Efficacy of integrated school based de-worming and prompt malaria treatment on helminths-Plasmodium falciparum co-infections: A 33 months follow up study
Efficacy of integrated school based de-worming and prompt malaria treatment on helminths-Plasmodium falciparum co-infections: A 33 months follow up study
复制标题
DOI：
10.1186/1472-698x-11-9
复制
发表时间：
2011-06-22
影响因子：
3
通讯作者：
Mduluza, Takafira
中科院分区：
文献类型：
--
作者：
Midzi, Nicholas;Mtapuri-Zinyowera, Sekesai;Mduluza, Takafira
背景资料：蠕虫和恶性疟原虫分布的地理一致性使得多寄生在撒哈拉以南非洲成为一种常见现象。蠕虫-疟原虫混合感染对小学生健康的破坏性影响引起了全球对综合控制的兴趣。然而，对蠕虫-疟原虫综合控制策略的可行性、时机和有效性知之甚少。在津巴布韦进行了一项研究，以评估重复结合学校为基础的驱虫和及时疟疾treatment.Methods的疗效：一个队列的小学生（5-17岁）接受吡喹酮，阿苯达唑治疗的基线，并再次在6，12和33个月的随访调查和持续及时疟疾治疗。在整个研究期间进行了持续及时的疟疾治疗。在基线和每个治疗点通过寄生虫学检查确定儿童的蠕虫、疟原虫和蠕虫-疟原虫合并感染的感染状况。S. haematobium，S.结果：纵向资料显示，吡喹酮和阿苯达唑每6个月联合治疗血吸虫病和STH 2次，并持续及时治疗疟疾，显著降低了血吸虫病和STH的总患病率。haematobium，S.曼氏、钩虫、恶性疟原虫感染率分别为73.5%、70.8%、67.3%、58.8%（P < 0.001、P <0.001、P < 0.001）。更重要的是，STH + β-内酰胺酶、P. f + β-内酰胺酶和P. f + STH + β-内酰胺酶合并感染的患病率分别降低了68.0%、84.2%和90.7%。在第12个月和第33个月随访调查之间缺乏抗蠕虫治疗导致STH+寄生虫体合并感染从第12个月随访调查时的3.3%急剧增加至10.7%，略高于基线水平（10.3%），而其他合并感染组合仍然显著较低。重度S. haematobium，S.曼氏疟原虫和钩虫感染强度分别从17.9-22.4%下降到2.6- 5.1%、1.6-3.3%下降到0.0%和0.0-0.7%下降到0.0%。结论：一年两次的以学校为基础的抗蠕虫和持续及时的疟疾治疗有可能减轻小学生蠕虫-疟原虫混合感染的负担。在疟疾传播稳定的地区，建议积极寻找病例，以跟踪和治疗无症状疟疾病例，因为这些病例可能在社区持续传播。
Background: The geographical congruency in distribution of helminths and Plasmodium falciparum makes polyparasitism a common phenomenon in Sub Saharan Africa. The devastating effects of helminths-Plasmodium co-infections on primary school health have raised global interest for integrated control. However little is known on the feasibility, timing and efficacy of integrated helminths-Plasmodium control strategies. A study was conducted in Zimbabwe to evaluate the efficacy of repeated combined school based antihelminthic and prompt malaria treatment.Methods: A cohort of primary schoolchildren (5-17 years) received combined Praziquantel, albendazole treatment at baseline, and again during 6, 12 and 33 months follow up surveys and sustained prompt malaria treatment. Sustained prompt malaria treatment was carried out throughout the study period. Children's infection status with helminths, Plasmodium and helminths-Plasmodium co-infections was determined by parasitological examinations at baseline and at each treatment point. The prevalence of S. haematobium, S. mansoni, STH, malaria, helminths-Plasmodium co-infections and helminths infection intensities before and after treatment were analysed.Results: Longitudinal data showed that two rounds of combined Praziquantel and albendazole treatment for schistosomiasis and STHs at 6 monthly intervals and sustained prompt malaria treatment significantly reduced the overall prevalence of S. haematobium, S. mansoni, hookworms and P. falciparum infection in primary schoolchildren by 73.5%, 70.8%, 67.3% and 58.8% respectively (p < 0.001, p < 0.001, p < 0.001, p < 0.001 respectively). More importantly, the prevalence of STH + schistosomes, P. f + schistosomes, and P. f + STHs + schistosomes co-infections were reduced by 68.0%, 84.2%, and 90.7%, respectively. The absence of anti-helminthic treatment between the 12 mth and 33 mth follow-up surveys resulted in the sharp increase in STHs + schistosomes co-infection from 3.3% at 12 months follow up survey to 10.7%, slightly more than the baseline level (10.3%) while other co-infection combinations remained significantly low. The overall prevalence of heavy S. haematobium, S. mansoni and hookworms infection intensities were significantly reduced from: 17.9-22.4% to 2.6-5.1%, 1.6-3.3% to 0.0% and 0.0-0.7% to 0.0% respectively.Conclusion: Biannual Integrated school based antihelminthic and sustained prompt malaria treatment has a potential to reduce the burden of helminths-plasmodium co-infections in primary school children. In areas of stable malaria transmission, active case finding is recommended to track and treat asymptomatic malaria cases as these may sustain transmission in the community.