The Interaction of Deworming, Improved Sanitation, and Household Flooring with Soil-Transmitted Helminth Infection in Rural Bangladesh.
The Interaction of Deworming, Improved Sanitation, and Household Flooring with Soil-Transmitted Helminth Infection in Rural Bangladesh.
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DOI：
10.1371/journal.pntd.0004256
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发表时间：
2015-12
影响因子：
3.8
通讯作者：
Colford JM Jr
中科院分区：
文献类型：
--
作者：
Benjamin-Chung J;Nazneen A;Halder AK;Haque R;Siddique A;Uddin MS;Koporc K;Arnold BF;Hubbard AE;Unicomb L;Luby SP;Addiss DG;Colford JM Jr
驱虫和改善环境卫生或个人卫生相结合可能会导致更大的减少土壤传播蠕虫（STH）感染比任何单一的干预措施本身。我们测量了孟加拉国农村的STH患病率，并评估了驱虫、卫生厕所和家庭装修地板之间的潜在相互作用。我们在孟加拉国农村的100个村庄进行了一项横断面调查（n = 1，630），以测量三种暴露：过去6个月自我报告的驱虫剂消费，卫生厕所的使用和家庭地板材料。我们收集了1-4岁、5-12岁儿童和15-49岁妇女的粪便样本。我们对保存的粪便样本进行了mini-FLOTAC，以检测蛔虫、蛲虫、钩虫和鞭虫卵。大约三分之一（32%）的人和40%的学龄儿童有STH感染。不到2%的样本有中度/重度感染。驱虫与较低的蛔虫患病率相关（校正患病率比（PR）= 0.53; 95% CI 0.40，0.71），但与钩虫（PR = 0.93，95% CI 0.60，1.44）或鞭虫（PR = 0.90，95% CI 0.74，1.08）无显著相关性。蛔虫、钩虫和鞭虫的卫生厕所使用PR分别为0.91（95%CI 0.67，1.24）、0.73（95%CI 0.43，1.24）和1.03（95%CI 0.84，1.27）。成品地板与较低的蛔虫患病率相关（PR = 0.56，95%CI 0.32，0.97），但与钩虫（PR = 0.48，95%CI 0.16，1.45）或鞭虫（PR = 0.98，95%CI 0.72，1.33）无关。在蠕虫和暴露组合中，联合暴露的调整后患病率始终比单独暴露更具保护性。我们在孟加拉国农村地区的儿童和育龄妇女中发现了中度STH患病率。这项研究是第一个检查独立和联合协会与驱虫，卫生和个人卫生。我们的研究结果表明，将驱虫与卫生和地板干预措施结合起来可能会更持久地降低STH的患病率。土壤传播的蠕虫感染在世界上许多低资源地区仍然普遍存在。世界卫生组织建议，在这些感染仍然普遍的国家，学童每年接受两次驱虫药物。然而，以前的研究表明，生活在这些感染常见的国家的人经常在服用驱虫药后6个月内再次感染。改善环境卫生和个人卫生的计划可能有助于补充驱虫计划，以减少再感染和预防传播。我们对孟加拉国农村的妇女和儿童进行了一项调查，以了解可能补充驱虫的卫生和个人卫生干预措施。我们发现，服用驱虫药并有卫生厕所的人比只服用驱虫药的人蠕虫感染率低。我们还发现，服用驱虫药的人和有一个完成地板的房子的人比只服用驱虫药的人患病率低。我们的研究结果表明，从长远来看，将驱虫与卫生和地板干预措施结合起来可能是减少STH传播的更成功的策略。
The combination of deworming and improved sanitation or hygiene may result in greater reductions in soil-transmitted helminth (STH) infection than any single intervention on its own. We measured STH prevalence in rural Bangladesh and assessed potential interactions among deworming, hygienic latrines, and household finished floors. We conducted a cross-sectional survey (n = 1,630) in 100 villages in rural Bangladesh to measure three exposures: self-reported deworming consumption in the past 6 months, access to a hygienic latrine, and household flooring material. We collected stool samples from children 1–4 years, 5–12 years, and women 15–49 years. We performed mini-FLOTAC on preserved stool samples to detect Ascaris lumbricoides, Enterobius vermicularis, hookworm, and Trichuris trichiura ova. Approximately one-third (32%) of all individuals and 40% of school-aged children had an STH infection. Less than 2% of the sample had moderate/heavy intensity infections. Deworming was associated with lower Ascaris prevalence (adjusted prevalence ratio (PR) = 0.53; 95% CI 0.40, 0.71), but there was no significant association with hookworm (PR = 0.93, 95% CI 0.60, 1.44) or Trichuris (PR = 0.90, 95% CI 0.74, 1.08). PRs for hygienic latrine access were 0.91 (95% CI 0.67,1.24), 0.73 (95% CI 0.43,1.24), and 1.03 (95% CI 0.84,1.27) for Ascaris, hookworm, and Trichuris, respectively. Finished floors were associated with lower Ascaris prevalence (PR = 0.56, 95% CI 0.32, 0.97) but not associated with hookworm (PR = 0.48 95% CI 0.16,1.45) or Trichuris (PR = 0.98, 95% CI 0.72,1.33). Across helminths and combinations of exposures, adjusted prevalence ratios for joint exposures were consistently more protective than those for individual exposures. We found moderate STH prevalence in rural Bangladesh among children and women of childbearing age. This study is one of the first to examine independent and combined associations with deworming, sanitation, and hygiene. Our results suggest that coupling deworming with sanitation and flooring interventions may yield more sustained reductions in STH prevalence. Soil-transmitted helminth infections remain prevalent in many low-resource areas of the world. The World Health Organization recommends that schoolchildren in countries where these infections remain common receive deworming medication two times a year. However, previous research has shown that people who live in countries where these infections are common are frequently reinfected within 6 months of taking deworming medication. Programs that improve sanitation and hygiene might help complement deworming programs to reduce reinfection and prevent transmission. We conducted a survey of women and children in rural Bangladesh to understand potential sanitation and hygiene interventions that could complement deworming. We found that people who took deworming medication and had access to a hygienic latrine had a lower worm infection prevalence than people who only took deworming medication. We also found that people who took deworming medication and had a house with a finished floor had a lower prevalence than people who only took deworming medication. Our results suggest that coupling deworming with sanitation and flooring interventions may be a more successful strategy for reducing STH transmission in the long run.