Prevalencia e intensidad de infección por geohelmintos, caracterizando los factores socio culturales y ambientales que inciden en la infección de escolares, Paraguay, 2015 / Prevalence and intensity of geohelminths infection characterizing the socio-cultural and environmental factors that affect the infection of school children, Paraguay, 2015

Resumen Introducción: Actualmente Paraguay no cuenta con estudios de prevalencia de infección por geohelmintos transmitidos por contacto con el suelo en escolares de 6 a 12 años. Objetivo: Determinar la prevalencia e intensidad de infección por Ascaris lumbricoides, Trichuris trichiura y las uncinarias y las características socio culturalesambientales de la población afectada. Materiales y Métodos: Estudio descriptivo, de corte transversal, en tres zonas climáticas: semi tropical continental, semi tropical semi estépico y semi tropical húmedo. Se seleccionaron 1.404 escolares de 20 escuelas de ocho departamentos, de las tres zonas climáticas del país. Se analizaron exámenes coproparasitológicos in situ con el método Kato-Katz. Resultados: La prevalencia nacional de geohelmintiasis fue de 3,7% (IC95% = 2,8-4,8). Los factores de riesgo fueron el consumo de agua de pozo OR: 2,88 (IC95% = 1,64-2,07), piso de tierra en la vivienda OR: 2,56 (IC95% = 1,45-4,50) y falta de baño con arrastre de agua en los hogares OR: 2,29 (IC95% = 1,23-4,28). Conclusión: A pesar de que la prevalencia nacional de geohelmintiasis fue baja, se recomienda promocionar buenas prácticas higiénicas, el uso de calzado, y consumo de agua segura, así como diseñar intervenciones con los sectores pertinentes para mejorar el acceso al agua segura y a instalaciones mejoradas de saneamiento básico.

Introduction: Currently, Paraguay has no data on the prevalence of soil-transmitted geohelminth infection in schoolchildren aged 6 to 12 years. Aim: To determine the prevalence and intensity of infection by Ascaris lumbricoides, Trichuris trichiura and hookworms and the socio-cultural-environmental characteristics of the affected population. Methods: Descriptive, cross-sectional study, in three semi-tropical climatic zones: continental, semi steppe and humid. A total of 1,404 schoolchildren from 20 schools in eight departments were selected from the country's three climate zones. Copro-parasitological exams were analyzed in situ with the Kato-Katz method. Results: The national prevalence for geohelminthiasis was 3.73% (95% CI = 2.8-4.8). The risk factors found were consumption of well water OR: 2.88 (95% CI = 1.64-2.07), ground floor in housing OR: 2.56 (95% CI = 1.45-4.50) and lack of flushing water baths in households OR: 2.29 (95% CI = 1.23-4.28). Conclusion: Although the national prevalence of geohelminthiasis was low, it is recommended to promote good hygienic practices, use of footwear, and safe water consumption, as well as designing interventions with all relevant sectors to improve access to safe water and improved basic sanitation facilities.

Impacto de la ivermectina sobre las geohelmintiasis en el foco de oncocercosis en Colombia / The effect of ivermectin on geohelminth frequency (i.e. as used in the onchocerciasis control program in Colombia)

Objetivo: Evaluar el efecto de la ivermectina sobre la frecuencia de infección por geohelmintos en una población colombiana incluida en el Programa para la Eliminación de la Oncocercosis en las Américas. Métodos: Estudio de evaluación de impacto con enfoque longitudinal como punto referente inicial, la población de Naicioná (1996) y como control, sujetos de la misma población (2008). Para el enfoque transversal se usó como referente la población de Naicioná en 2008 y como control, sujetos de Dos Quebradas en 2008. El procesamiento de las muestras de materia fecal se hizo por Ritchie-Frick modificado. Resultados: Ascaris lumbricoides fue el parásito más frecuente 49,6 % (60/121; IC 95 %:37,8-63,8) en Naicioná y 47,4 % (36/76; IC 95 %: 33,2-65,6) en Dos Quebradas. El mayor efecto de la ivermectina en mayores de 5 años fue la disminución del riesgo de infección, para Trichiuris trichiura, de 86 % (IC95 %:74-93) en la evaluación longitudinal y 63 % (IC 95 %:24-82) en la evaluación transversal. La disminución en la frecuencia de Strongyloides stercoralis fue 93 % (IC 95 %: 45-99), en la evaluación longitudinal y 85 % (IC95 %:-031 - 99) en la evaluación transversal. Conclusiones: El uso de la ivermectina en el contexto del Programa para la Eliminación de la Oncocercosis en las Américas no es suficiente para el control de la morbilidad de todas las geohelmintiasis, se requiere de programas integrales que incluyan los componentes de educación y saneamiento básico.

Objective: Evaluating the effect of ivermectin on soil-transmitted helminthes (STH) infection frequency in a Colombian population included in the Onchocerciasis Elimination Program for the Americas (OEPA). Methods: This was an impact evaluation study which adopted a longitudinal approach using the population of Naicioná (1996) as baseline for comparison to people from the same population as controls (2008). The cross-sectional approach involved comparing the reference population of Naicioná (2008) to the population of Dos Quebradas (2008) used as controls. Fecal samples were processed by a modified Ritchie-Frick method. Results: Ascaris lumbricoides was the most frequently found parasite in Naicioná (60/121; 49.6 %: 37.8-63.895%CI) and in Dos Quebradas (36/76; 47.4 %: 33.2-65.6 95 % CI). Ivermectin’s main effect on the population aged over 5 years was a decreased risk of Trichiuris trichiura infection in both longitudinal assessment (86 % reduction: 74-93 95 % CI) and cross-sectional assessment (63 %:24-82 95 % CI). A 93 % reduction (45-99 95 % CI) in Strongyloides stercoralis frequency was found in longitudinal assessment, compared to 85 % in cross-sectional assessment (-031-99 95 % CI). Conclusions: Ivermectin use in the OEPA is not sufficient for STH morbidity control. Integrated programs including education and basic sanitation are required.

Educación lúdica: una opción dentro de la educación ambiental en salud. Seguimiento de una experiencia rural colombiana sobre las geohelmintiasis / Play-based education: an option in environmental education in health. Monitoring of rural Colombian experience on geohelminthiasis / Educação lúdica: uma opção em educação em saúde ambiental. Monitoramento de experiência colombiana rural em geohelmintoses

Las geohelmintiasis son un problema de Salud Pública en los países en desarrollo, especialmente en escolares y preescolares, su control se basa en la integración de varias estrategias entre las cuales es esencial la educación en salud, que por sí sola ha demostrado ser altamente costo-efectiva. En este artículo se publican los resultados correspondientes a un estudio cualitativo aplicado, etnográfico, con enfoque crítico y participación comunitaria, cuyo objetivo fue desarrollar y hacer un seguimiento a una experiencia de educación lúdica, ambiental, dirigida a la prevención y el control de las geohelmintiasis en "La Virgen" (Cundinamarca, Colombia), basado en tres elementos: número de participantes en las actividades lúdicas, aceptación de las mismas y dificultades en su aplicación. Se efectuó un muestreo intencional a través del cual se seleccionaron maestros y estudiantes entre los ocho a quince años de cuatro instituciones educativas. Las técnicas utilizadas fueron entrevistas, observación participante, diarios de campo e instrumentos que permitieran el seguimiento de cada actividad. La validez de la metodología estuvo dada por la triangulación de datos. Las actividades lúdicas desarrolladas contaron con aceptación por parte de escolares, maestros y padres de familia. Hubo una fácil comprensión de los objetivos de los juegos y demás actividades lúdicas. Se presentó una participación considerable en el proceso por parte de maestros, alumnos, padres de familia y líderes comunitarios. Los primeros (especialmente las ludotecarias) se mostraron animados a colaborar en las actividades lúdicas y a emplearlas a futuro en sus clases; además, solicitaron otras capacitaciones relacionadas con salud. A partir de la interacción de la gente con el equipo de la Universidad Nacional surgieron nuevos materiales y actividades educativas lúdicas en salud (carteleras, canciones y un festival de la salud). Esta experiencia educativa ambiental lúdica permitió corroborar que la educación involucra un proceso profundo de enseñanza aprendizaje donde se construyen nuevos saberes; no se debe reducir a un nivel informativo que se refiere a una transmisión de datos emisor-receptor con carácter jerárquico. La lúdica optimiza el aprendizaje, promueve la participación y la creatividad. Además, permite identificar fácilmente problemas ambientales sentidos por la gente y aspectos relativos a la prevención que deben trabajarse tanto a nivel de saneamiento básico (por ejemplo, ausencia de alcantarillado) como de educación en salud, estimulando a la población a mejorar su calidad de vida...

Soil-transmitted helminths are a public health problem in developing countries, especially in school and preschool children. Their control is based on the integration of various strategies such as health education, which alone has proven to be highly cost-effective. This paper describes a qualitative applied study with an ethnographic design, a critical approach, and community participation. The study objective was to develop and track a play-based and environmental learning experience, aimed to prevent and control soil-transmitted helminths in "La Virgen" (Departamento de Cundinamarca, Colombia). The track was based on three elements: number of participants in recreational activities, acceptance of these activities, and difficulties in their implementation. Purposive sampling was performed through which teachers, and students aged 8 to 15, were selected mainly from 4 educational institutions. The techniques used were interviews, participant observation, field notes, and other instruments that allow the monitoring of each activity. The validity of the methodology was described by the triangulation of data. Recreational activities were accepted by school teachers and parents. The objectives of the games and other fun activities were easily understood by the children and other participants. Teachers, students, parents and community leaders also became involved in the process. The teachers, especially the toy librarians, were encouraged to attend recreational activities and promote their future employment in their classes. These instructors also requested additional health training workshops from the researchers. Effective collaboration between the participants from La Virgen and the researchers from la Universidad Nacional produced new materials and recreational activities in health education (such as billboards, songs, and a health festival). This educational experience corroborates the findings of previous studies, which indicate that simply presenting information does not necessarily ensure that it will be internalized by the subjects. Play-based education optimizes learning, while encouraging participation and creativity. In addition, it allows for the easy identification of environmental problems felt by the population, and the development of preventative activities related to both basic sanitation (e.g. lack of sewerage) and health education. These aspects of the project have the ability to improve participants' quality of life...

Prevalência e fatores associados às geo-helmintíases em crianças residentes em municípios com baixo IDH no Norte e Nordeste brasileiros / Prevalence and factors associated with geohelminth infections in children living in municipalities with low HDI in North and Northeast Brazil

Para determinar a prevalência de geo-helmintíases e identificar fatores associados a sua ocorrência, foram realizados inquéritos coprológicos em amostra de crianças entre 5 e 14 anos de idade, residentes em dez municípios brasileiros com baixo Índice de Desenvolvimento Humano. Aplicou-se questionário aos responsáveis, obtendo-se informações sócio-econômicas e ambientais e foi feita coleta de fezes. Estimaram-se prevalências de geohelmintos segundo variáveis de interesse e se avaliaram os fatores de risco mediante regressão logística multinível. Das 2.523 crianças estudadas, 36,5 por cento eram portadoras de um ou mais geohelmintos (Ascaris lumbricoides 25,1 por cento; ancilostomídeos 15,3 por cento, Trichuris trichiura 12,2 por cento). A proporção de geo-helmintíases para o conjunto na zona rural foi 45,7 por cento; na urbana, 32,2 por cento. Baixa renda familiar (OR = 1,75; 1,38-2,23), baixa escolaridade materna (OR = 1,69; 1,39-2,06), presença de lixo próximo ao domicílio (OR = 1,50; 1,22-1,84) e maior número de pessoas no domicílio (OR = 1,41; 1,17-1,71) mostraram-se associadas a tais infecções. Conclui-se que a ocorrência destas parasitoses está relacionada às condições sócio-econômicas e evidencia a importância de intervenções públicas direcionadas à melhoria das condições de vida para sua prevenção.

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