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 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.

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.

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.

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 infections among preschool and school-age children in Ethiopia:a systematic review and meta-analysis

Background:There is a lack of comprehensive national data on prevalence,geographical distribution of different species,and temporal trends in soil-helminthiasis(STHs).Therefore,this study aimed to provide a summary and location of the available data on STHs infection among preschool and school-age children in Ethiopia.Methods:The search was carried out in Medline via PubMed,Scopus,Science Direct,Web of Science,and Google Scholar on data published between 1997 to February 2020 for studies describing the rate of STHs infection among preschool and school-age in Ethiopian.We followed the Patient,Intervention,Comparison,and Outcome(PICO)approach to identify the studies.Meta-regression was performed to understand the trends and to summarize the prevalence using the“metaprop”command using STATA software version 14.0 Results:A total of 29,311 of the 61,690 children examined during the period under review were infected with one or more species of intestinal parasites yielding an overall prevalence of 48%(95%CI:43-53%).The overall pooled estimate of STHs was 33%(95%CI:28-38%).The prevalence was 44%(95%CI:31-58%)in SNNPR,34%(95%CI:28-41%)in Amhara region,31%(95%CI:19-43%)in Oromia region and 10%(95%CI:7-12%)in Tigray region.Soil-transmitted helminths infection rate has been decreasing from 44%(95%CI:30-57%)pre-Mass Drug Administration(MDA)era(1997-2012)to 30%(95%CI:25-34%)post-MDA(2013-2020),although statistically not significant(p=0.45).A lumbricoides was the predominant species with a prevalence of 17%.Conclusion:Southern Nations Nationalities and Peoples Region,Amhara,and Oromia regions carry the highest-burden and are categorized to Moderate Risk Zones(MRZ)and therefore,requiring MDA once annually with Albendazole or Mebendazole.The prevalence of STHs decreased after MDA compared to before MDA,but the decline was not statistically significant.A.lumbricoides was the predominant species of STHs among preschool and school-age children in Ethiopia.The high prevalence of STHs observed in this review,underscores the need for better control and prevention strategies in Ethiopia.

Prevalence, Pattern and Risk Factors of Soil Transmitted Helminth Infections amongst Children in a Tertiary Institution in South East, Nigeria

Introduction: Soil-transmitted helminthic infection (STHI) is a common public health challenge of children in the most deprived communities in low income countries. In the long-term, STHI can cause developmental and growth disorders leading to future learning defect. Objective: Our aim was to determine the prevalence and pattern of soil-transmitted helminthic infection among children attending a tertiary hospital in Imo State, Nigeria. Patients and Method: The study involved a cross-sectional survey of 268 children, aged 7 months to 18 years seen in a tertiary health facility in Nigeria;from August to December 2022. Data were collected using a structured questionnaire and stool samples were analyzed for intestinal helminths using the Kato-Katz method. Results: The prevalence of soil-transmitted helminthic infection (STHI) was 38.4%. Of all STHIs, Ascaris lumbricoides was the commonest geohelminth observed, 81 (62.1%). Multiple infections were noted in 25 (62.4%) of the specimen. The prevalence of soil-transmitted helminthic infection amongst subjects’ 5 - 9 years was high and least in children older than 15 years. This difference was not statistically significant (p = 0.3407). Statistically significant relationship was detected between STHI and low socioeconomic class. Conclusion: The high prevalence rate of soil-transmitted helminthic infection amongst the subjects is disturbing. This high rate justifies strengthening a structured and routine deworming amongst children in order to improve outcome.

A Survey on Poultry Helminth Infection in Golestan Province （North of Iran）

Poultry breeding in a traditional and open environment will carry a great potential of causing parasitic infections in poultry At the present study, 110 domestic poultry were gathered randomly from wet areas （Gorgan, Minoodasht, Azadshahr, Ali Abad Katool, Kalaleh, Galikesh） and dry areas （Gonbad Kavoos, Agh Ghala） of Golestan province in 1388s. After dissecting, their bronchial tube and digestive system were examined for presenting of parasitic helminthes. Consequently, the rate of parasitic infection in domestic poultry was 92.73% which comprised： Heterakis gallinarum （18.18%）, Subulura brumpti （7.27%）, Acuaria spiralis （15.45%）, Capillaria sp （1.81%）, Ascaridia galli （48.18%）, Syngamus trachea （15.45%）, Syngamus trachea sp （2.73%）, Choanotaenia infundibulum （11.81%）, Raillietina tetragona （53.63%）, Raillietina cesticyllus （14.45%）, Raillietina echinobothrida （25.45%） Drepanidotaenia lanceolata （1.81%）. It is also necessary to cite that there is no relevance between helminth infection and age （P = 0.178）, species （P = 0.278） and geographical zone （P = 0.504）. Therefore, in order to reduce the parasitic infection, performing a directorial system beside the efforts for reducing its potentiality is extremely necessary.

Soil-transmitted helminths detected from environmental samples in a campus of southern Brazil

Soil harbours enormous biodiversity,essential for maintaining environmental and human health.However,soil can also be a reservoir of various parasitic pathogens,such as soil-transmitted helminths(STH).We evaluated the presence of STH(e.g.,hookworms,roundworms and whipworms)in soil samples collected at twenty points within the perimeter of Campus do Vale(a university campus belonging to the Federal University of Rio Grande do Sul-UFRGS),during 2022 winter season.Considering the One Health perspective,human,animal and environmentrelated data from each sampling point were collected.All soil samples showed nematode larvae,representing natural components of soil biodiversity.Considering STH eggs,35%(n=7)of soil samples showed hookworm eggs(e.g.,from Necator americanus or Ancylostoma duodenale),10%(n=2)showed roundworm(Ascaris lumbricoides)eggs,and 5%(n=1)showed whipworm(Trichuris trichiura-like)eggs.Of note,10%of the sampling points showed the presence of rhabditiform hookworm larvae,5%showed Strongyloides stercoralis rhabditiform larvae and 5%had the presence of filariform hookworm larvae,indicating a risk of human percutaneous infection.The significant people circulation in Campus do Vale,in association with other environment-related factors,help to explain the prevalence of STH observed in this study.

Policy stakeholder perspectives on barriers and facilitators to launching a community-wide mass drug administration program for soil-transmitted helminths

Background:Recent evidence suggests that soil-transmitted helminth(STH)transmission interruption may be feasible through community-wide mass drug administration(cMDA)that deworms community members of all ages.A change from school-based deworming to cMDA will require reconfiguring of STH programs in endemic countries.We conducted formative qualitative research in Benin,India,and Malawi to identify barriers and facilitators to successfully launching a cMDA program from the policy-stakeholder perspective.Methods:We conducted 40 key informant interviews with policy stakeholders identified as critical change agents at national,state/district,and sub-district levels.Participants included World Health Organization country office staff,implementing partners,and national and sub-national government officials.We used the Consolidated Framework for Implementation Research to guide data collection,coding,and analysis.Heat maps were used to organize coded data and differentiate perceived facilitators and barriers to launching cMDA by stakeholder.Results:Key facilitators to launching a cMDA program included availability of high-quality,tailored sensitization materials,and human and material resources that could be leveraged from previous MDA campaigns.Key barriers included the potential to overburden existing health workers,uncertainty of external funding to sustain a cMDA program,and concerns about weak intragovernmental coordination to implement cMDA.Cross-cutting themes included the need for rigorous trial evidence on STH transmission interruption to gain confidence in cMDA,and implemen-tation evidence to effectively operationalize cMDA.Importantly,if policy stakeholders anticipate a cMDA program cannot be sustained due to cost and human resource barriers in the long term they may be less likely to support the launch of a program in the short term.Conclusions:Overall,policy stakeholders were optimistic about implementing cMDA primarily because they believe that the tools necessary to successfully implement cMDA are already available.Policy stakeholders in this study were cautiously optimistic about launching cMDA to achieve STH transmission interruption and believe that it is feasible to implement.However,launching cMDA as an alternative policy to school-based deworming will require addressing key resource and evidence barriers.

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.

Comparative assessment of intestinal helminths prevalence in Water,Sanitation and Hygiene(WASH) intervention and non-intervention communities in Abeokuta,Nigeria

Objective:This study compared the prevalence of intestinal helminths in Water,Sanitation and Hygiene(WASH) intervention and non-intervention communities in Abeokuta,Nigeria.Methods:Stool samples were collected from 225 respondents in a study carried out between July and November,2014.Stool samples were examined for presence of helminths using Formol-Ether concentration method.Data collected from stool samples were analyzed using SPSS for Windows(version 16).Results:Results showed that,at the intervention community,88 out of 113 respondents were infected with at least one helminth infection while at non-intervention community,80 out of 112 respondents were infected.This result revealed overall helminth prevalence of78% at Mawuko and 71% at Isolu.In both intervention(Mawuko) and non-intervention(Isolu) communities,hookworm was the most prevalent helminth observed(21% and18%,respectively) followed by Ascaris lumbricoides(13% and 13%,respectively),Taenia sp.(4% and 3%,respectively) and Trichostrongylus sp.(1% and 3%,respectively).Cases of single infections of Trichuris trichiura,Strongyloides stercoralis and Hymenolepsis nana were observed only at the non-intervention community.However,S.stercoralis occurred in the multiple infections observed at the intervention community.Significantly more(p < 0.05) cases of infections were observed in male(46%) at the intervention community than female(31%) while in non-intervention community females(39%) were significantly(p < 0.05) more infected than their male counterparts(32%).Conclusions:This study concludes that the Community Led-Total Sanitation intervention programme,which was executed in Mawuko was not effective as expected.

Ancylostoma ceylanicum and other zoonotic canine hookworms:neglected public and animal health risks in the Asia-Pacific region

Zoonotic hookworm infections remain a significant public health problem,causing nearly 500 milion cases globally and approximately four million disability-adjusted life years lost annually.More than one-fth of these cases are attrib-uted to Ancylostoma ceylanicum,an emerging zoonotic health issue in the Asia-Pacific region.This review presents key research gaps regarding the epidemiology,diagnosis,control,prevention and elimination of A.ceylanicum and other canine zoonotic hookworms as neglected health threats.A.ceylanicum is the second most prevalent human hook-worm in the region;it is the most common hookworm among dogs and cats-reservoirs of zoonotic infections.Previous population genetic and phylogenetic analyses revealed that A.ceylanicum has three possible transmis-sion dynamics:zoonotic,animal-only,and human-only pathways.The actual burden of zoonotic ancylostomiasis in most endemic countries remains unknown due to the use of parasitological techniques(e.g.,Kato-Katz thick smear and floatation techniques)that have reduced diagnostic performance and do not allow accurate species identifica-tion in helminth surveys.The emergence of benzimidazole resistance in soil-transmitted helminths(STHs),includ-ing hookworms,is a concern due to the protracted implementation of mass drug administration(MDA).Resistance is conferred by single nucleotide polymorphisms(SNPs)that occur in theβ-tubulin isotype 1 gene.These mutations have been reported in drug-resistant A.caninum but have not been found in A.ceylanicum in the field.A.ceylanicum remains understudied in the Asia-Pacific region.The zoonotic nature of the parasite warrants investigation of its occur-rence in human and animal reservoir hosts to understand the dynamics of zoonotic transmission in different endemic foci.The detection of benzimidazole resistance-associated SNPs in zoonotic hookworms from Asia-Pacific countries has yet to be thoroughly explored.Considering the high level of hookworm endemicity in the region,the circulation of resistant isolates between humans and animals potentially presents a significant One Health threat that can under-mine current MDA and proposed animal deworming-based control efforts.

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 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.

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.

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.

Distinct clinical characteristics and helminth co-infections in adult tuberculosis patients from urban compared to rural Tanzania

Background:Differences in rural and urban settings could account for distinct characteristics in the epidemiology of tuberculosis(TB).We comparatively studied epidemiological features of TB and helminth co-infections in adult patients from rural and urban settings of Tanzania.Methods:Adult patients(≥18 years)with microbiologically confirmed pulmonary TB were consecutively enrolled into two cohorts in Dar es Salaam,with~4.4 million inhabitants(urban),and Ifakara in the sparsely populated Kilombero District with~400000 inhabitants(rural).Clinical data were obtained at recruitment.Stool and urine samples were subjected to diagnose helminthiases using Kato-Katz,Baermann,urine filtration,and circulating cathodic antigen tests.Differences between groups were assessed byχ2,Fisher’s exact,and Wilcoxon rank sum tests.Logistic regression models were used to determine associations.Results:Between August 2015 and February 2017,668 patients were enrolled,460(68.9%)at the urban and 208(31.1%)at the rural site.Median patient age was 35 years(interquartile range[IQR]:27-41.5 years),and 454(68%)were males.Patients from the rural setting were older(median age 37 years vs.34 years,P=0.003),had a lower median body mass index(17.5 kg/m2 vs.18.5 kg/m2,P<0.001),a higher proportion of recurrent TB cases(9%vs.1%,P<0.001),and in HIV/TB co-infected patients a lower median CD4 cell counts(147 cells/μl vs.249 cells/μl,P=0.02)compared to those from urban Tanzania.There was no significant difference in frequencies of HIV infection,diabetes mellitus,and haemoglobin concentration levels between the two settings.The overall prevalence of helminth co-infections was 22.9%(95%confidence interval[CI]:20.4-27.0%).The significantly higher prevalence of helminth infections at the urban site(25.7%vs.17.3%,P=0.018)was predominantly driven by Strongyloides stercoralis(17.0%vs.4.8%,P<0.001)and Schistosoma mansoni infection(4.1%vs.16.4%,P<0.001).Recurrent TB was associated with living in a rural setting(adjusted odds ratio[aOR]:3.97,95%CI:1.16-13.67)and increasing age(aOR:1.06,95%CI:1.02-1.10).Conclusions:Clinical characteristics and helminth co-infections pattern differ in TB patients in urban and rural Tanzania.The differences underline the need for setting-specific,tailored public health interventions to improve clinical management of TB and comorbidities.