD 234 per zDALY averted using zDALY method hence considered highly cost-effective whereas controlling T. solium taeniasis/cysticercosis without incorporating STH and CSF was the least cost-effective (USD 3,672 per DALY averted). Additionally, the cost-effectiveness of controlling T. solium taeniasis/cysticercosis in people and pigs using zDALY as an alternative method was USD 3,662 per zDALY averted which was quite close to our findings using the aggregate net cost method. CONCLUSION: The study showed that control of T. solium taeniasis/cysticercosis alone in humans and pigs is not cost-effective in northern Lao PDR whereas control of STH is. Consequently, integrating T. solium taeniasis/cysticercosis control with other cost-effective programmes such as STH and CSF markedly improved the cost-effectiveness of the intervention. This is especially important in low resource countries where control of zoonotic neglected tropical diseases could be integrated with the human and animal health sectors to optimize use of the limited resources. TRIAL REGISTRATION: Australia New Zealand Clinical Trials Registry (ANZCTR) ACTRN12614001067662.

Intestinal Helminths of Wild Bonobos in Forest-Savanna Mosaic: Risk Assessment of Cross-Species Transmission with Local People in the Democratic Republic of the Congo.

Phylogenetic and geographic proximities between humans and apes pose a risk of zoonotic transmission of pathogens. Bonobos (Pan paniscus) of the Bolobo Territory, Democratic Republic of the Congo, live in a fragmented forest-savanna mosaic setting, a marginal habitat for this species used to living in dense forests. Human activities in the forest have increased the risk of contacts between humans and bonobos. Over 21 months (September 2010-October 2013), we monitored intestinal parasites in bonobo (n = 273) and in human (n = 79) fecal samples to acquire data on bonobo parasitology and to assess the risk of intestinal helminth transmission between these hosts. Coproscopy, DNA amplification, and sequencing of stored dried feces and larvae were performed to identify helminths. Little difference was observed in intestinal parasites of bonobos in this dryer habitat compared to those living in dense forests. Although Strongylids, Enterobius sp., and Capillaria sp. were found in both humans and bonobos, the species were different between the hosts according to egg size or molecular data. Thus, no evidence of helminth transmission between humans and bonobos was found. However, because humans and this threatened species share the same habitat, it is essential to continue to monitor this risk.

Soil transmitted helminths and scabies in Zanzibar, Tanzania following mass drug administration for lymphatic filariasis--a rapid assessment methodology to assess impact.

BACKGROUND: Ivermectin and albendazole are used in annual mass drug administration (MDA) for the lymphatic filariasis elimination programmes in African countries co-endemic for onchocerciasis, but have additional impact on soil transmitted helminths and the ectoparasitic mite which causes scabies. Assessing these collateral impacts at scale is difficult due to the insensitivity of available parasite detection techniques. METHODS: The numbers of cases diagnosed with intestinal helminths and scabies and who received prescriptions for treatment were evaluated in 50 health centres in Zanzibar. Records were examined from 2000, prior to the initiation of MDA to 2005, after six rounds of MDA for lymphatic filariasis had taken place. RESULTS: Health centre records showed a consistent decline in the number of cases of intestinal helminths and scabies diagnosed by community health workers in Zanzibar and the number of prescriptions issued across five age groups. A 90-98% decline in soil transmitted helminths and 68-98% decline in scabies infections were recorded. Poisson regression models aggregated to both the island-level and district-level indicated that the decline was statistically significant. CONCLUSIONS: The described method of examining health centre records has the potential for use on a large scale, despite limitations, as a rapid method to evaluate the impacts resulting from both lymphatic filariasis and onchocerciasis MDA. This would result in a reduction in the need for parasitological evaluations to determine prevalence and intensity.

Assessment of a school-based mass treatment for soil-transmitted helminth infections in Capiz, the Philippines.

We evaluated the War on Worms in the Western Visayas (WOW-V) school-based mass treatment strategy in Capiz, the Philippines by assessing potential determinants of program acceptance among parents, teachers, and local health and education officials involved. Written surveys were distributed to parents and teachers assessing knowledge, attitudes and practices regarding soil-transmitted helminth (STH) infections. Associations between data were examined using the Fisher's exact test (alpha = 0.05). Descriptive statistics and t-tests were employed to analyze teacher survey results. Local health and education officials participated in key-informant interviews (KIs) to evaluate their attitudes and practices regarding WOW-V; data was qualitatively analyzed and grouped. A strong association was observed between parental consent during the first two rounds of treatment and willingness to do so again. Most parents gave consent for their child to receive treatment at least once and demonstrated a high level of knowledge regarding STH infections. The majority of teachers had positive attitudes toward their role in the program. Many identified lack of training and a fear of side effects as barriers to higher coverage. Lack of funding, program monitoring difficulties and insufficient parental education were identified by local officials as barriers. Proper planning and design is important to achieve high initial consent for program acceptance. The results correlate with studies showing relationships between health education and treatment acceptance. The implementation of health education and monitoring measures has the potential to greatly improve both treatment coverage and program infrastructure.

Molecular characterization and assessment of zoonotic transmission of Cryptosporidium from dairy cattle in West Bengal, India.

Few studies in the past have examined the genetic diversity and zoonotic potential of Cryptosporidium in dairy cattle in India. To assess the importance of these animals as a source of human Cryptosporidium infections, fecal samples from 180 calves, heifers and adults and 51 farm workers on two dairy farms in West Bengal, India were genotyped by PCR-RFLP analysis of the 18S rRNA gene of Cryptosporidium followed by DNA sequencing of the PCR products. Phylogenetic analysis was carried out on the DNA sequences obtained in the study and those available in GenBank. The overall prevalence of Cryptosporidium in cattle was 11.7% though the infection was more prevalent in younger calves than in adult cattle. The occurrence of Cryptosporidium parvum, Cryptosporidium bovis, Cryptosporidium ryanae and Cryptosporidium andersoni in cattle followed an age-related pattern. A Cryptosporidium suis-like genotype was also detected in a calf. Farm workers were infected with Cryptosporidium hominis, C. parvum and a novel C. bovis genotype. These findings clearly suggest that there is a potential risk of zoonotic transmission of Cryptosporidium infections between cattle and humans on dairy farms in India.

Pesquisa participante na intervençäo da transmissäo de helmintos intestinais (Cidade Satélite do Paranoá - Distrito Federal) / Participant survey in the intervention of intestinal helminthiasis transmission (satellite city of Paranoá - Federal District)

Neste trabalho, desenvolvido na Cidade Satélite do Paranoá/DF, pretende-se desenvolver um projeto de pesquisa participante que contribuísse para a reduçao dos índices de infecçao de helmintoses intestinais em um grupo de crianças de risco nutricional. A unidade da pesquisa foi o Núcleo Familiar que compreendia pais, filhos e outros parentes que habitavam a mesma residência. Um conjunto de açoes instrumentais técnicas e de processos educativos acompanharam todas as etapas do projeto. As práticas foram participativas, problematizadoras, estimulantes a análises e reflexoes críticas, objetivando a construçao, socializaçao e apropriaçao de um novo saber. As açoes técnicas compreenderam os exames fecais e tratamento. As açoes educativas, tiveram como princípio a pedagogia problematizadora estimulante a análises e reflexoes críticas, tendo por eixo condutor a Promoçao à Saúde como Qualidade de Vida e Cidadania. O programa dessas açoes compreendeu: visitas domiciliares, aplicaçao de questionário, reunioes de grupos até a entrega dos resultados dos exames e tratamento. Procurou-se resgatar no Tema Gerador a História dos Indivíduos e da Comunidade, Identificaçao e Reflexao dos Problemas do Paranoá, Confronto da Realidade Vivenciada. Um conjunto de métodos e técnicas pedagógicas estimulantes à participaçao foram utilizados. Os processos avaliativos foram: quantitativos - avaliaçao dos índices de infecçao e número de participantes; qualitativos - ocorrendo durante todo o desenvolvimento do processo educativo, sendo traduzidos através do material produzido pelos participantes, dos depoimentos individuais e da presença ativa nas etapas e tarefas práticas dos trabalbos nas reunioes. Os resultados obtidos foram relevantes quanto à participaçao, à produçao e apropriaçao de conhecimentos e na intervençao da transmissao das helmintoses intestinais.

[Participant survey in the intervention of intestinal helminthiasis transmission (satellite city of Paranoá -- Federal District]. / Pesquisa participante na intervenção da transmissão de helmintoses intestinais (Cidade Satélite do Paranoá-Distrito Federal).

This work was developed in the Paranoá city town of the Federal District of Brazil. It used techniques of participative research with the aim of reducing intestinal helminths transmission in a group of children at nutritional risk. The family nucleus, that is, parents, children and other relatives living together in the same house, was used as reference for this research. All steps of the work were followed simultaneously by technical and educative actions. The technical actions were related to faecal examinations and medication. The educative process, stimulated critical analysis and reflections on the central problem and life conditions, with a strong focus on Health Promotion to improve life quality, as well as an empowerment process. During the work development, of the action program included the following steps: home visits, interviews, group meetings, feedback on the faeces examinations results and treatment. An evaluation of the final results was made through quantitative and qualitative methods, which showed the construction, acquisition and socialisation of knowledge.

Epidemiology and clinical significance of Blastocystis hominis in different population groups in Salamanca (Spain).

A prospective study was carried out to investigate the epidemiology and clinical significance of Blastocystis hominis in the following groups of the population of the city of Salamanca (Spain): in children attending 11 day care centres and 7 primary schools, two fecal samples were obtained from each child, and in 1231 patients attending the Clinical Hospital. A B. hominis incidence of 5.3-10.3% was found in the day care centres and an incidence rate of 13.4-19.4% was found in the primary schools. All the cases were observed in asymptomatic children. The incidence of B. hominis was greater in children older than 3 years in the day care centres and in the 10-14 year-old group in the primary schools. A heavier parasitization was observed in the boys than in the girls and in the students of schools in areas of low socio-economic level. B. hominis was identified in 40 patients attending the Clinical Hospital (3.25% of all those studied). The maximum peak of incidence was found in subjects with ages between 10 and 14 years. A follow up study was performed on 18 patients parasitized exclusively by B. hominis; 7 of these were considered to have acute gastroenteritis and one chronic gastroenteritis associated with the protozoan. No statistically significant association was observed between the number of B. hominis cells and the presence of diarrhoea. Our results show that despite the high number of asymptomatic carriers of B. hominis in the juvenile population, this protozoan may be, on other occasions, responsible for gastrointestinal symptoms.

Intestinal helminthiases in relation to the socioeconomic environment of Panamanian children.

A cross-sectional investigation was made into ascariasis and nutritional status in Panamanian preschool children from October 1983 to July 1984. Within this framework, an analysis was undertaken of possible relationships between a range of intestinal helminthiases and the socioeconomic status of the participants. Attention was paid to caregiver's education, parental occupation, family earnings, quality of housing and sanitation in the assessment of socioeconomic status. On this basis, strong associations were established between the socioeconomic status of the children and infection with Ascaris lumbricoides, Trichuris trichiura and hookworm. In general, the prevalence of single and multiple helminth infections was significantly higher in children living in housing made of wood or bamboo than in those living in housing made of concrete blocks. The same pattern applied to levels of sanitation. Ascaris lumbricoides occurred more frequently in children of mothers with the least formal education and in children living in relatively crowded conditions. Evidence was also obtained to indicate that the intensity of the intestinal helminth infections was greater in the children from the poorer environment. Since children from poorer socioeconomic conditions might be more exposed to infective stages than those from a better environment, the possible role of socioeconomic factors in contributing to the predisposition of some individuals to harbour large worm burdens of intestinal helminths was briefly discussed.