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The School Health Programme in Behera: an integrated helminth control programme at Governorate level in Egypt.

School Health Programmes offer the opportunity to deliver public health interventions to a great number of beneficiaries at a relatively low cost and are seen with growing interest by policy makers in developing countries and the donors' communities. In Egypt a pilot School Health Programme has been implemented for the past 6 years in Behera, the largest and most populous Governorate of the Nile Delta. The Programme integrated additional activities for the control of soil-transmitted helminthiasis, human fascioliasis and anaemia in the National Schistosomiasis Control Programme (NSCP), implemented in Egypt since 1988 by the Ministry of Health and Population (MoHP). To facilitate planning and direct actions, a strong monitoring system was also developed, that generated useful information for the schistosomiasis control programme. The practical steps adopted to develop the programme are presented and discussed. Results from three rounds of monitoring (2000, 2001, 2002) are analysed and compared with baseline data conducted in 1996, together with the cost of each activity. On the basis of the experience gained by the Behera School Health Programme a number of operational recommendations are formulated.

Adolescent↗

Is the exclusion of children under 24 months from anthelmintic treatment justifiable?

There are no reports documenting toxicity or adverse effects after treatment of children aged < 24 months with benzimidazole derivatives and there is an urgent need to clarify this point in light of the potential detrimental effect that soil-transmitted helminthiasis has on this age-group. A total of 653 treatments (317 mebendazole 500 mg; 336 placebo) were administered in 1996/97 to 212 children aged < 24 months as part of a 1-year anthelmintic drug study conducted among preschool-age children in Tanzania. Data on fever, cough, diarrhoea, dysentery and acute respiratory illness were collected 1 week following the treatment. No differences between the occurrence of adverse effects in the 2 groups were observed. In light of the potential nutritional benefit achieved by regular deworming in this young age-group, the policy that excludes children aged < 24 months from treatment should be re-considered.

Anthelmintics↗

Ascorbic acid content of blood plasma, erythrocytes, leukocytes and liver in camels (Camelus dromedarius) without or with parasite infections.

Healthy camels (Camelus dromedaris) and those naturally infected with trypanosomiasis, sarcoptic mange, and helminthiasis were compared as to ascorbic acid (vitamin C) contents of red blood cells, white blood cells, whole blood, plasma, and liver. The camels were kept under natural grazing conditions in Sudan. Reduced levels of vitamin C were found in camels with parasite infections, especially in animals with trypanosomiasis. It is suggested that the low vitamin C status in infected camels is caused by increased utilization and/or decreased synthesis of vitamin C.

Animals↗

Early childhood diarrhoea and helminthiases associate with long-term linear growth faltering.

BACKGROUND: Although the acute mortality from diarrhoeal diseases is well recognized, the potentially prolonged impact of early childhood diarrhoea on background growth and development is often overlooked. To examine the magnitude and duration of the association of early childhood enteric infections with growth faltering in later childhood, we investigated associations of early childhood diarrhoea (0-2 years) and intestinal helminthiases with nutritional status from age 2 to 7 years. METHODS: Twice-weekly diarrhoea surveillance and quarterly anthropometrics were followed from 1989 to 1998 in 119 children born into a Northeast Brazilian shantytown. RESULTS: Diarrhoea burdens at 0-2 years old were significantly associated with growth faltering at ages 2-7 years, even after controlling for nutritional status in infancy, helminthiases at 0-2 years old, family income, and maternal education by Pearson correlation, multivariate linear regression, and repeat measures analysis. The average 9.1 diarrhoeal episodes before age 2 years was associated with a 3.6 cm (95% CI : 0.6-6.6 cm) growth shortfall at age 7 years. Early childhood helminthiasis was also associated with linear growth faltering and a further 4.6 cm shortfall (95% CI : 0.8-7.9 cm) at age 7 years. CONCLUSIONS: Early childhood diarrhoea and helminthiases independently associate with substantial linear growth shortfalls that continue beyond age 6 years. Targeted interventions for their control may have profound and lasting growth benefits for children in similar settings.

Anthropometry↗

Helminthic infection and anthropometric indicators in children from a tropical slum: Ascaris reinfection after anthelmintic treatment.

We evaluated helminthic infection and anthropometric indicators of nutritional status in a group of school-age children from a slum area of Caracas, Venezuela. The proportions of children at or below the 10th percentiles for height/age and weight/age were significantly higher in those presenting helminthiasis than in those uninfected. Although this could partially reflect a codependence of both helminthic infection and undernutrition or poverty, when the children were administered regular anthelmintic treatment for a year their anthropometric values improved significantly. When they were re-evaluated 8 months after the end of anthelmintic administration, the degree of reinfection by the most common helminth, Ascaris lumbricoides, was significantly higher in the growth-retarded children. These results confirm the relationship between helminthic infection and decreased growth rates in underprivileged populations, and indicate that children at nutritional risk are more susceptible to such infections, even after a prolonged parasite-free period.

Anthelmintics↗

High allergic reactivity in a tropical environment.

The prevalence of atopic disease in tropical populations is often considered to be low, and this has been attributed to an immunological modulating effect of intestinal helminthiasis. We, however, report that the frequency of positive allergic history and skin-test reactivity to groups of major environmental allergens is extremely high (43 and 63% respectively) in children in Caracas, Venezuela (Lat. 10 degrees N). These values were statistically significantly greater than in a group of children with a similar age and sex distribution studied in parallel, but having limited or no contact with a tropical environment (29 and 37% respectively). The two groups differed with respect to the sporadic and light intestinal helminthic infections (such as ascariasis) experienced by the Venezuelans, compared to rare contact in the 'non-tropical' group. This was probably the cause of the increased total serum IgE levels of the former children (369 vs 68 iu/ml), and possibly, therefore, their higher allergic reactivity.

Adolescent↗

Status of soil-transmitted helminthic infection in Nepal.

A retrospective evaluation of the status of soil-transmitted helminthic infection in Nepal during the period from 1985 to 1992 was conducted at the Parasitology Laboratory, Department of Pathology, TU Teaching Hospital in Kathmandu. An average of 6,537 faecal samples were examined each year for the presence of various types of intestinal parasites. The annual rate of positivity of these samples for soil-transmitted helminthiasis ranged from 18.0 to 36.6%. The annual incidence decreased every successive calendar year in both adults and children, irrespective of sex. Among the various types of helminths, the most common was Ascaris lumbricoides (roundworm), followed by hookworm. The incidence of A. lumbricoides remained constant throughout the study period, while that of other parasites markedly decreased each year.

Adult↗

Evaluation of the common conditions associated with eosinophilia.

In an eosinophilic population of 47 boys of the same age, a large proportion (92%) were helminth infested or atopic, or both, compared with 36% of 36 controls. The methods used to detect these conditions were not costly or elaborate, except for the radioallergosorbent test, which was used to measure concentrations of circulating IgE antibodies to atopic allergens. It is suggested that an economical approach to detect helminthiasis and atopy in cases of eosinophilia is adopted using the methods employed here, with skin prick tests replacing the radioallergosorbent test.

Adolescent↗

Allergic reactivity and helminthic infection in Amerindians of the Amazon Basin.

Various aspects of the allergic reactivity of Amerindians in the Venezuelan sector of the Amazon basin were examined. The frequency of positivity in immediate hypersensitivity skin tests with extracts of common local environmental allergens was found to be extremely low (6.7%). As sera from significantly higher proportions of the study group contained specific IgE antibody against the test allergens, and their histamine-induced skin responses were normal, these results support previous suggestions of an inhibited expression of allergic reactivity in such populations. Indeed, the intense helminthic infections detected, and the extremely high total serum IgE levels measured (geometric mean 13,088 IU/ml) indicate the possible occurrence of mast cell saturation by parasite-induced IgE. However, despite a similar lack of agreement between the in vivo and in vitro tests for allergic reactivity against Ascaris lumbricoides in these subjects (43.5 and 97.9% positive, respectively), their extremely high responsiveness to the helminth allergens presents a marked contrast to that against the other environmental materials. Factors other than helminthiasis (e.g. racial, cultural, nutritional) might, therefore, also modulate the expression of allergic reactivity in such populations.

Antibody Formation↗

Joint modelling of repeated measurements and event time: application to performance traits and survival of lambs bred in sub-humid tropics.

We considered the analysis of a study for Dorper, Red Maasai and crossbred lambs born over a period of 6 years at the Diani Estate, Kenya. The study was designed to compare survival and performance traits of genotypes with differing susceptibilities to helminthiasis. The available data include information on time to death and repeated measurements of body weight, packed cell volume (PCV) and faecal egg count (FEC) of the animals. In the paper, we consider joint modelling of the survival time and the repeated measurements. Such an approach allows to account for the possible association between the survival and repeated measurement processes. The advantages and limitations of the joint modelling are discussed and illustrated using the Diani Estate study data.

Animals↗

[Intestinal parasitoses in schoolchildren of Martinésia District, Uberlândia, MG: a pilot study].

This work evaluates the occurrence of intestinal parasites in the students of the Martinésia District, Uberlândia municipality, Minas Gerais state. A total of 103 children were examined, from September to November 1995, according to Lutz or Hoffman, Pons and Janer method. The overall prevalence rate was 22.3% and the highest indices of infection were observed in 8-9 age group (34.8%), in village dwellers (30.0%) and in females (26.9%). Helminthiasis and protozoosis showed similar prevalence rates (10.7% and 12.6%, respectively). Giardia lamblia was the unique protozoan parasite verified and only one case of polyparasitism was found. We concluded that: the prevalence of enteroparasitosis in the studied group is lower than expectations for a rural community, what is, probably, a consequence of the good sanitary conditions presenting in that district.

Adolescent↗

Environmental pollution with soil-transmitted helminths in Sanliurfa, Turkey.

Soil transmitted helminth (STH) infection are endemic in developing countries. A study was carried out of sewage farms, streams and vegetables to determine the sources and routes of STH infection in Sanliurfa, Turkey. Stool samples from farmhouse inhabitants as well as soil and vegetable samples from the gardens were collected and examined. In addition, water samples from streams and vegetable samples from the city market were collected and examined. One hundred and eighty-seven (59.5%) of a total of 314 samples, including 88.4% of the stool samples, 60.8% of the water samples, 84.4% of the soil samples and 14% of the vegetable samples, were found to be positive for STH eggs. These results indicate that the water, soil and vegetables are heavily contaminated, and suggest a vicious circle between humans and the environment. Improving environmental sanitation is imperative for the control of soil-transmitted helminthiasis in Sanliurfa.

Animals↗

Helminth parasites in the intestinal tract of indigenous poultry in parts of Kenya.

A study was carried out on 456 indigenous poultry intestinal specimens from various towns in Kenya to determine the occurrence and distribution of helminth parasites in the intestinal tract of the birds. Of the specimens examined, 414 had parasites whereas the remaining 42 had none, which is an infection rate of 90.78%. The main species of helminths found in the intestines were Raillietina sp. (47.53%), Heterakis gallinarum (21.33%), Ascaridia galli (10.03%), Strongyloides avium (9.96%), Choanotaenia infundibulum (4.61%), Cotugnia digonopora (3.6%), Capillaria sp. (1.5%), Trichostrongylus tenius (1.04%) and Syngamus trachea (0.40%). Most helminths were present in both the mid- and hindguts. Syngamus trachea and C. digonopora were only found in the foregut and midgut, respectively. Although chickens from which the specimens were collected appeard healthy, the high prevalence of helminthiasis observed shows the poor level of helminth infection control practiced by the indigenous poultry keepers in the country, which might affect the health status of the birds and their growth rates. Poultry keepers should be encouraged to prevent, control and treat such cases.

Animals↗

Early childhood diarrhea is associated with diminished cognitive function 4 to 7 years later in children in a northeast Brazilian shantytown.

Diarrhea is well recognized as a leading cause of childhood mortality and morbidity in developing countries; however, possible long-term cognitive deficits from heavy diarrhea burdens in early childhood remain poorly defined. To assess the potential long-term impact of early childhood diarrhea (in the first 2 years of life) on cognitive function in later childhood, we studied the cognitive function of a cohort of children in an urban Brazilian shantytown with a high incidence of early childhood diarrhea. Forty-six children (age range, 6-10 years) with complete diarrhea surveillance during their first 2 years of life were given a battery of five cognitive tests. Test of Non-Verbal Intelligence-III (TONI) scores were inversely correlated with early childhood diarrhea (P = .01), even when controlling for maternal education, duration of breast-feeding, and early childhood helminthiasis (Ascaris or Trichuris). Furthermore, Wechsler Intelligence Scale for Children (WISC-III) Coding Tasks and WISC-III Digit Span (reverse and total) scores were also significantly lower in the 17 children with a history of early childhood persistent diarrhea (PD; P < .05), even when controlling for helminths and maternal education. No correlations were seen between diarrhea rates and Wide Range Assessment of Memory and Learning subtests or WISC-III Mazes. This report (with larger numbers of participants and new tests) confirms and substantially extends previous pilot studies, showing that long-term cognitive deficits are associated with early childhood diarrhea. These findings have important implications for the importance of interventions that may reduce early childhood diarrheal illnesses or their consequences.

Brazil↗

Hookworm infestation in a 3-month old female.

BACKGROUND: Intestinal helminthiasis is a major cause of morbidity and mortality in infants and children particularly in the tropics and subtropics. This report highlights the possibility of hookworm infestation in infancy. METHOD: A case report of hookworm infestation in a three-month old infant who was managed in the University of Port Harcourt Teaching Hospital, Port Harcourt in May 2001 for failure to thrive and recurrent severe anaemia. RESULT: The patient was admitted in the children's emergency ward with passage of dark watery stools, fever, excessive crying and severe anemia and was transfused twice. Stool microscopy revealed numerous ova of hookworm and she was treated with albendazole. Three days after administration of anti-helminthic, stools became formed with normal colour and temperature was normal. She gained weight before discharge home. CONCLUSION: Hookworm infestation should be suspected as a cause of severe anaemia in infants in communities with a high risk of infestation such as fishing port communities. To the best of my knowledge, symptomatic hookworm infestation in the first year of life has not been previously documented in Nigeria.

Anemia↗

Effect of intestinal helminth infection on some nutritional parameters among rural villagers in Nepal.

We report the prevalence of intestinal helminthiasis and its impact on health of Nepalese in two different rural Village Development Committees (VDC) in Nepal. A total of 261 school children from Okharpauwa VDC in Nuwakot district (Central Region) and 242 inhabitants of Boya VDC in Bhojpur district (Eastern Region) in Nepal were included in this study. The overall prevalence in these two different districts were 57.5% and 55.4%, respectively. Altogether four types of helminths were detected. In both districts, Ascaris lumbricoides was the commonest helminth. Mixed helminth infection in both study areas accounted for less than 5.0%. All helminth infected subjects were treated with a single dose of albendazole. Heavy Trichuris trichiura infection needed a second dose. Blood hemoglobin and serum total protein level in school children in Okharpauwa VDC increased significantly after chemotherapy (P < 0.05). Eosinophil count (10.1%; SD 5.0325) returned to normal (4.8%; SD 4.6997). Helminth infection in Boya VDC was more common in children than in adults. Serum total protein, albumin, total cholesterol and triglycerides levels were not influenced by the presence or absence of helminths among the inhabitants of Boya VDC. In both districts, more than 80.0% of the household had no latrine. In Boya VDC, 94.0% of inhabitants interviewed were not aware of other intestinal parasite other than A. lumbricoides.

Adolescent↗

[Genetic control of hypereosinophilias].

Polynuclear eosinophils play a major role in host defense against infectious diseases and especially helminthiasis. Onset of hypereosinophilia can be attributed to two mechanisms which can occur separately or in combination. The first mechanism involves enhancement of medullary production and differentiation of eosinophils. The second is prolonged life span of eosinophils. Response to eosinophils depends on various cytokines including IL-5, IL-4, IL-3 and GM-CSF. Since it contains the genes coding for these cytokines, the 5q31-q33 region of chromosome 5 is the focus of study on genetic control of human hypereosinophilia. The goal of these studies is to allow screening of subjects predisposed to helminthic infection and to deregulation of immune responses that may lead to atopy and various types systemic inflammatory diseases.

Chromosomes, Human, Pair 5↗

[Intestinal parasites in school children at a public institution in Maracaibo municipality, Venezuela].

To determine the prevalence and epidemiological parameters of intestinal parasites in schoolchildren, a faecal analysis was performed in 349 individuals of both sexes, between 5 and 16 years of age. The methodology used included, a fresh test, formol-ether technique and faecal egg counts by the Kato-Katz method. Eighty three per cent of the children presented enteroparasites, with a high prevalence of polyparasitism (71.6%). There was not significative difference between parasitoses, sex and age. However, it was observed an increase of helminthiasis and protozooses in children between 7 and 10 years of age. The principal enteroparasites founded were: Trichuris trichiura (41.8%), Ascaris lumbricoides (35.2%), Blastocystis hominis (48.1%) and Endolimax nana (22.9%). When the intensity of infestation was studied by the faecal egg counts, it was observed that the highest percentage of children with T. trichiura had light infestations (84.3%), while 45.9% of the children with A. lumbricoides had severe infestations. The Abundance, Mean Intensity and Aggregation Coefficient (k) values show an over-dispersed spatial disposition of both helminths, where only few children harbour heavy burdens and eliminate a large quantity of eggs. This aggregation was higher for T. trichiura (k = 0.298) than for A. lumbricoides (k = 1.138).

Adolescent↗