Effect of Poor Access to Water and Sanitation As Risk Factors for Soil-Transmitted Helminth Infection: Selectiveness by the Infective Route.
Effect of Poor Access to Water and Sanitation As Risk Factors for Soil-Transmitted Helminth Infection: Selectiveness by the Infective Route.
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DOI：
10.1371/journal.pntd.0004111
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发表时间：
2015-09
影响因子：
3.8
通讯作者：
Krolewiecki AJ
中科院分区：
文献类型：
--
作者：
Echazú A;Bonanno D;Juarez M;Cajal SP;Heredia V;Caropresi S;Cimino RO;Caro N;Vargas PA;Paredes G;Krolewiecki AJ
土源性蠕虫 (STH) 感染是全球资源有限环境中的一个公共卫生问题。慢性 STH 感染会损害最佳学习和生产力，导致贫困-疾病循环的长期存在。定期大量给药（MDA）是控制其的主要建议；以及水、环境卫生和个人卫生 (WASH) 干预措施。联合 WASH 干预措施对 STH 感染的影响已有报道；需要对 WASH 组成部分的独立影响进行研究，以有助于改进当前控制 STH 的建议。本研究的目的是评估缺乏水和卫生设施与 STH 感染的关系，同时考虑到物种间感染途径的差异以及家庭是否有足够的水和卫生设施。横断面研究，在阿根廷萨尔塔省进行。在一项招募了 6957 人的驱虫计划中；随机抽取 771 例进行粪便/血清取样，用于 STH 的寄生虫学和血清学诊断。采用双变量分层分析来探讨危险因素与 STH 感染之间的显着相关性，按皮肤穿透性（钩虫和粪类圆线虫）与口服摄入（蛔虫和毛虫）的进入机制分组。在控制了潜在的混杂因素后，未改善的卫生条件与皮肤穿透者感染几率的增加显着相关（调整后的比值比 [aOR] = 3.9；95% CI：2.6–5.9）。未经改善的饮用水与经口摄入的感染几率增加显着相关（aOR = 2.2；95% CI：1.3–3.7）。缺乏安全水和适当的卫生设施会带来 STH 感染的风险，根据每种 STH 物种进入人类宿主的途径，这种风险是不同的。控制 STH 的建议中应强调旨在改善水和卫生设施获取的干预措施。土源性蠕虫（STH）是一组与公共卫生密切相关的人类寄生感染，因为它们的患病率很高，并且在感染强度高的情况下可能会造成严重的发病率，特别是在贫困地区。常见的 STH 种类包括蛔虫、毛鞭虫、钩虫（十二指肠钩虫和美洲钩虫）和粪类圆线虫。它们的生命周期包括在土壤中的强制性传播，在那里它们成熟并能够将感染传播给新宿主。根据物种的不同，可以区分两种感染途径：口服虫卵和来自粪便污染土壤的幼虫通过皮肤渗透。卫生设施不足和供水不安全被认为是 STH 感染的危险因素；然而，需要更多关于这种关系的数据。控制 STH 的主要策略是通过大规模药物管理定期驱虫。对水、环境卫生和个人卫生 (WASH) 以及健康教育的干预对于维持驱虫治疗的益处也很重要。本研究报告了卫生条件差和供水与选择性寄生虫进入途径的 STH 感染之间的关联。这一发现可能有助于设计具体合理的建议，以减少土源性蠕虫的传播。
Soil-transmitted helminth (STH) infections are a public health problem in resource-limited settings worldwide. Chronic STH infection impairs optimum learning and productivity, contributing to the perpetuation of the poverty-disease cycle. Regular massive drug administration (MDA) is the cardinal recommendation for its control; along with water, sanitation and hygiene (WASH) interventions. The impact of joint WASH interventions on STH infections has been reported; studies on the independent effect of WASH components are needed to contribute with the improvement of current recommendations for the control of STH. The aim of this study is to assess the association of lacking access to water and sanitation with STH infections, taking into account the differences in route of infection among species and the availability of adequate water and sanitation at home. Cross-sectional study, conducted in Salta province, Argentina. During a deworming program that enrolled 6957 individuals; 771 were randomly selected for stool/serum sampling for parasitological and serological diagnosis of STH. Bivariate stratified analysis was performed to explore significant correlations between risk factors and STH infections grouped by mechanism of entry as skin-penetrators (hookworms and Strongyloides stercoralis) vs. orally-ingested (Ascaris lumbricoides and Trichuris trichiura). After controlling for potential confounders, unimproved sanitation was significantly associated with increased odds of infection of skin-penetrators (adjusted odds ratio [aOR] = 3.9; 95% CI: 2.6–5.9). Unimproved drinking water was significantly associated with increased odds of infection of orally-ingested (aOR = 2.2; 95% CI: 1.3–3.7). Lack of safe water and proper sanitation pose a risk of STH infections that is distinct according to the route of entry to the human host used by each of the STH species. Interventions aimed to improve water and sanitation access should be highlighted in the recommendations for the control of STH. Soil-transmitted helminths (STH) are a group of parasitic human infections of great public health relevance due to their high prevalence and potentially severe morbidity in case of heavy infection intensity, especially in poor settings. Common species of STH include Ascaris lumbricoides, Trichuris trichiura, Hookworm (Ancylostoma duodenale and Necator americanus) and Strongyloides stercoralis. Their life cycle includes an obligatory passage on soil, where they mature becoming capable of transmitting the infection to a new host. Two infective routes can be distinguished according to the species, oral ingestion of eggs versus skin penetration of larvae from fecally contaminated soil. Inadequate sanitation and unsafe water supply were described as risk factors for STH infections; however more data on this relationship is needed. The main strategy for STH control is the regular deworming, through mass drug administration. Interventions on water, sanitation and hygiene (WASH) and health education are also important to sustain the benefits of anthelmintic therapy. The present study reports an association between poor sanitation and water access and STH infections selective to the parasite route of entry. This finding could contribute to the design of specific and rational recommendations to reduce soil-transmitted helminths transmission.