Soil-Transmitted Helminthiases (STH) and Deworming

描述（由申请人提供）：拟议的热带医学中心的基本目标是改善人口的健康，特别是那些在世界上被忽视的热带疾病流行地区，通过开展和促进跨学科的研究卓越。其具体目标包括：i）促进和开展热带医学的高质量基础、临床和流行病学研究; ii）参与与当地、国家和国际研究人员的合作研究; iii）致力于培训和指导学生和初级研究人员。这一使命和目标的第一批具体例子体现在三个拟议的研究项目中，这些项目侧重于在被忽视的热带疾病中造成最大疾病负担的三种疾病，土壤传播的蛔虫病、钩虫病和鞭虫病的蠕虫病。这些疾病是秘鲁亚马逊地区的高度地方病，拟议的热带医学中心将设在该地区。每个研究项目都解决了高风险群体（即，学龄前儿童、学龄儿童和育龄妇女），以便世界卫生组织等全球机构和国家当局（及其合作伙伴）能够立即使用结果，为卫生政策和干预措施提供信息 驱虫策略最终，这项研究将有助于减少由土壤传播的蠕虫病引起的发病率，死亡率和残疾，据估计，目前影响着世界各地生活在资源贫乏社区的20亿人。 相关性：拟议的热带医学中心将设在秘鲁的亚马逊地区，将是一个以被忽视的热带疾病为重点的基础、临床和流行病学研究的高级研究中心。由于土壤传播蠕虫引起的疾病负担很高，这一系列疾病将构成新中心的首个研究重点。 项目一：通过在综合儿童保健中推广驱虫来改善资源贫乏的低收入国家儿童的生长和发育 项目负责人（PL）：Casapia，M. 描述（由申请人提供）：学龄前儿童是土壤传播蠕虫感染（STH）所致发病率的三个高危人群之一。在这个年龄，最重要的STH感染是蛔虫和鞭虫感染。世卫组织建议学龄前儿童从12个月开始驱虫，但没有经验证据表明何种驱虫接触（在给药年龄和给药频率方面）对健康最有益。因此，本研究项目建议跟踪一组学龄前儿童，这些儿童已知在12至24个月之间有不同的驱虫剂暴露史。通过对这些儿童进行长达5岁的随访，将测量累积的健康益处，并确定最佳的驱虫策略。预计这些健康益处将延伸到儿童后期及以后。研究结果还将用于为全球性病流行地区的驱虫卫生政策和战略提供信息。 相关性：12至24个月大的婴儿有一个重要的机会之窗，此时健康和营养干预措施在短期和长期健康方面都发挥着至关重要的作用。是 衡量这种健康影响非常重要，不仅因为它填补了研究空白，而且还因为它是项目经理和其他合作伙伴的有用反馈。在对5岁以下儿童的跟踪研究中，这项队列研究将为以下方面的健康影响提供关键的经验证据： 不同的驱虫策略针对这个高风险的年龄。

DESCRIPTION (provided by applicant): The essential goal of the proposed Tropical Medicine Center is to improve the health of populations, especially those in neglected tropical disease-endemic regions of the world, by undertaking and promoting interdisciplinary research excellence. Its specific objectives include: i) the promotion and conduct of high quality basic, clinical and epidemiological research in tropical medicine; ii) engagement in collaborative research with local, national and international researchers; and iii) commitment to the training and mentoring of students and junior investigators. The first concrete examples of this mission and objectives are illustrated in the three proposed research projects which focus on three diseases causing the highest burden of disease among the neglected tropical diseases, i.e., the soil-transmitted helminthiases of ascariasis, hookworm disease and trichuriasis. These diseases are highly endemic in the Amazon region of Peru where the proposed Tropical Medicine Center will be situated. Each research project addresses important research gaps in a high-risk group (i.e., preschool-age children, school-age children and women of reproductive age) such that results will be able to be used immediately by global agencies like the World Health Organization and national authorities (and their partners) to inform health policy and intervention strategy on deworming. Ultimately, this research will contribute to reducing the morbidity, mortality and disability caused by the soil-transmitted helminthiases which currently are estimated to affect two billion people living in resource-poor communities around the world. RELEVANCE: The proposed Tropical Medicine Center will be based in the Amazon region of Peru and will be a center of research excellence in basic, clinical and epidemiological research focusing on neglected tropical diseases. Because of the high burden of disease caused by the soil-transmitted helminthiases, this cluster of diseases will constitute the inaugural research focus of the new Center. Project 1: Improving Childhood Growth and Development in Resource-Poor LMICs with Deworming by Incorporating Deworming in Integrated Child Health Care Project Leader (PL): Casapia, M. DESCRIPTION (provided by applicant): Preschool-age children are one of the three high risk groups for morbidity attributable to soil-transmitted helminth infections (STH). At this age, the STH infections of most importance are Ascaris and Trichuris infections. WHO recommends deworming of preschool-age children as of 12 months of age, but there is no empirical evidence on what deworming exposure (in terms of age at administration and frequency of administration) has the most beneficial impact on health. This research project therefore proposes to follow a cohort of preschool-age children who are known to have had different deworming exposure histories between 12 and 24 months of age. By following these children up to five years of age, cumulative health benefits will be measured and the optimal deworming strategy identified. It is expected that these health benefits will extend into later childhood and beyond. Research results will also be used to inform deworming health policy and strategies in STH-endemic regions globally. RELEVANCE: An important window of opportunity exists between 12 and 24 months of age when health and nutrition interventions play a vital role in both short and long term health. It is important to measure this health impact, not only because it fills a research gap, but also because it is useful feedback for program managers, and other partners. In following children up to five years of age, this cohort study will provide key empirical evidence on the health impact of different deworming strategies targeted to this high risk age.