Prevalence, risk factors and health consequences of soil-transmitted helminth infection on the Bijagos Islands, Guinea Bissau: A community-wide cross-sectional study.
Prevalence, risk factors and health consequences of soil-transmitted helminth infection on the Bijagos Islands, Guinea Bissau: A community-wide cross-sectional study.
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DOI：
10.1371/journal.pntd.0008938
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发表时间：
2020-12
影响因子：
3.8
通讯作者：
Last A
中科院分区：
文献类型：
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作者：
Farrant O;Marlais T;Houghton J;Goncalves A;Teixeira da Silva Cassama E;Cabral MG;Nakutum J;Manjuba C;Rodrigues A;Mabey D;Bailey R;Last A
土壤传播的蠕虫(STH)是撒哈拉以南非洲的地方病和广为流行的疾病。使用Kato-Katz显微镜和qPCR方法在几内亚比绍的Bubaque岛进行了社区范围的土壤传播蠕虫(STH)流行调查。通过多变量Logistic回归确定感染的预测因素和发病率指标，并使用k统计量比较诊断方法。在396名参与者中，镜检STH的患病率为23.2%，钩虫是唯一一种，平均感染强度为每克312个虫卵。定量聚合酶链式反应分析显示，所有STH感染的总患病率为47.3%，其中以十二指肠弯曲杆菌为主(32.3%)，其次是美洲奈瑟氏菌(15.01%)和司氏葡萄球菌(13.2%)。伦氏吸虫和毛滴虫的感染率可以忽略不计，分别为0.25%。诊断试验之间的一致性为k=0.22，被解释为相当一致，两种方法测量的感染强度仅有极小的相关性(Rs=-0.03)。STH感染总体上在女性和31-40岁的成年人中更为常见。STH感染与露天排便、社会经济地位低和离水源较远有关。根据世卫组织的儿童生长标准，贫血(按世卫组织的年龄和性别标准定义为二元结果)的患病率为69.1%，44.2%的儿童营养不良。钩虫粪卵计数法检测钩虫感染强度与年龄(0.06卢比)无统计学相关性，而qPCR循环阈值法检测粪便钩虫感染强度学龄前儿童更高(Rs=0.30，p值0.03)。STH感染与儿童贫血(OR1.0p=0.8)、发育迟缓(OR1.9，p值0.5)和消瘦(OR2.0，p值0.2)无统计学意义。这项研究揭示了STH感染在整个社区持续存在，贫血和营养不良的比率很高，尽管学龄前儿童大量服用甲苯咪唑的覆盖率很高。这反映出需要一种新的战略来控制土壤传播的蠕虫，以减少感染并最终消除传播。迄今为止，世卫组织通过定期大规模给药(MDA)控制性病的总体目标是通过降低学龄儿童的感染强度来控制发病率。这一方法的主要局限性是再感染率很快，既来自卫生条件差地区的环境，也来自未被纳入丙型肝炎方案的成年人的持久性蓄水池。由于这一限制，有人呼吁通过在社区范围内驱虫来打破传播循环，将总体目标从发病率控制转变为完全消除性传播感染。然而，由于所使用的诊断方法的局限性，缺乏与STH有关的成人流行病学数据，此外，大多数调查排除了斯特氏类圆线虫。我们的研究旨在提供5岁以下儿童性病流行情况、个人和家庭感染危险因素以及与贫血和营养不良的关系的最新流行病学数据。从提供粪便样本的396名参与者中，我们发现STH感染的高流行率，主要是钩虫十二指肠钩虫，在所有年龄组和性别中都是如此。在这项研究中，STH感染和露天排便之间存在明显的关联，使用保护坑厕所可以防止感染。贫血和营养不良的发生率很高，与STH感染之间没有统计学意义的关联，可能是多因素的。这项研究发现，尽管甲苯咪唑丙二醛覆盖率很高，STH感染的发病率很高，而且STH感染和卫生条件不佳之间存在明显的联系，但STH感染仍然存在。这反映了进一步干预性研究的需要，以评估降低发病率和打破STH在该人群中传播周期的最佳策略。
Soil-transmitted helminths (STH) are endemic and widespread across Sub-Saharan Africa. A community wide soil-transmitted helminth (STH) prevalence survey was performed on the island of Bubaque in Guinea-Bissau using both Kato-katz microscopy and qPCR methodology. Predictors of infection and morbidity indicators were identified using multivariable logistic regression, and diagnostic methods were compared using k statistics. Among 396 participants, prevalence of STH by microscopy was 23.2%, hookworm was the only species identified by this method and the mean infection intensity was 312 eggs per gram. qPCR analysis revealed an overall prevalence of any STH infection of 47.3%, with the majority A. duodenale (32.3%), followed by N. americanus (15.01%) and S. stercoralis (13.2%). A. lumbricoides, and T. trichiura infections were negligible, with a prevalence of 0.25% each. Agreement between diagnostic tests was k = 0.22, interpreted as fair agreement, and infection intensity measured by both methods was only minimally correlated (Rs = -0.03). STH infection overall was more common in females and adults aged 31–40. STH infection was associated with open defaecation, low socio-economic status and further distance to a water-source. The prevalence of anaemia (defined as a binary outcome by the WHO standards for age and sex) was 69.1%, and 44.2% of children were malnourished according to WHO child growth standards. Hookworm infection intensity by faecal egg count showed no statistically significant association with age (Rs 0.06) but S. Stercoralis infection intensity by qPCR cycle threshold was higher in pre-school aged children (Rs = 0.30, p-value 0.03) There was no statistically significant association between STH infection and anaemia (OR 1.0 p = 0.8), stunting (OR 1.9, p-value 0.5) and wasting (OR 2.0, p-value 0.2) in children. This study reveals a persistent reservoir of STH infection across the community, with high rates of anaemia and malnutrition, despite high-coverage of mebendazole mass-drug administration in pre-school children. This reflects the need for a new strategy to soil-transmitted helminth control, to reduce infections and ultimately eliminate transmission. To date, the overall aim of the WHO policy of STH control through periodic mass-drug administration (MDA) has been morbidity control through a reduction in infection intensity in school-aged children. The main limitation of this approach is the rapid re-infection rate, both from the environment in areas with poor sanitation, and the persistent reservoir in adults who are not included in the MDA programme. As a consequence of this limitation, there have been calls to change the overall aim from morbidity control to the elimination of STH infection altogether by breaking the transmission cycle through community-wide deworming. However, there is a dearth of epidemiological data pertaining to adults in relation to STH and in addition, most surveys exclude the helminth Strongyloides stercoralis, due to limitations of the diagnostic methods used. Our study aims to provide up-to-date epidemiological data of STH prevalence, individual and household risk-factors for infection and the association with anaemia and malnutrition in children under 5 years. From 396 participants who provided a stool sample, we found a high prevalence of STH infection, predominantly the hookworm Ancylostoma duodenale, across all age-groups and both sexes. There was a clear association between STH infection and open defaecation in this study, with use of a protected pit latrine protective against infection. There were high rates of anaemia and malnutrition which had no statistically significant association with STH infection, and are likely multifactorial. This study uncovered an ongoing reservoir of STH infection despite high coverage with mebendazole MDA, high rates of morbidity alongside the STH infection and a clear association between STH infection and inadequate sanitation. This reflects the need for further interventional research to assess the optimum strategy to alleviate morbidity and break the STH transmission cycle in this population.
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DOI：
10.1046/j.1365-3156.1997.d01-180.x
发表时间：
1997-11-01
影响因子：
3.3
作者：
ManunEbo, M;Cousens, S;Kirkwood, B
通讯作者：
Kirkwood, B
影响因子：
158.5
作者：
Calis, Job C. J.;Phiri, Kamija S.;van Hensbroek, Michael Boele
通讯作者：
van Hensbroek, Michael Boele
全球流行病学，生态学和控制土壤传播的蠕虫感染。
影响因子：
--
作者：
Brooker, S.;Clements, A. C. A.;Bundy, D. A. P.
通讯作者：
Bundy, D. A. P.
影响因子：
1.9
作者：
LANDIS, JR;KOCH, GG
通讯作者：
KOCH, GG
DOI：
10.4269/ajtmh.13-0268
发表时间：
2014-03
期刊：
The American journal of tropical medicine and hygiene
影响因子：
--
作者：
Knopp S;Salim N;Schindler T;Karagiannis Voules DA;Rothen J;Lweno O;Mohammed AS;Singo R;Benninghoff M;Nsojo AA;Genton B;Daubenberger C
通讯作者：
Daubenberger C