Regional, household and individual factors that influence soil transmitted helminth reinfection dynamics in preschool children from rural indigenous Panamá.
Regional, household and individual factors that influence soil transmitted helminth reinfection dynamics in preschool children from rural indigenous Panamá.
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DOI：
10.1371/journal.pntd.0002070
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发表时间：
2013
影响因子：
3.8
通讯作者：
Scott ME
中科院分区：
文献类型：
--
作者：
Halpenny CM;Paller C;Koski KG;Valdés VE;Scott ME
很少有研究调查个体易感性、家庭暴露因素和感染的区域聚集对土壤传播蠕虫(STH)传播的相对影响。本研究调查了巴拿马农村一个极端贫困的土著环境中蛔虫、鞭虫和钩虫的再感染动态和空间聚集性，历时16个月，包括学龄前儿童的两个治疗和再感染周期。空间聚类分析被用来确定每种线虫的高流行集群。然后使用多变量模型(1)确定区分群内和群外家庭的因素，以及(2)检验区域(在高发群组中的存在)、家庭(家庭密度、基于资产的家庭财富、家庭拥挤、产妇教育)和个人(年龄、性别、每克处理前粪便含蛋量(EPG)、身高、厕所使用)因素对每个STH学龄前儿童再感染EPG的相对贡献。检测到鞭虫和钩虫的高流行空间聚集性，但没有蛔虫的高流行空间集群。这些集群的特点是家庭密度低，家庭财富指数(HWI)低。钩虫、蛔虫再感染EPG与治疗前EPG呈正相关，且发育迟缓儿童EPG高于治疗前。其他个人(使用厕所)和家庭变量(HWI、母亲教育)进入了蛔虫的再感染模型，但没有进入钩虫的再感染模型。即使在这一偏远农村地区赤贫的背景下，钩虫、鞭虫和蛔虫的独特传播模式也突显了多管齐下的干预战略的必要性。除减贫外，改善卫生条件和关注慢性营养不良将是减少蛔虫和钩虫传播的关键。控制土壤传播蠕虫(STH)感染对改善学龄前儿童健康至关重要，因为这些感染可对生长和发育产生长期后果。我们对巴拿马西部的土著Ngäbe学龄前儿童进行了为期16个月的研究。我们监测了三种STH感染(蛔虫、鞭虫和钩虫)在两个再感染周期中的再感染动态，以了解影响这些感染在学龄前儿童中传播的地区、家庭和个人因素。尽管在农村，几乎所有家庭都生活在极端贫困的条件下，但我们发现，鞭虫和钩虫在最偏远和最贫穷的地区高度流行，而蛔虫在整个研究地区都存在。长期营养不良(低身高)的学龄前儿童有较高的蛔虫和钩虫再感染负担。家庭贫困(相对家庭财富和母亲受教育程度较低)和不经常使用厕所也是蛔虫再感染的影响因素。这项对贫困农村地区学龄前儿童性病传播的跨学科分析为旨在打破贫困和感染循环的性病控制项目提供了相关信息。
Few studies have investigated the relative influence of individual susceptibility versus household exposure factors versus regional clustering of infection on soil transmitted helminth (STH) transmission. The present study examined reinfection dynamics and spatial clustering of Ascaris lumbricoides, Trichuris trichiura and hookworm in an extremely impoverished indigenous setting in rural Panamá over a 16 month period that included two treatment and reinfection cycles in preschool children. Spatial cluster analyses were used to identify high prevalence clusters for each nematode. Multivariate models were then used (1) to identify factors that differentiated households within and outside the cluster, and (2) to examine the relative contribution of regional (presence in a high prevalence cluster), household (household density, asset-based household wealth, household crowding, maternal education) and individual (age, sex, pre-treatment eggs per gram (epg) feces, height-for-age, latrine use) factors on preschool child reinfection epgs for each STH. High prevalence spatial clusters were detected for Trichuris and hookworm but not for Ascaris. These clusters were characterized by low household density and low household wealth indices (HWI). Reinfection epg of both hookworm and Ascaris was positively associated with pre-treatment epg and was higher in stunted children. Additional individual (latrine use) as well as household variables (HWI, maternal education) entered the reinfection models for Ascaris but not for hookworm. Even within the context of extreme poverty in this remote rural setting, the distinct transmission patterns for hookworm, Trichuris and Ascaris highlight the need for multi-pronged intervention strategies. In addition to poverty reduction, improved sanitation and attention to chronic malnutrition will be key to reducing Ascaris and hookworm transmission. Control of soil transmitted helminth (STH) infections is of central importance to improving preschool child health because these infections can have long lasting consequences on growth and development. Our study in indigenous Ngäbe preschool children in western Panama was conducted over a period of 16 months. We monitored reinfection dynamics of three STH infections (Ascaris, Trichuris and hookworm) over two reinfection cycles to gain an understanding of regional, household and individual factors that influenced transmission of these infections among preschool children. Despite the rural setting, where virtually all households live under conditions of extreme poverty, we identified spatial clusters of high prevalence of Trichuris and hookworm in the most remote and poorest area, whereas Ascaris was present throughout the study area. Preschool children who were chronically malnourished (low height-for-age) had a higher reinfection burden of Ascaris and hookworm. Household poverty (low relative household wealth and maternal education) and infrequent latrine use were also influential in Ascaris reinfection. This cross-disciplinary analysis of preschool child STH transmission in a poor rural setting provides pertinent information for STH control programs that aim to break the cycle of poverty and infection.