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Depriving Out-of-School Children of Deworming Tablets for Soil-Transmitted Helminth Infection in Bangladesh: The Irony of a School-Based Deworming Programme. Trop Med Infect Dis 2022; 7:tropicalmed7030035. [PMID: 35324582 PMCID: PMC8955424 DOI: 10.3390/tropicalmed7030035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/17/2022] Open
Abstract
Since 2008, Bangladesh has had a school-based deworming programme to combat soil-transmitted helminth (STH) infection among school-aged children (SACs). Existing programmes have trouble reaching SACs, especially those out-of-school (OSCs). This study evaluated deworming coverage among school going children (SGCs) and OSCs in two Nilphamari sub-districts. It also evaluated community knowledge on STH control and deworming coverage in both areas for all SACs. Saidpur (intervention) and Kishoregonj (control) sub-districts, in Nilphamari, were surveyed in December 2019. The survey included SACs and their parents. Among SGCs, the intervention group (89.0%) had higher deworming coverage than the control group (75.5%). In the intervention group, 59.9% of OSCs received the deworming tablet versus 24.6% in the control group. Community involvement activities including door-to-door visits, courtyard gatherings, and miking benefited both SACs and their primary caregivers. SACs living in the intervention region, awareness of the last pill distribution date, and caregivers observing BRAC workers in action, were linked to SAC deworming coverage. Re-strategizing the deworming programme to include the OSCs is vital and suggests timely action. Building community awareness and periodic epidemiological assessment can further facilitate an improved drug intake.
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Bauleni A, Tiruneh FN, Mwenyenkulu TE, Nkoka O, Chirwa GC, Gowelo S, Chipeta MG, Ntenda PAM. Effects of deworming medication on anaemia among children aged 6-59 months in sub-Saharan Africa. Parasit Vectors 2022; 15:7. [PMID: 35016722 PMCID: PMC8753868 DOI: 10.1186/s13071-021-05123-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 12/11/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite the limited knowledge regarding the effects of deworming medication (DM) on nutritional indicators in sub-Saharan Africa (SSA), deworming programmes continue to be implemented in resource-limited countries. Therefore, the current study aimed to examine the effects of DM on anaemia among children aged 6-59 months in SSA. METHODS The analysis was performed using data obtained from 17 demographic and health surveys (DHSs) conducted in SSA. Children were considered to be anaemic if their haemoglobin (Hb) concentration was less than 11.0 g/dl, adjusting for altitude. To account for both multiple measures at the cluster level and the clustering of children within the same country, generalized linear mixed models were used to analyse the anaemia outcomes in 50,075 children aged 6-59 months. RESULTS Overall, anaemia was reported in 61.8% of the children, and their median Hb concentration was 10.5 g/dl (interquartile range 9.4-11.5). The prevalence of anaemia ranged from 34.5% in Rwanda to 81.1% in Mali. Multivariate analyses showed that children who did not receive DM had increased odds of being anaemic (adjusted odds ratio [aOR]: 1.11; 95% confidence interval [CI] 1.07-1.16). CONCLUSIONS The current study revealed that DM can decrease the risk of anaemia among preschool-age children (pre-SAC) in SSA. Thus, tailored public health programmes aimed at reducing childhood anaemia need to consider deworming. However, longitudinal studies are needed to validate the association that has been reported in this cross-sectional study.
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Affiliation(s)
- Andy Bauleni
- Malaria Alert Centre, Kamuzu University of Health Sciences, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Fentanesh N Tiruneh
- Department of Applied Human Nutrition, Faculty of Chemical and Food Engineering, Bahir Dar Institute of Technology, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tisungane E Mwenyenkulu
- Department of Clinical Sciences, Academy of Medical Sciences, Malawi University of Science and Technology, PO Box 5196, Limbe, Malawi
| | - Owen Nkoka
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Gowokani C Chirwa
- Department of Economics, Chancellor College, University of Malawi, P.O. Box 280, Zomba, Malawi
| | - Steve Gowelo
- Malaria Alert Centre, Kamuzu University of Health Sciences, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Michael G Chipeta
- Geospatial Epidemiology, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Peter A M Ntenda
- Malaria Alert Centre, Kamuzu University of Health Sciences, Private Bag 360, Chichiri, Blantyre 3, Malawi.
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de Gier B, Nga TT, Winichagoon P, Dijkhuizen MA, Khan NC, van de Bor M, Ponce MC, Polman K, Wieringa FT. Species-Specific Associations Between Soil-Transmitted Helminths and Micronutrients in Vietnamese Schoolchildren. Am J Trop Med Hyg 2016; 95:77-82. [PMID: 27246448 DOI: 10.4269/ajtmh.15-0533] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 03/06/2016] [Indexed: 11/07/2022] Open
Abstract
Soil-transmitted helminth (STH) infections and micronutrient deficiencies are closely related and often coexist among low-income populations. We studied the association between infections with specific STH species and micronutrient status in rural Vietnamese schoolchildren. Children (N = 510) aged 6-9 years were recruited from two primary schools. STH infections were determined in stool samples. Hemoglobin, ferritin, retinol, and zinc were measured in blood samples, as well as C-reactive protein to control for inflammation. Iodine excretion was measured in urine. Associations of single and multiple infections with Ascaris lumbricoides, Trichuris trichiura, and hookworm with micronutrient status (hemoglobin, plasma ferritin, retinol, zinc, and urinary iodine) were estimated by multiple regression analysis. Ascaris infections showed a specific and intensity-dependent negative association with vitamin A. Trichuris and hookworm infections were associated with lower hemoglobin concentration, but not with plasma ferritin. Trichuris-infected children had zinc deficiency less often than uninfected children. In conclusion, our study shows species-specific associations between STH infections and micronutrient status in children. The different life cycles of STH species might have specific effects on the absorption or loss of specific micronutrients. Tailor-made combinations of deworming and nutritional interventions may be needed to improve child health and nutrition.
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Affiliation(s)
- Brechje de Gier
- Section Health and Life Sciences, Athena Institute, Vrije Universiteit (VU University), Amsterdam, The Netherlands
| | | | | | | | | | - Margot van de Bor
- Section Health and Life Sciences, Athena Institute, Vrije Universiteit (VU University), Amsterdam, The Netherlands
| | - Maiza Campos Ponce
- Section Infectious Diseases, Department of Health Sciences, Vrije Universiteit (VU University), Amsterdam, The Netherlands
| | - Katja Polman
- Section Infectious Diseases, Department of Health Sciences, Vrije Universiteit (VU University), Amsterdam, The Netherlands. Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Frank T Wieringa
- UMR-204 NutriPass IRD-UM-SupAgro, Institut de Recherche pour le Développement, Montpellier, France.
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Rajagopal S, Hotez PJ, Bundy DAP. Micronutrient supplementation and deworming in children with geohelminth infections. PLoS Negl Trop Dis 2014; 8:e2920. [PMID: 25101963 PMCID: PMC4125305 DOI: 10.1371/journal.pntd.0002920] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Selvi Rajagopal
- Departments of Medicine, Pediatrics, and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Peter J. Hotez
- Departments of Medicine, Pediatrics, and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development, Houston, Texas, United States of America
- * E-mail: (PH); (DB)
| | - Donald A. P. Bundy
- Human Development Department, World Bank, Washington, D.C., United States of America
- * E-mail: (PH); (DB)
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de Gier B, Campos Ponce M, van de Bor M, Doak CM, Polman K. Helminth infections and micronutrients in school-age children: a systematic review and meta-analysis. Am J Clin Nutr 2014; 99:1499-509. [PMID: 24740209 DOI: 10.3945/ajcn.113.069955] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Helminth infections and micronutrient deficiencies are highly prevalent in developing countries. Neither condition typically causes overt disease, but they do lead to indirect morbidity such as impaired physical and cognitive development. OBJECTIVE We aimed to systematically review current evidence on the relation of helminth infections with micronutrient status in school-age children worldwide. DESIGN We included both observational studies and randomized controlled trials (RCTs). We applied a random-effects meta-analysis to estimate 1) cross-sectional associations between helminths and micronutrient status, 2) effects of anthelminthic treatment on micronutrient status, and 3) effects of micronutrient supplementation on helminth infection and reinfection. RESULTS Meta-analyses of observational studies showed an association between helminth infections and serum retinol [standardized mean difference (SMD): -0.30; 95% CI: -0.48, -0.13] but not serum ferritin (SMD: 0.00; 95% CI: -0.7, 0.7). Conversely, meta-analyses of anthelminthic treatment RCTs showed a positive effect on ferritin (SMD: 0.16; 95% CI: 0.09, 0.22) but not retinol (SMD: 0.04; 95% CI: -0.06, 0.14). The number of studies on micronutrients other than ferritin and retinol was not sufficient for pooling. Meta-analyses of micronutrient-supplementation RCTs showed only a modest protective effect for multimicronutrient interventions on helminth infection and reinfection rates (OR: 0.77; 95% CI: 0.61, 0.97). CONCLUSIONS In this review, we show evidence of distinct associations between helminth infections and micronutrients in school-age children. More studies are needed on micronutrients other than iron and vitamin A and on possible helminth species-specific effects. A thorough comprehension of the interplay between helminth infections and micronutrients will help guide integrated and sustainable intervention strategies in affected children worldwide.
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Affiliation(s)
- Brechje de Gier
- From the Department of Health Sciences (MCP, CMD, and KP) and Section of Health and Life Sciences (BdG and MvdB), VU University Amsterdam, Amsterdam, Netherlands, and the Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium (KP)
| | - Maiza Campos Ponce
- From the Department of Health Sciences (MCP, CMD, and KP) and Section of Health and Life Sciences (BdG and MvdB), VU University Amsterdam, Amsterdam, Netherlands, and the Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium (KP)
| | - Margot van de Bor
- From the Department of Health Sciences (MCP, CMD, and KP) and Section of Health and Life Sciences (BdG and MvdB), VU University Amsterdam, Amsterdam, Netherlands, and the Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium (KP)
| | - Colleen M Doak
- From the Department of Health Sciences (MCP, CMD, and KP) and Section of Health and Life Sciences (BdG and MvdB), VU University Amsterdam, Amsterdam, Netherlands, and the Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium (KP)
| | - Katja Polman
- From the Department of Health Sciences (MCP, CMD, and KP) and Section of Health and Life Sciences (BdG and MvdB), VU University Amsterdam, Amsterdam, Netherlands, and the Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium (KP)
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Rai SK, Rai G, Hirai K, Abe A, Ohno Y. The health system in Nepal-An introduction. Environ Health Prev Med 2012; 6:1-8. [PMID: 21432230 DOI: 10.1007/bf02897302] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2000] [Accepted: 11/22/2000] [Indexed: 11/28/2022] Open
Abstract
We present here a study on the health system in Nepal. Approximately two-thirds of the health problems in Nepal are infectious diseases. Epidemics occur frequently with a high rate of morbidity and mortality and there are occasional outbreaks of infectious diseases of unknown etiology. In addition, the rapid rate of HIV infection in the Indian sub-continent is likely to add a new dimension of opportunistic infections. Until now, the Health System introduced as the General Health Plan in 1956 has been expanded by focusing on primary health care, and a comprehensive network-like Health System has been developed; the most basic unit is a Sub-Health Post or Health Post in each Village Development Committee area. However, the expansion of the Health System has not been matched by an expansion in the domestive resources, workers and supplies, and the available resources are not efficiently distributed. In addition, insufficient resources available for preventive and promotive medicine and the occurrence of non-infectious diseases such as cancer and cardiovascular diseases has been increasing. The Government recently introduced a Health Policy encouraging the private sector to invest in the production of health workers and in providing quality health services. As a result, several private health institutions have been founded and are expected to contribute to the development of the human resources required by Nepal.
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Affiliation(s)
- S K Rai
- Department of Microbiology, Nepal Medical College, Jorpati-7, Kathmandu
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Ngui R, Lim YAL, Chong Kin L, Sek Chuen C, Jaffar S. Association between anaemia, iron deficiency anaemia, neglected parasitic infections and socioeconomic factors in rural children of West Malaysia. PLoS Negl Trop Dis 2012; 6:e1550. [PMID: 22413027 PMCID: PMC3295806 DOI: 10.1371/journal.pntd.0001550] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 01/12/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Given that micronutrient deficiency, neglected intestinal parasitic infections (IPIs) and poor socioeconomic status are closely linked, we conducted a cross-sectional study to assess the relationship between IPIs and nutritional status of children living in remote and rural areas in West Malaysia. METHODS/FINDINGS A total of 550 children participated, comprising 520 (94.5%) school children aged 7 to 12 years old, 30 (5.5%) young children aged 1 to 6 years old, 254 (46.2%) boys and 296 (53.8%) girls. Of the 550 children, 26.2% were anaemic, 54.9% iron deficient and 16.9% had iron deficiency anaemia (IDA). The overall prevalence of helminths was 76.5% comprising Trichuris trichiura (71.5%), Ascaris lumbricoides (41.6%) and hookworm infection (13.5%). It was observed that iron deficiency was significantly higher in girls (p = 0.032) compared to boys. Univariate analysis demonstrated that low level of mother's education (OR = 2.52; 95% CI = 1.38-4.60; p = 0.002), non working parents (OR = 2.18; 95% CI = 2.06-2.31; p = 0.013), low household income (OR = 2.02; 95% CI = 1.14-3.59; p = 0.015), T. trichiura (OR = 2.15; 95% CI = 1.21-3.81; p = 0.008) and A. lumbricoides infections (OR = 1.63; 95% CI = 1.04-2.55; p = 0.032) were significantly associated with the high prevalence of IDA. Multivariate analysis confirmed that low level of mother's education (OR = 1.48; 95 CI% = 1.33-2.58; p<0.001) was a significant predictor for IDA in these children. CONCLUSION It is crucial that a comprehensive primary health care programme for these communities that includes periodic de-worming, nutrition supplement, improved household economy, education, sanitation status and personal hygiene are taken into consideration to improve the nutritional status of these children.
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Affiliation(s)
- Romano Ngui
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yvonne Ai Lian Lim
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Liam Chong Kin
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chow Sek Chuen
- School of Science, Monash University, Jalan Lagoon Selatan, Selangor Darul Ehsan, Malaysia
| | - Shukri Jaffar
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Kau AL, Ahern PP, Griffin NW, Goodman AL, Gordon JI. Human nutrition, the gut microbiome and the immune system. Nature 2011; 474:327-36. [PMID: 21677749 DOI: 10.1038/nature10213] [Citation(s) in RCA: 1670] [Impact Index Per Article: 128.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Marked changes in socio-economic status, cultural traditions, population growth and agriculture are affecting diets worldwide. Understanding how our diet and nutritional status influence the composition and dynamic operations of our gut microbial communities, and the innate and adaptive arms of our immune system, represents an area of scientific need, opportunity and challenge. The insights gleaned should help to address several pressing global health problems.
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Affiliation(s)
- Andrew L Kau
- Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St Louis, Missouri 63108, USA
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Al-Mekhlafi HM, Surin J, Sallam AA, Abdullah AW, Mahdy MAK. Giardiasis and poor vitamin A status among aboriginal school children in rural Malaysia. Am J Trop Med Hyg 2010; 83:523-7. [PMID: 20810815 DOI: 10.4269/ajtmh.2010.09-0371] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A cross-sectional study was carried out on 241 primary schoolchildren in Pahang, Malaysia to update their vitamin A status and to investigate the association of poor vitamin A status with their health and socioeconomic factors. All children were screened for intestinal parasitic infections. Blood samples were collected and vitamin A status was assessed. Socioeconomic data were collected by using pre-tested questionnaires. The results showed that 66 (27.4%) children had low serum retinol levels (< 0.70 micromol/L). Giardiasis and severe ascariasis were significantly associated with low serum retinol levels (P = 0.004 and P = 0.018, respectively). Logistic regression confirmed the significant association of giardiasis with low serum retinol (odds ratio = 2.7, 95% confidence interval = 1.3-5.5). In conclusion, vitamin A deficiency is still a public health problem in rural Malaysia. Vitamin A supplementation and treatment of intestinal parasitic infections should be distributed periodically to these children to improve their health and nutritional status.
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Affiliation(s)
- Hesham M Al-Mekhlafi
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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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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Sen B, Bhattacharya M, Niyogi SK. In vitro activity of cefpodoxime, an expanded-spectrum cephalosporin, against Salmonella enterica serotype typhi. Antimicrob Agents Chemother 2008; 52:802-3. [PMID: 18039924 PMCID: PMC2224739 DOI: 10.1128/aac.00867-07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Al-Mekhlafi MH, Azlin M, Aini UN, Shaik A, Sa’iah A, Norhayati M. Prevalence and predictors of low serum retinol and hypoalbuminaemia among children in rural Peninsular Malaysia. Trans R Soc Trop Med Hyg 2007; 101:1233-40. [DOI: 10.1016/j.trstmh.2007.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2007] [Revised: 09/06/2007] [Accepted: 09/06/2007] [Indexed: 10/22/2022] Open
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Payne LG, Koski KG, Ortega-Barria E, Scott ME. Benefit of vitamin A supplementation on ascaris reinfection is less evident in stunted children. J Nutr 2007; 137:1455-9. [PMID: 17513406 DOI: 10.1093/jn/137.6.1455] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Despite the common coexistence of vitamin A deficiency and Ascaris infection in preschool children in developing countries, and despite the widespread use of vitamin A supplements, remarkably little is understood about the impact of vitamin A supplementation on this gastrointestinal nematode. The Ministry of Health of Panama recently initiated a vitamin A supplementation program in rural indigenous populations. We took advantage of this initiative to assess the benefit of 200,000 IU (60 mg retinol) vitamin A on reinfection with Ascaris following deworming. Baseline stool exams, anthropometry, and socio-economic data were collected for 328 preschool children from 12-60 mo of age (106 supplemented within previous 3 mo and 222 unsupplemented within previous 6 mo). All children were dewormed with albendazole, and reinfection levels were monitored 3 and 5 mo later. Baseline prevalence of Ascaris was 79.5%. Stepwise regression showed that Ascaris intensity was lower in Vit A-supplemented children at baseline and 3 mo after deworming, but not after 5 mo. As 61% of the children were stunted, the impact of supplementation on Ascaris reinfection was examined separately for stunted and children of normal height. Prevalence and intensity of Ascaris at baseline and 3 mo after deworming were lower in children of normal height, but in stunted children the benefit was restricted to those who were dewormed within 6 wk of supplementation. Our study provides evidence that combined vitamin A supplementation and deworming reduces Ascaris reinfection in children living in areas of chronic parasitosis, but that the duration of the benefit is less in stunted children.
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Affiliation(s)
- Leslie G Payne
- School of Dietetics and Human Nutrition and 4Institute of Parasitology, McGill University (Macdonald Campus), Quebec, Canada
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Moller M, Gravenor MB, Roberts SE, Sun D, Gao P, Hopkin JM. Genetic haplotypes of Th-2 immune signalling link allergy to enhanced protection to parasitic worms. Hum Mol Genet 2007; 16:1828-36. [PMID: 17519224 DOI: 10.1093/hmg/ddm131] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Parasitic worm infection, allergy and asthma involve increased IgE production, eosinophil activity, mucus secretion and smooth muscle reactivity, effected through Th-2 immune signalling. These pathological features of allergic disorder, common in developed countries, appear to be protective features in resistance to parasitic worm infections prevalent in many developing countries. We investigated how genetic variation in the Th-2 signalling transduction molecule STAT6 relates to these clinical disorders, using immune phenotyping by serum IgE levels and haplotyping nine STAT6 genetic variants in a rural Chinese population, where Ascaris infection is prevalent, and an urban UK population where Ascaris is largely unknown but asthma and allergy are prevalent. We show for the first time that STAT6 haplotypes relate clearly to IgE levels, allergy and worm burden. The haplotypes segregated into two groups: those with raised IgE/low worm burden tended to have increased risk of allergic disorder, whereas low IgE/high worm burden tended to have a reduced risk of allergies. By estimating the mean worm burden for each haplotype in China and the relative risk of asthma for the matching haplotype in the UK, we draw a cross-population comparison and show a negative correlation between worm burden and expected risk of asthma. These data imply that the origin of common up-regulating variants of Th-2 signalling, involving STAT6, promotes asthma and allergy in developed countries, whereas in developing countries it protects against parasitic worm infections. Selective evolutionary mechanisms, driven by parasitic worm infection, may underlie the genetic contribution to risk of allergy and asthma in humans.
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Affiliation(s)
- Maria Moller
- School of Medicine, Institute of Life Science, Swansea University, Singleton Park, Swansea SA2 8PP, UK
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Albonico M, Montresor A, Crompton DWT, Savioli L. Intervention for the control of soil-transmitted helminthiasis in the community. ADVANCES IN PARASITOLOGY 2006; 61:311-48. [PMID: 16735168 PMCID: PMC5633078 DOI: 10.1016/s0065-308x(05)61008-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The global strategy for the control of soil-transmitted helminthiasis, based on regular anthelminthic treatment, health education and improved sanitation standards, is reviewed. The reasons for the development of a control strategy based on population intervention rather than on individual treatment are explained. The evidence and experience from control programmes that created the basis for (i) the definition of the intervention package, (ii) the identification of the groups at risk, (iii) the standardization of the community diagnosis and (iv) the selection of the appropriate intervention for each category in the community are discussed. How to best deliver the appropriate intervention, the impact of the control measures on morbidity and on indicators such as school attendance, cognitive development and productivity are presented. The factors influencing the cost-benefits of helminth control are also considered. The recent progress on the control of soil-transmitted helminth infections is illustrated. Research needs are analysed in relation to the most recent perceptions from private-public partnerships involved in helminth control. The way forward for the control of soil-transmitted helminth infections is described as a multi-disease approach that goes beyond deworming and fosters a pro-poor strategy that supports the aims of the Millennium Development Goals.
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Tiwari L, James J, Chowdhary S, Sharma A, Puliyel JM. Severe anaemia owing to hookworm in a 12-day-old Nepalese infant. ANNALS OF TROPICAL PAEDIATRICS 2005; 24:361-3. [PMID: 15720895 DOI: 10.1179/146532804x10844] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Lokesh Tiwari
- Department of Pediatrics, St Stephens Hospital, Tis Hazari, Delhi, India
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Koski KG, Scott ME. Gastrointestinal nematodes, nutrition and immunity: breaking the negative spiral. Annu Rev Nutr 2001; 21:297-321. [PMID: 11375439 DOI: 10.1146/annurev.nutr.21.1.297] [Citation(s) in RCA: 129] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Nutritionists have long understood that intestinal nematode parasites have deleterious effects on host nutritional status, but only recently has the importance of malnutrition as a predisposing factor to intestinal nematodes been recognized. Here we review experimental and field studies on the effects of protein, energy, zinc, vitamin A, and iron deficiencies on gastrointestinal (GI) nematodes of humans, livestock, and laboratory rodents, and draw certain conclusions about the state of our current understanding. In general, malnutrition promotes the establishment, survival, and fecundity of these parasites, but the magnitude of the effect depends on factors such as host species, parasite species, particular infection protocol used, magnitude of the infection, severity of the nutritional deficiency, and presence of single or multiple infections and single or multiple nutritional deficiencies. We highlight the Th2 arm of the immune system as a component of primary importance in the association between malnutrition and GI nematode infections. We summarize what is known about underlying mechanisms that may account for the observed patterns. Finally, we suggest future research directions.
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Affiliation(s)
- K G Koski
- School of Dietetics and Human Nutrition, Macdonald Campus of McGill University, Ste-Anne de Bellevue, Quebec H9X 3V9 Canada.
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Abstract
In populations where vitamin A availability from food is low, infectious diseases can precipitate vitamin A deficiency by decreasing intake, decreasing absorption, and increasing excretion. Infectious diseases that induce the acute-phase response also impair the assessment of vitamin A status by transiently depressing serum retinol concentrations. Vitamin A deficiency impairs innate immunity by impeding normal regeneration of mucosal barriers damaged by infection, and by diminishing the function of neutrophils, macrophages, and natural killer cells. Vitamin A is also required for adaptive immunity and plays a role in the development of T both-helper (Th) cells and B-cells. In particular, vitamin A deficiency diminishes antibody-mediated responses directed by Th2 cells, although some aspects of Th1-mediated immunity are also diminished. These changes in mucosal epithelial regeneration and immune function presumably account for the increased mortality seen in vitamin A-deficient infants, young children, and pregnant women in many areas of the world today.
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Affiliation(s)
- C B Stephensen
- USDA Western Human Nutrition Research Center and Nutrition Department, University of California, Davis, California 95616, USA.
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Rai SK, Nakanishi M, Upadhyay MP, Hirai K, Ohno Y, Ono K, Uga S, Shrestha HG, Matsumura T. Effect of intestinal helminth infection on retinol and β-carotene status among rural Nepalese. Nutr Res 2000. [DOI: 10.1016/s0271-5317(99)00134-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Albonico M, Crompton DW, Savioli L. Control strategies for human intestinal nematode infections. ADVANCES IN PARASITOLOGY 1999; 42:277-341. [PMID: 10050275 DOI: 10.1016/s0065-308x(08)60151-7] [Citation(s) in RCA: 116] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In recent years significant progress has been made in understanding the ecology, epidemiology and related morbidity and development of new tools for the control of soil-transmitted helminths. Such knowledge has recognized the impact of helminth infections on the health of infected groups and has created a rational basis for their control. Schoolchildren harbour some of the most intense helminthic infections, which produce adverse effects on health, growth and scholastic performance. However, although great effort has been put into targeting school-age children, women of child-bearing age and pre-school children are two other groups at high risk of morbidity due to intestinal nematode infections. Highly effective and safety-tested, single-dose anthelminthic drugs are now available, permitting periodical deworming of schoolchildren and other high-risk groups at affordable prices. Four anthelminthics against all intestinal nematodes are included in the WHO Essential Drug List (albendazole, levamisole, mebendazole and pyrantel). Recently ivermectin has also been registered for use against Strongyloides stercoralis in humans. Several well-monitored country experiences have shown that chemotherapy-based control of morbidity due to soil-transmitted helminths is possible and highly cost-effective.
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Affiliation(s)
- M Albonico
- Scientific Committee, Ivo de Carneri Foundation, Torino, Italy
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