Disparities in parasitic infections, perceived ill health and access to health care among poorer and less poor schoolchildren of rural Côte d'Ivoire

Abstract

SummaryDifferences in the state of health between rural and urban populations living in Africa have been described, yet only few studies analysed inequities within poor rural communities. We investigated disparities in parasitic infections, perceived ill health and access to formal health services among more than 4000 schoolchildren from 57 primary schools in a rural area of western Cô te d'Ivoire, as measured by their socioeconomic status. In a first step, we carried out a cross-sectional parasitological survey. Stool specimens and finger prick blood samples were collected and processed with standardized, qualitycontrolled methods, for diagnosis of Schistosoma mansoni, soil-transmitted helminths, intestinal protozoa and Plasmodium. Then, a questionnaire survey was carried out for the appraisal of selfreported morbidity indicators, as well as housing characteristics and household assets ownership. Mean travel distance from each village to the nearest health care delivery structure was provided by the regional health authorities. Poorer schoolchildren showed a significantly higher infection prevalence of hookworm than better-off children. However, higher infection prevalences of intestinal protozoa (i.e. Blastocystis hominis, Endolimax nana and Iodamoeba bü tschlii) were found with increasing socioeconomic status. Significant negative associations were observed between socioeconomic status and light infection intensities with hookworm and S. mansoni, as well as with several self-reported morbidity indicators. The poorest school-attending children lived significantly further away from formal health services than their richer counterparts. Our study provides evidence for inequities among schoolchildren's parasitic infection status, perceived ill health and access to health care in a large rural part of Cô te d'Ivoire. These findings call for more equity-balanced parasitic disease control interventions, which in turn might be an important strategy for poverty alleviation.keywords access to health care, concentration index, Cô te d'Ivoire, health inequities, household assets ownership, parasitic infections

Prediction of Child Health by Household Density and Asset-Based Indices in Impoverished Indigenous Villages in Rural Panamá

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Socio-environmental conditions, intestinal parasitic infections and nutritional status in children from a suburban neighborhood of La Plata, Argentina

“…Although the high percentage of intestinal protozoa in these children could be attributed to feces-polluted water, protozoa in particular were not associated with SEV. In this sense, Raso et al (2005) demonstrated that high prevalences of protozoa (i.e. B. hominis, E. nana and I. butschlii) were not indicative of poverty since they were more frequently observed in higher income groups.…”

Changing Patterns of Soil-Transmitted Helminthiases in Zanzibar in the Context of National Helminth Control Programs

“…Local risk factors sustaining helminth transmission can include specific environmental differences, such as soil composition and moisture, as well as socioeconomic discrepancies and differences in sanitation, hygiene, and health-seeking behavior. 12,[40][41][42][43][44] The lack of detailed appraisal of some of these risk factors is a limitation of this study and is the focus of our ongoing work. The observed higher risk for boys to be infected with hookworm coincides with findings from Pemba and elsewhere in Africa and might result from behavioral, immunological, or genetic idiosyncracies.…”