Schistosoma mekongi and other intestinal helminth infections remain public health concerns in Lao People's Democratic Republic, especially in remote areas where access to sanitation is limited.We performed an expe...Schistosoma mekongi and other intestinal helminth infections remain public health concerns in Lao People's Democratic Republic, especially in remote areas where access to sanitation is limited.We performed an experimental study in four villages where latrine construction was coupled with two rounds of mass drug administration (MDA) with praziquantel and albendazole, and compared with two control villages that only received two rounds of MDA. The prevalence of helminth infections before (baseline) and after (follow-up) intervention were compared. Additionally, the prevalence in intervention and control villages were compared 12 months post-intervention. Kato–Katz, formalin-ethyl acetate concentration and Baermann techniques were employed to assess helminth infections.We found infection prevalence of S. mekongi in the intervention and control villages was 28.6% and 1.8%, respectively. The prevalences of other helminth infections were as follows: Opisthorchis viverrini, 79.5% and 71.8%;hookworm, 48.8% and 65.6%;and Strongyloides stercoralis, 43.1% and 38.3%. Other helminth species were detected in less than 5% of the study participants. Latrine intervention coupled with two rounds of MDA in the intervention villages reduced the prevalence of S. mekongi infection by 6.0% (from 28.6% to 22.6%;P < 0.001), O. viverrini infection by 11.3% (from 79.5% to 68.2%;P < 0.001), hookworm infection by 22.6% (from 48.8% to 26.2%;P < 0.001), and S. stercoralis infection by 12.0% (from 43.1% to 31.1%;P < 0.001). The observed reductions were not significantly different when compared to the control villages, where only two rounds of MDA were implemented (P > 0.05). Study participants in both groups commonly engaged in behaviours such as open defecation, bathing in the Mekong River, consuming raw or undercooked fish dishes and walking barefoot. These practices and behaviours are associated with helminth infections. Concluding, this study showed only a marginal impact associated with latrine use in intervention communities. There is a need for longer term studies with integrated interventions, such as effective health education to foster behavioural changes related to open defecation, raw or undercooked food consumption, wearing protected footwear outdoors, and personal hygiene.展开更多
Background:Given the restricted distribution of Schistosoma mekongi in one province in Lao People’s Democratic Republic(Lao PDR)and two provinces in Cambodia,together with progress of the national control programmes ...Background:Given the restricted distribution of Schistosoma mekongi in one province in Lao People’s Democratic Republic(Lao PDR)and two provinces in Cambodia,together with progress of the national control programmes aimed at reducing morbidity and infection prevalence,the elimination of schistosomiasis mekongi seems feasible.However,sensitive diagnostic tools will be required to determine whether elimination has been achieved.We compared several standard and novel diagnostic tools in S.mekongi-endemic areas.Methods:The prevalence and infection intensity of S.mekongi were evaluated in 377 study participants from four villages in the endemic areas in Lao PDR and Cambodia using Kato-Katz stool examination,antibody detection based on an enzyme-linked immunosorbent assay(ELISA)and schistosome circulating antigen detection by lateral-flow tests.Two highly sensitive test systems for the detection of cathodic and anodic circulating antigens(CCA,CAA)in urine and serum were utilized.Results:Stool microscopy revealed an overall prevalence of S.mekongi of 6.4%(one case in Cambodia and 23 cases in Lao PDR),while that of Opisthorchis viverrini,hookworm,Trichuris trichiura,Ascaris lumbricoides and Taenia spp.were 50.4%,28.1%,3.5%,0.3%and 1.9%,respectively.In the urine samples,the tests for CCA and CAA detected S.mekongi infections in 21.0%and 38.7%of the study participants,respectively.In the serum samples,the CAA assay revealed a prevalence of 32.4%,while a combination of the CAA assay in serum and in urine revealed a prevalence of 43.2%.There was a difference between the two study locations with a higher prevalence reached in the samples from Lao PDR.Conclusions:The CCA,CAA and ELISA results showed substantially higher prevalence estimates for S.mekongi compared to Kato-Katz thick smears.Active schistosomiasis mekongi in Lao PDR and Cambodia might thus have been considerably underestimated previously.Hence,sustained control efforts are still needed to break transmission of S.mekongi.The pivotal role of highly sensitive diagnostic assays in areas targeting elimination cannot be overemphasised.展开更多
Background:Prevalence of Opisthorchis viverrini,Schistosoma mekongi and soil-transmitted helminths(STH)remains high in Lao People’s Democratic Republic(Lao PDR),despite control efforts including mass-drug administrat...Background:Prevalence of Opisthorchis viverrini,Schistosoma mekongi and soil-transmitted helminths(STH)remains high in Lao People’s Democratic Republic(Lao PDR),despite control efforts including mass-drug administration,education and communication campaigns.New approaches are required to advance helminth control.Methods:An ecohealth study was conducted on two Mekong islands in Southern Laos.Demographic and behavioural data were collected by questionnaire.Human and animal reservoir stools were examined.Bithynia spp.and Neotricula aperta snails were examined using shedding.Fresh water fish were examined using digestion technique.Multivariate random-effects analysis was used to find risk factors associated with helminth infections.Results:Human infection rates with O.viverrini,hookworm,S.mekongi,Trichuris trichiura,Ascaris lumbricoides and Taenia spp.were 60.7%,44.1%,22.2%,4.1%,0.6%and 0.1%,respectively.Heavy intensity infections were 4.2%,3.6%and 1.8%for O.viverrini,S.mekongi and hookworm,respectively.O.viverrini and S.mekongi infection rates among dogs and cats were 25.0%and 14.7%,respectively.Of the cats tested,53.1%were infected with O.viverrini.Prevalence of O.viverrini and S.mekongi in snails was 0.3%and 0.01%,respectively.Overall prevalence of O.viverrini infection in fresh water fish was 26.9%,with the highest infection rates occurring in Hampala dispa(87.1%),Cyclocheilichthys apogon(85.7%)and Puntius brevis(40.0%).Illiteracy and lower socioeconomic status increased the risk of O.viverrini infection,while those aged 10-16 years and possessing latrines at home were less likely to be infected.Household dogs and cats that consumed raw fish were significantly and positively associated with O.viverrini infection of the household members.For S.mekongi,children under 9 years old were exposed significantly to this infection,compared to older age groups.Conclusions:There is a pressing need to design and implement an integrated helminth control intervention on the Mekong Islands in southern Lao PDR.Given the highly dynamic transmission of O.viverrini,S.mekongi,STH and extended multiparasitism,annual mass-drug administration is warranted along with environmental modifications,health education and improved access to clean water and adequate sanitation to consolidate morbidity control and move towards elimination.Trail registration number:Our findings presented here are from a cross-sectional study,therefore,it has not been registered.展开更多
Background:The point-of-care circulating cathodic antigen(POC-CCA)test is increasingly used as a rapid diagnostic method for Schistosoma mansoni infection.The test has good sensitivity,although false positive results ...Background:The point-of-care circulating cathodic antigen(POC-CCA)test is increasingly used as a rapid diagnostic method for Schistosoma mansoni infection.The test has good sensitivity,although false positive results have been reported among pregnant women and patients with urine infections and hematuria.We validated the POC-CCA test's ability to diagnose Schistosoma mekongi infection in Lao People's Democratic Republic(Lao PDR),where S.mekongi is endemic.Of particular interest was the test's specificity and possible cross-reactivity with other helminth infections.Methods:We conducted a cross-sectional study of children and adults in the provinces of Champasack(Schistosoma mekongi and Opisthorchis viverrini endemic),Savannakhet(O.viverrini endemic)and Luang Prabang(soil-transmitted helminths endemic)between October 2018 and April 2019.POC-CCA and urine dipstick tests were administered to all study participants,while an additional pregnancy test was offered to women.Two stool samples were collected from participants and examined with a Kato-Katz test(two smears per stool).Logistic regression was used to associate potential confounding factors(predictors)with POC-CCA test results(outcome).Results:In S.mekongi-endemic Champasack,11.5%(n=366)and 0.5%(n=2)of study participants had positive POC-CCA and Kato-Katz test results,respectively.Only one of the two Kato-Katz positive patients was also POC-CCA positive.In Champasack and Luang Prabang,where S.rnekongi is not endemic,the POC-CCA test yielded(presumably)false positive results for 6.0%(n=22)and 2.5%(n=9)of study participants,respectively,while all of the Kato-Katz tests were negative.POC-CCA positive test results were significantly associated with O.viverrini infection(1.69,95%confidence interval(CI):1.02-2.77,P=0.042),increased leukocytes(adjusted Odds Ratio(aOR)=1.58,95%CI:1.15-2.17,P=0.005)and hematuria(aOR=1.50,95%CI:1.07-2.10,P=0.019)if the observed trace was counted as a positive test result.Two pregnant women from Champasack province had POC-CCA positive tests.Conclusions:We observed a cross-reaction between the POC-CCA test and O.viverrini infection.To some extent,we can confirm previous observations asserting that POC-CCA provides false positive results among patients with urinary tract infections and hematuria.In S.mekongi-endemic areas,POC-CCA can be applied cautiously for surveillance purposes,keeping in mind the considerable risk of false positive results and its unknown sensitivity.展开更多
Background Helminthiases are highly endemic in Southeast Asia,including the Lao People’s Democratic Republic(Lao PDR).This study aimed to assess the current intestinal helminth infections and the associated risk fact...Background Helminthiases are highly endemic in Southeast Asia,including the Lao People’s Democratic Republic(Lao PDR).This study aimed to assess the current intestinal helminth infections and the associated risk factors among adults across the Lao PDR.Methods A cross-sectional survey was conducted in 165 villages across 17 provinces and the Vientiane Capital,Lao PDR.A multi-stage sampling method was employed to select the adult study participants(≥18 years).Data collection included(1)interview of the study participants,(2)physical measurements,and(3)a fve gram of stool sample from each study participant was collected and preserved in 10%formalin solution for intestinal helminth detection using formalin-ether concentration technique(FECT).Descriptive analysis was used to describe the socio-demographic characteristics of study participants and the prevalence of intestinal helminth infections.Logistic regressions were applied to test the association between intestinal helminth infection and individual risk factors.A P-value below 0.05 was considered statistically signifcant.Results A total of 2800 study participants were enrolled.Their average age was 46.0 years;57.8%were female.Overall,30.9%,8.6%and 1.5%of study participants were infected with one,two,or three diferent intestinal helminth species,respectively.Among the study participants 21.6%were infected with hookworm,18.8%with Opisthorchis viverrini-like(Ov-like)infection,4.8%with Strongyloides stercoralis,2.3%with Ascaris lumbricoides,1.5%with Trichuris trichiura,and 3.3%with Taenia spp.Ov-like infection was of high prevalence in the southern(28.8%)and central(21.3%)provinces,while hookworm(26.3%),A.lumbricoides(7.3%),T.trichiura(3.1%),and Taenia spp.(4.2%)were prevalent in the northern provinces.Risk analysis showed that men were more likely to be infected with hookworm[adjusted odds ratio(aOR)=1.2,P=0.019].The Lao-Tai ethnic group had a 5.2-times(P<0.001)higher chance of having Ov-like infection than the minorities.Possession of toilet facility at home was associated with reduced odds for Ov-like(aOR=0.4,P<0.001)and hookworm(aOR=0.6,P<0.001)infections.Conclusions Our study provides a nationwide update of the intestinal helminth prevalence among adults in Lao PDR.To the best of our knowledge,this is the frst Lao nationwide survey on intestinal helminth infections and risk factors in adults.It provides crucial information for national control programs for intestinal helminth infections in Lao PDR.展开更多
Background:Severe hepatosplenic complications arise in patients with chronic Schistosoma mansoni infection after heavy exposure to disease agents in endemic areas.These complications are rarely reported and,hence,unde...Background:Severe hepatosplenic complications arise in patients with chronic Schistosoma mansoni infection after heavy exposure to disease agents in endemic areas.These complications are rarely reported and,hence,underestimated.Case presentation:We report on eight patients with severe morbidity associated with S.mansoni infection in Ituri Province,northeastern Democratic Republic of Congo(DRC).The patients were identified during a community-based survey in 2017;one patient was seen at the district hospital.After taking the patients'history,a clinical examination and an abdominal ultrasonographical examination were performed.S.mansoni infection was diagnosed in fecal(Kato-Katz technique)and urine(point-of-case circulating cathodic antigen test)samples.These eight patients with severe intestinal and hepatosplenic complications were identified from four villages with high 5.mansoni infection prevalence and related morbidity.The patients'ages ranged from 19 to 57 years;four patients were women.Three patients reported hematemesis.Two patients were severely anemic.All patients reported non-specific abdominal symptoms,such as diarrhea(six patients),abdominal pain(seven patients),and blood in the stool(five patients),as well as weight loss(two patients).Abdominal ultrasonography revealed ascites in four patients.All patients had portal hypertension with hepatomegaly(seven patients)or splenomegaly(five patients).Of the six patients with a discernable liver parenchyma pattern,five displayed pattern F and three patient displayed pattern E.Liver parenchyma was not visible for two patients with severe ascites.An 5.mansoni infection was confirmed in six patients,with infection intensity ranging from light to heavy.All S.mansoni positive patients were treated with praziquantel(40 mg/kg body weight)and referred to the district hospital for follow-up.One patient with severe ascites died two weeks after we saw her.Due to security and accessibility reasons,the villages could not be visited again and the patients were lost to follow-up.Conclusions:Our observations of patients with severe schistosomiasis document the severe degree of endemicity of S.mansoni in the province and suggest an urgent need for adequate schistosomiasis control measures that target vulnerable population groups and address severe complications.展开更多
Background:As a result of epidemiological transition,the health systems of low-and middle-income countries are increasingly faced with a dual disease burden of infectious diseases and emerging non-communicable disease...Background:As a result of epidemiological transition,the health systems of low-and middle-income countries are increasingly faced with a dual disease burden of infectious diseases and emerging non-communicable diseases.Little is known about the mutual influence of these two disease groups.The aim of this study was to investigate the cooccurrence of helminth infections and diabetes mellitus in adults in Lao People’s Democratic Republic(Lao PDR).Methods:We conducted a cross-sectional study among 1600 randomly selected adults aged 35 and older from four different socio-economical and ecological provinces.Information on socio-demographics,risk factors and health conditions was obtained from personal interviews.Clinical assessments including anthropometry(height,weight,waist and hip circumference)and blood pressure measurements were also conducted.Diabetes was classified based on selfreported diagnoses and a point-of-care glycated haemoglobin(HbA1c)test from finger prick blood samples.Stool samples for helminth diagnosis were examined with formalin-ether concentration technique for intestinal parasitic infections.The independent associations of helminth infections with diabetic status and HbA1c were assessed using multiple regression analyses.Results:The prevalence of pre-diabetes and diabetes was 37.3%and 22.8%,respectively.Fifty-six percent of diabetic cases were undiagnosed and 85%of diagnosed diabetic cases had poor glycemic control.Participants from rural areas and from southern parts of the country had higher infection rates,with Opisthorchis viverrini,being the most common helminth infection(30.5%).We found a positive association between Taenia spp.infections and HbA1c(β=0.117;95%CI:0.042-0.200)and diabetes mellitus risk(OR=2.98;95%CI:1.10-8.05).No other helminth species was associated with glycated hemoglobin.Conclusions:Hyperglycaemia and diabetic rates in Lao PDR are alarmingly high,but consistent with other high rates in the region.Given the high rates of under-diagnosis and poorly-controlled glycaemia in diabetes mellitus patients,routine diabetes screening and treatment is essential for the local healthcare system.Large longitudinal cohorts integrating biomarkers are warranted in the search of causal diabetes mellitus risk factors in the region.Common intestinal helminth infections,including O.viverrini,are unlikely to explain the high diabetes mellitus rates observed.展开更多
Background:Despite the high prevalence of strongyloidiasis in the Laotian population,Laotian hospitals still lack diagnostic capacity to appropriately diagnose Strongyloides stercoralis infections.This cross-sectional...Background:Despite the high prevalence of strongyloidiasis in the Laotian population,Laotian hospitals still lack diagnostic capacity to appropriately diagnose Strongyloides stercoralis infections.This cross-sectional hospital-based study was conducted to assess the prevalence of Strongyloides stercoralis infection among hospitalized patients treated at Mahosot Hospital,the primary reference hospital of Lao People’s Democratic Republic(Lao PDR),and to validate feasible methods for diagnosing S.stercoralis infection at hospital’s laboratory.Methods:Between September and December 2018,stool samples of 104 inpatients were investigated for S.stercoralis infection by wet smear,Baermann technique,Koga Agar plate culture(KAPC),and real-time detection polymerase chain reaction(RTD-PCR)at the Infectious Diseases Ward of the Mahosot Hospital in Vientiane.The sensitivity,the specificity,the negative predictive value(NPV)of each diagnostic test,as well as their combination(s)was calculated using a composite reference standard(CRS).The correlation of the different test methods was assessed by chi-square or Fisher’s exact test.Cohen’s kappa coefficient was used to assess the diagnostic agreement of the different test methods.Results:The overall prevalence of S.stercoralis infections among the study population was 33.4%.The cumulative infection prevalence statistically significantly increased from the lowest age group of 40 years and below(22.4%),to the medium(40.0%)and to the oldest age group of 61 year and above(72.7%)(P=0.003).The cumulative infection prevalence of CRS was considerably higher in male(40.4%)compared to female patients(28.1%),but not statistically different(P=0.184).The diagnostic sensitivity of Baermann technique,KAPC,RTD-PCR,and the combination of Baermann technique and KAPC were 60.0,60.0,74.3,and 77.1%,respectively.Only 13 patients(37.1%)of the total 35 S.stercoralis patients diagnosed with any technique had a simultaneously positive diagnostic test with Baermann,KAPC and RTD-PCR.Conclusions:We identified Baermann technique and KAPC to be currently the most feasible and implementable standard methods for diagnosing S.stercoralis at a hospital setting such as Mahosot Hospital and provincial and district hospitals in Lao PDR and other low-and middle income countries in Southeast Asia.Trial registration:This study was approved by the National Ethics Committee for Health Research in Lao PDR(reference no.083/NECHR)and by the Ethics Committee Northwest and Central Switzerland(reference no.2018–00594).展开更多
Background:Endemicity of lymphatic filariasis(LF)in Cambodia was proven in 1956 when microfilariae were detected in mosquitos in the Kratiéprovince.In 2001,an extensive study confirmed the presence of both Brugia...Background:Endemicity of lymphatic filariasis(LF)in Cambodia was proven in 1956 when microfilariae were detected in mosquitos in the Kratiéprovince.In 2001,an extensive study confirmed the presence of both Brugia malayi and Wuchereria bancrofti microfilariae.In 2003,the Ministry of Health established a national task force to develop policies and strategies for controlling and eliminating neglected tropical diseases(NTDs),with the goal of eliminating LF by 2015.This article summarizes the work accomplished to eliminate LF as a public health problem in Cambodia.Methods:The National Program to Eliminate Lymphatic Filariasis made excellent progress in the goal towards elimination due to strong collaboration between ministries,intensive supervision by national staff,and advocacy for mobilization of internal and external resources.Mass drug administration(MDA)with diethylcarbamazine citrate and albendazole was conducted in six implementation units,achieving>70%epidemiological coverage for five consecutive rounds,from 2005 to 2009.In 2006,in 14 provinces,healthcare workers developed a line list of lymphedema and hydrocele patients,many of whom were>40 years old and had been affected by LF for many years.The national program also trained healthcare workers and provincial and district staff in morbidity management and disability prevention,and designated health centers to provide care for lymphedema and acute attack.Two reference hospitals were designated to administer hydrocele surgery.Results:Effectiveness of MDA was proven with transmission assessment surveys.These found that less than 1%of school children had antigenemia in 2010,which fell to 0%in both 2013 and 2015.A separate survey in one province in 2015 using Brugia Rapid tests to test for LF antibody found one child positive among 1677 children.The list of chronic LF patients was most recently updated and confirmed in 2011-2012,with 32 lymphoedema patients and 17 hydrocele patients listed.All lymphedema patients had been trained on self-management and all hydrocele patients had been offered free surgery.Conclusions:Due to the success of the MDA and the development of health center capacity for patient care,along with benefits gained from socioeconomic improvements and other interventions against vector-borne diseases and NTDs,Cambodia was validated by the World Health Organization as achieving LF elimination as a public health problem in 2016.展开更多
Background Helminth infections, includingOpisthorchis viverrini, hookworm, andTrichuris trichiura, are prevalent in Khong district, Champasack province, southern Lao People’s Democratic Republic (PDR). Schistosomiasi...Background Helminth infections, includingOpisthorchis viverrini, hookworm, andTrichuris trichiura, are prevalent in Khong district, Champasack province, southern Lao People’s Democratic Republic (PDR). Schistosomiasis caused bySchistosoma mekongi is of public health concern on the islands of the Khong district. This study aimed to assess the impact of an Eco-Health/One-Health approach in combination with mass drug administration (MDA) to reduce these helminth infections.Methods We conducted a community intervention using a stepped-wedge trial approach on two endemic islands (Donsom and Donkhone) of the Khong district, Champasack province, Lao PDR, between April 2012 and March 2013. In each study village, 30–40 households were randomly selected. All members of selected households, who were at home during the study period were invited to participate in the study. A baseline study was conducted to assess helminth infections, knowledge attitudes and practices towardSchistosoma mekongi infection, behavior of open defecation and availability of latrine at home. After the baseline (T0), the Eco-Health/One-Health approach was implemented on Donsom (intervention) and Donkhone island (control). An assessment was conducted in 2014 (T1), one year after the completion of intervention implementation, to assess the short-term impact of the Eco-Health/One-Health approach on helminth infections and compare intervention and control islands. Later in 2015, the Eco-Health/One-Health approach was implemented on control island (Donkhone). After the implementation of intervention, the parasitological assessments were conducted annually in humans in 2015 (T2), in 2016 (T3) and in 2017 (T4), and in dogs in 2017 (T4) to evaluate the long-term impact of the intervention on helminth infections. Frequency was used to describe the prevalence of helminth infections. Logistic regression was applied to associate the KAP (knowledge, attitudes, and practices and open defecation behavior) and the reduction of helminth infections between intervention and control islands. The reduction in prevalence pre- and post-intervention was associated using a McNemar test. A two-independent samplet-test was applied to compare the mean eggs per gram (EPG) of helminth infections between control and intervention islands. A paired t-test test was used to compare the mean EPG of stool samples before (baseline) and after (follow-up) interventions for the two islands separately. AP-value lower than 0.05 was considered statistically significant.Results Eco-Health/One-Health approach appears to be associated with reduction in prevalence ofS. mekongi by 9.0% [odds ratio (OR) = 0.49,P = 0.003] compared to the use of mass drug administration alone (control island). Additionally, this intervention package significantly reducedO. viverrini infection by 20.3% (OR = 1.92,P < 0.001) and hookworm by 17.9% (OR = 0.71,P = 0.045), respectively. Annual parasitological assessments between 2012 and 2017 showed that the Eco-Health/One-Health approach, coupled with MDA, steadily reduced the prevalence ofS. mekongi on the intervention island from 29.1% to 1.8% and on the control island from 28.4% to 3.1%, respectively.Conclusions The study findings suggest that the Eco-Health/One-Health approach appears to be associated with a significant reduction in prevalence ofS. mekongi and helminth co-infections, particularly hookworm andT. trichiura. Therefore, implementing the Eco-Health/One-Health approach in schistosomiasis-endemic areas could accelerate the achievement of national goals for transmission interruption by 2025 and elimination by 2030.展开更多
Background:Multiple factors determine children’s nutritional status,including energy and nutrient intake,recurrent infectious diseases,access(or lack thereof)to clean water and improved sanitation,and hygiene practic...Background:Multiple factors determine children’s nutritional status,including energy and nutrient intake,recurrent infectious diseases,access(or lack thereof)to clean water and improved sanitation,and hygiene practices,among others.The“Vegetables go to School:improving nutrition through agricultural diversification”(VgtS)project implements an integrated school garden programme in five countries,including Burkina Faso.The aim of this study was to determine the prevalence of undernutrition and its risk factors among schoolchildren in Burkina Faso before the start of the project.Methods:In February 2015,a cross-sectional survey was carried out among 455 randomly selected children,aged 8-14 years,in eight schools in the Plateau Central and Centre-Ouest regions of Burkina Faso.Nutritional status was determined by anthropometric assessment.Helminth and intestinal protozoa infections were assessed using the Kato-Katz and a formalin-ether concentration method.A urine filtration technique was used to identify Schistosoma haematobium eggs.Prevalence of anaemia was determined by measuring haemoglobin levels in finger-prick blood samples.Questionnaires were administered to children to determine their knowledge of nutrition and health and their related attitudes and practices(KAP).Questionnaires were also administered to the children’s caregivers to identify basic household socio-demographic and economic characteristics,and water,sanitation and hygiene(WASH)conditions.To determine the factors associated with schoolchildren’s nutritional status,mixed logistic regression models were used.Differences and associations were considered statistically significant if P-values were below 0.05.Results:Complete datasets were available for 385 children.The prevalence of undernutrition,stunting and thinness were 35.1%,29.4%and 11.2%,respectively.The multivariable analysis revealed that undernutrition was associated with older age(i.e.12-14 years compared to<12 years;adjusted odds ratio(aOR)=3.45,95%confidence interval(CI)2.12-5.62,P<0.001),multiple pathogenic parasitic infections(aOR=1.87,95%CI 1.02-3.43,P=0.044)and with moderate and severe anaemia in children(aOR=2.52,95%CI 1.25-5.08,P=0.010).Conclusions:We found high prevalence of undernutrition among the children surveyed in the two study regions of Burkina Faso.We further observed that undernutrition,anaemia and parasitic infections were strongly associated.In view of these findings,concerted efforts are needed to address undernutrition and associated risk factors among school-aged children.As part of the VgtS project,WASH,health education and nutritional interventions will be implemented with the goal to improve children’s health.Trial registration:ISRCTN17968589(date assigned:17 July 2015).展开更多
基金funded by the World Health Organization,National Centres of Competence in Research,North-South and the Forlen Foundation.The project was also partially supported by the International Joint Laboratory on Tropical Diseases Control in Greater Mekong Subregion(no.21410750200)from Shanghai Municipality Government.
文摘Schistosoma mekongi and other intestinal helminth infections remain public health concerns in Lao People's Democratic Republic, especially in remote areas where access to sanitation is limited.We performed an experimental study in four villages where latrine construction was coupled with two rounds of mass drug administration (MDA) with praziquantel and albendazole, and compared with two control villages that only received two rounds of MDA. The prevalence of helminth infections before (baseline) and after (follow-up) intervention were compared. Additionally, the prevalence in intervention and control villages were compared 12 months post-intervention. Kato–Katz, formalin-ethyl acetate concentration and Baermann techniques were employed to assess helminth infections.We found infection prevalence of S. mekongi in the intervention and control villages was 28.6% and 1.8%, respectively. The prevalences of other helminth infections were as follows: Opisthorchis viverrini, 79.5% and 71.8%;hookworm, 48.8% and 65.6%;and Strongyloides stercoralis, 43.1% and 38.3%. Other helminth species were detected in less than 5% of the study participants. Latrine intervention coupled with two rounds of MDA in the intervention villages reduced the prevalence of S. mekongi infection by 6.0% (from 28.6% to 22.6%;P < 0.001), O. viverrini infection by 11.3% (from 79.5% to 68.2%;P < 0.001), hookworm infection by 22.6% (from 48.8% to 26.2%;P < 0.001), and S. stercoralis infection by 12.0% (from 43.1% to 31.1%;P < 0.001). The observed reductions were not significantly different when compared to the control villages, where only two rounds of MDA were implemented (P > 0.05). Study participants in both groups commonly engaged in behaviours such as open defecation, bathing in the Mekong River, consuming raw or undercooked fish dishes and walking barefoot. These practices and behaviours are associated with helminth infections. Concluding, this study showed only a marginal impact associated with latrine use in intervention communities. There is a need for longer term studies with integrated interventions, such as effective health education to foster behavioural changes related to open defecation, raw or undercooked food consumption, wearing protected footwear outdoors, and personal hygiene.
基金We are grateful to financial support of the Task Force for Global Health,Neglected Tropical Diseases Support Centre,the Department of Parasitology,Leiden University Medical Center and the Swiss Tropical and Public Health Institute.
文摘Background:Given the restricted distribution of Schistosoma mekongi in one province in Lao People’s Democratic Republic(Lao PDR)and two provinces in Cambodia,together with progress of the national control programmes aimed at reducing morbidity and infection prevalence,the elimination of schistosomiasis mekongi seems feasible.However,sensitive diagnostic tools will be required to determine whether elimination has been achieved.We compared several standard and novel diagnostic tools in S.mekongi-endemic areas.Methods:The prevalence and infection intensity of S.mekongi were evaluated in 377 study participants from four villages in the endemic areas in Lao PDR and Cambodia using Kato-Katz stool examination,antibody detection based on an enzyme-linked immunosorbent assay(ELISA)and schistosome circulating antigen detection by lateral-flow tests.Two highly sensitive test systems for the detection of cathodic and anodic circulating antigens(CCA,CAA)in urine and serum were utilized.Results:Stool microscopy revealed an overall prevalence of S.mekongi of 6.4%(one case in Cambodia and 23 cases in Lao PDR),while that of Opisthorchis viverrini,hookworm,Trichuris trichiura,Ascaris lumbricoides and Taenia spp.were 50.4%,28.1%,3.5%,0.3%and 1.9%,respectively.In the urine samples,the tests for CCA and CAA detected S.mekongi infections in 21.0%and 38.7%of the study participants,respectively.In the serum samples,the CAA assay revealed a prevalence of 32.4%,while a combination of the CAA assay in serum and in urine revealed a prevalence of 43.2%.There was a difference between the two study locations with a higher prevalence reached in the samples from Lao PDR.Conclusions:The CCA,CAA and ELISA results showed substantially higher prevalence estimates for S.mekongi compared to Kato-Katz thick smears.Active schistosomiasis mekongi in Lao PDR and Cambodia might thus have been considerably underestimated previously.Hence,sustained control efforts are still needed to break transmission of S.mekongi.The pivotal role of highly sensitive diagnostic assays in areas targeting elimination cannot be overemphasised.
基金We are grateful to the International Development Research CentreForeign Affairs,Trade and Development Canada(through the Global Health Research Initiative)the Australian Agency for International Development for funding support。
文摘Background:Prevalence of Opisthorchis viverrini,Schistosoma mekongi and soil-transmitted helminths(STH)remains high in Lao People’s Democratic Republic(Lao PDR),despite control efforts including mass-drug administration,education and communication campaigns.New approaches are required to advance helminth control.Methods:An ecohealth study was conducted on two Mekong islands in Southern Laos.Demographic and behavioural data were collected by questionnaire.Human and animal reservoir stools were examined.Bithynia spp.and Neotricula aperta snails were examined using shedding.Fresh water fish were examined using digestion technique.Multivariate random-effects analysis was used to find risk factors associated with helminth infections.Results:Human infection rates with O.viverrini,hookworm,S.mekongi,Trichuris trichiura,Ascaris lumbricoides and Taenia spp.were 60.7%,44.1%,22.2%,4.1%,0.6%and 0.1%,respectively.Heavy intensity infections were 4.2%,3.6%and 1.8%for O.viverrini,S.mekongi and hookworm,respectively.O.viverrini and S.mekongi infection rates among dogs and cats were 25.0%and 14.7%,respectively.Of the cats tested,53.1%were infected with O.viverrini.Prevalence of O.viverrini and S.mekongi in snails was 0.3%and 0.01%,respectively.Overall prevalence of O.viverrini infection in fresh water fish was 26.9%,with the highest infection rates occurring in Hampala dispa(87.1%),Cyclocheilichthys apogon(85.7%)and Puntius brevis(40.0%).Illiteracy and lower socioeconomic status increased the risk of O.viverrini infection,while those aged 10-16 years and possessing latrines at home were less likely to be infected.Household dogs and cats that consumed raw fish were significantly and positively associated with O.viverrini infection of the household members.For S.mekongi,children under 9 years old were exposed significantly to this infection,compared to older age groups.Conclusions:There is a pressing need to design and implement an integrated helminth control intervention on the Mekong Islands in southern Lao PDR.Given the highly dynamic transmission of O.viverrini,S.mekongi,STH and extended multiparasitism,annual mass-drug administration is warranted along with environmental modifications,health education and improved access to clean water and adequate sanitation to consolidate morbidity control and move towards elimination.Trail registration number:Our findings presented here are from a cross-sectional study,therefore,it has not been registered.
基金The World Health Organization,Western Pacific Region,International Development Research Centre,Phase 2 has funded our study,along with the Swiss Agency for Development and Cooperation and the Swiss National Science Foundation(project No.IZ07Z0-160930,R4D).
文摘Background:The point-of-care circulating cathodic antigen(POC-CCA)test is increasingly used as a rapid diagnostic method for Schistosoma mansoni infection.The test has good sensitivity,although false positive results have been reported among pregnant women and patients with urine infections and hematuria.We validated the POC-CCA test's ability to diagnose Schistosoma mekongi infection in Lao People's Democratic Republic(Lao PDR),where S.mekongi is endemic.Of particular interest was the test's specificity and possible cross-reactivity with other helminth infections.Methods:We conducted a cross-sectional study of children and adults in the provinces of Champasack(Schistosoma mekongi and Opisthorchis viverrini endemic),Savannakhet(O.viverrini endemic)and Luang Prabang(soil-transmitted helminths endemic)between October 2018 and April 2019.POC-CCA and urine dipstick tests were administered to all study participants,while an additional pregnancy test was offered to women.Two stool samples were collected from participants and examined with a Kato-Katz test(two smears per stool).Logistic regression was used to associate potential confounding factors(predictors)with POC-CCA test results(outcome).Results:In S.mekongi-endemic Champasack,11.5%(n=366)and 0.5%(n=2)of study participants had positive POC-CCA and Kato-Katz test results,respectively.Only one of the two Kato-Katz positive patients was also POC-CCA positive.In Champasack and Luang Prabang,where S.rnekongi is not endemic,the POC-CCA test yielded(presumably)false positive results for 6.0%(n=22)and 2.5%(n=9)of study participants,respectively,while all of the Kato-Katz tests were negative.POC-CCA positive test results were significantly associated with O.viverrini infection(1.69,95%confidence interval(CI):1.02-2.77,P=0.042),increased leukocytes(adjusted Odds Ratio(aOR)=1.58,95%CI:1.15-2.17,P=0.005)and hematuria(aOR=1.50,95%CI:1.07-2.10,P=0.019)if the observed trace was counted as a positive test result.Two pregnant women from Champasack province had POC-CCA positive tests.Conclusions:We observed a cross-reaction between the POC-CCA test and O.viverrini infection.To some extent,we can confirm previous observations asserting that POC-CCA provides false positive results among patients with urinary tract infections and hematuria.In S.mekongi-endemic areas,POC-CCA can be applied cautiously for surveillance purposes,keeping in mind the considerable risk of false positive results and its unknown sensitivity.
文摘Background Helminthiases are highly endemic in Southeast Asia,including the Lao People’s Democratic Republic(Lao PDR).This study aimed to assess the current intestinal helminth infections and the associated risk factors among adults across the Lao PDR.Methods A cross-sectional survey was conducted in 165 villages across 17 provinces and the Vientiane Capital,Lao PDR.A multi-stage sampling method was employed to select the adult study participants(≥18 years).Data collection included(1)interview of the study participants,(2)physical measurements,and(3)a fve gram of stool sample from each study participant was collected and preserved in 10%formalin solution for intestinal helminth detection using formalin-ether concentration technique(FECT).Descriptive analysis was used to describe the socio-demographic characteristics of study participants and the prevalence of intestinal helminth infections.Logistic regressions were applied to test the association between intestinal helminth infection and individual risk factors.A P-value below 0.05 was considered statistically signifcant.Results A total of 2800 study participants were enrolled.Their average age was 46.0 years;57.8%were female.Overall,30.9%,8.6%and 1.5%of study participants were infected with one,two,or three diferent intestinal helminth species,respectively.Among the study participants 21.6%were infected with hookworm,18.8%with Opisthorchis viverrini-like(Ov-like)infection,4.8%with Strongyloides stercoralis,2.3%with Ascaris lumbricoides,1.5%with Trichuris trichiura,and 3.3%with Taenia spp.Ov-like infection was of high prevalence in the southern(28.8%)and central(21.3%)provinces,while hookworm(26.3%),A.lumbricoides(7.3%),T.trichiura(3.1%),and Taenia spp.(4.2%)were prevalent in the northern provinces.Risk analysis showed that men were more likely to be infected with hookworm[adjusted odds ratio(aOR)=1.2,P=0.019].The Lao-Tai ethnic group had a 5.2-times(P<0.001)higher chance of having Ov-like infection than the minorities.Possession of toilet facility at home was associated with reduced odds for Ov-like(aOR=0.4,P<0.001)and hookworm(aOR=0.6,P<0.001)infections.Conclusions Our study provides a nationwide update of the intestinal helminth prevalence among adults in Lao PDR.To the best of our knowledge,this is the frst Lao nationwide survey on intestinal helminth infections and risk factors in adults.It provides crucial information for national control programs for intestinal helminth infections in Lao PDR.
基金The study was funded by private funds(Poverty Foundation,Basel,Switzerland).
文摘Background:Severe hepatosplenic complications arise in patients with chronic Schistosoma mansoni infection after heavy exposure to disease agents in endemic areas.These complications are rarely reported and,hence,underestimated.Case presentation:We report on eight patients with severe morbidity associated with S.mansoni infection in Ituri Province,northeastern Democratic Republic of Congo(DRC).The patients were identified during a community-based survey in 2017;one patient was seen at the district hospital.After taking the patients'history,a clinical examination and an abdominal ultrasonographical examination were performed.S.mansoni infection was diagnosed in fecal(Kato-Katz technique)and urine(point-of-case circulating cathodic antigen test)samples.These eight patients with severe intestinal and hepatosplenic complications were identified from four villages with high 5.mansoni infection prevalence and related morbidity.The patients'ages ranged from 19 to 57 years;four patients were women.Three patients reported hematemesis.Two patients were severely anemic.All patients reported non-specific abdominal symptoms,such as diarrhea(six patients),abdominal pain(seven patients),and blood in the stool(five patients),as well as weight loss(two patients).Abdominal ultrasonography revealed ascites in four patients.All patients had portal hypertension with hepatomegaly(seven patients)or splenomegaly(five patients).Of the six patients with a discernable liver parenchyma pattern,five displayed pattern F and three patient displayed pattern E.Liver parenchyma was not visible for two patients with severe ascites.An 5.mansoni infection was confirmed in six patients,with infection intensity ranging from light to heavy.All S.mansoni positive patients were treated with praziquantel(40 mg/kg body weight)and referred to the district hospital for follow-up.One patient with severe ascites died two weeks after we saw her.Due to security and accessibility reasons,the villages could not be visited again and the patients were lost to follow-up.Conclusions:Our observations of patients with severe schistosomiasis document the severe degree of endemicity of S.mansoni in the province and suggest an urgent need for adequate schistosomiasis control measures that target vulnerable population groups and address severe complications.
基金We are grateful to the financial support of the Agence Universitaire de la Francophonie and the Rudolf Geigy Foundation,Basel,Switzerland。
文摘Background:As a result of epidemiological transition,the health systems of low-and middle-income countries are increasingly faced with a dual disease burden of infectious diseases and emerging non-communicable diseases.Little is known about the mutual influence of these two disease groups.The aim of this study was to investigate the cooccurrence of helminth infections and diabetes mellitus in adults in Lao People’s Democratic Republic(Lao PDR).Methods:We conducted a cross-sectional study among 1600 randomly selected adults aged 35 and older from four different socio-economical and ecological provinces.Information on socio-demographics,risk factors and health conditions was obtained from personal interviews.Clinical assessments including anthropometry(height,weight,waist and hip circumference)and blood pressure measurements were also conducted.Diabetes was classified based on selfreported diagnoses and a point-of-care glycated haemoglobin(HbA1c)test from finger prick blood samples.Stool samples for helminth diagnosis were examined with formalin-ether concentration technique for intestinal parasitic infections.The independent associations of helminth infections with diabetic status and HbA1c were assessed using multiple regression analyses.Results:The prevalence of pre-diabetes and diabetes was 37.3%and 22.8%,respectively.Fifty-six percent of diabetic cases were undiagnosed and 85%of diagnosed diabetic cases had poor glycemic control.Participants from rural areas and from southern parts of the country had higher infection rates,with Opisthorchis viverrini,being the most common helminth infection(30.5%).We found a positive association between Taenia spp.infections and HbA1c(β=0.117;95%CI:0.042-0.200)and diabetes mellitus risk(OR=2.98;95%CI:1.10-8.05).No other helminth species was associated with glycated hemoglobin.Conclusions:Hyperglycaemia and diabetic rates in Lao PDR are alarmingly high,but consistent with other high rates in the region.Given the high rates of under-diagnosis and poorly-controlled glycaemia in diabetes mellitus patients,routine diabetes screening and treatment is essential for the local healthcare system.Large longitudinal cohorts integrating biomarkers are warranted in the search of causal diabetes mellitus risk factors in the region.Common intestinal helminth infections,including O.viverrini,are unlikely to explain the high diabetes mellitus rates observed.
文摘Background:Despite the high prevalence of strongyloidiasis in the Laotian population,Laotian hospitals still lack diagnostic capacity to appropriately diagnose Strongyloides stercoralis infections.This cross-sectional hospital-based study was conducted to assess the prevalence of Strongyloides stercoralis infection among hospitalized patients treated at Mahosot Hospital,the primary reference hospital of Lao People’s Democratic Republic(Lao PDR),and to validate feasible methods for diagnosing S.stercoralis infection at hospital’s laboratory.Methods:Between September and December 2018,stool samples of 104 inpatients were investigated for S.stercoralis infection by wet smear,Baermann technique,Koga Agar plate culture(KAPC),and real-time detection polymerase chain reaction(RTD-PCR)at the Infectious Diseases Ward of the Mahosot Hospital in Vientiane.The sensitivity,the specificity,the negative predictive value(NPV)of each diagnostic test,as well as their combination(s)was calculated using a composite reference standard(CRS).The correlation of the different test methods was assessed by chi-square or Fisher’s exact test.Cohen’s kappa coefficient was used to assess the diagnostic agreement of the different test methods.Results:The overall prevalence of S.stercoralis infections among the study population was 33.4%.The cumulative infection prevalence statistically significantly increased from the lowest age group of 40 years and below(22.4%),to the medium(40.0%)and to the oldest age group of 61 year and above(72.7%)(P=0.003).The cumulative infection prevalence of CRS was considerably higher in male(40.4%)compared to female patients(28.1%),but not statistically different(P=0.184).The diagnostic sensitivity of Baermann technique,KAPC,RTD-PCR,and the combination of Baermann technique and KAPC were 60.0,60.0,74.3,and 77.1%,respectively.Only 13 patients(37.1%)of the total 35 S.stercoralis patients diagnosed with any technique had a simultaneously positive diagnostic test with Baermann,KAPC and RTD-PCR.Conclusions:We identified Baermann technique and KAPC to be currently the most feasible and implementable standard methods for diagnosing S.stercoralis at a hospital setting such as Mahosot Hospital and provincial and district hospitals in Lao PDR and other low-and middle income countries in Southeast Asia.Trial registration:This study was approved by the National Ethics Committee for Health Research in Lao PDR(reference no.083/NECHR)and by the Ethics Committee Northwest and Central Switzerland(reference no.2018–00594).
基金The LF MDA and monitoring and evaluation activities were supported by the MoH,the WHO,the Cambodia Second Health Sector Support Program,and through the United States Agency for International Development(USAID)the END in Asia Project led by FHI 360(AID-OAA-A-10-00051)+1 种基金The writing of the dossier and article was made possible in part thanks to the generous support of the American people through the USAID(https://www.usaid.gov/)and the ENVISION project led by RTI International(AID-OAAA-11-00048)The authors’views expressed in this publication do not necessarily reflect the views of the USAID or the US government.
文摘Background:Endemicity of lymphatic filariasis(LF)in Cambodia was proven in 1956 when microfilariae were detected in mosquitos in the Kratiéprovince.In 2001,an extensive study confirmed the presence of both Brugia malayi and Wuchereria bancrofti microfilariae.In 2003,the Ministry of Health established a national task force to develop policies and strategies for controlling and eliminating neglected tropical diseases(NTDs),with the goal of eliminating LF by 2015.This article summarizes the work accomplished to eliminate LF as a public health problem in Cambodia.Methods:The National Program to Eliminate Lymphatic Filariasis made excellent progress in the goal towards elimination due to strong collaboration between ministries,intensive supervision by national staff,and advocacy for mobilization of internal and external resources.Mass drug administration(MDA)with diethylcarbamazine citrate and albendazole was conducted in six implementation units,achieving>70%epidemiological coverage for five consecutive rounds,from 2005 to 2009.In 2006,in 14 provinces,healthcare workers developed a line list of lymphedema and hydrocele patients,many of whom were>40 years old and had been affected by LF for many years.The national program also trained healthcare workers and provincial and district staff in morbidity management and disability prevention,and designated health centers to provide care for lymphedema and acute attack.Two reference hospitals were designated to administer hydrocele surgery.Results:Effectiveness of MDA was proven with transmission assessment surveys.These found that less than 1%of school children had antigenemia in 2010,which fell to 0%in both 2013 and 2015.A separate survey in one province in 2015 using Brugia Rapid tests to test for LF antibody found one child positive among 1677 children.The list of chronic LF patients was most recently updated and confirmed in 2011-2012,with 32 lymphoedema patients and 17 hydrocele patients listed.All lymphedema patients had been trained on self-management and all hydrocele patients had been offered free surgery.Conclusions:Due to the success of the MDA and the development of health center capacity for patient care,along with benefits gained from socioeconomic improvements and other interventions against vector-borne diseases and NTDs,Cambodia was validated by the World Health Organization as achieving LF elimination as a public health problem in 2016.
基金This intervention study was funded by the International Development Research CentreForeign Affairs,Trade and Development Canada(through the Global Health Research Initiative),the Australian Agency for International Development for funding support,under funding number 105509-027the International Joint Laboratory on Tropical Diseases Control in Greater Mekong Subregion from Shanghai Municipality Government(No.21410750200).
文摘Background Helminth infections, includingOpisthorchis viverrini, hookworm, andTrichuris trichiura, are prevalent in Khong district, Champasack province, southern Lao People’s Democratic Republic (PDR). Schistosomiasis caused bySchistosoma mekongi is of public health concern on the islands of the Khong district. This study aimed to assess the impact of an Eco-Health/One-Health approach in combination with mass drug administration (MDA) to reduce these helminth infections.Methods We conducted a community intervention using a stepped-wedge trial approach on two endemic islands (Donsom and Donkhone) of the Khong district, Champasack province, Lao PDR, between April 2012 and March 2013. In each study village, 30–40 households were randomly selected. All members of selected households, who were at home during the study period were invited to participate in the study. A baseline study was conducted to assess helminth infections, knowledge attitudes and practices towardSchistosoma mekongi infection, behavior of open defecation and availability of latrine at home. After the baseline (T0), the Eco-Health/One-Health approach was implemented on Donsom (intervention) and Donkhone island (control). An assessment was conducted in 2014 (T1), one year after the completion of intervention implementation, to assess the short-term impact of the Eco-Health/One-Health approach on helminth infections and compare intervention and control islands. Later in 2015, the Eco-Health/One-Health approach was implemented on control island (Donkhone). After the implementation of intervention, the parasitological assessments were conducted annually in humans in 2015 (T2), in 2016 (T3) and in 2017 (T4), and in dogs in 2017 (T4) to evaluate the long-term impact of the intervention on helminth infections. Frequency was used to describe the prevalence of helminth infections. Logistic regression was applied to associate the KAP (knowledge, attitudes, and practices and open defecation behavior) and the reduction of helminth infections between intervention and control islands. The reduction in prevalence pre- and post-intervention was associated using a McNemar test. A two-independent samplet-test was applied to compare the mean eggs per gram (EPG) of helminth infections between control and intervention islands. A paired t-test test was used to compare the mean EPG of stool samples before (baseline) and after (follow-up) interventions for the two islands separately. AP-value lower than 0.05 was considered statistically significant.Results Eco-Health/One-Health approach appears to be associated with reduction in prevalence ofS. mekongi by 9.0% [odds ratio (OR) = 0.49,P = 0.003] compared to the use of mass drug administration alone (control island). Additionally, this intervention package significantly reducedO. viverrini infection by 20.3% (OR = 1.92,P < 0.001) and hookworm by 17.9% (OR = 0.71,P = 0.045), respectively. Annual parasitological assessments between 2012 and 2017 showed that the Eco-Health/One-Health approach, coupled with MDA, steadily reduced the prevalence ofS. mekongi on the intervention island from 29.1% to 1.8% and on the control island from 28.4% to 3.1%, respectively.Conclusions The study findings suggest that the Eco-Health/One-Health approach appears to be associated with a significant reduction in prevalence ofS. mekongi and helminth co-infections, particularly hookworm andT. trichiura. Therefore, implementing the Eco-Health/One-Health approach in schistosomiasis-endemic areas could accelerate the achievement of national goals for transmission interruption by 2025 and elimination by 2030.
基金This work is part of the‘Vegetables go to School’research project(Collaborative Project)supported by the Swiss Agency for Development and Cooperation under grant agreement contract number 81024052(project 7 F-08511.01)The funder had no role in the study design,data collection and analysis,decision to publish or preparation of the manuscript.
文摘Background:Multiple factors determine children’s nutritional status,including energy and nutrient intake,recurrent infectious diseases,access(or lack thereof)to clean water and improved sanitation,and hygiene practices,among others.The“Vegetables go to School:improving nutrition through agricultural diversification”(VgtS)project implements an integrated school garden programme in five countries,including Burkina Faso.The aim of this study was to determine the prevalence of undernutrition and its risk factors among schoolchildren in Burkina Faso before the start of the project.Methods:In February 2015,a cross-sectional survey was carried out among 455 randomly selected children,aged 8-14 years,in eight schools in the Plateau Central and Centre-Ouest regions of Burkina Faso.Nutritional status was determined by anthropometric assessment.Helminth and intestinal protozoa infections were assessed using the Kato-Katz and a formalin-ether concentration method.A urine filtration technique was used to identify Schistosoma haematobium eggs.Prevalence of anaemia was determined by measuring haemoglobin levels in finger-prick blood samples.Questionnaires were administered to children to determine their knowledge of nutrition and health and their related attitudes and practices(KAP).Questionnaires were also administered to the children’s caregivers to identify basic household socio-demographic and economic characteristics,and water,sanitation and hygiene(WASH)conditions.To determine the factors associated with schoolchildren’s nutritional status,mixed logistic regression models were used.Differences and associations were considered statistically significant if P-values were below 0.05.Results:Complete datasets were available for 385 children.The prevalence of undernutrition,stunting and thinness were 35.1%,29.4%and 11.2%,respectively.The multivariable analysis revealed that undernutrition was associated with older age(i.e.12-14 years compared to<12 years;adjusted odds ratio(aOR)=3.45,95%confidence interval(CI)2.12-5.62,P<0.001),multiple pathogenic parasitic infections(aOR=1.87,95%CI 1.02-3.43,P=0.044)and with moderate and severe anaemia in children(aOR=2.52,95%CI 1.25-5.08,P=0.010).Conclusions:We found high prevalence of undernutrition among the children surveyed in the two study regions of Burkina Faso.We further observed that undernutrition,anaemia and parasitic infections were strongly associated.In view of these findings,concerted efforts are needed to address undernutrition and associated risk factors among school-aged children.As part of the VgtS project,WASH,health education and nutritional interventions will be implemented with the goal to improve children’s health.Trial registration:ISRCTN17968589(date assigned:17 July 2015).
