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2.
BMC Public Health ; 19(1): 1398, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31660915

RESUMO

BACKGROUND: Achieving the Sustainable Development Goal of a 90% reduction in neglected tropical diseases (NTDs) by 2030 requires innovative control strategies. This proof-of-concept study examined the effectiveness of integrating control programs for two NTDs: mass drug administration (MDA) for soil-transmitted helminths in humans and mass dog rabies vaccination (MDRV). METHODS: The study was carried out in 24 Tanzanian villages. The primary goal was to demonstrate the feasibility of integrating community-wide MDA for STH and MDRV for rabies. The objectives were to investigate the popularity, participation and cost and time savings of integrated delivery, and to investigate the reach of the MDA with respect to primary school-aged children and other community members. To implement, we randomly allocated villages for delivery of MDA and MDRV (Arm A), MDA only (Arm B) or MDRV only (Arm C). RESULTS: Community support for the integrated delivery was strong (e.g. 85% of focus group discussions concluded that it would result in people getting "two for one" health treatments). A high proportion of households participated in the integrated Arm A events (81.7% MDA, 80.4% MDRV), and these proportions were similar to those in Arms B and C. These findings suggest that coverage might not be reduced when interventions are integrated. Moreover, in addition to time savings, integrated delivery resulted in a 33% lower cost per deworming dose and a 16% lower cost per rabies vaccination. The median percentage of enrolled primary school children treated by this study was 76%. However, because 37% of the primary school aged children that received deworming treatment were not enrolled in school, we hypothesize that the employed strategy could reach more school-aged children than would be reached through a solely school-based delivery strategy. CONCLUSIONS: Integrated delivery platforms for health interventions can be feasible, popular, cost and time saving. The insights gained could be applicable in areas of sub-Saharan Africa that are remote or underserved by health services. These results indicate the utility of integrated One Health delivery platforms and suggest an important role in the global campaign to reduce the burden of NTDs, especially in hard-to-reach communities. TRIAL REGISTRATION: clinicaltrials.gov NCT03667079 , retrospectively registered 11th September 2018.


Assuntos
Prestação Integrada de Cuidados de Saúde , Doenças do Cão/prevenção & controle , Helmintíase/prevenção & controle , Raiva/prevenção & controle , Solo/parasitologia , Animais , Criança , Redução de Custos/estatística & dados numéricos , Prestação Integrada de Cuidados de Saúde/economia , Cães , Helmintíase/transmissão , Humanos , Administração Massiva de Medicamentos/economia , Vacinação em Massa/economia , Vacinação em Massa/veterinária , Avaliação de Programas e Projetos de Saúde , Raiva/transmissão , Raiva/veterinária , Vacinas Antirrábicas/administração & dosagem , Vacinas Antirrábicas/economia , População Rural , Tanzânia/epidemiologia
3.
Korean J Parasitol ; 57(4): 329-339, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31533400

RESUMO

Indonesia and South Korea have become inseparable in various respects since the 2 countries established diplomatic relation in 1973. Indonesia is a tropical region that stretches across the equator, comprised of 5 main islands (Java, Kalimantan, Sumatra, Sulawesi, and Papua) and 4 archipelagoes (Riau, Bangka Belitung, Nusa Tenggara, and Maluku). As most population of Eastern Indonesia (Sulawesi, Papua and Nusa Tenggara & Maluku) live in poor areas, it is expected that there will be many parasites. Nevertheless, little is known about the status of parasites in Indonesia. This study examines the prevalences of malaria and lymphatic filaria, which are prevalent in Indonesia, as well as those of soil-transmitted-helminths (STH). As a result, the Plasmodium falciparum and P. vivax case loads are almost equal. The current prevalence of P. vivax is uniformly low (<5%) in all age groups and annual parasite incidence (API) showed decreasing tendency as 0.84 per 1,000 population in 2016. However, more than 65 million people still live in malaria epidemic regions. Lymphatic filariasis remains an important public health problem and 236 cities were classified as endemic areas in 514 cities/districts in 2017. It is difficult to ascertain the current prevalence rate of STH in Indonesia, although West Sumba and Southwest Sumba in East Nusa Tenggara reported prevalence rate of more than 20%. The study also considers the (sero) prevalences of other parasites identified in Indonesia. This report should be useful not only to parasitologists but also to travelers and people with business in Indonesia.


Assuntos
Doenças Parasitárias/epidemiologia , Filariose Linfática/epidemiologia , Helmintíase/epidemiologia , Helmintíase/transmissão , Indonésia/epidemiologia , Malária/epidemiologia , Doenças Parasitárias/transmissão , Prevalência , Esquistossomose Japônica/epidemiologia , Solo/parasitologia , Teníase/epidemiologia
4.
Cochrane Database Syst Rev ; 9: CD011055, 2019 09 24.
Artigo em Inglês | MEDLINE | ID: mdl-31549742

RESUMO

BACKGROUND: Diarrhoea and soil-transmitted helminth (STH) infections represent a large disease burden worldwide, particularly in low-income countries. As the aetiological agents associated with diarrhoea and STHs are transmitted through faeces, the safe containment and management of human excreta has the potential to reduce exposure and disease. Child faeces may be an important source of exposure even among households with improved sanitation. OBJECTIVES: To assess the effectiveness of interventions to improve the disposal of child faeces for preventing diarrhoea and STH infections. SEARCH METHODS: We searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, Embase, and 10 other databases. We also searched relevant conference proceedings, contacted researchers, searched websites for organizations, and checked references from identified studies. The date of last search was 27 September 2018. SELECTION CRITERIA: We included randomized controlled trials (RCTs) and non-randomized controlled studies (NRS) that compared interventions aiming to improve the disposal of faeces of children aged below five years in order to decrease direct or indirect human contact with such faeces with no intervention or a different intervention in children and adults. DATA COLLECTION AND ANALYSIS: Two review authors selected eligible studies, extracted data, and assessed the risk of bias. We used meta-analyses to estimate pooled measures of effect where appropriate, or described the study results narratively. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: Sixty-three studies covering more than 222,800 participants met the inclusion criteria. Twenty-two studies were cluster RCTs, four were controlled before-and-after studies (CBA), and 37 were NRS (27 case-control studies (one that included seven study sites), three controlled cohort studies, and seven controlled cross-sectional studies). Most study sites (56/69) were in low- or lower middle-income settings. Among studies using experimental study designs, most interventions included child faeces disposal messages along with other health education messages or other water, sanitation, and hygiene (WASH) hardware and software components. Among observational studies, the main risk factors relevant to this review were safe disposal of faeces in the latrine or defecation of children under five years of age in a latrine.Education and hygiene promotion interventions, including child faeces disposal messages (no hardware provision)Four RCTs found that diarrhoea incidence was lower, reducing the risk by an estimated 30% in children under six years old (rate ratio 0.71, 95% confidence interval (CI) 0.59 to 0.86; 2 trials, low-certainty evidence). Diarrhoea prevalence measured in two other RCTs in children under five years of age was lower, but evidence was low-certainty (risk ratio (RR) 0.93, 95% CI 0.84 to 1.04; low-certainty evidence).Two controlled cohort studies that evaluated such an intervention in Bangladesh did not detect a difference on diarrhoea prevalence (RR 0.91, 95% CI 0.64 to 1.28; very low-certainty evidence). Two controlled cross-sectional studies that evaluated the Health Extension Package in Ethiopia were associated with a lower two-week diarrhoea prevalence in 'model' households than in 'non-model households' (odds ratio (OR) 0.26, 95% CI 0.16 to 0.42; very low-certainty evidence).Programmes to end open defecation by all (termed community-led total sanitation (CLTS) interventions plus adaptations)Four RCTs measured diarrhoea prevalence and did not detect an effect in children under five years of age (RR 0.92, 95% CI 0.79 to 1.07; moderate-certainty evidence). The analysis of two trials did not demonstrate an effect of the interventions on STH infection prevalence in children (pooled RR 1.03, 95% CI 0.64 to 1.65; low-certainty evidence).One controlled cross-sectional study compared the prevalence of STH infection in open defecation-free (ODF) villages that had received a CLTS intervention with control villages and reported a higher level of STH infection in the intervention villages (RR 2.51, 95% CI 1.74 to 3.62; very low-certainty evidence).Sanitation hardware and behaviour change interventions, that included child faeces disposal hardware and messagingTwo RCTs had mixed results, with no overall effect on diarrhoea prevalence demonstrated in the pooled analysis (RR 0.79, 95% CI 0.49 to 1.26; very low-certainty evidence).WASH hardware and education/behaviour change interventionsOne RCT did not demonstrate an effect on diarrhoea prevalence (RR 1.15, 95% CI 0.93 to 1.41; very low-certainty evidence).Two CBAs reported that the intervention reduced diarrhoea incidence by about a quarter in children under five years of age, but evidence was very low-certainty (rate ratio 0.77, 95% CI 0.71 to 0.84). Another CBA reported that the intervention reduced the prevalence of STH in an intervention village compared to a control village, again with GRADE assessed at very low-certainty (OR 0.17, 95% CI 0.02 to 0.73).Case-control studiesPooled results from case-control studies that presented data for child faeces disposal indicated that disposal of faeces in the latrine was associated with lower odds of diarrhoea among all ages (OR 0.73, 95% CI: 0.62 to 0.85; 23 comparisons; very low-certainty evidence). Pooled results from case-control studies that presented data for children defecating in the latrine indicated that children using the latrine was associated with lower odds of diarrhoea in all ages (OR 0.54, 95% CI 0.33 to 0.90; 7 studies; very low-certainty evidence). AUTHORS' CONCLUSIONS: Evidence suggests that the safe disposal of child faeces may be effective in preventing diarrhoea. However, the evidence is limited and of low certainty. The limited research on STH infections provides only low and very-low certainty evidence around effects, which means there is currently no reliable evidence that interventions to improve safe disposal of child faeces are effective in preventing such STH infections.While child faeces may represent a source of exposure to young children, interventions generally only address it as part of a broader sanitation initiative. There is a need for RCTs and other rigorous studies to assess the effectiveness and sustainability of different hardware and software interventions to improve the safe disposal of faeces of children of different age groups.


Assuntos
Diarreia/parasitologia , Helmintíase/prevenção & controle , Helmintíase/transmissão , Saneamento , Solo/parasitologia , Animais , Criança , Pré-Escolar , Estudos Controlados Antes e Depois , Fezes , Helmintos , Humanos , Lactente , Ensaios Clínicos Controlados Aleatórios como Assunto
5.
Parasit Vectors ; 12(1): 438, 2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31522681

RESUMO

BACKGROUND: Soil-transmitted helminth (STH) infections affect predominantly socio-economically disadvantaged populations in sub-Saharan Africa, East Asia and the Americas. Previous mathematical modelling studies have evaluated optimal intervention strategies to break STH transmission in clusters of villages. These studies assumed that villages are closed independent units with no movement of people in or out of communities. Here we examine how human population movement, for example, of seasonal migrant labourers, affect the outcome of mass drug administration (MDA) programmes. RESULTS: We used a stochastic individual-based metapopulation model to analyse the impact of human population movement at varying rates on STH elimination efforts. Specifically, we looked at seasonal clumped movement events of infected individuals into a village. We showed that even if on average 75% of the entire resident population within a village are treated, an annual rate of 2-3% of the population arriving from an untreated source village can reduce the probability of STH elimination to less than 50% in high-prevalence settings. If a village is infection-free, an annual movement rate of 2-3% from an infected source village imposes a risk of re-introduction of STH of 75% or higher, unless the prevalence in the source village is less than 20%. Even a single arrival of 2-3% of the population can impose a risk of re-introducing STH of 50% or greater depending on the prevalence in the source village. The risk of re-introduction also depends on both the age group of moving individuals and STH species, since the pattern of cross-sectional age-prevalence and age-intensity profiles of infection in the human host are species-specific. CONCLUSIONS: Planning for STH elimination programmes should account for human mobility patterns in defined regions. We recommend that individuals arriving from areas with ongoing STH transmission should receive preventive chemotherapy for STHs. This can most easily be implemented if migration is seasonal and overlaps with treatment rounds, e.g. seasonal migrant labour. Moreover, transmission hotspots in or near treatment clusters should be eliminated, for example, by implementing appropriate water, sanitation and hygiene (WASH) measures and targeting treatment to individuals living in hotspots.


Assuntos
Anti-Helmínticos/uso terapêutico , Transmissão de Doença Infecciosa/prevenção & controle , Helmintíase/prevenção & controle , Helmintíase/transmissão , Migração Humana , Administração Massiva de Medicamentos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Modelos Estatísticos , Prevalência , População Rural , Resultado do Tratamento , Adulto Jovem
7.
PLoS Negl Trop Dis ; 13(8): e0007446, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31369558

RESUMO

BACKGROUND: Because the success of deworming programs targeting soil-transmitted helminths (STHs) is evaluated through the periodically assessment of prevalence and infection intensities, the use of the correct diagnostic method is of utmost importance. The STH community has recently published for each phase of a deworming program the minimal criteria that a potential diagnostic method needs to meet, the so-called target product profiles (TPPs). METHODOLOGY: We compared the diagnostic performance of a single Kato-Katz (reference method) with that of other microscopy-based methods (duplicate Kato-Katz, Mini-FLOTAC and FECPAKG2) and one DNA-based method (qPCR) for the detection and quantification of STH infections in three drug efficacy trials in Ethiopia, Lao PDR, and Tanzania. Furthermore, we evaluated a selection of minimal diagnostic criteria of the TPPs. PRINCIPAL FINDINGS: All diagnostic methods showed a clinical sensitivity of ≥90% for all STH infections of moderate-to-heavy intensities. For infections of very low intensity, only qPCR resulted in a sensitivity that was superior to a single Kato-Katz for all STHs. Compared to the reference method, both Mini-FLOTAC and FECPAKG2 resulted in significantly lower fecal egg counts for some STHs, leading to a substantial underestimation of the infection intensity. For qPCR, there was a positive significant correlation between the egg counts of a single Kato-Katz and the DNA concentration. CONCLUSIONS/SIGNIFICANCE: Our results indicate that the diagnostic performance of a single Kato-Katz is underestimated by the community and that diagnostic specific thresholds to classify intensity of infection are warranted for Mini-FLOTAC, FECPAKG2 and qPCR. When we strictly apply the TPPs, Kato-Katz is the only microscopy-based method that meets the minimal diagnostic criteria for application in the planning, monitoring and evaluation phase of an STH program. qPCR is the only method that could be considered in the phase that aims to seek confirmation for cessation of program. TRIAL REGISTRATION: ClinicalTrials.gov NCT03465488.


Assuntos
Testes Diagnósticos de Rotina/métodos , Helmintíase/parasitologia , Helmintíase/transmissão , Helmintos/isolamento & purificação , Técnicas de Diagnóstico Molecular/métodos , Reação em Cadeia da Polimerase em Tempo Real/métodos , Solo/parasitologia , Adolescente , Animais , Brasil , Criança , Testes Diagnósticos de Rotina/instrumentação , Etiópia/epidemiologia , Fezes/parasitologia , Feminino , Helmintíase/diagnóstico , Helmintíase/epidemiologia , Helmintos/genética , Humanos , Laos/epidemiologia , Masculino , Microscopia , Técnicas de Diagnóstico Molecular/instrumentação , Contagem de Ovos de Parasitas/métodos , Prevalência , Sensibilidade e Especificidade , Tanzânia/epidemiologia , Organização Mundial da Saúde
8.
BMC Public Health ; 19(1): 1066, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391023

RESUMO

BACKGROUND: Soil-transmitted helminth infection (STH) is one of the neglected tropical disease that affects approximately 2 billion people globally. School children represent the age group that is most commonly infected with STHs, resulting in poor school performance, impaired cognitive function, and many other detrimental effects. The transmission of STH is determined by many factors, such as hygiene and sanitation. Understanding the factors that influence disease transmission in a particular area is key to effective STH control. The objective of this study was to determine the prevalence of STH in North Sumatera and to identify the associated risk factors among school children. METHODS: A cross-sectional study was carried out among primary school children in Suka village, Tigapanah subdistrict. Stool samples were processed using a single Kato-Katz method. The potential risk factors analyzed were parent education and occupation, hand washing habits, latrine usage, footwear usage and contact with soil. The Chi-square test was performed to identify an association between risk factors and parasitological results. Logistic regression analysis was used to measure the strength of association. RESULTS: We enrolled 468 school children between 6 and 12 years of age. Among those children, 268 children (57.24%) were positive for one or more STH infections. Approximately 62.39% of children played with soil/dirt every day, and only 50% regularly washed their hands after activities. Most of the children wore shoes/slippers when going outside (87.82%) and used a latrine for defecation (85.04%). Playing with soil/dirt have been shown to increase the risk of STH infections 7.53 times, while hand washing habits and latrine usage decreased the risk of STH infections 0.16 times each. CONCLUSION: The prevalence of STH infection in school children in Suka village, Tigapanah subdistrict is still high. Playing with soil/dirt increased the risk of infection, while hand washing habits and latrine usage decreased the risk of infection. The combined strategies of improving the personal hygiene of children and biannual deworming can reduce the risk of STH infection in school children in Suka village, Tigapanah subdistrict.


Assuntos
Agricultura , Helmintíase/epidemiologia , Helmintíase/transmissão , Características de Residência/estatística & dados numéricos , Solo/parasitologia , Criança , Estudos Transversais , Fezes/parasitologia , Feminino , Humanos , Higiene/normas , Indonésia/epidemiologia , Masculino , Prevalência , Fatores de Risco , Toaletes/estatística & dados numéricos
9.
PLoS Negl Trop Dis ; 13(7): e0007581, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31306433

RESUMO

BACKGROUND: More than 1.5 billion people are infected with soil-transmitted helminths (Ascaris lumbricoides, hookworm, Strongyloides stercoralis, and Trichuris trichiura), causing an estimated global burden in excess of 3 million disability-adjusted life years. However, the relationship between soil-transmitted helminth infection, adverse health consequences, and beneficial effects of deworming are not well understood. METHODOLOGY: We pursued a detailed longitudinal clinical evaluation of school-age children to evaluate morbidity associated with soil-transmitted helminth infection and responses to treatment. This exploratory study was embedded into a randomized controlled trial. Overall, 434 children, aged 7-14 years, underwent a detailed medical history, physical examination, stool microscopy for soil-transmitted helminths, and hemoglobin (Hb) measurement at baseline. Medical history and stool examination were repeated at 3 and 18 weeks posttreatment. Additionally, Hb measurement was performed at the 18-week treatment follow-up. Logistic regression was employed to assess clinical factors associated with soil-transmitted helminth infection at baseline, and longitudinal data analysis to examine change in health outcomes following treatment over time. PRINCIPAL FINDINGS: All enrolled children were infected with T. trichiura, and randomized into four different treatment interventions. None of the medical history, physical examination, and laboratory (i.e., Hb) findings were associated with A. lumbricoides, hookworm, or S. stercoralis infection at baseline. A composite of physical exam findings for anemia, including pallor of the conjunctiva, nail beds, and palmar creases predicted lower Hb values (-3.8 g/dl, 95% confidence interval (CI): -6.9, -0.6 g/dl). When examining longitudinal trends, we did not find improvements to Hb or face Wong-Baker Likert scale among children with soil-transmitted helminth infection compared to those without infection, although there was a slight trend toward improving Hb values after treating hookworm infection. CONCLUSIONS/SIGNIFICANCE: Our study demonstrates the challenges of measuring morbidity in the context of soil-transmitted helminth infection and treatment, thus confirming the mainly subtle morbidity effects of infection.


Assuntos
Helmintíase/epidemiologia , Helmintíase/terapia , Helmintíase/transmissão , Solo/parasitologia , Adolescente , Ancylostomatoidea , Anemia , Animais , Ascaríase , Ascaris lumbricoides , Criança , Fezes/parasitologia , Feminino , Helmintíase/fisiopatologia , Helmintos , Hemoglobinas/análise , Infecções por Uncinaria , Humanos , Ilhas do Oceano Índico/epidemiologia , Ilhas , Masculino , Morbidade , Prevalência , Instituições Acadêmicas , Strongyloides stercoralis , Tanzânia/epidemiologia , Tricuríase/epidemiologia , Tricuríase/transmissão , Trichuris
10.
J Glob Health ; 9(2): 020402, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31360445

RESUMO

Background: Water, sanitation, and hygiene (WASH) in schools is promoted by development agencies as a modality to improve school attendance by reducing illness. Despite biological plausibility, the few rigorous studies that have assessed the effect of WASH in schools (WinS) interventions on pupil health and school attendance have reported mixed impacts. We evaluated the impact of the Laos Basic Education, Water, Sanitation and Hygiene Programme - a comprehensive WinS project implemented by UNICEF Lao People's Democratic Republic (Lao PDR) in 492 primary schools nationwide between 2013 and 2017 - on pupil education and health. Methods: From 2014-2017, we conducted a cluster-randomized trial among 100 randomly selected primary schools lacking functional WASH facilities in Saravane Province, Lao PDR. Schools were randomly assigned to either the intervention (n = 50) or comparison (n = 50) arm. Intervention schools received a school water supply, sanitation facilities, handwashing facilities, drinking water filters, and behavior change education and promotion. Comparison schools received the intervention after research activities ended. At unannounced visits every six to eight weeks, enumerators recorded pupils' roll-call absence, enrollment, attrition, progression to the next grade, and reported illness (diarrhea, respiratory infection, conjunctivitis), and conducted structured observations to measure intervention fidelity and adherence. Stool samples were collected annually prior to de-worming and analyzed for soil-transmitted helminth (STH) infection. In addition to our primary intention-to-treat analysis, we conducted secondary analyses to quantify the role of intervention fidelity and adherence on project impacts. Results: We found no impact of the WinS intervention on any primary (pupil absence) or secondary (enrollment, dropout, grade progression, diarrhea, respiratory infection, conjunctivitis, STH infection) impacts. Even among schools with the highest levels of fidelity and adherence, impact of the intervention on absence and health was minimal. Conclusions: While WinS may create an important enabling environment, WinS interventions alone and as currently delivered may not be sufficient to independently impact pupil education and health. Our results are consistent with other recent evaluations of WinS projects showing limited or mixed effects of WinS.


Assuntos
Absenteísmo , Diarreia/prevenção & controle , Helmintíase/prevenção & controle , Infecções Respiratórias/prevenção & controle , Serviços de Saúde Escolar , Animais , Criança , Diarreia/epidemiologia , Fezes/parasitologia , Feminino , Helmintíase/epidemiologia , Helmintíase/transmissão , Helmintos/isolamento & purificação , Humanos , Higiene/educação , Higiene/normas , Laos/epidemiologia , Masculino , Avaliação de Programas e Projetos de Saúde , Infecções Respiratórias/epidemiologia , Saneamento/normas , Solo/parasitologia , Abastecimento de Água/normas
11.
Pan Afr Med J ; 32: 96, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31231453

RESUMO

Introduction: Controlling vitamin A deficiency and soil-transmitted helminth infections are public health imperatives. We aimed at revealing some caregiver and child-related determinants of uptake of vitamin A supplementation and deworming, and examine their programmatic implications in Kenyan context. Methods: A cross-sectional study of randomly selected 1,177 households with infants and young children aged 6-59 months in three of the 47 counties of Kenya. The number of times a child was given vitamin A supplements and dewormed 6 months and one year preceding the study was extracted from mother-child health books. Results: Coverage for age-specific deworming was considerably depressed compared to corresponding vitamin A supplementation and for both services, twice-yearly provisions were disproportionately lower than half-yearly. Univariate and multivariate analyses showed relatively younger children, of Islam-affiliated caregivers (vis a vis Christians) and those who took less time to nearest health facilities as more likely to be supplemented with vitamin A. Similar observations were made for deworming where additionally, maternal and child ages were also determinants in favour of older groups. Other studied factors were not significant determinants. Programmatic allusions of the determining factors were discussed. Conclusion: Key to improving uptake of vitamin A supplementation and deworming among Kenyan 6-59 months olds are: increasing access to functional health facilities, expanding outreaches and campaigns, dispelling faith-related misconceptions and probably modulating caregiver and child age effects by complementing nutrition literacy with robust and innovative caregiver reminders. Given analogous service points and scheduling, relative lower uptake of deworming warrants further investigations.


Assuntos
Anti-Helmínticos/administração & dosagem , Helmintíase/tratamento farmacológico , Deficiência de Vitamina A/tratamento farmacológico , Vitamina A/administração & dosagem , Cuidadores , Pré-Escolar , Estudos Transversais , Suplementos Nutricionais , Feminino , Acesso aos Serviços de Saúde , Helmintíase/transmissão , Humanos , Lactente , Quênia , Masculino , Estado Nutricional , Religião , População Rural , Solo/parasitologia
12.
Parasit Vectors ; 12(1): 216, 2019 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-31064387

RESUMO

BACKGROUND: Humans are susceptible to over 1400 pathogens. Co-infection by multiple pathogens is common, and can result in a range of neutral, facilitative, or antagonistic interactions within the host. Soil-transmitted helminths (STH) are powerful immunomodulators, but evidence of the effect of STH infection on the direction and magnitude of concurrent enteric microparasite infections is mixed. METHODS: We collected fecal samples from 891 randomly selected children and adults in rural Laos. Samples were analyzed for 5 STH species, 6 viruses, 9 bacteria, and 5 protozoa using a quantitative reverse transcription polymerase chain reaction (qRT-PCR) assay. We utilized logistic regression, controlling for demographics and household water, sanitation, and hygiene access, to examine the effect of STH infection on concurrent viral, bacterial, and protozoal infection. RESULTS: We found that STH infection was associated with lower odds of concurrent viral infection [odds ratio (OR): 0.48, 95% confidence interval (CI): 0.28-0.83], but higher odds of concurrent bacterial infections (OR: 1.81, 95% CI: 1.06-3.07) and concurrent protozoal infections (OR: 1.50, 95% CI: 0.95-2.37). Trends were consistent across STH species. CONCLUSIONS: The impact of STH on odds of concurrent microparasite co-infection may differ by microparasite taxa, whereby STH infection was negatively associated with viral infections but positively associated with bacterial and protozoal infections. Results suggest that efforts to reduce STH through preventive chemotherapy could have a spillover effect on microparasite infections, though the extent of this impact requires additional study. The associations between STH and concurrent microparasite infection may reflect a reverse effect due to the cross-sectional study design. Additional research is needed to elucidate the exact mechanism of the immunomodulatory effects of STH on concurrent enteric microparasite infection.


Assuntos
Coinfecção/epidemiologia , Helmintíase/complicações , Helmintíase/transmissão , Enteropatias/etiologia , Solo/parasitologia , Adulto , Infecções Bacterianas/complicações , Criança , Pré-Escolar , Estudos Transversais , Fezes/microbiologia , Fezes/parasitologia , Fezes/virologia , Feminino , Helmintíase/epidemiologia , Humanos , Enteropatias/microbiologia , Enteropatias/parasitologia , Enteropatias/virologia , Enteropatias Parasitárias/complicações , Laos/epidemiologia , Masculino , Prevalência , Viroses/complicações
13.
PLoS Negl Trop Dis ; 13(5): e0007323, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31050672

RESUMO

BACKGROUND: Soil transmitted helminths (STH) infect >1.5 billion people. Mass drug administration (MDA) effectively reduces infection; however, there is evidence for rapid reinfection and risk of potential drug resistance. We conducted a randomized controlled trial in Bangladesh (WASH Benefits, NCT01590095) to assess whether water, sanitation, hygiene and nutrition interventions, alone and combined, reduce STH in a setting with ongoing MDA. METHODOLOGY/PRINCIPAL FINDINGS: In 2012-2013, we randomized 720 clusters of 5551 pregnant women into water treatment, sanitation, handwashing, combined water+sanitation+handwashing (WSH), nutrition, nutrition+WSH (N+WSH) or control arms. In 2015-2016, we enrolled 7795 children, aged 2-12 years, of 4102 available women for STH follow-up and collected stool from 7187. We enumerated STH infections with Kato-Katz. We estimated intention-to-treat intervention effects on infection prevalence and intensity. Participants and field staff were not blinded; laboratory technicians and data analysts were blinded. Prevalence among controls was 36.8% for A. lumbricoides, 9.2% for hookworm and 7.5% for T. trichiura. Most infections were low-intensity. Compared to controls, the water intervention reduced hookworm by 31% (prevalence ratio [PR] = 0.69 (0.50,0.95), prevalence difference [PD] = -2.83 (-5.16,-0.50)) but did not affect other STH. Sanitation improvements reduced T. trichiura by 29% (PR = 0.71 (0.52,0.98), PD = -2.17 (-4.03,-0.38)), had a similar borderline effect on hookworm and no effect on A. lumbricoides. Handwashing and nutrition interventions did not reduce any STH. WSH and N+WSH reduced hookworm prevalence by 29-33% (WSH: PR = 0.71 (0.52,0.99), PD = -2.63 (-4.95,-0.31); N+WSH: PR = 0.67 (0.50,0.91), PD = -3.00 (-5.14,-0.85)) and marginally reduced A. lumbricoides. Effects on infection intensity were similar. CONCLUSIONS/SIGNIFICANCE: In a low-intensity infection setting with MDA, we found modest but sustained hookworm reduction from water treatment and combined WSH interventions. Impacts were more pronounced on STH species with short vs. long-term environmental survival. Our findings suggest possible waterborne transmission for hookworm. Water treatment and sanitation improvements can augment MDA to interrupt STH transmission. TRIAL REGISTRATION: NCT01590095.


Assuntos
Água Doce/parasitologia , Desinfecção das Mãos/métodos , Helmintíase/prevenção & controle , Helmintos/isolamento & purificação , Saneamento/métodos , Animais , Bangladesh/epidemiologia , Criança , Pré-Escolar , Dieta , Fezes/parasitologia , Feminino , Helmintíase/epidemiologia , Helmintíase/transmissão , Helmintos/classificação , Helmintos/genética , Humanos , Masculino , Avaliação Nutricional , Gestantes , Solo/parasitologia
14.
Pak J Pharm Sci ; 32(2 (Supplementary)): 799-803, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31103975

RESUMO

Information on prevalence of soil-transmitted helminth (STH) infections among school children is scarce in Pakistan. This study was aimed to investigate the prevalence of soil-transmitted helminth in school children of three districts in, Khyber Pakhtunkhwa, Pakistan. A total of 300 stool samples were examined from August 2015 to August 2016 using direct smear (Normal saline and Lugol's Iodine solution) and the concentration methods. One hundred and eighty seven (62.3%) pupils were found infected with soil-transmitted helminths. One hundred and forty five (77.5%) were infected with single parasite and forty two (22.4%) with multiple infections. Ascaris lumbricoides 125 (66.4%), Trichuris trichura 50 (26.5%) and Ancylostoma duedenale 13 (6.91%) were detected. The children above 8 years in age were more parasitized than below 8 years (p=0.7832; P>0.05). Males were found more parasitized than females (p=0.9315; P>0.05). Children in lower Dir district were found more infected followed by Swat and upper Dir (P< 0.0001; p<0.05). No significant relationship was found among the examined and that of infected children for ages and sex in all the districts. Malakand division is an area with poor hygiene located in temperate zone near the border of Afghanistan and China. The prevalence of reported nematode parasites here compared with the same studies is unexpectedly high. These types of studies should continue time to time to know the hazardous nature of such parasitic infections for the betterment of the human health.


Assuntos
Helmintíase/epidemiologia , Helmintíase/transmissão , Animais , Ascaríase/epidemiologia , Ascaríase/transmissão , Ascaris lumbricoides/isolamento & purificação , Criança , Coinfecção/epidemiologia , Coinfecção/parasitologia , Estudos Transversais , Fezes/parasitologia , Feminino , Infecções por Uncinaria/epidemiologia , Infecções por Uncinaria/transmissão , Humanos , Masculino , Paquistão/epidemiologia , Prevalência , Microbiologia do Solo , Tricuríase/epidemiologia , Tricuríase/transmissão , Trichuris/isolamento & purificação , Trichuris/patogenicidade
15.
Acta Trop ; 197: 105035, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31128094

RESUMO

Large sectors of the Afghan population have limited access to safe water and sanitation, which increases the risk of transmission of water- and food- borne diseases, including Soil-Transmitted Helminth (STH) infections. STHs interfere with the human host's health status, and their burden of disease is highest among children of school age. Based on the results of a nationwide survey conducted in 2003, which showed an STH prevalence of 47.2%, and with the aim of reducing morbidity among school children, Afghanistan has been conducting nationwide deworming for preschool-age and school-age children since 2004. In 2017, 14 years after the first baseline assessment, a follow-up survey was carried out among schoolchildren aged 8-10 years to provide an update on STH epidemiology and facilitate evidence-informed planning of future deworming campaigns. Stool samples were collected from 2263 pupils aged 8-10 years in five provinces representing the different ecological zones of the country - Kabul, Balkh, Herat, Nangarhar and Kandahar. Microscopic examination was carried out by the Kato-Katz thick smear technique, to assess the presence and the number of parasites and/or their eggs. The survey revealed that 26.6% of the sample was infected with at least one of the STH, a marked decrease from the level registered in 2003. The most prevalent infection was the one with A. lumbricoides (25.7%), followed by T. trichiura (1.0%) and hookworms (0.1%). All positive children were noted to have light-intensity infections, compared to the previous survey where 9.7% of the sample had moderate-to-heavy intensity infections. Only 0.2% of the children had co-infection with two or more parasites. Meanwhile, 6.8% of the students were found infected with the dwarf tapeworm, Hymenolepis nana. The absence of infections of moderate-to-heavy intensity after several yearly rounds of deworming and overall improvements in provision of safe water and sanitation, indicates successful control of morbidity due to STH and, overall, their elimination as a public-health problem from Afghanistan. Nevertheless, current levels of prevalence of infection still show persistence of active transmission of STHs, thus justifying the continued implementation of mass deworming interventions among children. The permanent elimination of STH transmission, however, will be possible only when the country reaches a sanitation level sufficient to impede fecal contamination of the environment with human excreta.


Assuntos
Helmintíase/epidemiologia , Afeganistão/epidemiologia , Ancylostomatoidea/isolamento & purificação , Animais , Ascaríase/epidemiologia , Ascaris lumbricoides/isolamento & purificação , Criança , Estudos Transversais , Fezes/parasitologia , Feminino , Helmintíase/transmissão , Infecções por Uncinaria/epidemiologia , Infecções por Uncinaria/transmissão , Humanos , Himenolepíase/epidemiologia , Hymenolepis nana/isolamento & purificação , Masculino , Contagem de Ovos de Parasitas , Prevalência , Saneamento , Instituições Acadêmicas , Solo/parasitologia , Estudantes , Inquéritos e Questionários , Tricuríase/epidemiologia , Tricuríase/transmissão , Trichuris/isolamento & purificação
17.
Acta Trop ; 194: 148-154, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30951685

RESUMO

Soil transmitted helminths (STHs) burden was enormous in China several decades ago, however, rigorous control efforts have been successful with appreciable reduction in diseases burden. Here, we assessed provincial-level data derived from cross sectional surveys, executed in 1989, 2002 and 2014, on the prevalence of STHs among populations in Jiangxi province, China. This study, also, reported STHs integrated control intervention aimed at reducing STHs transmission and worm burden among population at county-level. The intervention strategies included mass drug administration (MDA), health education, improved water supply for drinking, improved sanitary facilities and environmental modification in Guixi municipality. The overall infection rate of STHs in Jiangxi province decreased from 77.7% (1989) to 6.3% (2014), while Ascaris lumbricoides, hookworm and Trichuris trichiura decreased from 71.1%, 17.6% and 17.0% (1989) to 0.9%, 4.7% and 1.0% (2014), respectively. STHs infection rates in female population were higher than male in the three surveys. Reduction in STHs prevalence was observed in all age groups, but the decline was less in higher age group. STHs prevalence in Guixi intervention region indicated remarkable reduction from 31.8% (2006) to 6.1% (2009) (χ2=255.22, P<0.01). A. lumbricoides, hookworm and T. trichiura infection rates decreased from 10.4%, 17.0% and 7.1% (2006) to 0.1%, 4.1% and 2.2%, respectively (2009) (X2A.l = 110.23, P<0.01; X2hk = 103.57, P < 0.01; X2T.t = 32.0, P < 0.01). A. lumbricoides infection rate declined the most of all STHs. Following control efforts with integrated control intervention strategies, STHs prevalence in Jiangxi province experienced remarkable trend in decline between 1989 and 2014. Consolidating control efforts with sustained integrated control strategies is, therefore, important to achieving STHs elimination in China.


Assuntos
Anti-Helmínticos/uso terapêutico , Helmintíase/prevenção & controle , Solo/parasitologia , Animais , Anti-Helmínticos/administração & dosagem , Criança , China/epidemiologia , Estudos Transversais , Feminino , Helmintíase/epidemiologia , Helmintíase/transmissão , Humanos , Masculino , Administração Massiva de Medicamentos , Prevalência , Saneamento , Abastecimento de Água
18.
Acta Trop ; 194: 135-147, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30946810

RESUMO

BACKGROUND: Foodborne Neglected Zoonotic Helminths (FNZH) are parasites of both economic and public health importance. They include Taenia solium, Echinococcus granulosus sensu lato, Echinococcus multilocularis and Foodborne trematodes (FBT). FNZH are earmarked for major interventions for control, elimination and eradication. This systematic review highlights the progress towards development of rapid tests for the diagnosis of FNZH since 2010 when they were listed as neglected tropical diseases. METHODOLOGY: A systematic search was conducted in three databases, World of Science, Embase and PubMed using the same search phrase. The search produced 480 hits. Three studies from back referencing were included. Only 22 of these met the inclusion criteria. Data was extracted from these and presented qualitatively. RESULTS: Twenty-five rapid diagnostic tests were found to have been developed since 2010, eight for diagnosis of T. solium infections, eight for echinococcosis and nine for FBT infections. The rapid tests for diagnosing T. solium infections included six antibody detecting and two antigen detecting tests. They constitute a combination among them, with some tests providing qualitative, others quantitative results. Similarly, seven out of the eight rapid tests developed for Echinococcus infections were antibody detecting tests save for one loop mediated isothermal amplification test. All of them were qualitative tests. For FBT infections, nine rapid tests were described; two antibody and one nucleic acid detecting test for diagnosis of Fascioliasis; three nucleic acid detecting tests for Opisthorchiasis; one antibody detecting test for Paragonimiasis; and for Clonorchiasis, one antibody and one nucleic acid detecting test. The FBT infection rapid tests were all qualitative in nature. Most of these tests have not undergone field evaluation in endemic areas where they will be used most. CONCLUSION: This review describes the development and evaluation of rapid diagnostic tests, while highlighting the need for in depth validations of the tools to determine how well they can perform in endemic areas.


Assuntos
Testes Diagnósticos de Rotina/métodos , Parasitologia de Alimentos/métodos , Helmintíase/prevenção & controle , Helmintíase/transmissão , Helmintos/isolamento & purificação , Zoonoses/diagnóstico , Animais , Helmintíase/diagnóstico , Humanos , Doenças Negligenciadas/diagnóstico , Doenças Negligenciadas/parasitologia , Doenças Negligenciadas/prevenção & controle , Fatores de Tempo , Zoonoses/parasitologia
20.
BMC Med ; 17(1): 69, 2019 03 28.
Artigo em Inglês | MEDLINE | ID: mdl-30917824

RESUMO

BACKGROUND: The most prevalent neglected tropical diseases are treated through blanket drug distribution that is reliant on lay community medicine distributors (CMDs). Yet, treatment rates achieved by CMDs vary widely and it is not known which CMDs treat the most people. METHODS: In Mayuge District, Uganda, we tracked 6779 individuals (aged 1+ years) in 1238 households across 31 villages. Routine, community-based mass drug administration (MDA) was implemented for schistosomiasis, lymphatic filariasis, and soil-transmitted helminths. For each CMD, the percentage of eligible individuals treated (offered and ingested medicines) with at least one drug of praziquantel, albendazole, or ivermectin was examined. CMD attributes (more than 25) were measured, ranging from altruistic tendencies to socioeconomic characteristics to MDA-specific variables. The predictors of treatment rates achieved by CMDs were selected with least absolute shrinkage and selection operators and then analyzed in ordinary least squares regression with standard errors clustered by village. The influences of participant compliance and the ordering of drugs offered also were examined for the treatment rates achieved by CMDs. RESULTS: Overall, only 44.89% (3043/6779) of eligible individuals were treated with at least one drug. Treatment rates varied amongst CMDs from 0% to 84.25%. Treatment rate increases were associated (p value< 0.05) with CMDs who displayed altruistic biases towards their friends (13.88%), had friends who helped with MDA (8.43%), were male (11.96%), worked as fishermen/fishmongers (14.93%), and used protected drinking water sources (13.43%). Only 0.24% (16/6779) of all eligible individuals were noncompliant by refusing to ingest all offered drugs. Distributing praziquantel first was strongly, positively correlated (p value < 0.0001) with treatment rates for albendazole and ivermectin. CONCLUSIONS: These findings profile CMDs who treat the most people during routine MDA. Criteria currently used to select CMDs-community-wide meetings, educational attainment, age, years as a CMD, etc.-were uninformative. Participant noncompliance and the provision of praziquantel before albendazole and ivermectin did not negatively impact treatment rates achieved by CMDs. Engaging CMD friend groups with MDA, selecting CMDs who practise good preventative health behaviours, and including CMDs with high-risk occupations for endemic infections may improve MDA treatment rates. Evidence-based guidelines are needed to improve the monitoring, selection, and replacement of CMDs during MDA.


Assuntos
Antiparasitários/uso terapêutico , Medicina Comunitária/organização & administração , Assistência à Saúde/organização & administração , Filariose Linfática/tratamento farmacológico , Helmintíase/tratamento farmacológico , Administração Massiva de Medicamentos , Esquistossomose/tratamento farmacológico , Solo/parasitologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Criança , Pré-Escolar , Medicina Comunitária/normas , Medicina Comunitária/estatística & dados numéricos , Assistência à Saúde/normas , Assistência à Saúde/estatística & dados numéricos , Eficiência Organizacional , Filariose Linfática/epidemiologia , Filariose Linfática/transmissão , Feminino , Helmintíase/epidemiologia , Helmintíase/transmissão , Humanos , Lactente , Masculino , Administração Massiva de Medicamentos/métodos , Administração Massiva de Medicamentos/normas , Administração Massiva de Medicamentos/estatística & dados numéricos , Pessoa de Meia-Idade , Prevalência , Esquistossomose/epidemiologia , Esquistossomose/transmissão , Uganda/epidemiologia , Desempenho Profissional , Adulto Jovem
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