Background:Soil-transmitted helminths (STH) have remained a major threat to humans, especially children in developing countries, including Nigeria. Interventions have always been geared towards school-aged children, neglecting preschool-aged children and occupational risk adults. The Soil-Transmitted Helminthiasis Advisory Committee (STHAC) recently suggested incorporating other at-risk groups.Objective:This study assessed the associated risk of STH infection among agrarian communities of Kogi State, Nigeria.Methods:A total of 310 individuals of all ages participated in the cross-sectional survey. Stool samples were analyzed using standard Kato-Katz method.Results:A total of 106 (34.2%) individuals were infected with at least one STH. Hookworm was the most prevalent (18.1%); followed by Ascaris lumbricoides (16.8%). Worm intensity was generally light. Prevalence of infection was similar between four age groups considered (preschool, school, ‘women of reproductive age’ and older at-risk group). Poor socio-economic status (SES) was a major risk for STH infection. Using a 20-asset based criteria, 68 (23.1%) and 73 (24.7%) of 295 questionnaire respondents were classified into first (poorest) and fifth (richest) wealth quintiles respectively. Risk of infection with STH was 60% significantly lower in the richest wealth quintile compared to the poorest (Prevalence Ratio [PR] = 0.4843, 95% CI = 0.2704–0.8678, p = 0.015). Open defecators were more likely to harbour STH than those who did not (PR = 1.7878, 95% CI = 1.236–2.5846, p = 0.00201). Pit latrine and water closet toilets each approximately reduced STH infection by 50% (p < 0.05).Conclusion:Preventive chemotherapy for all age groups, health education and provision of basic amenities especially toilets are needed in order to achieve the goal toward the 2020 target of STH control.

Background: Mapping the distribution of parasitic diseases in time and space has a pivotal role to play in their control. Objectives: This study mapped urinary schistosomiasis in Anambra State. Methods: Sampling covered the three senatorial districts, Anambra North, Anambra Central and Anambra South. However, only nine of the 21 local government areas (LGAs) and one town in each LGA were covered. A geographic information system (GIS) was used to map the distribution of schistosomiasis in the state. With the aid of GIS, the distance of the towns to water bodies was calculated. A total of 450 urine samples collected from the nine LGAs were examined for haematuria and Schistosoma haematobium eggs. A questionnaire was used to assess exposure and risks status to infection. The urine samples were examined for haematuria using dipstick and microscopy. Findings: Overall prevalence of infection in the study was 2.9% and 5.5% for microscopy and haematuria, respectively. Prevalence of schistosomiasis was different between the districts, and this was statistically significant (χ 2 = 7.763, p = 0.021). Prevalence of urinary schistosomiasis in the towns had a significant negative linear relationship with distance to water body (r = –0.767, p = 0.016). Based on infection status from microscopy, the adjusted odds of infection in fishers was over 103 times higher than in students; the difference was significant statistically (AOR = 103.0443, 95% CI = 4.6278–7093.972, p = 0.0114). People who washed things in stream had 12 times significantly greater odds of infection than those that did not (AOR = 12.4585, 95% CI = 1.9590–258.8108, p = 0.02542). The distance of respondents to stream was a major determinant of infection with urinary schistosomiasis in the state. Those who lived close to water were approximately 1131% more likely to be infected than those who lived far from water bodies (AOR = 11.3157, 95% CI 2.2473–90.6889, p = 0.00713). Conclusions: Anambra State is endemic for urinary schistosomiasis. There is therefore a need for focal studies; and there may probably be a need to design a health program aimed at controlling the infection in focal areas in the state. The study also provides relevant information for designing a plan of action for the selective integrated and targeted control of urinary schistosomiasis in the LGAs.

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Pregnancy-associated malaria (PAM) is a major public health concern constituting a serious risk to the pregnant woman, her foetus, and newborn. Management of cases and prevention rely partly on effective and efficient antenatal services. This study examined the effectiveness of antenatal service provision in a major district hospital in sub-Saharan Africa at preventing PAM. A cross-sectional hospital based study design aided by questionnaire was used. Malaria diagnosis was by microscopy. Overall prevalence of PAM was 50.7% (38/75). Mean Plasmodium falciparum density was (112.89 ± standard error of mean, 22.90) × 103/µL red blood cell (RBC). P. falciparum prevalence was not significantly dependent on gravidity, parity, trimester, age, and BMI status of the women (p > 0.05). Difference in P. falciparum density per µL RBC in primigravidae (268.13 ± 58.23) × 103 vs. secundi- (92.14 ± 4.72) × 103 vs. multigravidae (65.22 ± 20.17) × 103; and in nulliparous (225.00 ± 48.25) × 103 vs. primiparous (26.25 ± 8.26) × 103 vs. multiparous (67.50 ± 20.97) × 103 was significant (p < 0.05). Majority of attendees were at 3rd trimester at time of first antenatal visit. Prevalence of malaria parasitaemia in the first-time (48.6%), and multiple-time (52.6%) antenatal attendees was not significantly different (χ2 = 0.119, p = 0.730). The higher prevalence of malaria among bed net owners (69.6% vs. 42.9%, χ2 = 2.575, p = 0.109, OR = 3.048 (95% CI 0.765–12.135)) and users (66.7% vs. 33.3%, χ2 = 2.517, p = 0.113, OR = 4.000 (95% CI 0.693–23.089)) at multiple antenatal visits vs. first timers was not significant. None of the pregnant women examined used malaria preventive chemotherapy. Antenatal services at the hospital were not effective at preventing PAM. Holistic reviews reflecting recommendations made here can be adopted for effective service delivery.

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Pregnancy-associated malaria remains a major risk to the pregnant woman, her foetus and infants in sub-Saharan Africa. Infection by Plasmodium falciparum significantly affects maternal, foetal and neonatal wellbeing. Maternal anaemia, low birth weight, preterm labour, spontaneous abortion, and maternal and neonatal mortalities are some of its consequences. It complicates maternal immunological responses and possibly also selfishly preempts foetal immunological responses by transplacental communications. Therefore, the impacts may extend well beyond the duration of pregnancy and the immediate period post-delivery. Effective case management and prevention continue to yield positive results, but challenges still remains especially in sub-Saharan Africa. The challenges of antenatal service provision, compliance with intermittent preventive treatment at pregnancy with sulfadoxine-pyrimethamine (IPTp-SP), widespread SP resistance, and resistance to insecticide treated nets (ITNs) and insecticides continue to complicate efforts at PAM control in sub-Saharan Africa. Hopefully, the Global Technical Strategy for Malaria 2016-2030 will comprehensively consider these challenges and improve the prospect of every pregnant woman in sub-Saharan Africa.

33 Soil-transmitted helminths (STH) have remained a major threat to human especially children 34 in developing countries including Nigeria. Interventions have always been geared towards 35 school-aged children, neglecting preschool-aged children and occupational risk adults. The 36 Soil-Transmitted Helminthiasis Advisory Committee (STHAC) recently suggested 37 incorporating other at-risk groups. In the context of this recommendation, this study assessed 38 the associated risk of STH infection among agrarian communities of Kogi State, Nigeria. A 39 total of 310 individuals of all ages participated in the cross-sectional survey. Stool samples 40 were analyzed using standard Kato-Katz method. A total of 106 (34.2%) individuals were 41 infected with at least one STH. Hookworm was the most prevalent (18.1%); followed by 42 Ascaris lumbricoides (16.8%). Worm intensity was generally light. Prevalence of infection 43 was similar between four age groups considered (preschool, school, 'women of reproductive 44 age' and older at-risk group). Poor socio-economic status (SES) was a major risk for STH 45 infection. Using a 20-assets based criteria, 68 (23.1%) and 73 (24.7%) of 295 questionnaire 46 respondents were classified into first (poorest) and fifth (richest) wealth quintiles respectively.47 Risk of infection with STH was 60% significantly lower in the richest wealth quintile 48 compared to the poorest (Prevalence Ratio (PR) = 0.4843, 95% CI = 0.2704 -0.8678, p = 3 3 49 0.015). Open defecators were more likely to harbour STH than those who did not (PR = 50 1.7878, 95% CI = 1.2366 -2.5846, p = 0.00201). Pit latrine and water closet toilet each 51 approximately reduced STH infection by 50% (p < 0.05). Preventive chemotherapy for all age 52 groups, health education and provision of basic amenities especially toilets are needed in 53 order to achieve the goal toward the 2020 target of STH control. Author summary58 Soil-transmitted helminths (STHs) are major cause of morbidities globally, especially among 59 children in developing countries such as Nigeria. Present World Health Organization 60 recommended control strategy solely require preventive chemotherapy targeting preschool-61 aged children (PSAC) and school-aged children (SAC), and the recently included women of 62 reproductive age (WRA). The Soil-Transmitted Helminthiasis Advisory Committee (STHAC) 63 which is saddled with responsibility of evaluating STHs status and providing appropriate 64 recommendations proposed that preventive chemotherapy be extended to other at-risk groups.65 This study evaluates this and some other recommendations of STHAC 2016 using sections of 66 a state in Nigeria where soil-transmitted helminthiasis is endemic.67 Findings from this study supports recommendations for extension of preventive chemotherapy 68 to other at-risk groups apart from PSAC and SAC. It supports WASH (water, sanitation and 69 hygiene) as integral part of STH control. This finding emphasizes the need for health 70 education and change in attitude which could promote tene...

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