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1.
PLoS Negl Trop Dis ; 14(9): e0008625, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32956390

RESUMO

BACKGROUND: Efforts to control soil-transmitted helminth (STH) infections have intensified over the past decade. Field-survey data on STH prevalence, infection intensity and drug efficacy is necessary to guide the implementation of control programs and should be of the best possible quality. METHODOLOGY: During four clinical trials designed to evaluate the efficacy of albendazole against STHs in Brazil, Ethiopia, Lao PDR and Tanzania, quality control (QC) was performed on the duplicate Kato-Katz thick smears and the data entry. We analyzed datasets following QC on both fecal egg counts (FECs) and data entry, and compared the prevalence of any STH infection and moderate-to-heavy intensity (MHI) infections and the drug efficacy against STH infections. RESULTS: Across the four study sites, a total of 450 out of 4,830 (9.3%) Kato-Katz thick smears were re-examined. Discrepancies in FECs varied from ~3% (hookworms) to ~6.5% (Ascaris lumbricoides and Trichuris trichiura). The difference in STH prevalence and prevalence of MHI infections using the datasets with and without QC of the FECs did not exceed 0.3%, except for hookworm infections in Tanzania, where we noted a 2.2 percentage point increase in MHI infections (pre-QC: 1.6% vs. post-QC: 3.8%). There was a 100% agreement in the classification of drug efficacy of albendazole against STH between the two datasets. In total, 201 of the 28,980 (0.65%) data entries that were made to digitize the FECs were different between both data-entry clerks. Nevertheless, the overall prevalence of STH, the prevalence of MHI infections and the classification of drug efficacy remained largely unaffected. CONCLUSION/SIGNIFICANCE: In these trials, where staff was informed that QC would take place, minimal changes in study outcomes were reported following QC on FECs or data entry. Nevertheless, imposing QC did reduce the number of errors. Therefore, application of QC together with proper training of the personnel and the availability of clear standard operating procedures is expected to support higher data quality.


Assuntos
Albendazol/uso terapêutico , Helmintíase/tratamento farmacológico , Controle de Qualidade , Ancylostomatoidea , Animais , Ascaris , Brasil/epidemiologia , Ensaios Clínicos como Assunto , Etiópia/epidemiologia , Fezes/parasitologia , Guias como Assunto , Helmintíase/epidemiologia , Helmintíase/transmissão , Infecções por Uncinaria/tratamento farmacológico , Infecções por Uncinaria/epidemiologia , Humanos , Laos/epidemiologia , Contagem de Ovos de Parasitas , Prevalência , Solo/parasitologia , Tanzânia/epidemiologia , Trichuris
2.
PLoS Negl Trop Dis ; 14(9): e0008486, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32976501

RESUMO

In most endemic sub-Saharan African countries, repeated infections with soil-transmitted helminth (STH) occur as early as six weeks after the end of mass drug administration (MDA) with albendazole. In this study, we designed a new health educational board game Worms and Ladders and evaluated its potential to complement MDA with albendazole and reduce reinfection rates through the promotion of good hygiene practices among school-aged children. The evaluation employed a randomized control trial (RCT) design. Baseline knowledge, attitude and practices (KAP) relating to STH were obtained using a questionnaire from 372 pupils across six schools in Abeokuta, Nigeria. Schools were randomly assigned into intervention and control group, with the former and latter receiving Worms and Ladders and the common Snake and Ladder board game respectively. Fresh stool samples were also collected at baseline for STH diagnosis before administering 400mg single dose albendazole. Follow-up assessments of STH burden and KAP were conducted three and six months' post-intervention. Data generated from the study were analyzed using SPSS 20.0 software, with confidence interval set at 95%. Prevalence of STH dropped from 25.0% to 10.4% in the intervention group and 49.4% to 33.3% in the control group at three months' post-intervention. The prevalence further dropped to 5.6% in the intervention group at six months' post-intervention. However, it increased to 37.2% in the control group at six months' post-intervention. There was a significant difference (p<0.05) in prevalence after intervention among the groups. KAP on transmission, control and prevention of STH significantly improved (p<0.05) from 5.2% to 97.9% in the intervention group compared to 6.2% to 7.1% in the control group. The Worms and Ladders board game shows the potential to teach and promote good hygiene behavior among SAC. These findings posit the newly developed game as a reliable tool to complement mass drug administration campaigns for STH control.


Assuntos
Jogos Recreativos , Educação em Saúde/métodos , Helmintíase/prevenção & controle , Adolescente , Albendazol/uso terapêutico , Anti-Helmínticos/uso terapêutico , Criança , Pré-Escolar , Fezes/parasitologia , Feminino , Helmintíase/tratamento farmacológico , Humanos , Masculino , Administração Massiva de Medicamentos , Nigéria/epidemiologia , Prevalência , Instituições Acadêmicas
3.
PLoS Negl Trop Dis ; 14(8): e0008600, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32853225

RESUMO

Helminth infections are among the World Health Organization's top neglected diseases with significant impact in many Less Economically Developed Countries. Despite no longer being endemic in Europe, the widespread presence of helminth eggs in archaeological deposits indicates that helminths represented a considerable burden in past European populations. Prevalence of infection is a key epidemiological feature that would influence the elimination of endemic intestinal helminths, for example, low prevalence rates may have made it easier to eliminate these infections in Europe without the use of modern anthelminthic drugs. To determine historical prevalence rates we analysed 589 grave samples from 7 European sites dated between 680 and 1700 CE, identifying two soil transmitted nematodes (Ascaris spp. and Trichuris trichiura) at all locations, and two food derived cestodes (Diphyllobothrium latum and Taenia spp.) at 4 sites. The rates of nematode infection in the medieval populations (1.5 to 25.6% for T. trichiura; 9.3-42.9% for Ascaris spp.) were comparable to those reported within modern endemically infected populations. There was some evidence of higher levels of nematode infection in younger individuals but not at all sites. The genetic diversity of T. trichiura ITS-1 in single graves was variable but much lower than with communal medieval latrine deposits. The prevalence of food derived cestodes was much lower (1.0-9.9%) than the prevalence of nematodes. Interestingly, sites that contained Taenia spp. eggs also contained D. latum which may reflect local culinary practices. These data demonstrate the importance of helminth infections in Medieval Europe and provide a baseline for studies on the epidemiology of infection in historical and modern contexts. Since the prevalence of medieval STH infections mirror those in modern endemic countries the factors affecting STH decline in Europe may also inform modern intervention campaigns.


Assuntos
Helmintíase/epidemiologia , Intestinos/parasitologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Anti-Helmínticos/uso terapêutico , Ascaríase/epidemiologia , Ascaríase/transmissão , Ascaris , Criança , Pré-Escolar , Europa (Continente)/epidemiologia , Feminino , Variação Genética , Helmintíase/tratamento farmacológico , Helmintíase/transmissão , Helmintos/genética , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Doenças Negligenciadas/epidemiologia , Nematoides , Prevalência , Solo/parasitologia , Toaletes , Tricuríase/epidemiologia , Tricuríase/transmissão , Trichuris , Adulto Jovem
4.
PLoS Negl Trop Dis ; 14(6): e0008388, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32569278

RESUMO

BACKGROUND: The World Health Organization recommends that schistosomiasis be treated through Mass Drug Administration (MDA). In line with this recommendation, Zimbabwe commenced a national helminth control program in 2012 targeting schoolchildren throughout the country for 6 years. This study, part of a larger investigation of the impact of helminth treatment on the overall health of the children, determined the effect of annual praziquantel treatment on schistosome infection and morbidity in a cohort of children during Zimbabwe's 6-year national helminth control program. METHODOLOGY/PRINCIPAL FINDINGS: A school-based longitudinal study was carried out in 35 sentinel sites across Zimbabwe from September 2012 to November 2017. The sentinel sites were selected following a countrywide survey conducted in 280 primary schools. Schistosoma haematobium was diagnosed using the urine filtration technique. Schistosoma mansoni was diagnosed using both the Kato-Katz and formol-ether concentration techniques. S. haematobium morbidity was determined through detection of macro and microhaematuria. A cohort of children aged 6-15 years old was surveyed annually before MDA and 6 weeks post treatment. Maximum treatment coverage reached 90% over the 6 rounds of MDA. At baseline S. haematobium infection prevalence and intensity were 31.7% (95% CI = 31.1-32.2) and 28.75 eggs/10ml urine (SEM = 0.81) respectively, while S. mansoni prevalence and intensity were 4.6% (95% CI = 4.4-4.8) and 0.28 eggs/25mg (SEM = 0.02). Prior to the 6th round of MDA, S. haematobium infection prevalence had reduced to 1.56% (p<0.001) and infection intensity to 0.07 (SEM 0.02). Six weeks later after the 6th MDA, both were 0. Similarly the prevalence of S. haematobium morbidity as indicated by haematuria also fell significantly from 32.3% (95% CI = 29.9-34.6) to 0% (p< 0.0001) prior to the final MDA. For S.mansoni, both prevalence and intensity had decreased to 0 prior to the 6th MDA. After 6 rounds of annual MDA, prevalence and intensity of both schistosome species decreased significantly to 0% (p< 0.0001). CONCLUSION: Zimbabwe's helminth control program significantly reduced schistosome infection intensity and prevalence and urogenital schistosomiasis morbidity prevalence in a cohort of school-aged children, moving the schistosome prevalence in the children from moderate to low by WHO classification. These findings will inform the design of the country's next stage interventions for helminth control and eventual elimination.


Assuntos
Helmintíase/tratamento farmacológico , Administração Massiva de Medicamentos/métodos , Praziquantel/uso terapêutico , Infecções por Trematódeos/tratamento farmacológico , Adolescente , Animais , Criança , Estudos de Coortes , Estudos Transversais , Feminino , Helmintíase/diagnóstico , Helmintíase/epidemiologia , Helmintos/isolamento & purificação , Hematúria , Humanos , Estudos Longitudinais , Masculino , Morbidade , Prevalência , Schistosoma haematobium , Schistosoma mansoni , Schistosomatidae/isolamento & purificação , Esquistossomose Urinária/tratamento farmacológico , Instituições Acadêmicas , Inquéritos e Questionários , Infecções por Trematódeos/diagnóstico , Infecções por Trematódeos/epidemiologia , Zimbábue/epidemiologia
5.
PLoS Negl Trop Dis ; 14(6): e0008322, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32574160

RESUMO

BACKGROUND: The World Health Organization now recommends semiannual mass drug administration (MDA) of albendazole with integrated vector management as an option for eliminating lymphatic filariasis (LF) in areas of loiasis-endemic countries where it may not be safe to use diethylcarbamazine or ivermectin in MDA programs. However, the published evidence base to support this policy is thin, and uptake by national programs has been slow. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a community trial to assess the impact of semiannual MDA on lymphatic filariasis and soil-transmitted helminth infections (STH) in two villages in the Bandundu province of the Democratic Republic of the Congo with moderately high prevalences for LF and hookworm infections. MDA with albendazole was provided every six months from June 2014 to December 2017 with treatment coverages of the eligible population (all ≥ 2 year of age) that ranged between 56% and 88%. No adverse effects were reported during the trial. Evaluation at 48 months, (i.e. 6 months after the 8th round of MDA), showed that W. bancrofti microfilaremia (Mf) prevalence in the study communities had decreased between 2014 to 2018 from 12% to 0.9% (p<0.001). The prevalence of W. bancrofti antigenemia was also significantly reduced from 31.6% to 8.5% (p<0.001). MDA with albendazole also reduced hookworm, Ascaris lumbricoides and Trichuris trichiura infection prevalences in the community from 58.6% to 21.2% (p<0.001), from 14.0% to 1.6% and 4.1% to 2.9%, respectively. Hookworm and Ascaris infection intensities were reduced by 93% (p = 0.02) and 57% (p = 0.03), respectively. In contrast, Trichuris infection intensity was not significantly reduced by MDA (p = 0.61) over this time period. CONCLUSION/SIGNIFICANCE: These results provide strong evidence that semiannual MDA with albendazole alone is a safe and effective strategy for LF elimination in Central Africa. Community MDA also had a major impact on STH infections.


Assuntos
Albendazol/uso terapêutico , Anti-Helmínticos/uso terapêutico , Filariose Linfática/tratamento farmacológico , Helmintíase/tratamento farmacológico , Adolescente , Adulto , Animais , Antígenos de Helmintos/imunologia , Ascaríase/tratamento farmacológico , Ascaríase/epidemiologia , Ascaris lumbricoides/efeitos dos fármacos , Ascaris lumbricoides/isolamento & purificação , Criança , República Democrática do Congo/epidemiologia , Filariose Linfática/epidemiologia , Feminino , Helmintíase/epidemiologia , Helmintíase/parasitologia , Infecções por Uncinaria/tratamento farmacológico , Infecções por Uncinaria/epidemiologia , Humanos , Masculino , Solo/parasitologia , Tricuríase/epidemiologia , Trichuris/efeitos dos fármacos , Trichuris/isolamento & purificação , Wuchereria bancrofti/efeitos dos fármacos , Wuchereria bancrofti/isolamento & purificação , Adulto Jovem
6.
Trends Parasitol ; 36(7): 573-575, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32387059

RESUMO

Diseases caused by helminth infections affect more than a quarter of the population of the world, but the therapeutic arsenal is limited. The approval of moxidectin in 2018 and triclabendazole in 2019 by the FDA marked an important moment in the fight against diseases of poverty, such as helminthiases.


Assuntos
Aprovação de Drogas , Helmintíase/tratamento farmacológico , Macrolídeos/uso terapêutico , Triclabendazol/uso terapêutico , Animais , Anti-Helmínticos/uso terapêutico , Humanos , Estados Unidos , United States Food and Drug Administration
7.
Korean J Parasitol ; 58(2): 109-119, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32418379

RESUMO

Soil-transmitted helminths and Schistosoma haematobium affect more than 3 billion people globally and mainly occur in sub-Saharan Africa. The present study assessed the overall infection status of a 1716-student cohort of school-children in Zanzibar and applied mass drug administration (MDA) to the cohort from 2007 to 2009. Schools in Pemba, Zanzibar, had a much higher prevalence of soil-transmitted helminth infections than those in Unguja, and the Chaani, Ghana, and Machui schools of Unguja exhibited high S. haematobium infection rates. The MDA program only partially controlled parasite infections, owing to high rates of re-infection. The infection rate of S. haematobium across all 10 schools, for example, was only reduced by 1.8%, and even this change not significant, even though the S. haematobiuminfection rates of the Chaani and Mzambarauni schools were significantly reduced from 64.4 and 23.4%, respectively, at the first screening, to 7.3 and 2.3% at the last screening. The overall infection rate of Ascaris lumbricoides was reduced from 36.0% at the first screening to 22.6% at the last screening. However, the infection rates for both Trichuris trichiuraand hookworm were generally unaffected by MDA. In the future, parasite control programs should involve strategically designed MDA schedules and holistic intervention (e.g., sanitation improvement, hygiene behavior changes, and control of intermediated hosts).


Assuntos
Helmintíase/tratamento farmacológico , Helmintíase/prevenção & controle , Administração Massiva de Medicamentos , Doenças Negligenciadas , Esquistossomose Urinária/tratamento farmacológico , Esquistossomose Urinária/prevenção & controle , Compostos de Cetrimônio , Criança , Estudos de Coortes , Combinação de Medicamentos , Feminino , Helmintíase/epidemiologia , Helmintíase/parasitologia , Humanos , Masculino , Programas de Rastreamento , Miristatos , Resultados Negativos , Ácidos Nicotínicos , Esquistossomose Urinária/epidemiologia , Simeticone , Ácidos Esteáricos , Tanzânia/epidemiologia
8.
PLoS Negl Trop Dis ; 14(4): e0008258, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32310966

RESUMO

Soil-transmitted helminthiases (STH) are one of 17 neglected tropical diseases (NTDs) earmarked for control or elimination by 2020 in the WHO's Roadmap on NTDs. Deworming programs for STH have thus far been focused on treating pre-school and school-aged children; however, there is a growing consensus that to achieve elimination of STH transmission, programs must also target adults, potentially through community-wide mass drug administration (MDA). There is currently a gap in the literature on what components are required to deliver community-wide MDA for STH in order to achieve high intervention reach and uptake. Nested within the TUMIKIA Project, a cluster randomized trial in Kenya evaluating the effectiveness of school-based deworming versus community-wide MDA, we collected qualitative data from program implementers and recipients in eight clusters where community-wide MDA was delivered. Data collection included semi-structured in-depth interviews (n = 72) and focus group discussions (n = 32). A conceptual framework for drug distribution was constructed to help build an analysis codebook. Case memos were developed for each top-level theme. Community-wide MDA for STH was perceived as a complex intervention with key administrative and social mobilization domains. Key actionable themes included: (1) developing an efficient strategy to allocate reasonable workload for implementers to cover all targeted households; (2) maximizing community drug distributors' motivation through promoting belief in the effectiveness of the intervention and providing sufficient financial incentives; (3) developing effective capacity building strategies for implementers; and (4) implementing a context-adapted community engagement strategy that leverages existing community structures and takes into consideration past community experiences of MDAs. Transitioning from STH control to elimination goals requires significant planning and action to ensure community-wide MDA is delivered with sufficient reach and uptake. We present findings that can inform national deworming programs to increase intervention delivery capacity.


Assuntos
Anti-Helmínticos/uso terapêutico , Controle de Doenças Transmissíveis/organização & administração , Transmissão de Doença Infecciosa/prevenção & controle , Helmintíase/tratamento farmacológico , Helmintíase/prevenção & controle , Administração Massiva de Medicamentos/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Erradicação de Doenças/organização & administração , Feminino , Humanos , Entrevistas como Assunto , Quênia , Masculino , Pessoa de Meia-Idade , Doenças Negligenciadas/tratamento farmacológico , Doenças Negligenciadas/prevenção & controle , Resultado do Tratamento , Adulto Jovem
9.
PLoS Negl Trop Dis ; 14(4): e0008153, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32302298

RESUMO

The World Health Organization's Neglected Tropical Disease Roadmap has accelerated progress towards eliminating select neglected tropical diseases (NTDs). This momentum has catalyzed research to determine the feasibility of interrupting transmission of soil-transmitted helminths (STH) using community-wide mass drug administration (MDA). This study aims to identify potential gender-specific facilitators and barriers to accessing and participating in community-wide STH MDA, with the goal of ensuring programs are equitable and maximize the probability of interrupting STH transmission. This research was conducted prior to the launch of community-wide MDA for STH in Comé, Benin. A total of 10 focus group discussions (FGDs) were conducted separately among 40 men, 38 women, and 15 community drug distributors (CDDs). Salient themes included: both men and women believe that community-wide MDA would reduce the financial burden associated with self-treatment, particularly for low income adults. Community members believe MDA should be packaged alongside water, sanitation, and other health services. Women feel past community-wide programs have been disorganized and are concerned these distributions will be similar. Women also expressed interest in increased engagement in the implementation of future community-based public health programs. Men often did not perceive themselves to be at great risk for STH infection and did not express a high demand for treatment. Finally, the barriers discussed by CDDs generally did not align with gender-specific concerns, but rather represented concerns shared by both genders. A door-to-door distribution strategy for STH MDA is preferred by women in this study, as this platform empowers women to participate as health decision makers for their family. In addition, involving women in planning and implementation of community-wide programs may help to increase treatment coverage and compliance.


Assuntos
Helmintíase/tratamento farmacológico , Helmintíase/prevenção & controle , Helmintíase/transmissão , Administração Massiva de Medicamentos/métodos , Benin/epidemiologia , Feminino , Grupos Focais , Helmintíase/epidemiologia , Humanos , Masculino , Serviços Preventivos de Saúde , Saúde Pública/métodos , Saneamento , Fatores Socioeconômicos , Solo/parasitologia , Água/parasitologia
10.
PLoS Negl Trop Dis ; 14(4): e0008198, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32294081

RESUMO

INTRODUCTION: Praziquantel has been in use by helminthiasis and schistosomiasis control programs for about 30 years. Although deemed to be safe with regard to its adverse drug reaction profile in reference to the product information of Biltricide, the Eritrean Pharmacovigilance Center received reports of visual abnormalities related to the drug. This is a case series assessment of unusual cases of visual abnormalities associated with praziquantel. METHODS: Search was made in VigiBase by setting praziquantel as a drug substance, Eritrea as the reporting country and all eye disorders, high level term (HLT) to capture all visual disorders associated with Praziquantel. The retrieved dataset was exported into an Excel spreadsheet for descriptive analysis and causality was assessed using Austin Bradford-Hill criteria. RESULTS: There are a total of 2579 Individual Case Safety Reports (ICSRs) of various Adverse Drug Reactions (ADRs) of praziquantel reported from Eritrea in VigiBase. The 61 reports of visual abnormalities that arose within the first 24 hours of praziquantel administration are of note. With a strong association as evidenced by the positive IC025 value, the association of praziquantel and blurred vision was consistently reported from different health facilities over a period of three years. It is a specific association in terms of both the exposure (only praziquantel) and the outcome (blurred vision) as reported in majority of the cases. However, experimental evidences for the association are lacking, the underweight profile of the Eritrean population suggests overdosing as a possible risk factor for the occurrence of these reactions. CONCLUSION: The strength, temporal plausibility, consistency and specificity of the association are suggestive of a causal association between praziquantel and visual disorders.


Assuntos
Anti-Helmínticos/efeitos adversos , Praziquantel/efeitos adversos , Transtornos da Visão/induzido quimicamente , Transtornos da Visão/epidemiologia , Adolescente , Adulto , Sistemas de Notificação de Reações Adversas a Medicamentos , Idoso , Criança , Bases de Dados Factuais , Eritreia/epidemiologia , Feminino , Helmintíase/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Farmacovigilância , Fatores de Risco , Adulto Jovem
11.
PLoS Negl Trop Dis ; 14(4): e0008185, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32267856

RESUMO

Animal and human helminth infections are highly prevalent around the world, with only few anthelminthic drugs available. The anthelminthic drug performance is expressed by the cure rate and the egg reduction rate. However, which kind of mean should be used to calculate the egg reduction rate remains a controversial issue. We visualized the distributions of egg counts of different helminth species in 7 randomized controlled trials and asked a panel of experts about their opinion on the egg burden and drug efficacy of two different treatments. Simultaneously, we calculated infection intensities and egg reduction rates using different types of means: arithmetic, geometric, trimmed, winsorized and Hölder means. Finally, we calculated the agreement between expert opinion and the different means. We generated 23 different trial arm pairs, which were judged by 49 experts. Among all investigated means, the arithmetic mean showed poorest performance with only 64% agreement with expert opinion (bootstrap confidence interval [CI]: 60-68). Highest agreement of 94% (CI: 86-96) was reached by the Hölder mean M0.2, followed by the geometric mean (91%, CI: 85-94). Winsorized and trimmed means showed a rather poor performance (e.g. winsorization with 0.1 cut-off showed 85% agreement, CI: 78-87), but they performed reasonably well after excluding treatment arms with a small number of patients. In clinical trials with moderate sample size, the currently recommended arithmetic mean does not necessarily rank anthelminthic efficacies in the same order as might be obtained from expert evaluation of the same data. Estimates based on the arithmetic mean should always be reported together with an estimate, which is more robust to outliers, e.g. the geometric mean.


Assuntos
Anti-Helmínticos/uso terapêutico , Helmintíase/tratamento farmacológico , Helmintos/efeitos dos fármacos , Contagem de Ovos de Parasitas/métodos , Estatística como Assunto , Animais , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
12.
PLoS Negl Trop Dis ; 14(3): e0008106, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32176703

RESUMO

Lymphatic filariasis has remained endemic in Fiji despite repeated mass drug administration using the well-established and safe combination of diethylcarbamazine and albendazole (DA) since 2002. In certain settings the addition of ivermectin to this combination (IDA) remains a safe strategy and is more efficacious. However, the safety has yet to be described in scabies and soil-transmitted helminth endemic settings like Fiji. Villages of Rotuma and Gau islands were randomised to either DA or IDA. Residents received weight-based treatment unblinded with standard exclusions. Participants were actively found and asked by a nurse about their health daily for the first two days and then asked to seek review for the next five days if unwell. Anyone with severe symptoms were reviewed by a doctor and any serious adverse event was reported to the Medical Monitor and Data Safety Monitoring Board. Of 3612 enrolled and eligible participants, 1216 were randomised to DA and 2396 to IDA. Age and sex in both groups were representative of the population. Over 99% (3598) of participants completed 7 days follow-up. Adverse events were reported by 600 participants (16.7%), distributed equally between treatment groups, with most graded as mild (93.2%). There were three serious adverse events, all judged not attributable to treatment by an independent medical monitor. Fatigue was the most common symptom reported by 8.5%, with headache, dizziness, nausea and arthralgia being the next four most common symptoms. Adverse events were more likely in participants with microfilaremia (43.2% versus 15.7%), but adverse event frequency was not related to the presence of scabies or soil-transmitted helminth infection. IDA has comparable safety to DA with the same frequency of adverse events experienced following community mass drug administration. The presence of co-endemic infections did not increase adverse events. IDA can be used in community programs where preventative chemotherapy is needed for control of lymphatic filariasis and other neglected tropical diseases.


Assuntos
Albendazol/efeitos adversos , Antiparasitários/efeitos adversos , Dietilcarbamazina/efeitos adversos , Inseticidas/efeitos adversos , Ivermectina/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Albendazol/administração & dosagem , Antiparasitários/administração & dosagem , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/tratamento farmacológico , Dietilcarbamazina/administração & dosagem , Quimioterapia Combinada/efeitos adversos , Quimioterapia Combinada/métodos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/patologia , Filariose Linfática/tratamento farmacológico , Feminino , Fiji , Helmintíase/tratamento farmacológico , Humanos , Lactente , Inseticidas/administração & dosagem , Ivermectina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Doenças Negligenciadas/tratamento farmacológico , População Rural , Escabiose/tratamento farmacológico , Resultado do Tratamento , Adulto Jovem
13.
Int J Parasitol ; 50(3): 217-225, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32135180

RESUMO

Polyparasitism, involving soil-transmitted helminths. and Schistosoma blood flukes, is common in low to middle income countries. These helminths impact on the gut environment and can cause changes to the gut microbiome composition. Here we examined the gut microbiome in individuals with polyparasitism from two human cohorts in the Philippines utilising DNA sequencing-based profiling. Multiple helminth species infections were high with 70.3% of study participants harbouring at least two parasite species, and 16% harbouring at least five species. Increased numbers of helminth co-infections, in particular with the gut-resident soil-transmitted helminths, were significantly associated with increased bacterial diversity; however no significant parasite-gut microbiome associations were evident for individuals infected only with Schistosoma japonicum. In general, a healthy gut is associated with high bacterial diversity, which in these human cohorts may be the result of helminth-mediated immune modulation, or due to changes in the gut environment caused by these parasitic helminths.


Assuntos
Coinfecção , Microbioma Gastrointestinal/genética , Helmintíase/epidemiologia , Helmintos/isolamento & purificação , Esquistossomose/epidemiologia , Adolescente , Adulto , Albendazol/uso terapêutico , Ancylostoma/isolamento & purificação , Ancylostomatoidea/isolamento & purificação , Animais , Ascaris/isolamento & purificação , Bactérias/classificação , Bactérias/genética , Bactérias/isolamento & purificação , Criança , Pré-Escolar , Estudos de Coortes , Coinfecção/microbiologia , Coinfecção/parasitologia , Fezes/microbiologia , Fezes/parasitologia , Feminino , Genes Bacterianos , Helmintíase/tratamento farmacológico , Helmintos/genética , Interações Hospedeiro-Parasita , Humanos , Masculino , Metagenômica , Interações Microbianas , Pessoa de Meia-Idade , Patologia Molecular , Filipinas/epidemiologia , Schistosoma/isolamento & purificação , Esquistossomose/tratamento farmacológico , Solo/parasitologia , Trichuris/isolamento & purificação , Adulto Jovem
14.
PLoS One ; 15(2): e0229235, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32069318

RESUMO

Life Cycle Assessment typically focuses on the footprint of products and services, expressed on three Areas of Protection (AoP): Human Health, Ecosystems and Resources. While the handprint is often expressed qualitatively, quantified handprints have recently been compared directly to the footprint concerning one AoP: Human Health. We propose to take this one step further by simultaneously comparing the quantified handprint and footprint on all AoPs through normalization and weighting of the results towards a single score. We discuss two example cases of a pharmaceutical treatment: mebendazole to treat soil-transmitted helminthiases and paliperidone palmitate to treat schizophrenia. Each time, treatment is compared to 'no treatment'. The footprint of health care is compared to the handprint of improved patient health. The handprint and footprint were normalized separately. To include sensitivity in the normalization step we applied four sets of external normalization factors for both handprint (Global Burden of Disease) and footprint (ReCiPe and PROSUITE). At the weighting step we applied 26 sets of panel weighting factors from three sources. We propose the Relative Sustainability Benefit Rate (RSBR) as a new metric to quantify the relative difference in combined handprint and footprint single score between two alternatives. When only considering the footprint, the first case study is associated with an increased single score burden of treatment compared to 'no treatment', while in the second case study treatment reduces the single score burden by 41.1% compared to 'no treatment'. Also including the handprint provided new insights for the first case study, now showing a decrease of 56.4% in single score burden for treatment compared to 'no treatment'. For the second case study the reduction of single score burden was confirmed as the handprint burden was also decreased because of treatment by 9.9%, reinforcing the findings.


Assuntos
Assistência à Saúde/normas , Setor de Assistência à Saúde/normas , Necessidades e Demandas de Serviços de Saúde/normas , Helmintíase/tratamento farmacológico , Modelos Estatísticos , Preparações Farmacêuticas/administração & dosagem , Esquizofrenia/tratamento farmacológico , Nível de Saúde , Helmintíase/epidemiologia , Humanos , Esquizofrenia/epidemiologia
16.
Parasit Vectors ; 13(1): 102, 2020 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-32103783

RESUMO

School-based deworming programmes are currently the main approach used to control the soil-transmitted helminths (STHs). A key unanswered policy question is whether mass drug administration (MDA) should be targeted to the whole community instead, and several trials in this area have been conducted or are currently on-going. A recent well-conducted trial demonstrated that successful community-wide treatment is a feasible strategy for STH control and can be more effective than school-based treatment in reducing prevalence and intensity of hookworm infection. However, we would argue that it is vital that these findings are not taken out of context or over generalised, as the additional health benefits gained from switching to community-wide treatment will vary depending on the STH species and baseline endemicity. Moreover, community-wide treatment will typically be more expensive than school-based treatment. The epidemiological evidence for an additional benefit from a switch to community-wide treatment has yet to be proven to represent "good value for money" across different settings. Further work is needed before changes in policy are made regarding the use of community-wide treatment for STH control, including comprehensive assessments of its additional public health benefits and costs across a range of scenarios, accounting for the presence of alternative treatment delivery platforms.


Assuntos
Anti-Helmínticos/administração & dosagem , Helmintíase/tratamento farmacológico , Helmintos/efeitos dos fármacos , Solo/parasitologia , Adolescente , Animais , Anti-Helmínticos/economia , Criança , Pré-Escolar , Feminino , Política de Saúde/economia , Helmintíase/economia , Helmintíase/parasitologia , Helmintos/isolamento & purificação , Helmintos/fisiologia , Humanos , Quênia , Masculino , Características de Residência
17.
Trials ; 21(1): 22, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31907019

RESUMO

BACKGROUND: In low- and middle-income countries, infectious diseases remain a key public health issue. Additionally, non-communicable diseases are a rapidly growing public health problem that impose a considerable burden on population health. One way to address this dual disease burden, is to incorporate (lifestyle) health promotion measures within the education sector. In the planned study, we will (i) assess and compare physical activity, physical fitness, micronutrient status, body composition, infections with soil-transmitted helminths, Schistosoma mansoni, malaria, inflammatory and cardiovascular health risk markers, cognitive function, health-related quality of life, and sleep in schoolchildren in Côte d'Ivoire, South Africa and Tanzania. We will (ii) determine the bi- and multivariate associations between these variables and (iii) examine the effects of a school-based health intervention that consists of physical activity, multi-micronutrient supplementation, or both. METHODS: Assuming that no interaction occurs between the two interventions (physical activity and multi-micronutrient supplementation), the study is designed as a cluster-randomised, placebo-controlled trial with a 2 × 2 factorial design. Data will be obtained at three time points: at baseline and at 9 months and 21 months after the baseline assessment. In each country, 1320 primary schoolchildren from grades 1-4 will be recruited. In each school, classes will be randomly assigned to one of four interventions: (i) physical activity; (ii) multi-micronutrient supplementation; (iii) physical activity plus multi-micronutrient supplementation; and (iv) no intervention, which will serve as the control. A placebo product will be given to all children who do not receive multi-micronutrient supplementation. After obtaining written informed consent from the parents/guardians, the children will be subjected to anthropometric, clinical, parasitological and physiological assessments. Additionally, fitness tests will be performed, and children will be invited to wear an accelerometer device for 7 days to objectively assess their physical activity. Children infected with S. mansoni and soil-transmitted helminths will receive deworming drugs according to national policies. Health and nutrition education will be provided to the whole study population independently of the study arm allocation. DISCUSSION: The study builds on the experience and lessons of a previous study conducted in South Africa. It involves three African countries with different social-ecological contexts to investigate whether results are generalisable across the continent. TRIAL REGISTRATION: The study was registered on August 9, 2018, with ISRCTN. https://doi.org/10.1186/ISRCTN29534081.


Assuntos
Saúde da Criança , Suplementos Nutricionais , Exercício Físico/fisiologia , Educação em Saúde/organização & administração , Instituições Acadêmicas/organização & administração , Acelerometria , Anti-Helmínticos/uso terapêutico , Criança , Desenvolvimento Infantil/fisiologia , Bem-Estar da Criança , Costa do Marfim , Feminino , Helmintíase/diagnóstico , Helmintíase/tratamento farmacológico , Helmintíase/prevenção & controle , Humanos , Masculino , Micronutrientes/administração & dosagem , Aptidão Física/fisiologia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , África do Sul , Tanzânia , Resultado do Tratamento
18.
PLoS Negl Trop Dis ; 14(1): e0007901, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31999690

RESUMO

BACKGROUND: Large-scale deworming programs have, to date, mostly targeted preschool- and school-age children. As community-based deworming programs become more common, deworming will be offered to women of reproductive age. The World Health Organization recommends preventive chemotherapy be administered to pregnant women only after the first trimester. It is therefore important for deworming programs to be able to identify women in early pregnancy. Our objective was to validate a short questionnaire which could be used by deworming program managers to identify and screen out women in early pregnancy. METHODOLOGY/PRINCIPAL FINDINGS: In May and June 2018, interviewers administered a questionnaire, followed by a pregnancy test, to 1,203 adult women living in the Peruvian Amazon. Regression analyses were performed to identify questions with high predictive properties (using the pregnancy test as the gold standard). Test parameters were computed at different decision tree nodes (where nodes represented questions). With 106 women confirmed to be pregnant, the positive predictive value of asking the single question 'Are you pregnant?' was 100%, at a 'cost' of a false negative rate of 1.9% (i.e. 21 women were incorrectly identified as not pregnant when they were truly pregnant). Additional questions reduced the false negative rate, but increased the false positive rate. Rates were dependent on both the combination and the order of questions. CONCLUSIONS/SIGNIFICANCE: To identify women in early pregnancy when deworming programs are community-based, both the number and order of questions are important. The local context and cultural acceptability of different questions should inform this decision. When numbers are manageable and resources are available, pregnancy tests can be considered at different decision tree nodes to confirm pregnancy status. Trade-offs in terms of efficiency and misclassification rates will need to be considered to optimize deworming coverage in women of reproductive age.


Assuntos
Gravidez , Inquéritos e Questionários , Adulto , Feminino , Helmintíase/tratamento farmacológico , Helmintíase/prevenção & controle , Humanos , Pessoa de Meia-Idade , Peru , Testes de Gravidez
19.
Acta Trop ; 202: 105279, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31758913

RESUMO

Intestinal parasites cause a significant public health problem worldwide due to the associated morbidities, mainly in infected school-aged children (SAC). The strategy of large-scale deworming in SAC to control the transmission of soil-transmitted helminths (STH) has been advocated by the World Health Organization and was recently adopted in Brazil; however, the long-term effects of mass deworming on the larger parasitological profile have been less studied. After a five-year period of school-based large-scale treatment for STH using an annual single dose of albendazole in a community of Sergipe state, Brazil, a marked reduction in prevalence was observed (15.4%% vs.7.4% for Ascaris sp., 6.0%%  vs. 0.4% for hookworm, and 12.8%%  vs. 4.5%% for Trichuris trichiura), with the exception of Strongyloides stercoralis, which had no statistically significant change in prevalence. There was, however, an increase in the prevalence of intestinal protozoans, specifically Entamoeba histolytica/E. dispar (0.0%% vs. 36.0%), Blastocystis hominis (0.0%%  vs. 40.1%), and Giardia duodenalis (5.6%% vs. 14.5%). Although the findings showed a dramatic reduction in the prevalence of STH after four rounds of preventive chemotherapy, there was an increase in intestinal protozoan infections, indicating a change in the epidemiological profile.


Assuntos
Helmintíase/epidemiologia , Enteropatias Parasitárias/epidemiologia , Infecções por Protozoários/epidemiologia , Solo/parasitologia , Albendazol/uso terapêutico , Animais , Brasil/epidemiologia , Quimioprevenção , Criança , Feminino , Helmintíase/tratamento farmacológico , Humanos , Masculino , Prevalência
20.
Int Health ; 12(2): 86-94, 2020 02 12.
Artigo em Inglês | MEDLINE | ID: mdl-31290969

RESUMO

BACKGROUND: Schistosomiasis and soil-transmitted helminths (STH) infections are major public health problems. We aimed to study the 6-mo impact of mass drug administration with praziquantel and albendazole on urinary schistosomiasis and STH. METHODS: We examined children (aged 2-15 y) from one hamlet, who provided urine and faeces samples at baseline (n=197), 1 mo (n=102) and 6 mo (n=92); 67 completed the protocol. RESULTS: At baseline, 47/67 (70.1%) children presented Schistosoma haematobium (75.8% in the baseline total sample) and 12/67 (17.9%) with STH (30.5% in the initial sample, p=0.010). Among the children, 47.3% had heavy Schistosoma haematobium infection. The most frequent STH was Trichuris trichiura in 9.0%. We also found Hymenolepis nana (13.2%) and Plasmodium falciparum (9.1%) infections and anaemia (82.1%). One mo after chemotherapy there was a significant (p=0.013) reduction of Schistosoma haematobium prevalence (23.5%) and a high egg reduction rate (86.9%). Considering the sample of 67 children, the mean egg concentration was 498 at baseline, 65 at 1 mo and 252 at 6 mo (p<0.05). We also observed a reduction in STH infections, 50% in Ascaris lumbricoides, 33.3% in T. trichiura and 50% in hookworms. At 6 mo, the prevalence of Schistosoma haematobium (76.1%) was similar to the baseline and the STH reduction was not significant. CONCLUSIONS: Longitudinal studies have reported many losses in these settings, but we were able to show that mass drug administration for control of schistosomiasis and STH present low effectiveness, that reinfections occur rapidly and that stand alone anthelmintic therapy is not a sustainable choice.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Helmintíase/tratamento farmacológico , Administração Massiva de Medicamentos , Esquistossomose Urinária/tratamento farmacológico , Solo/parasitologia , Adolescente , Albendazol/uso terapêutico , Angola/epidemiologia , Animais , Anti-Helmínticos/uso terapêutico , Criança , Pré-Escolar , Fezes/parasitologia , Feminino , Humanos , Masculino , Praziquantel/uso terapêutico , Prevalência , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Schistosoma haematobium/isolamento & purificação , Esquistossomose Urinária/epidemiologia , Urina/parasitologia
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