Prevalence and intensity of urinary schistosomiasis and soil-transmitted helminths among women of reproductive age in Mwaluphamba,Kwale

Objective:To assess the epidemiology of urinary schistosomiasis and soil-transmitted helminthiasis among women of reproductive age in Mwaluphamba,Kwale County,Kenya.Methods:A community-based cross-sectional study design was employed to randomly sample 422 women of reproductive age(15-<50 years)from four villages in Mwaluphamba location.Stool specimens were collected and examined using the Kato-Katz method,while filtration technique was used to analyze urine specimens.Participants’sociodemographic details were obtained using a standardized questionnaire.Results:Urinary schistosomiasis prevalence was at 4.7%(20/422,95%CI 2.8%-6.9%)while the prevalence of soil-transmitted helminthiasis infection was 4.5%(19/422,95%CI 2.6%-6.7%).The infection intensities of urinary schistosomiasis among the study participants ranged from 1 to 120 eggs/10 mL of urine with median egg count of 18.45 eggs/10 mL.The patients were diagnosed with light infection,of 56.16 egg/gram and 48.48 egg/gram for Trichuris trichiura and hookworms,respectively.Women without latrines had 15.7 times higher risk of having urinary schistosomiasis compared to those with a latrine.Similarly,use of surface water(aOR=1.0,95%CI 0.2-1.4,P=0.010)and crossing the river to go to a place(aOR=1.1,95%CI 0.3-1.6,P=0.009)were statistically significant risk factors for getting urinary schistosomiasis.In bivariable regression analysis,defecating around the water source(OR=4.3,95%CI 1.5-12.9)had a statistically significant association with the prevalence of soil-transmitted helminthiasis(P=0.008).Conclusions:This study has given an insight on the prevalence and intensity of urinary schistosomiasis and soil-transmitted helminthiasis in Mwaluphamba location that form a basis for strengthening the control and elimination programmes for these neglected tropical diseases.

Soil-transmitted helminth egg contamination from soil of indigenous communities in selected barangays in Tigaon, Camarines Sur, Philippines

Objective:To provide baseline data on the prevalence and intensity of soil-transmitted helminthiasis egg contamination in the soil among indigenous communities.Methods:A total of 317 soil samples from three barangays of indigenous communities communities in Tigaon,Camarines Sur,Philippines were examined for soil-transmitted helminthiasis egg contamination using optimized sugar flotation method.Results:Of the soil samples examined,141(44.48%)were contaminated by Ascaris spp.,Toxocara spp.,and Trichuris spp.with cumulative prevalence varying across the study sites(P<0.01).Ascaris spp.was predominant in all study sites,followed by Toxocara spp.and Trichuris spp.with a prevalence of 41.96%,7.57%,and 5.36%,respectively.Interestingly,Toxocara pp.has the highest intensity of contamination,followed by Ascaris spp.and Trichuris spp.in term of geometric mean soil-transmitted helminthiasis eggs recovered per one gram soil sample(34.25,21.45,and 11.85 respectively).Each study site harbors significant amount of soiltransmitted helminthiasis eggs and zoonotic Toxocara eggs,which present high risk of soil-transmitted helminthiasis infection,particularly among children observed to play and cohabitate with animals known to be hosts of these parasites.Conclusions:The alarming rate of soil-transmitted helminthiasis and Toxocara egg contamination reported in this study suggests that additional measures should be undertaken to control soil-transmitted helminthiasis and zoonotic intestinal infections in the country.

High prevalence of soil-transmitted helminths in Southern Belize-highlighting opportunity for control interventions

Objective:To assess prevalence and intensity of soil-transmitted helminths(STH) in school age children of two southern districts as baseline information prior to implement a deworming program against intestinal parasites as part of an integrated country development plan.Methods:Children randomly selected from urban and rural schools in Southern Belize provided one stool sample each,analysed by the Kato-Katz method to assess prevalence and intensity of STH infections.Epi Info software was used for data analysis;Chi-square test and Fischer exact test were applied to compare group proportions;P<0.05 was considered of statistical significance;descriptive statistics were expressed as percentages.Results:A total of 500 children from 10 schools participated in the study from May to December2005.Prevalence of STH ranged between 40%and 82%among schools,with a median of 59.2%;the majority of light intensity,and with 2.2%high intensity infection.Trichuris and Axaris infections presented similar frequency in children aged from 6 to 9 years old;hookworm infections tended to be more frequent in the older group 10 to 12 years old.Statistical significances(P≤0.01)were found in children in rural schools infected with any species of STH,in moderate Trichuris infections,in hookworm infections in rural areas with strong Mayan presence and in Ascaris infections in children of Mayan origin.Conclusions:High prevalence of STH in Southern Belize provided sound ground for implementing an integrated deworming control program.

Prevalence of Soil-Transmitted Helminths and Intestinal Protozoa among School Children in Lome, Togo

Background: Significant morbidity in children is associated with infectious diseases especially soil-transmitted helminth (STH) infections which are prevalent in sub-Saharan African countries. The objective of this study is to estimate the prevalence of STH and intestinal protozoa among schoolchildren in Lomé, Togo. Patients and Methods: In November 2013, in each of the five districts of the Lomé-commune region, thirty pupils per level of the third, fourth, fifth and sixth grades of five primary schools were included. Each child submitted a single stool sample that was analyzed by the Kato-Katz method for STH. In addition, stool samples of school children selected in third and sixth grades were examined by direct visualization using saline and Lugol’s stain for intestinal protozoa. Results: A total of 2944 children were enrolled at 25 schools. The overall prevalence of STH at schools was 5.0% (range 1.5% to 8.6%), was higher in boys than girls, and increased with age and grade. Hookworm was the most prevalent species (3.4% of children surveyed). Intestinal protozoa were found in 52.2% (765/1465) of children tested and commensal amoebae represented 22.7% of these protozoa identified. Entamoeba histolytica/dispar/moshkovskii and Giardia intestinalis were identified in 2.3% and 11.5% of children, respectively. Co-infestation was noted in 1.35% of children with intestinal helminths and 12.2% of children with protozoa. Conclusion: Although a high prevalence of intestinal protozoa was found in our study, the majority were non-pathogenic protozoa and the low prevalence of STH among school-age children in Lomé-commune region confirms that mass drug administration (MDA) is not needed. Children should receive additional education on best hygiene practices.

Effectiveness of ivermectin mass drug administration in the control of soil-transmitted helminth infections in endemic populations: a systematic review and meta-analysis

Background Current soil-transmitted helminth(STH)control guidelines endorse the use of albendazole or meben-dazole for school-based targeted preventive chemotherapy(PC),yet their reduced efficacy against Strongyloides sterc-oralis and Trichuris trichiura presents significant limitations.Emerging evidence indicates that community-wide PC[or mass drug administration(MDA)]using ivermectin,commonly used in other neglected tropical disease(NTD)control programs,may play an important role in controlling these parasites.We conducted a systematic review and meta-analysis to evaluate the effectiveness of ivermectin PC in reducing STH prevalence in endemic populations.Methods We searched Pubmed,EMBASE,and Web of Science on February 14,2023,for studies that investigated the effectiveness of ivermectin PC,either alone or in combination with other anthelmintic drugs,on STH infec-tions,and provided a measure of STH prevalence before and after PC.We calculated pooled prevalence reductions for each STH using random-effects meta-analyses.Our protocol is available on PROSPERO(registration number CRD42023401219).Results A total of 21 were eligible for the systematic review,of which 15 were eligible for meta-analysis.All studies delivered ivermectin through MDA.The pooled prevalence reduction of S.stercoralis following MDA with ivermec-tin alone was 84.49%(95%CI:54.96-94.66)across five studies and 81.37%(95% CI:61.62-90.96)across seven studies with or without albendazole.The prevalence reduction of T.trichiura was 49.93%(95%CI:18.23-69.34)across five studies with ivermectin alone,and 89.40%(95%CI:73.66-95.73)across three studies with the addition of albendazole.There was high heterogeneity for all syntheses(I^(2)>65%).Conclusions This study underscores the key role of ivermectin-based MDA in addressing limitations in current global STH guidelines in terms of limited efficacy against S.stercoralis and T.trichiura.Based on these findings,revising inter-national STH guidelines to include ivermectin is a promising option to progress the control and eventual elimination ofSTHsandotherNTDs.

Prevalence and risk factors of schistosomiasis and soil-transmitted helminthiases among preschool aged children (1-5 years) in rural KwaZulu-Natal, South Africa: a cross-sectional study

Background:Despite efforts to control neglected tropical diseases(NTDs),schistosomiasis and soil-transmitted helminthiases remain widely prevalent in sub-Saharan Africa.Recent data suggest that these infections are prevalent among preschool aged children(PSAC)in poor communities.Evidence of schistosomiasis and soil-transmitted helminths(STH)infection patterns and prevalence among PSAC is essential for effective treatment and control programmes.The aim of the study was to determine the prevalence,intensity and risk factors of schistosomiasis and STH infection among PSAC in the Ingwavuma area of uMkhanyakude District,South Africa.Methods:A cross-seaional study was conducted among 1143 PSAC aged 1-5 years in 34 preschools and early childhood development(ECD)centres.Data on risk factors was collected using a semi-struaured questionnaire.A Kruskal-Wallis test was used to compare the differences in infection intensity with age.Pearson Chi-square test and multivariate logistic regression were performed to assess the association between PSAC infection status,sociodemographic,household,water and sanitation variables and hygiene practices of PSAC and their caregivers.Results:We observed a low prevalence o f Schistosom a haem atobium(1.0%)and 5.m ansoni(0.9%).The prevalence of Ascaris lum bricoides(18.3%)was high compared to Trichuris trichiuro(1.2%),hookworms(1.6%)and Taenio(6.4%).The odds of schistosome infection were lowest among PSAC under younger(15-24 years)caregivers(0.1,95%CI:0.02-0.54)and those who used tap water(0.3,95%Cl:0.09-0.78)for domestic purposes.Schistosome infection was however higher among PSAC who bathed in river water(17.4,95%CI:5.96-51.04).STH infection on the other hand was lowest among PSAC who did not play in soil(0.1,95%CI:0.51-0.28),were from households that used tap water for domestic purposes(0.5,95%CI:0.27-0.80)and PSAC under the care of younger(25-35 years)caregivers(0.3,95%Cl:0.10-0.75).The risk of STH infeaion was highest among PSAC who did not wash their hands with soap(3.5,95%CI:1.04-11.67)and PSAC whose nails were not trimmed(3.6,95%CI:1.75-7.26).Conclusions:The findings show low prevalence and infection intensity of schistosomiasis and STH infection except A lum bricoides among PSAC.Factors predicting schistosomiasis and STH infection among PSAC were related to caregivers'age,educational status,water and hygiene practices.STH infection was exclusively associated with PSAC playing and handwashing habits.These findings highlight the need to include PSAC caregivers in schistosomiasis and STH prevention and control programmes.

The control of soil-transmitted helminthiases in the Philippines: the story continues

Background:Soil-transmitted helminth(STH)infections have long been an important public health concern in the Philippines.In this review,we describe the current status of STH infections there and highlight the control efforts undertaken to reduce STH burden.Main text:A nationwide STH mass drug administration(MDA)programme was started in 2006 but the overall STH prevalence remains stubbornly high across the Philippines,rangi ng from 24.9%to 97.4%.

Prevalence and distribution of soil-transmitted helminth infections in Nigerian children:a systematic review and meta-analysis

Background:Soil transmitted helminth(STH)infections still remain a notable health problem in resource-limited countries due to difficulties in the implementation of control measures.In Nigeria for instance,despite several community-based and provincial reports,national data on prevalence,burdens and risk zones(RZs)for STH infections are lacking.Methods:The present study employed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)to determine the prevalence,distribution and RZs for STH infections among Nigerian children through a meta-analysis of data published between 1980 and 2015.Pooled prevalence estimate(PPE)was determined by the random-effects model while heterogeneity was evaluated using the Cochran’s Q-test.Results:A total of 18901 of the 34518 Nigerian children aged 0-17 years examined across 19 Nigerian states during the period under review were infected with one or more species of STHs.The overall PPE for STH infections was 54.8%(95%CI:54.2-55.3).PPEs for sub-groups ranged between 13.2%(95%CI:11.5-15.1)and 80.9%(95%CI:80.0-81.7).Highest PPEs for STH infections were observed among children within community settings(59.0%,95%CI:57.7-60.4)and school-aged children(54.9%,95%CI:54.3-55.5).Ascaris lumbricoides was the most prevalent species(44.6%,95%CI:44.0-45.2).Over 36%(15/41)of the studies were published from south-western Nigeria.South-western region was the only high risk zone(HRZ)for STH infections while the rest of the regions were low risk zones(LRZs).Conclusions:STH infections involving Ascaris lumbricoides,Strongyloides stercoralis,Trichuris trichiura and hookworms are highly prevalent across Nigeria.Strategic use of anthelmintics,health education and adequate sanitation,taking into account this epidemiologic information will help in the control of these infections in Nigeria.

Schistosomiasis and soil-transmitted helminthiasis in Rwanda:an update on their epidemiology and control

Even though Rwanda lies within a region that has a high prevalence of schistosomiasis and soil-transmitted helminth(STH)infections,epidemiological information regarding these infections in the country remains scarce.The present review attempts to compile the available data on schistosomiasis and STHs,from 1940 to 2014,to provide an insight on the epidemiological profile of these infections.This information will,in turn,support the design and implementation of sustainable control measures.The available records indicate that only Schistosoma mansoni and all the major species of STHs are endemic in Rwanda.In 2008,the national prevalence of S.mansoni was reported to be 2.7%,ranging from 0 to 69.5%,and that of STH infections was 65.8%(diagnosed using the Kato-Katz technique).The prevalence of these infections varies from one district to another,with schoolchildren remaining a highly affected group.The main control approach is mass drug administration using albendazole and praziquantel,mostly targeting school-aged children in school environments.In 2008,adult individuals living in areas with a prevalence of S.mansoni≥30%were also included in the mass drug administration programme.However,despite Rwanda achieving an almost 100%coverage of this programme in 2008-2010,the transmission of S.mansoni and STHs continues to take place,as illustrated by the most recent surveys.If Rwanda is to achieve sustainable control and elimination of schistosomiasis and STHs,there is a need to revise the country’s control strategy and adopt an integrated control approach that involves a combination of measures.

Capacity gaps in health facilities for case management of intestinal schistosomiasis and soil-transmitted helminthiasis in Burundi

Background:Schistosomiasis and soil-transmitted helminthiasis(STH)are endemic diseases in Burundi.STH control is integrated into health facilities(HF)across the country,but schistosomiasis control is not.The present study aimed to assess the capacity of HF for integrating intestinal schistosomiasis case management into their routine activities.In addition,the current capacity for HF-based STH case management was evaluated.Methods:A random cluster survey was carried out in July 2014,in 65 HF located in Schistosoma mansoni and STH endemic areas.Data were collected by semi-quantitative questionnaires.Staff with different functions at the HF were interviewed(managers,care providers,heads of laboratory and pharmacy and data clerks).Data pertaining to knowledge of intestinal schistosomiasis and STH symptoms,human and material resources and availability and costs of diagnostic tests and treatment were collected.Findings:Less than half of the 65 care providers mentioned one or more major symptoms of intestinal schistosomiasis(abdominal pain 43.1%,bloody diarrhoea 13.9%and bloody stool 7.7%).Few staff members(15.7%)received higher education,and less than 10%were trained in-job on intestinal schistosomiasis case management.Clinical guidelines and laboratory protocols for intestinal schistosomiasis diagnosis and treatment were available in one third of the HF.Diagnosis was performed by direct smear only.Praziquantel was not available in any of the HF.The results for STH were similar,except that major symptoms were more known and cited(abdominal pain 69.2%and diarrhoea 60%).Clinical guidelines were available in 61.5%of HF,and albendazole or mebendazole was available in all HF.Conclusions:The current capacity of HF for intestinal schistosomiasis and STH detection and management is inadequate.Treatment was not available for schistosomiasis.These issues need to be addressed to create an enabling environment for successful integration of intestinal schistosomiasis and STH case management into HF routine activities in Burundi for better control of these diseases.

Polyparasitism with Schistosoma haematobium,Plasmodium and soil-transmitted helminths in school-aged children in Muyuka-Camero on following implementation ofc ontrol measures:a cross sectional study

Background:Despite the ubiquity of polyparasitism,its health impacts have been inadequately studied.The aim of this study was to determine the prevalence and determinants of polyparasitism with Schistosoma haematobium,Plasmodium and soil-transmitted helminths(STH)following sustained control measures,as well as evaluate the outcomes and clinical correlates of infection in school-aged children(SAC)living in the schistosomiasis endemic focus of Muyuka-Cameroon.Methods:In a cross-sectional study,urine,blood and stool samples were each collected from SAC(4-14 years)selected at random between March and June 2015.Microhaematuria in urine was detected using reagent strip and 5.haematobium ova by filtration/microscopy methods.Plasmodium was detected using Giemsa-stained blood films and complete blood count was obtained using an auto-haematology analyser.STH in stool was detected by the Kato-Katz method.Categorical and continuous variables were compared as required,Kappa value estimated and the adjusted odds ratio(aOR)in the multivariate analysis was used to evaluate association of the risk factors with infection.

Soil-transmitted helminths and plasmodium falciparum malaria among individuals living in different agroecosystems in two rural communities in the mount Cameroon area:a cross-sectional study

Background:Soil-transmitted helminths(STHs)and Plasmodium falciparum infections remain public health problems in Cameroon.A cross-sectional study was carried out in the Mount Cameroon area to determine the prevalence and intensity of STHs and P.falciparum infections in individuals living in different agroecosystems;to assess the influence of these infections on haematological parameters;and to identify the risk factors associated with STH infections.Methods:STH and malaria parasites were detected using the Kato-Katz method and Giemsa staining of blood films,respectively.Complete blood count values were obtained using an automatic haematology analyser.Soil samples were analysed using the sucrose floatation sedimentation method.Categorical and continuous variables were compared as required and logistic regression models were used to assess the risk factors for STH infections and anaemia.Results:Of the 450 participants examined,STHs,P.falciparum and mixed co-infections were detected in 14.0,33.3 and 5.6%of participants,respectively.Significantly higher prevalences of Ascaris(18.8%)and Trichuris(7.9%)infections were observed in participants from tea plantation areas compared to those from banana and palm plantation areas,with similar trends in egg density.P.falciparum prevalence and parasite density were comparable between the different agroecosystems.The overall prevalence of anaemia was 64.2%.The prevalence of haematological manifestations such as moderate(48.0%)and severe(8.0%)anaemia,leucopenia(26.9%)and microcytosis(30.8%)was significantly higher among Plasmodium-STH co-infected participants.Soil samples from plantations showed the highest prevalences of STH eggs compared to soil samples from areas around pit toilets and public water taps.Living in a tea plantation area(OR=3.07),age(AOR=1.49)and lack of access to potable water(OR=2.25)were identified as risk factors for STH infections,while the age groups 15-25 years(OR=2.928)and 26-35 years(OR=2.832),and being female(OR=2.671)were significant risk factors for anaemia.Conclusions:STHs,malaria and anaemia are still of public health concern in plantation communities.Co-infections negatively influence haematological parameters.The tea farming agroecosystem,age and lack of access to potable water were identified as significant risk factors for STH infections.Trial registration:Not applicable.

Burden and factors associated with schistosomiasis and soil-transmitted helminth infections among school-age children in Huambo,Uige and Zaire provinces,Angola

Background:Schistosomiasis and soil-transmitted helminths(STHs)contribute high disease burdens amongst the neglected tropical diseases(NTDs)and are public health problems in Angola.This study reports the prevalence,intensity and risk factors for schistosomiasis and STH infection in Huambo,Uige and Zaire provinces,Angola,to inform a school-based preventive chemotherapy program.Methods:A two-stage cluster design was used to select schools and schoolchildren to participate in parasitological and water,sanitation and hygiene(WASH)surveys across Huambo,Uige,and Zaire provinces.Point-of-care circulating cathodic antigen and urinalysis rapid diagnostic tests(RDTs)were used to determine the prevalence of Schistosoma mansoni and S.haematobium,respectively.Kato-Katz was used to identify and quantify STH species and quantify and compare with RDTs for S.mansoni.Urine filtration was used to quantify and compare with RDTs for S.haematobium.Descriptive statistics were used for prevalence and infection intensity of schistosomiasis and STH infection.Performance of RDTs was assessed through specificity and Cohen’s Kappa agreement with microscopy.A multivariate regression analysis was used to determine demographic and WASH factors associated with schistosomiasis and STH infection.Results:A total 575 schools and 17,093 schoolchildren participated in the schistosomiasis survey,of which 121 schools and 3649 schoolchildren participated in the STH survey.Overall prevalence of S.mansoni was 21.2%(municipality range 0.9–74.8%)and S.haematobium 13.6%(range 0–31.2%),with an overall prevalence of schistosomiasis of 31.4%(range 5.9–77.3%).Overall prevalence of Ascaris lumbricoides was 25.1%(range 0–89.7%),hookworm 5.2%(range 0–42.6%),and Trichuris trichiura 3.6%(range 0–24.2%),with an overall prevalence of STH infection of 29.5%(range 0.8–89.7%).Ecological zone and ethnicity were factors associated with schistosomiasis and STH infection,with older age and female sex additional risk factors for S.haematobium.Conclusions:Most municipalities met World Health Organization defined prevalence thresholds for a schistosomiasis preventive chemotherapy program.A STH preventive chemotherapy program is indicated for nearly all municipalities in Uige and select municipalities in Huambo and Zaire.The association between ecological zone and ethnicity with schistosomiasis and STH infection necessitates further evaluation of home and school environmental,sociodemographic and behavioural factors to inform targeted control strategies to complement preventive chemotherapy programs.

Multi-intervention integrated deworming strategy for sustained control of soil-transmitted helminths infections: a case study in Jiangsu Province, China

Background:Soil-transmitted helminths(STH)infections still present a global health problem.Mass drug adminis‑tration(MDA)is a widely applied strategy to reduce morbidity and mortality caused by STH.Yet,this approach has some shortcomings.In this study,we analyzed the impact of a multi-intervention integrated deworming approach including MDA,health education(HE),and environmental sanitation improvements(ESI)for sustained STH control in Jiangsu Province of China that was applied from 1989 to 2019.Methods:Data,including infection rate of STH,medications used,coverage of the medication,non-hazardous lavatory rate,and household piped-water access rate in rural areas,and actions related to HE and ESI were collected(from archives)and analyzed in this retrospective descriptive study.Pearson’s correlation analysis was applied to test correlations.Results:There was a dramatic decline in the infection rate of STH from 1989(59.32%)to 2019(0.12%).From 1995 to 1999,MDA and HE were recommended in rural areas.A negative correlation was observed between infection rate and medication from 1994 to 1998(r=-0.882,P=0.048).From 2000 to 2005,targeted MDA was given to high-risk populations with HE continuously promoting good sanitation behaviors.From 2006 to 2014,targeted MDA+HE and ESI were used to consolidate the control efect.ESI was strengthened from 2006,and a negative correlation was observed between the coverage rate of the non-hazardous lavatory and the infection rate from 2006 to 2019(r=-0.95,P<0.001).The targeted MDA was interrupted in 2015,while continuous eforts like HE and ESI contributed in sustaining STH control.Conclusions:Multi-intervention integrated deworming strategy contributes to the reduction of STH infections.This approach is a valuable example of how diferent interventions can be integrated to promote durable STH control.

High prevalence of soil-transmitted helminth infections among primary school children,Uttar Pradesh,India,2015

Background:Soil-transmitted helminth(STH)infections often affect the poorest and most deprived communities.In order to generate reliable data for planning a school based deworming program,we conducted a survey among primary school children studying in government schools in the Indian state of Uttar Pradesh.The objectives of our survey were to estimate the prevalence and intensity of STH infections.Methods:We conducted a cross-sectional survey among children studying in 130 primary schools from 9 agroclimatic zones,during May-August 2015.Information about socio-demographic details,defecation and handhygiene practices,and stool samples were collected from the school children.Stool samples were examined using the Kato-Katz method.Results:Stool samples from 6421 school children were examined.The overall weighted prevalence of any STH in the State was 75.6%(95%CI:71.2-79.5).The prevalence was more than 50%in six of the nine agro-climatic zones.A.lumbricoides was the most prevalent STH(prevalence:69.6%),followed by hookworm(prevalence:22.6%)and T.trichura(4.6%).The majority of the STH infections were of low intensity.The practice of open defecation and not washing hands with soap after defecation and residence in kutcha house were significant risk factors of STH infection.Conclusions:STH prevalence among primary school children in Uttar Pradesh was high.Given the WHO guidelines on deworming frequency according to STH prevalence,Govt of Uttar Pradesh needs to implement a school-based deworming program with bi-annual frequency.The findings of our survey would also help monitor the performance of school based deworming programme.

High infection rates for onchocerciasis and soil-transmitted helminthiasis in children under fve not receiving preventive chemotherapy:a bottleneck to elimination

Background:The current mainstay for control/elimination of onchocerciasis and soil-transmitted helminthiasis(STH)relies on ivermectin-and mebendazole/albendazole-based preventive chemotherapies.However,children under fve years of age have been excluded in both research activities and control programs,because they were believed to have insignifcant infection rates.There is therefore a need for up-to-date knowledge on the prevalence and inten‑sity of STH and onchocerciasis infections in this age group.This study aimed at assessing the rates and intensities of onchocerciasis and STH infections in children under fve years of age who are excluded from ivermectin-or mebenda‑zole/albendazole-based preventive chemotherapies.Methods:A series of cross-sectional surveys was conducted in four Health Districts in the Centre and Littoral Regions of Cameroon between 2018 and 2019.All subjects aged 2 to 4 years,were screened for prevalence(or infection rate)and intensity[number of eggs per gram of stool(epg)or number of microflariae per skin snip(mf/ss)]of STH and onchocerciasis infections respectively using the Kato-Katz and skin snip methodologies.Chi-square and the nonparametric tests(Mann Whitney and Kruskal Wallis)were used to compare infection rates and intensities of infections between Health Districts and genders,respectively.Results:A total of 421 children were enrolled in this study.The overall prevalence of onchocerciasis was 6.6%[95% confdence interval(CI):4.3‒9.9],ranging from 3.6%(in the Ntui Health District)to 12.2%(in the Bafa Health District).The intensity of infection ranged from 0.5 to 46 microflariae per skin snip[median:5;interquartile range(IQR):2.25‒8.5].The overall prevalence of STH was 9.6%(95%CI:6.5‒13.9),with a high infection rate(29.6%)in the Akonolinga Health District.Two STH species(Ascaris lumbricoides and Trichuris trichiura)were found among infected individuals.The median intensities of STH infections were 1,992 epg(IQR:210‒28,704)and 96 epg(IQR:48‒168)for A.lumbricoides and T.trichiura,respectively.Conclusions:This study reveals that children<5 years of age are highly infected with STH and onchocerciasis,and could contribute to the spread of these diseases,perpetuating a vicious circle of transmission and hampering elimi‑nation eforts.These fndings reveal the urgent need to provide(or scale)treatments(likely pediatric formulations)to these preschool-aged children,especially in areas of high transmission,to accelerate eforts to reach WHO 2030 target.

Sustained preventive chemotherapy for soil-transmitted helminthiases leads to Pdaes reduction in prevalence and anthelminthic tablets required

Background:The goal of soil-transmitted helminthiases(STH)control programmes is to eliminate STH-associated morbidity in the target population by reducing the prevalence of moderate-and heavy-intensity infections and the overall STH infection prevalence mainly through preventive chemotherapy(PC)with either albendazole or mebendazole.Endemic countries should measure the success of their control programmes through regular epidemiological assessments.We evaluated changes in STH prevalence in countries that conducted effective PC coverage for STH to guide changes in the frequency of PC rounds and the number of tablets needed.Methods:We selected countries from World Health Organization(WHO)^Preventive Chemotherapy and Transmission control(PCT)databank that conducted≥5 years of PC with effective coverage for school-age children(SAC)and extracted STH baseline and impact assessment data using the WHO Epidemiological Data Reporting Form,Ministry of Health reports and/or peer-reviewed publications.We used pooled and weighted means to plot the prevalence of infection with any STH and with each STH species at baseline and after≥5 years of PC with effective coverage.Finally,using the WHO STH decision tree,we estimated the reduction in the number of tablets needed.Results:Fifteen countries in four WHO regions conducted annual or semi-annual rounds of PC for STH for 5 years or more and collected data before and after interventions.At baseline,the pooled prevalence was 48.9%(33.1-64.7%)for any STH,23.2%(13.7-32.7%)for Ascoris lumbricoides,21.01%(9.7-32.3%)for Trichuris trichiuro and 18.2%(10.9-25.5%)for hookworm infections,while after>5 years of PC for STH,the prevalence was 14.3%(7.3-21.3%)for any STH,6.9%(1.3-12.5%)for A.lumbricoides,5.3%(1.06-9.6%)for T.trichiura and 8.1%(4.0-12.2%)for hookworm infections.Conclusions:Countries endemic for STH have made tremendous progress in reducing STH-associated morbidity,but very few countries have data to demonstrate that progress.In this study,the data show that nine countries should adapt their PC strategies and the frequency of PC rounds to yield a 36%reduction in drug needs.The study also highlights the importance of impact assessment surveys to adapt control strategies according to STH prevalence.

Estimated need for anthelminthic medicines to control soil-transmitted helminthiases in school-aged children,2020–2030

Background:Soil-transmitted helminthiases(STH)are part of the group of neglected tropical diseases traditionally treated with preventive chemotherapy interventions.In recent years,drug donations have been essential to expanding preventive chemotherapy and achieving progressive control of morbidity from STH.This study aims to evaluate the need for anthelminthic medicines during 2020–2030.Methods:To estimate the need for anthelminthic medicines,we considered three different scenarios:(1)the control programmes continues to expand coverage and maintains the frequency of drug administration established at baseline;(2)the programmes continues to expand coverage but adapts the frequency of drug administration when the STH prevalence is reduced and(3)the STH programme becomes self-sustainable in some endemic countries.Results:We estimate that the number of anthelmintic medicines needed to treat school-aged children will increase by 40%by 2025 and by 52%by 2030 if countries do not change the frequency of preventive chemotherapy(scenario 1);that the number of tablets needed will reduce by 32.4%by 2025 and by 49.1%in 2030 if endemic countries reduce the frequency of preventive chemotherapy(scenario 2);and drug donations could be reduced by 54.4%by 2025 and 74.4%by 2030 if some endemic countries could become independent in drug procurement(scenario 3).Conclusions:The number of anthelmintic medicines needed to achieve elimination of morbidity due to STH in school-aged children will decline during 2020–2030.The decline will be substantial if a number of“upper-middle income”countries in which STH are endemic procure,as expected,anthelminthic medicines independently.

Soil-transmitted helminth infection in school age children in Sierra Leone after a decade of preventive chemotherapy interventions

Background:Baseline mapping of soil-transmitted helminth(STH)infections among school age children(SAC)in 2008-2009 found high or moderate prevalence in 13 of the 14 districts in Sierra Leone.Following these surveys,mass drug administration(MDA)of mebendazole/albendazole was conducted biannually at national level targeting pre-school children(PSC)aged 12-59 months and intermittently at sub-national level targeting SAC.In addition,MDA with ivermectin and albendazole for eliminating lymphatic filariasis(LF)has been conducted nationwide since 2010 targeting individuals over 5 years of age.Each MDA achieved high coverage,except in 2014 when all but one round of MDA for PSC was cancelled due to the Ebola emergency.The objective of the current study was to determine the prevalence and intensity of STH infections among SAC after a decade of these deworming campaigns.Methods:Seventy-three schools in 14 districts were purposefully selected,including 39 schools from the baseline surveys,with approximately two sites from each of low,moderate and high prevalence categories at baseline per district.Fresh stool samples were collected from 3632 children aged 9-14 years(male 51%,female 49%)and examined using the Kato Katz technique.Results:The prevalence of STH infections in Sierra Leone decreased in 2016 compared to 2008:Ascaris lumbricoides 4.4%(95%confidence interval[CI]:3.7-5.1%)versus 6.6%(95%CI:0-25%),Trichuris trichiura 0.7%(95%CI:0.5-1.1%)versus 1.8%(95%CI:0-30.2%),hookworm 14.9%(95%CI:13.8-16.1)versus 38.5%(95%CI:5.4-95.1%),and any STH 18.3%(95%CI:17.0-19.5%)versus 48.3%(CI:5.4-96.3%),respectively.In 2016,no district had high hookworm prevalence and four districts had moderate prevalence,compared with eight and four districts respectively in 2008.In 2016,the arithmetic mean hookworm egg count in all children examined was light:45.5 eggs per gram(EPG)of faeces,(95%CI:\35.96-55.07 EPG);three(0.08%)children had heavy infections and nine(0.25%)children had moderate infections.Conclusions:Sierra Leone has made considerable progress toward controlling STH as a public health problem among SAC.As LF MDA phases out(between 2017 and 2021),transition of deworming to other platforms and water and sanitation strategies need to be strengthened to maintain STH control and ultimately interrupt transmission.

Risk Factors for Geo-Helminthiasis in Children Aged 6 - 36 Months in a Rural Health District in Cameroon

Introduction and Objectives: Soil-Transmitted-Helminthiasis (STH) is a public health problem in Cameroon. The control strategies currently in place, particularly chemoprevention, has shortcomings linked to the target population, which are school-age children. The objective was to determine the prevalence and the risk factors associated with geo-helminthiasis in children aged 0 to 3 years in a rural health district. Method: From December 2020 to May 2021, a descriptive and analytical cross-sectional study of 376 children between 6 and 36 months was carried out in the Akonolinga health district. This was a cluster sampling in 4 health areas. Stool samples were collected and analysed using the mini-FLOTAC method. The results expressed as the number of eggs per gram of stool. A questionnaire on socio-demographic and lifestyle data was administered to the parents. The Chi-squared test was used to measure the association between geo-helminth infection and the data collected. A multivariate analysis using logistic regression was performed (p 0.05). Results: The prevalence of STH was 19.4% (Ascaris lumbricoides: 16% and Trichuris trichiura: 8%). Risk factors were: consumption of contaminated water (AOR = 1.93 [1.03 - 3.6];p = 0.040), early contact of the child with the ground (before age of 4 months) (AOR = 4.9 [2.1 - 11.37];p .001), habit of walking barefoot (AOR = 2.91 [1.1 - 7.97];p = 0.038), and living in a habitat with unpaved ground (AOR = 7.4 [1.55 - 35.7];p = 0.012). Conclusion: The prevalence of STHs in infants was high. Preventive chemotherapy should be extended to this age-group, and other measures intensified.