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Trippler L, Knopp S, Welsche S, Webster BL, Stothard JR, Blair L, Allan F, Ame SM, Juma S, Kabole F, Ali SM, Rollinson D, Pennance T. The long road to schistosomiasis elimination in Zanzibar: A systematic review covering 100 years of research, interventions and control milestones. ADVANCES IN PARASITOLOGY 2023; 122:71-191. [PMID: 37657854 DOI: 10.1016/bs.apar.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
Zanzibar is among the few places in sub-Saharan Africa where interruption of Schistosoma transmission seems an achievable goal. Our systematic review identifies and discusses milestones in schistosomiasis research, control and elimination efforts in Zanzibar over the past 100 years. The search in online databases, libraries, and the World Health Organization Archives revealed 153 records published between May 1928 and August 2022. The content of records was summarised to highlight the pivotal work leading towards urogenital schistosomiasis elimination and remaining research gaps. The greatest achievement following 100 years of schistosomiasis interventions and research is undoubtedly the improved health of Zanzibaris, exemplified by the reduction in Schistosoma haematobium prevalence from>50% historically down to<5% in 2020, and the absence of severe morbidities. Experiences from Zanzibar have contributed to global schistosomiasis guidelines, whilst also revealing challenges that impede progression towards elimination. Challenges include: transmission heterogeneity requiring micro-targeting of interventions, post-treatment recrudescence of infections in transmission hotspots, biological complexity of intermediate host snails, emergence of livestock Schistosoma species complicating surveillance whilst creating the risk for interspecies hybridisation, insufficient diagnostics performance for light intensity infections and female genital schistosomiasis, and a lack of acceptable sanitary alternatives to freshwater bodies. Our analysis of the past revealed that much can be achieved in the future with practical implementation of integrated interventions, alongside operational research. With continuing national and international commitments, interruption of S. haematobium transmission across both islands is within reach by 2030, signposting the future demise of urogenital schistosomiasis across other parts of sub-Saharan Africa.
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Affiliation(s)
- Lydia Trippler
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland.
| | - Stefanie Knopp
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | | | - Bonnie L Webster
- Natural History Museum, London, United Kingdom; London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | | | | | - Fiona Allan
- Natural History Museum, London, United Kingdom; London Centre for Neglected Tropical Disease Research, London, United Kingdom; University of St Andrews, St Andrews, United Kingdom
| | - Shaali Makame Ame
- Neglected Diseases Programme, Zanzibar Ministry of Health, Lumumba, Unguja, United Republic of Tanzania
| | - Saleh Juma
- Neglected Diseases Programme, Zanzibar Ministry of Health, Mkoroshoni, Pemba, United Republic of Tanzania
| | - Fatma Kabole
- Neglected Diseases Programme, Zanzibar Ministry of Health, Lumumba, Unguja, United Republic of Tanzania
| | - Said Mohammed Ali
- Public Health Laboratory - Ivo de Carneri, Wawi, Chake Chake, Pemba, United Republic of Tanzania
| | - David Rollinson
- Natural History Museum, London, United Kingdom; London Centre for Neglected Tropical Disease Research, London, United Kingdom; Global Schistosomiasis Alliance, London, United Kingdom
| | - Tom Pennance
- Natural History Museum, London, United Kingdom; London Centre for Neglected Tropical Disease Research, London, United Kingdom; Western University of Health Sciences, Lebanon, OR, United States.
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Mogaji HO, Adekunle ON, Omitola OO, Yaro CA, Babalola AS, Odoemene SN, Adeaga DO, Adubi TO, Ekpo UF. Understanding the relationship between WASH and malnutrition: Analysis of anthropometric data of children attending WASH-supported schools in Ogun State, Nigeria. Nutr Health 2023:2601060231168007. [PMID: 37093799 DOI: 10.1177/02601060231168007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND There has been a growing interest in better understanding the association between water, sanitation, and hygiene (WASH) and malnutrition. AIM We analysed anthropometric data of children attending WASH intervention schools and those from non-intervention schools in Ogun State, Nigeria. METHODS A total of 353 children across six schools (three interventions and three non-interventions) participated in this study. WASH conditions were assessed using WHO standardized tools and anthropometric data of children were analysed in WHO AnthroPlus and R Software. RESULTS The prevalence of stunting was 26.2% in the intervention group, and 29.4% in the control group (p = 0.045). Underweight was lower in the intervention group (3.9% vs. 10.1%) (p = 0.45). However, wasting was higher in the intervention group (32.3% vs. 8.2%) (p = 0.001). Of the variables included in our multivariate model (age, gender, and school category, i.e. intervention/control and class grade), only age was selected, and negatively associated with underweight, stunting and wasting (p = 0.000). CONCLUSION Regardless of WASH programming status, nutritional outcomes were significantly influenced by age of the children. Children are more likely to have lower z-scores as they grow older.
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Affiliation(s)
- Hammed Oladeji Mogaji
- Parasitology and Epidemiology Unit, Department of Animal and Environmental Biology, Federal University Oye-Ekiti, Ekiti, Nigeria
| | - Oladunni Nimota Adekunle
- Department of Zoology and Environmental Biology, Olabisi Onabanjo University, Ago-Iwoye, Ogun, Nigeria
| | - Olaitan Olamide Omitola
- Department of Pure and Applied Zoology, Federal University of Agriculture, Abeokuta, Nigeria
| | - Clement Ameh Yaro
- Department of Animal and Environmental Biology, University of Uyo, Uyo, Nigeria
| | - Ayodele Samuel Babalola
- Department of Pure and Applied Zoology, Federal University of Agriculture, Abeokuta, Nigeria
- Department of Public Health and Epidemiology, Nigerian Institute of Medical Research, Lagos, Nigeria
| | | | | | | | - Uwem Friday Ekpo
- Department of Pure and Applied Zoology, Federal University of Agriculture, Abeokuta, Nigeria
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Modjadji P, Madiba S. The Multidimension of Malnutrition among School Children in a Rural Area, South Africa: A Mixed Methods Approach. Nutrients 2022; 14:nu14235015. [PMID: 36501045 PMCID: PMC9741400 DOI: 10.3390/nu14235015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022] Open
Abstract
To address childhood malnutrition, the use of multifaceted methodologies, such as mixed methods research, is required to inform effective and contextual interventions. However, this remains limited in studying malnutrition among school children in a South African context, notwithstanding its persistence. We adopted a convergent parallel mixed methods design to best understand the magnitude of malnutrition through multilevel influences in a rural area. A quantitative survey determined the magnitude of malnutrition and associated factors among school children and their mothers (n = 508), parallel to a qualitative study, which explored mothers' insights into the influences of child growth and nutrition in interviews using seven focus group discussions. Mixed methods integration was achieved through convergence of the quantitative constructs developed from measured variables for malnutrition and related factors with ten emergent qualitative themes using a joint display analysis to compare the findings and generate meta-inferences. Qualitative themes on food unavailability and affordability, poor feeding beliefs and practices, and decision to purchase foods were consistent with the quantified poor socio-demographic status of mothers. Furthermore, the qualitative data explained the high prevalence of undernutrition among children but did not corroborate the high estimated households' food security in the quantitative survey. The misperceptions of mothers on child growth agreed with limited food knowledge as well as lack of knowledge on child growth gathered during the survey. Moreover, mothers believed that their children were growing well despite the high presence of childhood undernutrition. Mothers further overrated the effectiveness of school feeding programmes in providing healthy food to children as compared to their household food. They reported high incidence of food allergies, diarrhea, and vomiting caused by food consumed at school which resulted in children not eating certain foods. This might have impacted on the nutritional status of children since mothers depended on the school feeding program to provide food for their children. The ambiguity of cultural influences in relation to child growth was evident and substantiated during qualitative interview. Mixed methods integration offered a better understanding of malnutrition from empirical findings on interrelated factors at child, maternal, household, and school levels. This study points to a need for multilevel, informed, and contextual multidimensional interventions to contribute towards addressing childhood malnutrition in South Africa.
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Affiliation(s)
- Perpetua Modjadji
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Ga-Rankuwa MEDUNSA, P.O. Box 215, Pretoria 0204, South Africa
- Non-Communicable Diseases Research Unit, South African Medical Research Council (SAMRC), Cape Town 7505, South Africa
- Correspondence:
| | - Sphiwe Madiba
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Ga-Rankuwa MEDUNSA, P.O. Box 215, Pretoria 0204, South Africa
- Faculty of Health Sciences, University of Limpopo, Polokwane 0700, South Africa
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Garn JV, Wilkers JL, Meehan AA, Pfadenhauer LM, Burns J, Imtiaz R, Freeman MC. Interventions to improve water, sanitation, and hygiene for preventing soil-transmitted helminth infection. Cochrane Database Syst Rev 2022; 6:CD012199. [PMID: 35726112 PMCID: PMC9208960 DOI: 10.1002/14651858.cd012199.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND It is estimated that 1.5 billion people are infected with soil-transmitted helminths (STHs) worldwide. Re-infection occurs rapidly following deworming, and interruption of transmission is unlikely without complementary control efforts such as improvements in water, sanitation, and hygiene (WASH) access and behaviours. OBJECTIVES To assess the effectiveness of WASH interventions to prevent STH infection. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 19 October 2021. SELECTION CRITERIA We included interventions to improve WASH access or practices in communities where STHs are endemic. We included randomized controlled trials (RCTs), as well as trials with an external control group where participants (or clusters) were allocated to different interventions using a non-random method (non-RCTs). We did not include observational study designs. Our primary outcome was prevalence of any STH infection. Prevalence of individual worms was a secondary outcome, including for Ascaris lumbricoides, Trichuris trichiura, hookworm (Ancylostoma duodenale or Necator americanus), or Strongyloides stercoralis. Intensity of infection, measured as a count of eggs per gram of faeces for each species, was another secondary outcome. DATA COLLECTION AND ANALYSIS Two review authors independently reviewed titles and abstracts and full-text records for eligibility, performed data extraction, and assessed risk of bias using the Cochrane risk of bias assessment tool for RCTs and the EPOC tool for non-RCTs. We used a random-effects meta-analysis to pool study estimates. We used Moran's I² statistic to assess heterogeneity and conducted subgroup analyses to explore sources of heterogeneity. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included 32 studies (16 RCTs and 16 non-RCTs) involving a total of 52,944 participants in the review. Twenty-two studies (14 RCTs (16 estimates) and eight non-RCTs (11 estimates)) reported on our primary outcome, prevalence of infection with at least one STH species. Twenty-one studies reported on the prevalence of A lumbricoides (12 RCTs and 9 non-RCTs); 17 on the prevalence of T trichiura (9 RCTs and 8 non-RCTs); 18 on the prevalence of hookworm (10 RCTs and 8 non-RCTs); and one on the prevalence of S stercoralis (1 non-RCT). Sixteen studies measured the intensity of infection for an individual STH type. Ten RCTs and five non-RCTs reported on the intensity of infection of A lumbricoides; eight RCTs and five non-RCTs measured the intensity of infection of T trichiura; and eight RCTs and five non-RCTs measured the intensity of hookworm infection. No studies reported on the intensity of infection of S stercoralis. The overall pooled effect estimates showed that the WASH interventions under study may result in a slight reduction of any STH infection, with an odds ratio (OR) of 0.86 amongst RCTs (95% confidence interval (CI) 0.74 to 1.01; moderate-certainty evidence) and an OR of 0.71 amongst non-RCTs (95% CI 0.54 to 0.94; low-certainty evidence). All six of the meta-analyses assessing individual worm infection amongst both RCTs and non-RCTs had pooled estimates in the preventive direction, although all CIs encapsulated the null, leaving the possibility of the null or even harmful effects; the certainty of the evidence ranged from very low to moderate. Individual studies assessing intensity of infection showed mixed evidence supporting WASH. Subgroup analyses focusing on narrow specific subsets of water, sanitation, and hygiene interventions did very little to elucidate which interventions might be better than others. Data on intensity of infection (e.g. faecal egg count) were reported in a variety of ways across studies, precluding the pooling of results for this outcome. We did not find any studies reporting adverse events resulting from the WASH interventions under study or from mass drug administration (MDA). AUTHORS' CONCLUSIONS Whilst the available evidence suggests that the WASH interventions under study may slightly protect against STH infection, WASH also serves as a broad preventive measure for many other diseases that have a faecal oral transmission route of transmission. As many of the studies were done in addition to MDA/deworming (i.e. MDA was ongoing in both the intervention and control arm), our data support WHO recommendations for implementation of improvements to basic sanitation and adequate access to safe water alongside MDA. The biological plausibility for improved access to WASH to interrupt transmission of STHs is clear, but WASH interventions as currently delivered have shown impacts that were lower than expected. There is a need for more rigorous and targeted implementation research and process evaluations in order that future WASH interventions can better provide benefit to users. Inconsistent reporting of the intensity of infection underscores the need to define the minimal, standard data that should be collected globally on STHs to enable pooled analyses and comparisons.
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Affiliation(s)
- Joshua V Garn
- Division of Biostatistics, Epidemiology and Environmental Health, School of Public Health, University of Nevada, Reno, Reno, Nevada, USA
| | - Jennifer L Wilkers
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Ashley A Meehan
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lisa M Pfadenhauer
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Jacob Burns
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Rubina Imtiaz
- Children without Worms, The Task Force for Global Health, Atlanta, Georgia, USA
| | - Matthew C Freeman
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Minzi OM, Mnkugwe RH, Ngaimisi E, Kinung’hi S, Hansson A, Pohanka A, Kamuhabwa A, Aklillu E. Effect of Dihydroartemisinin-Piperaquine on the Pharmacokinetics of Praziquantel for Treatment of Schistosoma mansoni Infection. Pharmaceuticals (Basel) 2021; 14:ph14050400. [PMID: 33922522 PMCID: PMC8145331 DOI: 10.3390/ph14050400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 12/14/2022] Open
Abstract
Praziquantel (PZQ) and dihydroartemisinin-piperaquine (DHP) combination recently showed superior effectiveness than PZQ alone to treat intestinal schistosomiasis. In this follow-up study, we investigated the effect of DHP co-administration on the pharmacokinetics of PZQ and its enantiomers among 64 Schistosoma mansoni infected children treated with PZQ alone (n = 32) or PZQ + DHP combination (n = 32). Plasma samples collected at 0, 1, 2, 4, 6, and 8 h post-dose were quantified using UPLCMS/MS. The geometric mean (GM) of AUCs for total PZQ, R-PZQ and S-PZQ were significantly higher among children who received PZQ + DHP than PZQ alone. The geometric mean ratio (GMR) and (90% CI) of AUC0–∞ for PZQ + DHP to PZQ for total PZQ, R-PZQ, and S-PZQ were 2.18 (1.27, 3.76), 3.98 (2.27, 7.0) and 1.86 (1.06, 3.28), respectively. The GMR and (90% CI) of AUC0–8 for total PZQ, R-PZQ, and S-PZQ were 1.73 (1.12, 2.69), 2.94 (1.75, 4.92), and 1.50 (0.97, 2.31), respectively. The GM of Cmax for total PZQ, R-PZQ and S-PZQ were significantly higher among those who received PZQ + DHP than PZQ alone. The GMR (90% CI) of Cmax of PZQ + DHP to PZQ for total PZQ, R-PZQ, and S-PZQ were 1.75 (1.15, 2.65), 3.08 (1.91, 4.96), and 1.50 (1.0, 2.25%), respectively. The 90% CI of the GMRs for both AUCs and Cmax for total PZQ, R-PZQ, and S-PZQ were outside the acceptable 0.80–1.25 range, indicating that the two treatment arms were not bioequivalent. DHP co-administration significantly increases systemic PZQ exposure, and this may contribute to increased effectiveness of PZQ + DHP combination therapy than PZQ alone to treat schistosomiasis.
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Affiliation(s)
- Omary Mashiku Minzi
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, 11103 Dar es Salaam, Tanzania; (O.M.M.); (A.K.)
| | - Rajabu Hussein Mnkugwe
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, 141 86 Stockholm, Sweden; (R.H.M.); (A.P.)
- Department of Clinical Pharmacology, School of Medicine, Muhimbili University of Health and Allied Sciences, 11103 Dar es Salaam, Tanzania
| | - Eliford Ngaimisi
- Office of Clinical Pharmacology, Division of Pharmacometrics, Food and Drugs Administration, Silver Spring, MD 20993, USA;
| | - Safari Kinung’hi
- National Institute for Medical Research, Mwanza Research Centre, 33104 Mwanza, Tanzania;
| | - Anna Hansson
- Department of Clinical Pharmacology, Karolinska University Hospital-Huddinge, 141 86 Stockholm, Sweden;
| | - Anton Pohanka
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, 141 86 Stockholm, Sweden; (R.H.M.); (A.P.)
- Department of Clinical Pharmacology, Karolinska University Hospital-Huddinge, 141 86 Stockholm, Sweden;
| | - Appolinary Kamuhabwa
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, 11103 Dar es Salaam, Tanzania; (O.M.M.); (A.K.)
| | - Eleni Aklillu
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, 141 86 Stockholm, Sweden; (R.H.M.); (A.P.)
- Correspondence: ; Tel.: +46-73-511-6131
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Modjadji P. Engaging Mothers on the Growth of School-Age Children in a Rural South African Health and Demographic Site: A Qualitative Insight. Healthcare (Basel) 2021; 9:225. [PMID: 33670435 PMCID: PMC7922540 DOI: 10.3390/healthcare9020225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 12/23/2022] Open
Abstract
A qualitative study was conducted to explore mothers' insights on the growth of school-age children in a rural Health and Demographic site of Limpopo Province, in South Africa. The participants were selected using purposive sampling. Data were collected from seven focus group discussions, which were audio-taped and transcribed verbatim. NVivo10 was used to analyse interview transcripts, following qualitative thematic analysis. Fifty-four mothers aged between 27 and 52 years were interviewed. Unfavourable sociodemographic status with poor living conditions of mothers were observed, particularly in terms of unemployment, minimal tertiary education, and rural locality. The perceptions of mothers on child growth linked growth of their children to various factors such as poverty and socioeconomic status, genetic/family heredity, and household environment. Mothers further related child growth to purchasing power and decisions regarding types of food, food unavailability, affordability issues, feeding beliefs and practices; and child food preferences, school feeding schemes, and maternal and societal cultural beliefs and practices. Despite their concerns, mothers perceived that their children were growing well, but differently. It is worth noting that the views of mothers on child growth were up to their aptitude level and might have been restricted due to their level of education and rural locality. Hence, there is a need for novel information, education, and communication strategies to effectively reach mothers, especially in rural areas, regarding the importance of identifying children with growth failure and its prevention. Mothers should be able to identify when a child is affected by growth failure and to seek healthcare, in order to prevent children from progressing to severe forms. This study informs on the timing of nutritional interventions for children and context-specific health promotion and health education programs to improve the knowledge of mothers on child growth.
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Affiliation(s)
- Perpetua Modjadji
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa
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Kimani BW, Mbugua AK, Kihara JH, Ng’ang’a M, Njomo DW. Safety, efficacy and acceptability of praziquantel in the treatment of Schistosoma haematobium in pre-school children of Kwale County, Kenya. PLoS Negl Trop Dis 2018; 12:e0006852. [PMID: 30332403 PMCID: PMC6205662 DOI: 10.1371/journal.pntd.0006852] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 10/29/2018] [Accepted: 09/17/2018] [Indexed: 11/18/2022] Open
Abstract
Background The recommended strategy for control of schistosomiasis is preventive chemotherapy with praziquantel (PZQ). Pre-school children (PSC) are excluded from population treatment programs. In high endemic areas, these children are also at risk, and require treatment with PZQ. The Government of Kenya initiated the National School-Based Deworming Programme (NSBDP) where PSC in Early Childhood Development Education (ECDE) Centers are only eligible for treatment with albendazole (ABZ) but not with PZQ. Methodology/Principal findings 400 PSC were enrolled, from 10 randomly selected ECDE Centers in Kwale County, Kenya where children were treated with crushed PZQ tablets mixed with orange juice, at a single dose of 40 mg/kg. Adverse events were assessed 24 hours post-treatment through questionnaires administered to the parents or guardians. Acceptability was determined by observing if the child spat and/ or vomited all or part of the PZQ dose immediately after treatment. Efficacy was assessed by examining urine samples for Schistosoma haematobium eggs in the 5 weeks post-treatment follow-up. Children testing negative for S. haematobium during the follow-up were considered cured. Egg reduction rate (ERR) was calculated as the decrement in the infection intensity (group’s geometric mean egg counts per 10 ml of urine) following treatment expressed as a proportion of the pre-treatment infection intensity. Before treatment, 80 out of the 400 children enrolled in the study tested positive for S. haematobium (20.0% (95% confidence interval (CI) 16.4–24.2%). Of these, 41 had infections of heavy intensity (51.3%) while the rest (48.7%) were of light intensity. Five weeks post-treatment, 10 children who had heavy intensity infection were diagnosed with S. haematobium (prevalence: 2.5% (95% CI 1.5–4.9%). Infection intensities decreased significantly from 45.9 (95% CI: 31.0–68.0) eggs/ 10 ml urine to1.4 (95% CI: 1.1–1.7) eggs/ 10 ml urine during pre-and post-treatment respectively. The ERR was 96.9%. There were no severe adverse events during follow up 24 hours post treatment. Treatment tolerability among the 400 children was high as none of the children spat and/ or vomited as observed in this study. Conclusion/Significance The study revealed that crushed PZQ is safe and effective in the treatment of urogenital schistosomiasis in this age group. It is therefore recommended that PZQ should be administered to the PSC in Kwale County. Control of schistosome infections is through treatment of infected people with a single dose of the anti-helminth drug praziquantel (PZQ) which is safe, highly efficacious, and can reverse schistosome-related morbidity particularly in the early stages of disease progression. However pre-school children are normally excluded due to the belief that these children are not sufficiently exposed to infective water to experience high infection rates. This could lead to clinical manifestation of the disease and the lack of safety data on praziquantel in this age group. Due to this we investigated the safety, efficacy and acceptability of praziquantel in Kwale County, Kenya. We examined urine samples from 400 preschool children. They were treated with crushed praziquantel (40mg/kg) mixed with orange juice and the efficacy of the treatment was determined 5 weeks after treatment. Acceptability was determined by whether the child spat and/ or vomited the treatment through the direct observed treatment (DOT).No child spat or vomited during treatment. Safety of the treatment was assessed by interviewing the parents of the treated children for adverse events (e.g., abdominal pain, dizziness, and headache). The treatment was well tolerated and most of the parasites were cleared by praziquantel.
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Affiliation(s)
- Bridget W. Kimani
- Center for Microbiology Research (CMR), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
- Institute of Tropical Medicine and Infectious Diseases, Jomo Kenyatta University of Agriculture and Technology (JKUAT), Nairobi, Kenya
- * E-mail:
| | - Amos K. Mbugua
- Institute of Tropical Medicine and Infectious Diseases, Jomo Kenyatta University of Agriculture and Technology (JKUAT), Nairobi, Kenya
| | - Jimmy H. Kihara
- Institute of Tropical Medicine and Infectious Diseases, Jomo Kenyatta University of Agriculture and Technology (JKUAT), Nairobi, Kenya
- Division of Vector Borne Diseases & Neglected Tropical Diseases (DVBD-NTD), Ministry of Public Health and Sanitation, Nairobi, Kenya
| | - Murima Ng’ang’a
- Division of Vector Borne Diseases & Neglected Tropical Diseases (DVBD-NTD), Ministry of Public Health and Sanitation, Nairobi, Kenya
| | - Doris W. Njomo
- Eastern and Southern Africa Center of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
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Abstract
AbstractInadequate nutrient intakes put children at risk for impaired growth and development. We described diet, usual intakes of energy and macro- and micronutrients and prevalence of nutrient intake adequacies among 4–8-year-old Zambian children. Children not yet in school and living in Mkushi District, Central Province, Zambia were enrolled into an efficacy trial of pro-vitamin A biofortified maize. Children in the non-intervened arm were included in this analysis (n 202). Dietary intake data were collected by tablet-based 24-h recall on a monthly basis over the 6-month trial. Observed nutrient intakes were derived from reported food quantities, standard recipes and food composition tables. Usual nutrient intake distributions were modelled based on observed intakes. Prevalence of inadequacy was estimated by comparing the usual nutrient intake distribution to the nutrient requirement distribution. Frequency and quantity of consumption of commonly reported foods were described and key sources of energy and nutrients were identified. Median usual energy intake was 6422 kJ/d (1535 kcal/d). Most childrens’ macronutrient intakes fell within recommended ranges (74–98 %). Estimated prevalences of inadequate intakes of Fe, folate, vitamin B12 and Ca were 25, 57, 76 and >99 %, respectively. Estimated prevalences of inadequacy for other micronutrients were low (0·1–2·2 %). Commonly consumed foods included maize, vegetable oil, tomatoes, rape leaves and small fish (>0·6 servings/d), whereas meat, eggs or dairy were rarely eaten (<0·2 servings/d). These findings suggest that the heavily plant-based diet of rural Zambian children provides inadequate Ca, folate, vitamin B12 and Fe to meet recommended nutrient intakes.
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Cooper MT, Searing RA, Thompson DM, Bard D, Carabin H, Gonzales C, Zavala C, Woodson K, Naifeh M. Missing the Mark? A Two Time Point Cohort Study Estimating Intestinal Parasite Prevalence in Informal Settlements in Lima, Peru. Glob Pediatr Health 2017; 4:2333794X17739190. [PMID: 29152541 PMCID: PMC5680937 DOI: 10.1177/2333794x17739190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 10/03/2017] [Indexed: 11/15/2022] Open
Abstract
Objectives: The World Health Organization's (WHO) recommendations list Peru as potentially needing prevention of soil-transmitted helminthiasis (STH). Prevalence of STH varies regionally and remains understudied in the newest informal settlements of the capital city, Lima. The purpose of this study was to evaluate the need for Mass Drug Administration (MDA) of antiparasitic drugs in the newest informal settlements of Lima. The aim of this study was to estimate the season-specific prevalence of STH to determine if these prevalence estimates met the WHO threshold for MDA in 3 informal settlements. Methods: A 2 time point cohort study was conducted among a sample of 140 children aged 1 to 10 years living in 3 purposively sampled informal settlements of Lima, Peru. Children were asked to provide 2 stool samples that were analyzed with the spontaneous sedimentation in tube technique. The season-specific prevalence proportions of MDA-targeted STH were estimated using a hidden (latent) Markov modeling approach to adjust for repeated measurements over the 2 seasons and the imperfect validity of the screening tests. Results: The prevalence of MDA targeted STH was low at 2.2% (95% confidence interval = 0.3% to 6%) and 3.8% (95% confidence interval = 0.7% to 9.3%) among children sampled in the summer and winter months, respectively, when using the most conservative estimate of test sensitivity. These estimates were below the WHO threshold for MDA (20%). Conclusions: Empiric treatment for STH by organizations active in the newest informal settlements is not supported by the data and could contribute to unnecessary medication exposures and poor allocation of resources.
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Affiliation(s)
| | - Rapha A Searing
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - David M Thompson
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - David Bard
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Hélène Carabin
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | | | - Kyle Woodson
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Monique Naifeh
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Erismann S, Diagbouga S, Schindler C, Odermatt P, Knoblauch AM, Gerold J, Leuenberger A, Shrestha A, Tarnagda G, Utzinger J, Cissé G. School Children's Intestinal Parasite and Nutritional Status One Year after Complementary School Garden, Nutrition, Water, Sanitation, and Hygiene Interventions in Burkina Faso. Am J Trop Med Hyg 2017; 97:904-913. [PMID: 28722585 PMCID: PMC5590586 DOI: 10.4269/ajtmh.16-0964] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 05/22/2017] [Indexed: 11/07/2022] Open
Abstract
The potential health benefits of combined agricultural, nutrition, water, sanitation, and hygiene (WASH) interventions are poorly understood. We aimed to determine whether complementary school garden, nutrition, and WASH interventions reduce intestinal parasites and improve school children's nutritional status in two regions of Burkina Faso. A cluster-randomized controlled trial was conducted in the Plateau Central and Center-Ouest regions of Burkina Faso. A total of 360 randomly selected children, aged 8-15 years, had complete baseline and end-line survey data. Mixed regression models were used to assess the impact of the interventions, controlling for baseline characteristics. The prevalence of intestinal parasitic infections decreased both in intervention and control schools, but the decrease was significantly higher in the intervention schools related to the control schools (odds ratio [OR] of the intervention effect = 0.2, 95% confidence interval [CI] = 0.1-0.5). Indices of undernutrition did not decrease at end-line in intervention schools. Safe handwashing practices before eating and the use of latrines at schools were significantly higher in the intervention schools than in the control schools at end-line (OR = 6.9, 95% CI = 1.4-34.4, and OR = 14.9, 95% CI = 1.4-153.9, respectively). Parameters of water quality remained unchanged. A combination of agricultural, nutritional, and WASH-related interventions embedded in the social-ecological systems and delivered through the school platform improved several child health outcomes, including intestinal parasitic infections and some WASH-related behaviors. Sustained interventions with stronger household and community-based components are, however, needed to improve school children's health in the long-term.
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Affiliation(s)
- Séverine Erismann
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Serge Diagbouga
- Institut de Recherches en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Peter Odermatt
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Astrid M. Knoblauch
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Jana Gerold
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Andrea Leuenberger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Akina Shrestha
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Kathmandu University, Dhulikhel, Nepal
| | - Grissoum Tarnagda
- Institut de Recherches en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Guéladio Cissé
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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11
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Anthropometry and Nutritional Status of Primary School Children in a Sub-urban Region in Tanzania. INTERNATIONAL JOURNAL OF SCHOOL HEALTH 2017. [DOI: 10.5812/intjsh.46079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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12
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Saltzman E, Schlossman N, Brown CA, Balan I, Fuss P, Batra P, Braima de Sa A, Shea MK, Pruzensky WM, Bale C, Roberts SB. Nutrition Status of Primary School Students in Two Rural Regions of Guinea-Bissau. Food Nutr Bull 2016; 38:103-114. [PMID: 28027671 DOI: 10.1177/0379572116679071] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The nutrition status of primary schoolchildren in Africa has received relatively little attention in comparison to that of younger children. We surveyed primary school students in Guinea-Bissau, a nation that is among the poorest in the world. OBJECTIVE Anthropometry and prevalence of anemia and vitamin A deficiency were assessed in schoolchildren participating in International Partnership for Human Development's school feeding program in 2 regions of Guinea-Bissau. METHODS A cross-sectional survey of 32 schools in the regions of Cacheu and Oio was conducted in November 2011. Variables included age, gender, weight, height, hemoglobin, and retinol-binding protein concentrations. Z scores for height for age (HAZ), body mass index for age (BAZ), and weight for age were calculated using World Health Organization reference data. RESULTS Anthropometric assessment of 4784 students revealed stunting (HAZ < -2) in 15.5%, thinness (BAZ < -2) in 13.2%, and anemia in 42.0%. Stunting, thinness, and anemia were significantly more common in males, in students from Oio, and in older students. Vitamin A deficiency, detected in 21.5% of the population, was the only assessment that did not demonstrate significant differences between genders or regions. About 61.1% of all children had 1 or more indicators of undernutrition. CONCLUSION There are substantial rates of stunting, thinness, underweight, anemia, and vitamin A deficiency in primary schoolchildren in Guinea-Bissau, even among those participating in a school lunch program and particularly among males and older students. The results suggest the need for evaluating feeding programs and other methods to improve nutrition status in primary school students, especially in older students.
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Affiliation(s)
- Edward Saltzman
- 1 Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.,2 Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Nina Schlossman
- 1 Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.,3 Global Food and Nutrition Inc., Washington, DC, USA
| | - Carrie A Brown
- 2 Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Ionela Balan
- 4 International Partnership for Human Development, Leesburg, VA, USA
| | - Paul Fuss
- 2 Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Payal Batra
- 1 Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.,2 Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | | | - Mary Kyla Shea
- 2 Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | | | - Carlito Bale
- 4 International Partnership for Human Development, Leesburg, VA, USA
| | - Susan B Roberts
- 1 Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.,2 Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
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Kinung’hi S, Magnussen P, Kaatano G, Olsen A. Infection with Schistosoma mansoni has an Effect on Quality of Life, but not on Physical Fitness in Schoolchildren in Mwanza Region, North-Western Tanzania: A Cross-Sectional Study. PLoS Negl Trop Dis 2016; 10:e0005257. [PMID: 28027317 PMCID: PMC5222294 DOI: 10.1371/journal.pntd.0005257] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 01/09/2017] [Accepted: 12/14/2016] [Indexed: 01/19/2023] Open
Abstract
Background Infection with Schistosoma mansoni negatively impact children’s physical health and may influence their general well-being. The aim of this study was to investigate the effect of S. mansoni infections on a panel of morbidity indicators with emphasis on quality of life (PedsQL; measured in four different dimensions) and physical fitness (measured as VO2 max) among 572 schoolchildren aged 7–8 years. Methodology/Principal findings Prevalence of S. mansoni infections was 58.7%, with an arithmetic mean (95% CI) among positives of 207.3 (169.2–245.4) eggs per gram (epg). Most infections were light (56.5%), while 16.4% had heavy infections. Girls had significantly higher arithmetic mean intensities (95% CI) than boys (247.4 (189.2–305.6) vs. 153.2 (110.6–195.8); P = 0.004). A total of 30.1% were anaemic with no sex difference. Stunting and wasting was found in less than 10% of the population. There was no association between S. mansoni prevalence or intensities and the following parameters: anthropometry, anaemia, liver or spleen pathology in neither univariable nor multivariable linear regression analyses. However, in univariable analyses children with S. mansoni infection had a significantly lower score in emotional PedsQL (95% CI) than uninfected (77.3 (74.5–80.1) vs. 82.7 (79.9–85.5); P = 0.033) and infected children had a higher VO2 max (95% CI) compared to uninfected (51.4 (51.0–51.8) vs. 50.8 (50.3–51.3); P = 0.042). In multivariable linear regression analyses, age, S. mansoni infection, haemoglobin and VO2 max were significant predictors for emotional PedsQL while significant predictors for VO2 max were physical PedsQL, height, age and haemoglobin. S. mansoni infection was thus not retained in the multivariable regression analyses on VO2 max. Conclusions/Significance Of the measured morbidity parameters, S. mansoni infection had a significant effect on the emotional dimension of quality of life, but not on physical fitness. If PedsQL should be a useful tool to measure schistosome related morbidity, more in depth studies are needed in order to refine the tool so it focuses more on aspects of quality of life that may be affected by schistosome infections. Millions of school-age children in Tanzania are infected with Schistosoma mansoni which have an impact on their physical health by reducing growth and fitness, causing anaemia and liver and spleen pathology. Apart from these measurable physical parameters, self-rating of well-being by administration of quality of life questionnaires has been proposed for measuring schistosome related morbidity. A total of 572 schoolchildren aged 7–8 years were examined for S. mansoni infection, anaemia, malnutrition and liver/spleen enlargement. Furthermore, the children participated in a 20 metres shuttle run fitness test and answered a quality of life questionnaire for children. While there was no association between S. mansoni prevalence or intensities and anaemia, malnutrition, fitness or organ enlargement, S. mansoni infected children had a significantly lower self-perceived emotional quality of life. Thus, infected children were more often scared, sad, angry or worried about their future compared to their uninfected peers. More in depth studies are needed in order to refine the questionnaire so it focuses more on aspects of quality of life that may be affected by schistosome infections.
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Affiliation(s)
- Safari Kinung’hi
- National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania
| | - Pascal Magnussen
- Parasitology and Aquatic Diseases, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Centre for Medical Parasitology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Godfrey Kaatano
- National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania
| | - Annette Olsen
- Parasitology and Aquatic Diseases, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
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Kuong K, Fiorentino M, Perignon M, Chamnan C, Berger J, Sinuon M, Molyden V, Burja K, Parker M, Ly SC, Friis H, Roos N, Wieringa FT. Cognitive Performance and Iron Status are Negatively Associated with Hookworm Infection in Cambodian Schoolchildren. Am J Trop Med Hyg 2016; 95:856-863. [PMID: 27573634 PMCID: PMC5062788 DOI: 10.4269/ajtmh.15-0813] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 07/13/2016] [Indexed: 01/25/2023] Open
Abstract
Soil-transmitted helminth (STH) infection has been associated with lower cognitive performance of schoolchildren. To identify pathways through which STH infection might affect school performance, baseline data from a large rice-fortification trial in Cambodian schoolchildren were used to investigate associations between STH infection, micronutrient status, anemia, and cognitive performance. Complete data on anthropometry, cognitive performance, and micronutrient status were available for 1,760 schoolchildren, 6-16 years of age. STH infection was identified using Kato-Katz, whereas cognitive performance was assessed using Raven's Colored Progressive Matrices (RCPM), block design, and picture completion. STH infection was found in 18% of the children; almost exclusively hookwork infection. After adjusting for age and gender, raw cognitive test scores were significantly lower in hookworm-infected children (-0.65; -0.78; -2.03 points for picture completion, RCPM, and block design, respectively; P < 0.05 for all). Hookworm infection was associated with iron status (total body iron), but not with vitamin A and zinc status, nor with inflammation or anthropometry. Body iron was negatively associated with increased intensity of hookworm infection (R = 0.22, P < 0.001). Hookworm infection in Cambodian schoolchildren was associated with lower cognitive performance, an effect most likely mediated through lower body iron. Interventions that are more effective against hookworm infection are needed to contribute to better health and improvement of cognitive performance.
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Affiliation(s)
- Khov Kuong
- Department of Fisheries Post-Harvest Technologies and Quality Control, Ministry of Agriculture, Forestry and Fisheries, Phnom Penh, Cambodia. Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark.
| | | | - Marlene Perignon
- Institut de Recherche pour le Développement, Montpellier, France
| | - Chhoun Chamnan
- Department of Fisheries Post-Harvest Technologies and Quality Control, Ministry of Agriculture, Forestry and Fisheries, Phnom Penh, Cambodia
| | - Jacques Berger
- Institut de Recherche pour le Développement, Montpellier, France
| | - Muth Sinuon
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Vann Molyden
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Kurt Burja
- United Nations World Food Program, Phnom Penh, Cambodia
| | | | - Sou Chheng Ly
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Nanna Roos
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Frank T Wieringa
- Institut de Recherche pour le Développement, Montpellier, France
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15
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Geary DC. Can Neglected Tropical Diseases Compromise Human Wellbeing in Sex-, Age-, and Trait-Specific Ways? PLoS Negl Trop Dis 2016; 10:e0004489. [PMID: 27077746 PMCID: PMC4831682 DOI: 10.1371/journal.pntd.0004489] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Traits that facilitate competition for reproductive resources or that influence mate choice have evolved to signal resilience to infectious disease and other stressors. As a result, the dynamics of competition and choice can, in theory, be used to generate predictions about sex-, age-, and trait-specific vulnerabilities for any sexually reproducing species, including humans. These dynamics and associated vulnerabilities are reviewed for nonhuman species, focusing on traits that are compromised by exposure to parasites. Using the same approach, sex-, age-, and trait-specific vulnerabilities to parasitic disease are illustrated for children's and adolescent's physical growth and fitness. Suggestions are then provided for widening the assessment of human vulnerabilities to include age-appropriate measures of behavioral (e.g., children's play) and cognitive (e.g., language fluency) traits. These are traits that are likely to be compromised by infection in age- and sex-specific ways. Inclusion of these types of measures in studies of neglected tropic diseases has the potential to provide a more nuanced understanding of how these diseases undermine human wellbeing and may provide a useful means to study the efficacy of associated treatments.
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Affiliation(s)
- David C. Geary
- Department of Psychological Sciences, Interdisciplinary Neuroscience, University of Missouri, Columbia, Missouri, United States of America
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16
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Worrell CM, Wiegand RE, Davis SM, Odero KO, Blackstock A, Cuéllar VM, Njenga SM, Montgomery JM, Roy SL, Fox LM. A Cross-Sectional Study of Water, Sanitation, and Hygiene-Related Risk Factors for Soil-Transmitted Helminth Infection in Urban School- and Preschool-Aged Children in Kibera, Nairobi. PLoS One 2016; 11:e0150744. [PMID: 26950552 PMCID: PMC4780697 DOI: 10.1371/journal.pone.0150744] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 02/18/2016] [Indexed: 12/27/2022] Open
Abstract
Soil-transmitted helminth (STH) infections affect persons living in areas with poor water, sanitation, and hygiene (WASH). Preschool-aged children (PSAC) and school-aged children (SAC) are disproportionately affected by STH infections. We aimed to identify WASH factors associated with STH infection among PSAC and SAC in Kibera, Kenya. In 2012, households containing a PSAC or SAC were randomly selected from those enrolled in the International Emerging Infections Program, a population-based surveillance system. We administered a household questionnaire, conducted environmental assessments for WASH, and tested three stools from each child for STH eggs using the Kato-Katz method. WASH factors were evaluated for associations with STH infection using univariable and multivariable Poisson regression. Any-STH prevalence was 40.8% among 201 PSAC and 40.0% among 475 SAC enrolled. Using the Joint Monitoring Programme water and sanitation classifications, 1.5% of households reported piped water on premises versus 98.5% another improved water source; 1.3% reported improved sanitation facilities, while 81.7% used shared sanitation facilities, 13.9% had unimproved facilities, and 3.1% reported no facilities (open defecation). On univariable analysis, STH infection was significantly associated with a household toilet located off-premises (prevalence ratio (PR) = 1.33; p = 0.047), while always treating water (PR = 0.81; p = 0.04), covering drinking water containers (PR = 0.75; p = 0.02), using clean towels during hand drying (PR = 0.58; p<0.01), having finished household floor material (PR = 0.76; p<0.01), having electricity (PR = 0.70; p<0.01), and increasing household elevation in 10-meter increments (PR = 0.89; p<0.01) were protective against STH infection. On multivariable analysis, usually versus always treating water was associated with increased STH prevalence (adjusted prevalence ratio (aPR) = 1.52; p<0.01), while having finished household floor material (aPR = 0.76; p = 0.03), reported child deworming in the last year (aPR = 0.76; p<0.01), and 10-meter household elevation increases (aPR = 0.89; p<0.01) were protective against infection. The intersection between WASH and STH infection is complex; site-specific WASH interventions should be considered to sustain the gains made by deworming activities.
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Affiliation(s)
- Caitlin M. Worrell
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ryan E. Wiegand
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Stephanie M. Davis
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kennedy O. Odero
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Anna Blackstock
- Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Victoria M. Cuéllar
- Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sammy M. Njenga
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Joel M. Montgomery
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Sharon L. Roy
- Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - LeAnne M. Fox
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Mekonnen Z, Meka S, Zeynudin A, Suleman S. Schistosoma mansoni infection and undernutrition among school age children in Fincha'a sugar estate, rural part of West Ethiopia. BMC Res Notes 2014; 7:763. [PMID: 25348748 PMCID: PMC4216851 DOI: 10.1186/1756-0500-7-763] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 10/14/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Parasitic infection like schistosomiasis is known to exert a negative effect on nutritional status of school-aged children. However, studies associating parasitic infections with undernutrition are scarce. Thus, this study was primarily to document the association between Schistosoma mansoni infection and undernutrition among school-aged children in a rural setting of Fincha'a Sugar Estate, Ethiopia. METHODS A cross-sectional study was conducted on a total of 453 school-aged children (5-18 years). Stool specimen was collected and examined using the standard Kato-katz technique. Children's height-for-Age Z-score (HAZ) and Body mass index-for-Age Z- score (BAZ) was determined. Z-Scores for each nutritional index were compared with the WHO child growth standards reference values. Children were considered stunted or wasted as HAZ or BAZ falls below -2 standard deviations, respectively. RESULT The overall prevalence of Schistosoma mansoni infection was 53.2%. Out of the total school children examined, 11.5% and 13.2% were stunted and wasted, respectively. Multivariate logistic regression analysis was done to determine the relationship between Schistosoma mansoni infection and nutritional status controlling for other factors. Accordingly, stunting was not significantly associated while wasting was negatively associated with Schistosoma mansoni infection. Paternal occupation was the best predictor of stunting and wasting such that, unemployed fathers have 4.28 (95% CI; 2.13, 8.63) (p < 0.001) and 3.83, 95% CI; 1.89, 7.79) (p < 0.001) chance of having stunted and wasted children, respectively. CONCLUSION Schistosoma mansoni infection is highly prevalent in the study area. The high prevalence of wasting, and moderate level of stunting among study subjects in this study area indicate that they are affected by both infection and undernutrition. Therefore, regular preventive chemotherapy against S. mansoni and other control measures are recommended. Moreover, possibilities of synchronized nutritional rehabilitation and creation of employment opportunities to the families should be looked for.
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Affiliation(s)
- Zeleke Mekonnen
- />Department of Medical Laboratory Sciences and Pathology, College of Public Health and Medical Sciences, Jimma University, P.O. Box 378, Jimma, Ethiopia
| | - Selima Meka
- />Department of Medical Laboratory Sciences and Pathology, College of Public Health and Medical Sciences, Jimma University, P.O. Box 378, Jimma, Ethiopia
| | - Ahmed Zeynudin
- />Department of Medical Laboratory Sciences and Pathology, College of Public Health and Medical Sciences, Jimma University, P.O. Box 378, Jimma, Ethiopia
| | - Sultan Suleman
- />Department of Pharmacy, College of Public Health and Medical Sciences, Jimma University, P.O. Box 378, Jimma, Ethiopia
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Heinrich-Weltzien R, Zorn C, Monse B, Kromeyer-Hauschild K. Relationship between malnutrition and the number of permanent teeth in Filipino 10- to 13-year-olds. BIOMED RESEARCH INTERNATIONAL 2013; 2013:205950. [PMID: 24069590 PMCID: PMC3773387 DOI: 10.1155/2013/205950] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 07/23/2013] [Accepted: 07/24/2013] [Indexed: 11/17/2022]
Abstract
In the present study, we determined whether there is a delay in the eruption of permanent teeth (PT) among Filipino adolescents with stunting or thinness. Height, weight, and number of PT were recorded in 1554 Filipino 10- to 13-year-olds (711 boys; 843 girls). z-scores for height (HAZ) and body mass index (BMI) were calculated according to the WHO growth reference, and their correlations to the number of PT were assessed. 54.9% of the children have at least one form of malnutrition. Significantly, more boys (22.9%) than girls (16.5%) were thin, while no sex difference in stunting was noted (boys 48.5%; girls 44.0%). The number of PT was significantly correlated to HAZ and BMI-z-score. Stunted and thin students had significantly fewer PT than their nonaffected peers. These differences tended to be the result of delay in tooth eruption in thin and stunted adolescents. In 13-year-old girls, all PT were erupted regardless of their nutritional status indicating a catch-up. Thin and stunted boys had one tooth less than normal boys at this age. Impaired physical growth and dental development seem to have common risk factors. Therefore, regular monitoring of growth and dental development might be helpful for targeting support programmes in developing countries.
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Affiliation(s)
- Roswitha Heinrich-Weltzien
- Department of Preventive and Paediatric Dentistry, Jena University Hospital, WHO Collaborating Centre for Prevention of Oral Diseases, Bachstraße 18, 07743 Jena, Germany
| | - Carsten Zorn
- Department of Preventive and Paediatric Dentistry, Jena University Hospital, WHO Collaborating Centre for Prevention of Oral Diseases, Bachstraße 18, 07743 Jena, Germany
| | - Bella Monse
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, GIZ Office Manila, PDCP Bank Centre, V.A. Rufino Corner L.P. Leviste Street, Makati, 1007 Metro Manila, Philippines
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Mwaniki EW, Makokha AN. Nutrition status and associated factors among children in public primary schools in Dagoretti, Nairobi, Kenya. Afr Health Sci 2013; 13:39-46. [PMID: 23658566 DOI: 10.4314/ahs.v13i1.6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Malnutrition among school-age children is due to inadequacies in one or more of the three main preconditions for good nutrition: food, care and health. Children stunted at school age are likely to have been exposed to poor nutrition since early childhood. Interventions for school age children can supplement efforts to reduce levels of stunting in the preschool years. OBJECTIVE To assess the nutrition status and associated risk factors of children in selected public primary schools in Dagoretti Division, Nairobi. METHODS Descriptive cross sectional design was used. 208 students aged 4-11years of both gender were randomly selected from four public primary schools in Dagoretti Division. Data was collected from school registers and directly questioning the students, parents /guardians. RESULTS Among the children surveyed, 24.5% were stunted, 14.9% underweight and 9.7% were wasted. There were more boys than girls who were stunted. Breakfast contributed 10.2% of the daily energy intake. Few children consumed foods from more than four food groups. Incidence of diarrhea, colds/coughs increased the risk of stunting and underweight. CONCLUSION Consumption of food which is inadequate in required calories and from less than four varieties of food groups by the children were important predictors of malnutrition.
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Affiliation(s)
- E W Mwaniki
- Jomo Kenyatta University of Agriculture and Technology, Kenya.
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Coulibaly JT, N'Gbesso YK, Knopp S, Keiser J, N'Goran EK, Utzinger J. Efficacy and safety of praziquantel in preschool-aged children in an area co-endemic for Schistosoma mansoni and S. haematobium. PLoS Negl Trop Dis 2012; 6:e1917. [PMID: 23236526 PMCID: PMC3516585 DOI: 10.1371/journal.pntd.0001917] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 10/08/2012] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa the recommended strategy to control schistosomiasis is preventive chemotherapy. Emphasis is placed on school-aged children, but in high endemicity areas, preschool-aged children are also at risk, and hence might need treatment with praziquantel. Since a pediatric formulation (e.g., syrup) is not available outside of Egypt, crushed praziquantel tablets are used, but the efficacy and safety of this treatment regimen is insufficiently studied. METHODOLOGY We assessed the efficacy and safety of crushed praziquantel tablets among preschool-aged children (<6 years) in the Azaguié district, south Côte d'Ivoire, where Schistosoma mansoni and S. haematobium coexist. Using a cross-sectional design, children provided two stool and two urine samples before and 3 weeks after treatment. Crushed praziquantel tablets, mixed with water, were administered at a dose of 40 mg/kg. Adverse events were assessed and graded 4 and 24 hours posttreatment by interviewing mothers/guardians. PRINCIPAL FINDINGS Overall, 160 preschool-aged children had at least one stool and one urine sample examined with duplicate Kato-Katz thick smears and a point-of-care circulating cathodic antigen (POC-CCA) cassette for S. mansoni, and urine filtration for S. haematobium diagnosis before and 3 weeks after praziquantel administration. According to the Kato-Katz and urine filtration results, we found high efficacy against S. mansoni (cure rate (CR), 88.6%; egg reduction rate (ERR), 96.7%) and S. haematobium (CR, 88.9%; ERR, 98.0%). POC-CCA revealed considerably lower efficacy against S. mansoni (CR, 53.8%). Treatment was generally well tolerated, but moderately severe adverse events (i.e., body and face inflammation), were observed in four Schistosoma egg-negative children. CONCLUSIONS/SIGNIFICANCE Crushed praziquantel administered to preschool-aged children at a dose of 40 mg/kg is efficacious against S. mansoni and S. haematobium in a co-endemic setting of Côte d'Ivoire. Further research is required with highly sensitive diagnostic tools and safety must be investigated in more depth. TRIAL REGISTRATION Controlled-Trials.com ISRCTN53172722.
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Affiliation(s)
- Jean T. Coulibaly
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Yve K. N'Gbesso
- Centre de Santé Rural d'Azaguié, Departement d'Agboville, Azaguié, Côte d'Ivoire
| | - Stefanie Knopp
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Jennifer Keiser
- University of Basel, Basel, Switzerland
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Eliézer K. N'Goran
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Jürg Utzinger
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
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Mazigo HD, Nuwaha F, Kinung’hi SM, Morona D, de Moira AP, Wilson S, Heukelbach J, Dunne DW. Epidemiology and control of human schistosomiasis in Tanzania. Parasit Vectors 2012; 5:274. [PMID: 23192005 PMCID: PMC3549774 DOI: 10.1186/1756-3305-5-274] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 11/16/2012] [Indexed: 01/02/2023] Open
Abstract
In Tanzania, the first cases of schistosomiasis were reported in the early 19th century. Since then, various studies have reported prevalences of up to 100% in some areas. However, for many years, there have been no sustainable control programmes and systematic data from observational and control studies are very limited in the public domain. To cover that gap, the present article reviews the epidemiology, malacology, morbidity, and the milestones the country has made in efforts to control schistosomiasis and discusses future control approaches. The available evidence indicates that, both urinary and intestinal schistosomiasis are still highly endemic in Tanzania and cause significant morbidity.Mass drug administration using praziquantel, currently used as a key intervention measure, has not been successful in decreasing prevalence of infection. There is therefore an urgent need to revise the current approach for the successful control of the disease. Clearly, these need to be integrated control measures.
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Affiliation(s)
- Humphrey D Mazigo
- Department of Medical Parasitology and Entomology, School of Medicine, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania
- Department of Environmental Health and Communicable Disease Control, School of Public Health|, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
- National Institute for Medical Research, Mwanza Research Centre, P.O. Box 1462, Mwanza, Tanzania
- Department of Pathology, Parasitology Section, Cambridge University, Tennis Court Road, Cambridge, CB2 1QP, UK
| | - Fred Nuwaha
- Department of Environmental Health and Communicable Disease Control, School of Public Health|, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Safari M Kinung’hi
- National Institute for Medical Research, Mwanza Research Centre, P.O. Box 1462, Mwanza, Tanzania
| | - Domenica Morona
- Department of Medical Parasitology and Entomology, School of Medicine, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Angela Pinot de Moira
- Department of Pathology, Parasitology Section, Cambridge University, Tennis Court Road, Cambridge, CB2 1QP, UK
| | - Shona Wilson
- Department of Pathology, Parasitology Section, Cambridge University, Tennis Court Road, Cambridge, CB2 1QP, UK
| | - Jorg Heukelbach
- Department of Community Health, School of Medicine, Federal University of Ceará, Ceará, Fortaleza, Brazil
| | - David W Dunne
- Department of Pathology, Parasitology Section, Cambridge University, Tennis Court Road, Cambridge, CB2 1QP, UK
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Ahmed A, Al-Mekhlafi HM, Al-Adhroey AH, Ithoi I, Abdulsalam AM, Surin J. The nutritional impacts of soil-transmitted helminths infections among Orang Asli schoolchildren in rural Malaysia. Parasit Vectors 2012; 5:119. [PMID: 22704549 PMCID: PMC3419660 DOI: 10.1186/1756-3305-5-119] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 06/15/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Soil-transmitted helminths (STH) infections, anaemia and malnutrition are major public health problems in school-age children in developing countries. This study was conducted on 289 Orang Asli (aboriginal) schoolchildren in order to assess the current prevalence and predictors of anaemia and malnutrition, as well as the nutritional impacts of STH infections among these children. METHODS A cross-sectional study was combined with a longitudinal follow-up three months after treatment with anthelminthic drugs. Blood samples were collected from the children to measure haemoglobin (Hb) level. Anthropometric and socioeconomic data were also collected and the children were screened for STH. RESULTS The baseline findings revealed that the prevalence of anaemia, significant stunting, underweight and wasting among the children were 41.0%, 28.0%, 29.2% and 12.5%, respectively. Overall, the prevalence of trichuriasis, ascariasis and hookworm infections were 84.6%, 47.6% and 3.9%, respectively. Haemoglobin level was significantly lower among the moderate-to-heavy infected children compared to the negative-to-light infected children. Age <10 years and moderate-to-heavy ascariasis were the predictors of anaemia. Stunting was associated with gender, age, moderate-to-heavy ascariasis and trichuriasis. Three months post-treatment assessment showed that the moderate-to-heavy infected children gained significant increment in their mean Hb level compared to the negative-to-light infected children (0.44 g/dL compared to 0.08 g/dL). However, no difference was found in the mean increments in growth indices between the groups. CONCLUSION STH infections, anaemia and malnutrition are still prevalent and a matter of public health concern in Orang Asli communities in Malaysia. Sustainable deworming programme at school and community levels among these populations will help to improve their health and nutritional status.
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Affiliation(s)
- Abdulhamid Ahmed
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia.
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Jiraanankul V, Aphijirawat W, Mungthin M, Khositnithikul R, Rangsin R, Traub RJ, Piyaraj P, Naaglor T, Taamasri P, Leelayoova S. Incidence and risk factors of hookworm infection in a rural community of central Thailand. Am J Trop Med Hyg 2011; 84:594-8. [PMID: 21460016 DOI: 10.4269/ajtmh.2011.10-0189] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
A cohort study to identify incidence and risk factors of hookworm infection was conducted in a rural community, central Thailand from November 2005 to February 2007. Stool specimens were examined for hookworm eggs using wet preparation, Kato thick smear, and water-ethyl acetate sedimentation technique. The incidence rate of hookworm infection was 7.5/100 person-years. The independent risk factors for acquiring hookworm infection were barefoot walking (incidence rate ratio [IRR] = 4.2, 95% confidence interval [CI] = 1.2-14.5) and raising buffaloes around the house (IRR = 4.8, 95% CI = 1.9-11.8). Sequencing of internal transcribed spacer 1 (ITS1)-5.8S-ITS2 region of the ribosomal RNA gene were performed for identifying species of hookworm. Necator americanus was the most common hookworm identified in this population. Ancylostoma duodenale and A. ceylanicum were also detected. Our data suggest transmission of both human and animal hookworms in this community. Thus, prevention and control strategies of hookworm infection should cover both human and animal infection.
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Affiliation(s)
- Vittaya Jiraanankul
- Department of Parasitology, Department of Military and Community Medicine, Phramongkutklao College of Medicine, Ratchawithi Road, Bangkok, Thailand
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Mutapi F, Rujeni N, Bourke C, Mitchell K, Appleby L, Nausch N, Midzi N, Mduluza T. Schistosoma haematobium treatment in 1-5 year old children: safety and efficacy of the antihelminthic drug praziquantel. PLoS Negl Trop Dis 2011; 5:e1143. [PMID: 21610855 PMCID: PMC3096601 DOI: 10.1371/journal.pntd.0001143] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 02/25/2011] [Indexed: 12/14/2022] Open
Abstract
Background Morbidity due to schistosomiasis is currently controlled by treatment of schistosome infected people with the antihelminthic drug praziquantel (PZQ). Children aged up to 5 years are currently excluded from schistosome control programmes largely due to the lack of PZQ safety data in this age group. This study investigated the safety and efficacy of PZQ treatment in such children. Methods Zimbabwean children aged 1–5 years (n = 104) were treated with PZQ tablets and side effects were assessed by questionnaire administered to their caregivers within 24 hours of taking PZQ. Treatment efficacy was determined 6 weeks after PZQ administration through schistosome egg counts in urine. The change in infection levels in the children 1–5 years old (n = 100) was compared to that in 6–10 year old children (n = 435). Principal Findings Pre-treatment S. haematobium infection intensity in 1–5 year olds was 14.6 eggs/10 ml urine and prevalence was 21%. Of the 104 children, 3.8% reported side effects within 24 hours of taking PZQ treatment. These were stomach ache, loss of appetite, lethargy and inflammation of the face and body. PZQ treatment significantly reduced schistosome infection levels in 1–5 year olds with an egg reduction rate (ERR) of 99% and cure rate (CR) of 92%. This was comparable to the efficacy of praziquantel in 6–10 year olds where ERR was 96% and CR was 67%. Interpretation/Significance PZQ treatment is as safe and efficacious in children aged 1–5 years as it is in older children aged 6–10 years in whom PZQ is the drug of choice for control of schistosome infections. Urogenital schistosomiasis is an important, but neglected, infectious disease affecting over 100 million people, mainly in Africa. Children carry the heaviest burden of infection with children as young as 1 year old showing signs of infection. Children aged 5 years and below are currently excluded from schistosome control programmes for several reasons, including operational difficulties associated with accessing preschool children, misconceptions about their level of exposure to infective water and lack of safety data on the drug of choice for schistosome control, praziquantel, in children aged 5 years and below. This study was one of a small number of studies recently funded by the World Health Organization to investigate the need for praziquantel treatment in preschool children (aged 1–5 years) and to subsequently assess the safety and efficacy of the drug praziquantel in this age group. This study confirmed that preschool children carry significant levels of schistosome infection, exceeding those carried by their parents/guardians, highlighting the urgent need for their immediate inclusion in schistosome control programmes. The study also showed that praziquantel treatment is as safe and efficacious in children aged 1–5 years as it is in older children aged 6–10 years who are currently the target for mass drug administration.
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Affiliation(s)
- Francisca Mutapi
- Ashworth Laboratories, Institute of Immunology & Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom.
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Best C, Neufingerl N, van Geel L, van den Briel T, Osendarp S. The nutritional status of school-aged children: why should we care? Food Nutr Bull 2010; 31:400-17. [PMID: 20973461 DOI: 10.1177/156482651003100303] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The nutritional status of school-aged children impacts their health, cognition, and subsequently their educational achievement. The school is an opportune setting to provide health and nutrition services to disadvantaged children. Yet, school-aged children are not commonly included in health and nutrition surveys. An up-to-date overview of their nutritional status across the world is not available. OBJECTIVE To provide a summary of the recent data on the nutritional status of school-aged children in developing countries and countries in transition and identify issues of public health concern. METHODS A review of literature published from 2002 to 2009 on the nutritional status of children aged 6 to 12 years from Latin America, Africa, Asia, and the Eastern Mediterranean region was performed. Eligible studies determined the prevalence of micronutrient deficiencies or child under- and overnutrition using biochemical markers and internationally accepted growth references. RESULTS A total of 369 studies from 76 different countries were included. The available data indicate that the nutritional status of school-aged children in the reviewed regions is considerably inadequate. Underweight and thinness were most prominent in populations from South-East Asia and Africa, whereas in Latin America the prevalence of underweight or thinness was generally below 10%. More than half of the studies on anemia reported moderate (> 20%) or severe (> 40%) prevalence of anemia. Prevalences of 20% to 30% were commonly reported for deficiencies of iron, iodine, zinc, and vitamin A. The prevalence of overweight was highest in Latin American countries (20% to 35%). In Africa, Asia, and the Eastern Mediterranean, the prevalence of overweight was generally below 15%. CONCLUSIONS The available data indicate that malnutrition is a public health issue in school-aged children in developing countries and countries in transition. However, the available data, especially data on micronutrient status, are limited. These findings emphasize the need for nutrition interventions in school-aged children and more high-quality research to assess nutritional status in this age group.
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Affiliation(s)
- Cora Best
- United Nations World Food Programme, Rome, Italy.
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Health implications of chronic hepatosplenomegaly in Kenyan school-aged children chronically exposed to malarial infections and Schistosoma mansoni. Trans R Soc Trop Med Hyg 2009; 104:110-6. [PMID: 19818465 PMCID: PMC2824847 DOI: 10.1016/j.trstmh.2009.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 08/14/2009] [Accepted: 08/14/2009] [Indexed: 11/23/2022] Open
Abstract
Hepatosplenomegaly among school-aged children in sub-Saharan Africa is highly prevalent. Two of the more common aetiological agents of hepatosplenomegaly, namely chronic exposure to malaria and Schistosoma mansoni infection, can result in similar clinical presentation, with the liver and spleen being chronically enlarged and of a firm consistency. Where co-endemic, the two parasites are thought to synergistically exacerbate hepatosplenomegaly. Here, two potential health consequences, i.e. dilation of the portal vein (indicative of increased portal pressure) and stunting of growth, were investigated in a study area where children were chronically exposed to malaria throughout while S. mansoni transmission was geographically restricted. Hepatosplenomegaly was associated with increased portal vein diameters, with enlargement of the spleen rather than the liver being more closely associated with dilation. Dilation of the portal vein was exacerbated by S. mansoni infection in an intensity-dependent manner. The prevalence of growth stunting was not associated with either relative exposure rates to malarial infection or with S. mansoni infection status but was significantly associated with hepatosplenomegaly. Children who presented with hepatosplenomegaly had the lowest height-for-age Z-scores. This study shows that hepatosplenomegaly associated with chronic exposure to malaria and schistosomiasis is not a benign symptom amongst school-aged children but has potential long-term health consequences.
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Mupfasoni D, Karibushi B, Koukounari A, Ruberanziza E, Kaberuka T, Kramer MH, Mukabayire O, Kabera M, Nizeyimana V, Deville MA, Ruxin J, Webster JP, Fenwick A. Polyparasite helminth infections and their association to anaemia and undernutrition in Northern Rwanda. PLoS Negl Trop Dis 2009; 3:e517. [PMID: 19753110 PMCID: PMC2737105 DOI: 10.1371/journal.pntd.0000517] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Accepted: 08/20/2009] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Intestinal schistosomiasis and soil-transmitted helminth (STH) infections constitute major public health problems in many parts of sub-Saharan Africa. In this study we examined the functional significance of such polyparasite infections in anemia and undernutrition in Rwandan individuals. METHODS Three polyparasite infection profiles were defined, in addition to a reference profile that consisted of either no infections or low-intensity infection with only one of the focal parasite species. Logistic regression models were applied to data of 1,605 individuals from 6 schools in 2 districts of the Northern Province before chemotherapeutic treatment in order to correctly identify individuals who were at higher odds of being anaemic and/or undernourished. FINDINGS Stunted relative to nonstunted, and males compared to females, were found to be at higher odds of being anaemic independently of polyparasite infection profile. The odds of being wasted were 2-fold greater for children with concurrent infection of at least 2 parasites at M+ intensity compared to those children with the reference profile. Males compared to females and anaemic compared to nonanaemic children were significantly more likely to be stunted. None of the three polyparasite infection profiles were found to have significant effects on stunting. CONCLUSION The present data suggest that the levels of polyparasitism, and infection intensities in the Rwandan individuals examined here may be lower as compared to other recent similar epidemiological studies in different regions across sub-Saharan Africa. Neither the odds of anaemia nor the odds of stunting were found to be significantly different in the three-polyparasite infection profiles. However, the odds of wasting were higher in those children with at least two parasites at M+ intensity compared to those children with the reference profile. Nevertheless, despite the low morbidity levels indicated in the population under study here, we recommend sustainable efforts for the deworming of affected populations to be continued in order to support the economic development of the country.
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Affiliation(s)
| | | | - Artemis Koukounari
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
- * E-mail:
| | | | | | - Michael H. Kramer
- TRAC Plus - Center for Treatment and Research on AIDS, Malaria, Tuberculosis and Other Epidemics, Kigali, Rwanda
| | | | | | - Vianney Nizeyimana
- TRAC Plus - Center for Treatment and Research on AIDS, Malaria, Tuberculosis and Other Epidemics, Kigali, Rwanda
| | - Marie-Alice Deville
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Josh Ruxin
- Access Project, Kigali, Rwanda
- The Earth Institute, Columbia University, New York, New York, United States of America
| | - Joanne P. Webster
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Alan Fenwick
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
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Evaluation and application of potential schistosome-associated morbidity markers within large-scale mass chemotherapy programmes. Parasitology 2009; 136:1789-99. [PMID: 19523252 DOI: 10.1017/s0031182009006350] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A primary objective of schistosomiasis control programmes is to achieve, and hence also demonstrate, a quantifiable reduction in schistosome-associated morbidity as a consequence of chemotherapeutic intervention. Inherent within such an objective, it is necessary to define and validate direct and indirect indicators of schistosome-related morbidity. However, to define and thereby document such morbidity, and its reduction following treatment, may not be straightforward, particularly for intestinal schistosomiasis-induced morbidity, which is often not apparent in all but the most severe or chronic cases. Within all 'Schistosomiasis Control Initiative' activities, across selected sub-Saharan African countries since 2002, a range of standard and novel potential morbidity markers have been monitored and evaluated. Parasitological intensity measures, combined with haemoglobin/anaemia counts and ultrasonography, proved valuable schistosomiasis-related morbidity indicators, being both logistically practical and informative. Additional measures tested, such as albumin excretion profiles, were promising, and are subject to ongoing research, whilst some measures, such as distended stomach/umbilical circumference, anthropometrics and health questionnaires proved less reliable. These results serve to both illustrate the success of current control activities in reducing schistosome-induced morbidity, and to highlight key tools and techniques for continued application within ongoing and future mass drug administration programmes.
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Ayoola O, Ebersole K, Omotade OO, Tayo BO, Brieger WR, Salami K, Dugas LR, Cooper RS, Luke A. Relative height and weight among children and adolescents of rural southwestern Nigeria. Ann Hum Biol 2009; 36:388-99. [PMID: 19449276 DOI: 10.1080/03014460902835606] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND There are few data describing the relative height and weight patterns of children and adolescents in rural Nigeria, despite a prevalence of stunting of over 38% among children younger than 5 years. AIM The present study documented the height and weight patterns relative to international standards among children and adolescents aged 5-20 years in rural Nigeria. SUBJECTS AND METHODS Children 5-20 years of age were enrolled from two rural villages. Height and weight were measured; body composition was estimated using bioelectrical impedance analysis. z-scores and centiles for height and body mass index were calculated; prevalences of low relative height (i.e.>2 standard deviations below mean for age and sex) and weight by sex and age were estimated. RESULTS A total of 623 participants (326 male and 297 female) were enrolled. The mean height-for-age z-score for males younger than 19 years was -2.1 and prevalence of low relative height was 50%. Among females, the mean height-for-age z-score was -1.2 during adolescence; only 15% of adolescent females were of low relative height. Based on BMI-for-age, 37% of the adolescent males and 23% of females were underweight. No children or adolescents were overweight based on BMI-for-age. CONCLUSIONS Low relative height and underweight occur in a large proportion of children and adolescents in rural Nigeria, with the lowest relative heights and weights occurring in mid-adolescence and among males.
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Affiliation(s)
- Omolola Ayoola
- Department of Paediatrics/Institute of Child Health, University College Hospital, University of Ibadan, Ibadan, Nigeria
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Albonico M, Allen H, Chitsulo L, Engels D, Gabrielli AF, Savioli L. Controlling soil-transmitted helminthiasis in pre-school-age children through preventive chemotherapy. PLoS Negl Trop Dis 2008; 2:e126. [PMID: 18365031 PMCID: PMC2274864 DOI: 10.1371/journal.pntd.0000126] [Citation(s) in RCA: 167] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Accepted: 10/16/2007] [Indexed: 12/05/2022] Open
Abstract
Pre-school age children account for 10%–20% of the 2 billion people worldwide who are infected with soil-transmitted helminths (STHs): Ascaris lumbricoides (roundworm), Trichuris trichiura (whipworm), and Ancylostoma duodenale/Necator americanus (hookworms). Through a systematic review of the published literature and using information collated at World Health Organization headquarters, this paper summarizes the available evidence to support the recommendation that pre-school children should be included in regular deworming programmes. The first section describes the burden of STH disease in this age group, followed by a summary of how infection impacts iron status, growth, vitamin A status, and cognitive development and how STHs may exacerbate other high mortality infections. The second section explores the safety of the drugs themselves, given alone or co-administered, drug efficacy, and the importance of safe administration. The third section provides country-based evidence to demonstrate improved health outcomes after STH treatment. The final section provides country experiences in scaling up coverage of pre-school children by using other large scale public health interventions, including vitamin A programmes, immunization campaigns, and Child Health days. The paper concludes with a number of open research questions and a summary of some of the operational challenges that still need to be addressed.
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Triple co-administration of ivermectin, albendazole and praziquantel in zanzibar: a safety study. PLoS Negl Trop Dis 2008; 2:e171. [PMID: 18235853 PMCID: PMC2217668 DOI: 10.1371/journal.pntd.0000171] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Accepted: 12/21/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Public health interventions based on distribution of anthelminthic drugs against lymphatic filariasis (LF), onchocerciasis, soil-transmitted helminthiasis (STH) and schistosomiasis have been implemented separately to date. A better use of available resources might be facilitated by a more coordinated approach to control such infections, including the possibility of co-administering the three recommended anthelminthic drugs through a single, large-scale intervention. METHODOLOGY/PRINCIPAL FINDINGS Ivermectin, albendazole and praziquantel were co-administered to 5,055 children and adults living in areas endemic for LF, STH and schistosomiasis in Zanzibar, United Republic of Tanzania, during a pilot intervention aimed at elucidating and quantifying possible side-effects. Subsequently, these drugs were co-administered to about 700,000 individuals during a countrywide intervention targeting a large part of the total population of Zanzibar. Passive and active surveillance measures carried out during both interventions showed that side-effects attributable to the three drugs given at the same time were mild and self-limiting events. CONCLUSIONS/SIGNIFICANCE Our data suggest that co-administration of ivermectin, albendazole and praziquantel is safe in areas where lymphatic filariasis, soil-transmitted helminthiasis and schistosomiasis are co-endemic and where several rounds of treatment with one or two drugs have been implemented in the past. Passive surveillance measures, however, should be continued and detection, management and reporting of possible side-effects should be considered a key component of any health intervention administering drugs.
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Ricci KA, Girosi F, Tarr PI, Lim YW, Mason C, Miller M, Hughes J, von Seidlein L, Agosti JM, Guerrant RL. Reducing stunting among children: the potential contribution of diagnostics. Nature 2006. [DOI: 10.1038/nature05444] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Casapía M, Joseph SA, Núñez C, Rahme E, Gyorkos TW. Parasite risk factors for stunting in grade 5 students in a community of extreme poverty in Peru. Int J Parasitol 2006; 36:741-7. [PMID: 16650426 DOI: 10.1016/j.ijpara.2006.03.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2005] [Revised: 03/06/2006] [Accepted: 03/21/2006] [Indexed: 11/21/2022]
Abstract
Malnutrition in school-age children is common in developing countries and includes both stunting and underweight. Stunting, which represents a chronic state of nutritional stress, leads to adverse health, educational and cognitive effects. Although much research is focused on preschool-age children, recent studies show both the high prevalence of stunting and the effectiveness of interventions in school-age children. The objectives of the current study were to determine the risk factors for stunting only, and stunting and underweight. A survey was conducted in 1074 grade 5 children (mean age 10 years) from 17 schools in Belen, Peru, a community of extreme poverty. Prevalence of underweight and stunting were 10.5 and 34.5%, respectively, co-prevalence was 9.3%. Based on multivariable logistic regression analyses, significant independent risk factors (odds ratio: OR) for stunting and underweight were: age (per 1 year increment) (OR=1.55; 95% confidence interval (CI): 1.33, 1.81); diarrhoea in the last week (OR=1.96; 95% CI: 1.17, 3.29) and hookworm infection (OR=1.74; 95% CI: 1.05, 2.86). Significant independent risk factors for stunting only were: age (per 1 year increment) (OR=1.51; 95% CI: 1.35, 1.70); anaemia (OR=1.98; 95% CI: 1.26, 3.11); and moderate and heavy Trichuris and Ascaris co-infection (OR=1.95; 95% CI: 1.35, 2.82). Our results indicate a high prevalence of stunting, in addition to other adverse health indicators, in the study population. Due to the interrelation between many of these health and nutrition problems, interventions at both the school and community levels, including de-worming, feeding programs and health and hygiene education, are needed to reduce malnutrition in this and other similar populations living in conditions of extreme poverty.
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Coutinho HM, Acosta LP, McGarvey ST, Jarilla B, Jiz M, Pablo A, Su L, Manalo DL, Olveda RM, Kurtis JD, Friedman JF. Nutritional status improves after treatment of schistosoma japonicum-infected children and adolescents. J Nutr 2006; 136:183-8. [PMID: 16365080 DOI: 10.1093/jn/136.1.183] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Studies addressing the relation between chronic schistosomiasis japonica and nutritional status are limited. We conducted a longitudinal treatment-reinfection study in Leyte, the Philippines, among 477 Schistosoma japonicum-infected subjects aged 7-20 y, to evaluate changes in nutritional status after treatment with praziquantel. Stool, Tanner stage, anthropometric indices, and hemoglobin (Hb) were evaluated at baseline, 4 wk post-treatment, and every 3 mo for 18 mo. Height-for-age Z-score (HAZ) and BMI Z-score (BMIZ) were calculated. Change scores relative to baseline were created for all outcome measures. Multilevel repeated-measures analyses were used to adjust for socioeconomic status, sex, either pubertal status or age, and household-level clustering. Z-scores improved modestly but significantly over time. BMIZ in children wasted at baseline improved the most [0.41 (0.26-0.56) Z-score unit] and HAZ improved only in children stunted at baseline [0.17 (0.l2-0.21) Z-score unit]. Hb improvement peaked at 15 mo and occurred only in subjects that were anemic at baseline [peak improvement: 8.3 (6.0-10.6) g/L] and in males [peak improvement 4.7 (2.9-6.6) g/L]. Reinfection, evaluated as egg count over time and egg count 3 mo earlier to assess a delay in effect, was inversely associated with improvement in Hb (P = 0.06 and 0.004, respectively). High-intensity reinfection at 18 mo was associated with significantly less absolute growth from baseline compared with lower-intensity and no reinfection. Based on the peak Hb improvement at 15 mo post-treatment, annual treatment intervals are recommended to reduce schistosomiasis-associated nutritional morbidity.
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Affiliation(s)
- Hannah M Coutinho
- Center for International Health Research, Brown University Medical School, Providence, RI, USA.
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Friedman JF, Phillips-Howard PA, Mirel LB, Terlouw DJ, Okello N, Vulule JM, Hawley WA, Nahlen BL, ter Kuile F. Progression of stunting and its predictors among school-aged children in western Kenya. Eur J Clin Nutr 2005; 59:914-22. [PMID: 15928684 DOI: 10.1038/sj.ejcn.1602161] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The objectives of this study were (1) to assess whether a cohort of school-aged children experiences progression of stunting over a 2-y-period of observation and (2) to identify baseline nutritional and body composition risk factors for the progression of stunting. METHODS As part of a large-scale, randomized controlled trial assessing the impact of insecticide-treated bednets (ITNs) on nutritional status, we longitudinally followed a cohort of school-aged children over a 2-y-period in western Kenya. Anthropometric measurements were made at four time points from which Z-scores for height-for-age (HAZ), weight-for-age (WAZ), and body mass index (BMIZ) were calculated. Two measures of body composition, upper arm fat area and upper arm muscle area, were derived from mid-upper arm circumference (MUAC) and triceps skinfold thickness. RESULTS Subjects experienced a mean change in HAZ from baseline to 9 months of -0.16 [-0.19, -0.13], from baseline to 16 months of -0.18 [-0.22, -0.15], and from baseline to 24 months of -0.36 [-0.41, -0.31]. Thus, the average individual's change in HAZ at the three follow-up time points is significantly less than zero, meaning that, on average, the cohort is deviating further from NCHS reference medians over time. The baseline nutritional measure that explained the greatest amount of variance in the progression of stunting was the upper arm muscle area Z-score (F=8.1; P=0.005). CONCLUSIONS This longitudinal study provides further evidence from a distinct ecological setting regarding the progression of undernutrition during middle childhood in the developing world. It suggests that school-aged children in the developing world do not experience catch-up growth or remain stable. Rather, they continue to deviate from NCHS standards, accruing greater height deficits with age. In addition, absolute lean body mass explained the most variability in the progression of stunting, which supports cross-sectional findings from other studies.
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Affiliation(s)
- J F Friedman
- US Department of State, Institute of International Education, Fulbright Fellowships, Washington, DC, USA.
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Mamabolo RL, Alberts M, Mbenyane GX, Steyn NP, Nthangeni NG, Delemarre-Van De Waal HA, Levitt NS. Feeding practices and growth of infants from birth to 12 months in the central region of the Limpopo Province of South Africa. Nutrition 2004; 20:327-33. [PMID: 14990278 DOI: 10.1016/j.nut.2003.11.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We evaluated feeding practices and growth patterns of infants in the central region of the Limpopo Province over the first 12 mo of life. METHODS A follow-up study on a cohort of term infants born to 276 mothers recruited during their third trimester of pregnancy was undertaken. The mothers were recruited by the nursing staff at nine randomly selected clinics. From this sample, 219 women gave birth at the local hospital and the infants were followed from birth to 12 mo. Data collected included infant feeding practices and anthropometry at regular intervals (1, 3, 6, 9 and 12 mo). The anthropometric measurements taken were body weight, length, and head circumference. RESULTS At birth 8.8% of infants had a low birth weight, 9.6% were stunted, 48.9% were underweight, and 7.3% were wasted. Mothers in this study breastfed their infants for long periods with more than 80% still breastfeeding by the ninth month. However, exclusive breastfeeding during the first 3 mo was uncommon as mothers tended to introduce supplementary feeds at an early age, with 56% of the infants receiving some form of supplement by the end of the first month. The most common supplementary foods were maize meal porridge and mabella (sorghum). Stunting became increasingly apparent in the early months with 30% of infants being stunted (<-2 standard deviations [SD] of the National Center for Health Statistics [NCHS] reference curves) by the first month, and this percentage remained high for the 12-mo period, remaining at below - 1 SD NCHS height-for-age standard. Increased weight gain was seen during the first 3 mo and then declined until mean weight-for-age at 12 mo was below 0 SD NCHS. Twelve percent of infants were overweight (>2 SD NCHS) by the 12th month. Postnatally the infants showed a pattern of gradual stunting. Postnatal factors associated with this pattern were related to maternal socioeconomic status, and these included the mother's level of education, employment status, parity, and access to electricity. CONCLUSION There was a high frequency of underweight infants at birth but stunting was less common. With respect to feeding practices, the mothers tended to introduce supplementary feeds at an early age.
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Affiliation(s)
- Ramoteme L Mamabolo
- Medical Sciences Discipline, University of the North, Polokwane, South Africa
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Leenstra T, Petersen LT, Kariuki SK, Oloo AJ, Kager PA, ter Kuile FO. Prevalence and severity of malnutrition and age at menarche; cross-sectional studies in adolescent schoolgirls in western Kenya. Eur J Clin Nutr 2004; 59:41-8. [PMID: 15305179 DOI: 10.1038/sj.ejcn.1602031] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Nutritional status is an important marker of overall health and linear growth retardation has serious long-term physiological and economic consequences. Approximately 35 and 29% of preschool children in sub-Saharan Africa are stunted and underweight, respectively. There is relatively little information available about the nutritional status in adolescents, the age group with the highest growth velocity after infancy. We conducted a series of cross-sectional surveys to determine the prevalence and main risk groups for malnutrition and to describe the associations between age, sexual maturation and nutritional status in adolescent schoolgirls in western Kenya. DESIGN Three cross-sectional surveys; one in Mumias, using random sampling in all schools, and two surveys in Asembo, using a multi-stage random sample design. SETTING Public primary schools in two different rural malaria endemic areas in western Kenya with high levels of malnutrition in preschool children. SUBJECTS In all, 928 randomly selected adolescent schoolgirls aged 12-18 y. RESULTS Overall prevalence of stunting and thinness was 12.1 and 15.6%, respectively. Of the total, 2% were severely stunted. Menarche and start of puberty were delayed by approximately 1.5-2 y compared to a US reference population. The prevalence of stunting and thinness decreased with age and mean height for age z-scores converged towards the median of the US reference curve. Girls who had not yet started menstruating were more likely to be stunted than the girls of the same age who were post-menarche. CONCLUSIONS Stunting and thinness are common in young adolescent schoolgirls in these poor rural settings in western Kenya, but the prevalence decreases with age, providing observational support that children catch up on incomplete growth attained earlier in life due to a maturational delay of 1.5-2 y allowing prolonged growth.
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Affiliation(s)
- T Leenstra
- Kenya Medical Research Institute, Centre for Vector Biology and Control Research, Kisumu, Kenya.
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Magak P, King CH, Ireri E, Kadzo H, Ouma JH, Muchiri EM. High prevalence of ectopic kidney in Coast Province, Kenya. Trop Med Int Health 2004; 9:595-600. [PMID: 15117304 DOI: 10.1111/j.1365-3156.2004.01228.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To establish the prevalence of congenital urinary tract abnormalities in a full population-based ultrasound survey of an area of coastal Kenya. METHODS Ultrasound examination of 3118 residents of 912 households, including all available subjects over 2 years of age, residing in five contiguous rural villages 50 km south of Mombasa. RESULTS Survey findings indicated simple renal ectopia in 11 of 3118 subjects (0.35%) and renal agenesis in three (0.096%). No cases of horseshoe kidney or complex urinary anomaly were detected, and no cases of multiple congenital anomaly were found. Ectopia cases were evenly distributed between men and women, and across the five study villages. None of the individuals affected by renal ectopia were closely related (i.e. <5th-degree relations). CONCLUSION There is an unusually high prevalence of ectopia among unrelated subjects in this area. In this setting, the findings suggest either a common exposure to teratogenetic factors, or a hereditary condition with variable penetrance, where more severely affected individuals are not observed because of foetal/infant mortality.
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Affiliation(s)
- Philip Magak
- Department of Radiology, Ministry of Health, Nairobi, Kenya.
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Daniels MC, Adair LS. Growth in young Filipino children predicts schooling trajectories through high school. J Nutr 2004; 134:1439-46. [PMID: 15173409 DOI: 10.1093/jn/134.6.1439] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Several studies link childhood malnutrition to adverse schooling outcomes, including delayed or diminished enrollment and increased grade repetition. However, the effects of nutrition on schooling trajectories are obscured by the cross-sectional nature of most previous research and the complex array of other phenomena that affect schooling outcomes. We explored the association between height-for-age Z-score (HAZ) at 2 y and schooling trajectory among 2198 children from the Cebu Longitudinal Health and Nutrition Survey. Parity, parental education, maternal height, household assets, environmental cleanliness, presence of electricity, and household income were identified as potential confounders. Crude and adjusted logistic and multinomial regressions of schooling outcomes (entrance age, grade repetition, and grades completed) were conducted. Entrance age and IQ were evaluated as potential mediators between HAZ and schooling outcomes. After adjustment for confounders, greater height for age protected against late enrollment among both boys and girls and predicted early enrollment among boys. Taller children were less likely to repeat grades [girls OR = 0.78 (0.67, 0.89); boys OR = 0.86 (0.74, 0.99)] and less likely to drop out during grade school rather than graduate from high school [girls OR = 0.74 (0.56, 0.98; boys OR = 0.66 (0.51, 0.84)]. Models predicting the changes in school outcomes associated with a change in overall height from -2 to 0 SD of HAZ were simulated. Absolute probability of late enrollment dropped substantially, from 6% for both boys and girls to 2% for boys and 1% for girls. Absolute grade repetition dropped approximately 7% for boys and 9% for girls. Improving early childhood nutrition may have long-lasting educational benefits, increasing the likelihood of high school completion in developing countries.
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Beasley M, Brooker S, Ndinaromtan M, Madjiouroum EM, Baboguel M, Djenguinabe E, Bundy DAP. First nationwide survey of the health of schoolchildren in Chad. Trop Med Int Health 2002; 7:625-30. [PMID: 12100447 DOI: 10.1046/j.1365-3156.2002.00900.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Survey data are presented from a nationwide survey of the health of schoolchildren in Chad. The country was stratified into distinct ecological zones based on satellite sensor environmental data. Twenty schools were visited and 1024 children aged between 6 and 15 years were included in the study. The overall prevalence of stunting, underweight, anaemia and goitre was 18.7, 16.5, 25.1 and 23.3%, respectively. Schistosoma haematobium, Schistosoma mansoni and hookworm were the only helminth species found with prevalences of 13.2, 1 and 32.7%, respectively. A greater proportion of boys were stunted, underweight, anaemic and infected with S. haematobium and hookworm than girls. Older children were more stunted, underweight and infected with S. haematobium and hookworm than younger children, but less anaemic. The prevalence of infection showed marked geographical heterogeneity, with hookworm prevalence being highest in the Sudanian and tropical zone, and S. haematobium being most prevalent in the Sahelian zone and the Logone and Chari basins in the west of the country. These data show that there is a high prevalence of helminth infection in Chad, but that treatment for S. haematobium and hookworm should be targeted to different geographical areas.
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Affiliation(s)
- Michael Beasley
- Department of Infectious Disease Epidemiology, Imperial College School of Medicine, London, UK
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Yamanaka M, Ashworth A. Differential workloads of boys and girls in rural Nepal and their association with growth. Am J Hum Biol 2002; 14:356-63. [PMID: 12001093 DOI: 10.1002/ajhb.10030] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
In developing countries, heavy workloads of women adversely affect their nutritional status and that of their children. Little is known, however, about the effect of children's heavy workloads on their own well-being. In Nepal, girls are expected to help their mothers in time-consuming and energy-demanding tasks from an early age. The aim of this study was to compare work patterns and anthropometric status of boys and girls age 6-17 years in western rural Nepal. It was hypothesized that girls would work longer and harder than boys and would have poorer growth status. It was also anticipated that children's work patterns might differ between highland and lowland areas. Two study sites were therefore chosen: one in the hills and the other in the lowland terai. A time allocation study was conducted for 237 children. They were observed continuously from 7:00 AM to 7:00 PM to determine the time spent in light, moderate, and heavy activities. Body weights and heights were also measured. On average, girls worked twice as long as boys (5.8 vs. 2.8 h/day, P < 0.001) and undertook more heavy work (1.5 vs. 0.7 h/day, (P < 0.001), but they did not have poorer anthropometric status. Children in the hills worked longer hours and did heavier work than those in the terai and were more stunted in growth.
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Affiliation(s)
- Miki Yamanaka
- Public Health Nutrition Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1B 3DP
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Brooker S, Marriot H, Hall A, Adjei S, Allan E, Maier C, Bundy DA, Drake LJ, Coombes MD, Azene G, Lansdown RG, Wen ST, Dzodozmenyo M, Cobbinah J, Obro N, Kihamia CM, Issae W, Mwanri L, Mweta MR, Mwaikemwa A, Salimu M, Ntimbwa P, Kiwelu VM, Turuka A, Nkungu DR, Magingo J. Community perception of school-based delivery of anthelmintics in Ghana and Tanzania. Trop Med Int Health 2001; 6:1075-83. [PMID: 11737845 DOI: 10.1046/j.1365-3156.2001.00806.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This paper presents the results of an evaluation of community perception of two large-scale, government-run, school-based health programmes delivering anthelmintic drugs to primary school children, in Ghana (80 442 children in 577 schools) and Tanzania (110 000 children in 352 schools). Most teachers (96% in Ghana and 98% in Tanzania) were positive about their role in the programme, including administration of anthelmintic drugs, and parents and children fully accepted their taking on this role. The benefits of the programme were apparent to teachers, parents and children in terms of improved health and well-being of the children. Over 90% of parents in both Ghana and Tanzania indicated a willingness to pay for the continuation of drug treatment. The evaluation also highlighted areas that are critical to programme effectiveness, such as communication between schools and parents, the issue of collaboration between the health and education sectors, parents' perception of the importance of helminth infection as a serious and chronic health problem (compared with more acute and life threatening illnesses such as malaria), and who should pay for treatment of side-effects.
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Affiliation(s)
- S Brooker
- The Partnership for Child Development, Imperial College School of Medicine, London, UK
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Abstract
Ascaris lumbricoides, the most frequent human intestinal nematode, is the causative agent of ascariasis, with an estimated worldwide prevalence of over one billion people, especially in moist tropical and subtropical regions, but also in cooler climates. Although characterised with low morbidity and mortality rates, the global prevalence of ascariasis still results in approximately 20,000 deaths annually, primarily as a consequence of intestinal obstruction. In humans, transmission usually occurs by hand-to-mouth route by way of contaminated agricultural products and food, or from dirty hands. Three phases of ascariasis may be present, namely, the pulmonary, intestinal and the complications stage. Although generally asymptomatic, heavy infestation may cause serious pulmonary disease, or partial or complete obstruction of biliary or intestinal tracts. Anthelminthic chemotherapy is required to eradicate the parasites and prevent potentially serious complications. Mebendazole, albendazole and pyrantel pamoate are the most widely used agents to treat ascariasis. Preventive chemotherapy delivered to communities in endemic regions may serve as an affordable and cost-effective strategy to reduce the prevalence and morbidity in endemic regions. Under unusual circumstances, Ascaris suum, the cause of helminthic infection in pigs, may also cause disease in humans.
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Affiliation(s)
- V St Georgiev
- National Institute of Allergy and Infectious Diseases, NIH 6700-B Rockledge Drive, Room 2102, Bethesda, MD 20892, USA.
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Shariff ZM, Bond JT, Johnson NE. Nutrition and educational achievement of urban primary schoolchildren in Malaysia. Asia Pac J Clin Nutr 2000; 9:264-73. [DOI: 10.1046/j.1440-6047.2000.00191.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Beasley NM, Hall A, Tomkins AM, Donnelly C, Ntimbwa P, Kivuga J, Kihamia CM, Lorri W, Bundy DA. The health of enrolled and non enrolled children of school age in Tanga, Tanzania. Acta Trop 2000; 76:223-9. [PMID: 10974162 DOI: 10.1016/s0001-706x(00)00101-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The health of 227 children enrolled at primary school was compared with that of 214 non enrolled children living in rural Tanga, Tanzania. No consistent difference was observed with respect to prevalence and intensity of parasitic infection (hookworm, T. trichiura, A. lumbricoides, S. haematobium and P. falciparum). Since enrolled children were as commonly and as heavily infected as non enrolled children, treatment of enrolled children would be effective in reducing transmission throughout the total population. Non enrolled children were more stunted (P=0.0001) and wasted (P=0.0001) than enrolled children and also tended to be more anaemic (P=0.080) showing that poor nutrition is not only associated with delayed enrolment but continues to be associated with non enrolment throughout the school age years. Given that treatment has the greatest impact on the most malnourished children, additional measures to extend treatment to non enrolled children would be justified.
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Affiliation(s)
- N M Beasley
- Partnership for Child Development, Wellcome Trust Centre for the Epidemiology of Infectious Disease, Oxford University, South Parks Road, OX1 3PS, Oxford, UK
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46
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McGarvey ST. Schistosomiasis: Impact on childhood and adolescent growth, malnutrition, and morbidity. ACTA ACUST UNITED AC 2000. [DOI: 10.1053/spid.2000.9642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lwambo NJ, Siza JE, Brooker S, Bundy DA, Guyatt H. Patterns of concurrent hookworm infection and schistosomiasis in schoolchildren in Tanzania. Trans R Soc Trop Med Hyg 1999; 93:497-502. [PMID: 10696404 DOI: 10.1016/s0035-9203(99)90349-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
A cross-sectional study of 6897 schoolchildren in 59 out of the 155 primary schools in Magu District on the shores of Lake Victoria, Tanzania, was undertaken in 1997 to determine the prevalence of single- and multiple-species helminth infection. Schistosoma haematobium, hookworm (primarily Necator americanus) and S. mansoni were the most common helminth species infecting schoolchildren in the district. The prevalences of Ascaris lumbricoides and Trichuris trichiura were negligible (< 1%). Anaemia and stunting were highly prevalent and widespread. Hookworm and S. mansoni occurred more frequently in multiple infections with other helminths than as single-species infections, but triple-species infection was rare. Analysis of the frequency distribution of infection amongst schools showed that prevalences of S. haematobium and hookworm tended to be normally distributed, with medians 75% and 45%, respectively, while the distribution of S. mansoni was markedly skewed such that only 17% schools had a prevalence greater than 20%. An inverse association between S. mansoni and S. haematobium was observed. Geographical information system (GIS) analysis indicated that S. mansoni infection was highly prevalent only along the shore of Lake Victoria, whilst S. haematobium was homogeneously prevalent everywhere except the lakeshore. This pattern appears to reflect the distribution of schistosome species-specific snail intermediate hosts. The results imply that joint treatment for hookworm infection and schistosomiasis would be beneficial throughout the district.
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Affiliation(s)
- N J Lwambo
- National Institute for Medical Research, Mwanza Research Centre, Tanzania
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Tsuyuoka R, Bailey JW, Nery Guimarães AM, Gurgel RQ, Cuevas LE. Anemia and intestinal parasitic infections in primary school students in Aracaju, Sergipe, Brazil. CAD SAUDE PUBLICA 1999; 15:413-21. [PMID: 10409794 DOI: 10.1590/s0102-311x1999000200026] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Anemia is estimated to affect half the school-age children and adolescents in developing countries. The main causes are parasitic infections, malaria, and low iron intake. This study aimed to describe the prevalence of anemia, parasitic infections, and nutritional status of children attending public primary schools in Aracaju, Northeast Brazil. Of 360 students, 26.7% were anemic, and prevalence was higher in children under 8 and over 15 years of age. Overall prevalence of intestinal parasites was 42%, with Ascaris lumbricoides (28.7%), Trichuris trichiura (15.6%), and hookworm (1. 7%) most frequently found. There was an association between parasitic infections and poor sanitary conditions, but there was no association between anemia and presence of intestinal parasites. Height-for-age Z scores were lower than the NCHS standard, and prevalence of stunting was 5.4%. Although intestinal parasites were not associated with anemia, children with parasites had lower nutritional indices (weight- and height-for-age Z scores) than those without parasites.
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Affiliation(s)
- R Tsuyuoka
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
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The anthropometric status of schoolchildren in five countries in the partnership for child development. Proc Nutr Soc 1998; 57:149-58. [PMID: 9571720 DOI: 10.1079/pns19980021] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Stoltzfus RJ, Albonico M, Tielsch JM, Chwaya HM, Savioli L. School-based deworming program yields small improvement in growth of Zanzibari school children after one year. J Nutr 1997; 127:2187-93. [PMID: 9349846 DOI: 10.1093/jn/127.11.2187] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Efficacy trials of antihelminthic therapies conducted in Africa have reported improvements in children's growth, but nutritional evaluations of large-scale deworming programs are lacking. We evaluated the first-year effect on growth of a school-based deworming program in Zanzibar, where growth retardation occurs in school children. Children in four primary schools were given thrice-yearly mebendazole (500 mg) and compared with children in four schools that received twice-yearly mebendazole and children in four non-program schools. Evaluation schools were randomly selected and allocated to control, twice-yearly or thrice-yearly deworming. Approximately 1000 children in each program group completed the 1-y follow-up. Children <10 y old gained 0.27 kg more weight (P < 0.05) and 0.13 cm more height (P = 0.20) in the twice-yearly group, and 0. 20 kg more weight (P = 0.07) and 0.30 cm more height (P < 0.01) in the thrice-yearly group, compared with the control group. Children <10 y old with higher heights-for-age at baseline had higher weight and height gains in response to deworming. In children >/=10 y old, overall program effects on height or weight gains were not significant. But in this age range, younger boys had significant improvements in height gain with thrice-yearly deworming, and children with higher heights-for-age had greater improvements in weight gain with deworming. We conclude that the deworming program improved the growth of school children, especially children who were younger and less stunted, but the improvements were small. More effective antihelminthic regimens or additional dietary or disease control interventions may be needed to substantially improve the growth of school children in areas such as Zanzibar.
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Affiliation(s)
- R J Stoltzfus
- Center for Human Nutrition, Department of International Health, The Johns Hopkins School of Public Health, Baltimore, MD 21205, USA
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