Soil‐transmitted helminths in southern highland Rwanda: associated factors and effectiveness of school‐based preventive chemotherapy

Abstract

Abstractobjectives Preventive chemotherapy of schoolchildren against soil-transmitted helminths (STHs) is widely implemented in Rwanda. However, data on its actual efficacy are lacking. We assessed prevalence, associated factors and manifestation of STH infection among schoolchildren in southern highland Rwanda as well as cure and reinfection rates.methods Six hundred and twenty-two children (rural, 301; urban, 321) were included preceding the administration of a single dose of 500 mg mebendazole. Before treatment, and after 2 and 15 weeks, STH infection was determined by Kato-Katz smears and by PCR assays for Ascaris lumbricoides. Clinical and anthropometric data, socio-economic status and factors potentially associated with STH infection were assessed.results Soil-transmitted helminth (STH) infection was present in 38% of rural and in 13% of urban schoolchildren. Ascaris lumbricoides accounted for 96% of infections. Of these, one-third was detected by PCR exclusively. Factors associated with STH infection differed greatly between rural and urban children. Likewise, STH infection was associated with stunting and anaemia only among urban children. The cure rate after 2 weeks was 92%. Among eight non-cleared A. lumbricoides infections, seven were submicroscopic. Reinfection within 3 months occurred in 7%, but the rate was higher among rural children, and with initially present infection, particularly at comparatively high intensity.conclusions The rural-urban difference in factors associated with STH infection and in reinfection rates highlights the need for targeted interventions to reduce transmission. PCR assays may help in detecting low-level infections persisting after treatment. In southern Rwanda, mebendazole is highly effective against the STH infections predominated by A. lumbricoides.

Age-dependent decline and association with stunting of Giardia duodenalis infection among schoolchildren in rural Huye district, Rwanda

“…Notably, in this regard, results from Lesotho indicate that the amount of water used for personal and domestic hygiene rather than its quality may influence the risk of G. duodenalis infection (Esrey et al, 1989). A. lumbricoides and G. duodenalis infections shared only few risk factors, e.g., parental education (Staudacher et al, 2014), but were not associated with each other. This points to subtle differences in the routes of transmission, or again, ubiquitous contamination with G. duodenalis.…”

“…On examination, classic symptoms of acute giardiasis, e.g., diarrhoea, were not present. Prevailing findings were skin infection, clinically assessed malnutrition and dental caries (Staudacher et al, 2014). Thus, although the statement that G. duodenalis was not a cause of acute gastrointestinal symptoms holds true, we may have missed some mild clinical histories by not specifically interviewing the parents in this regard.…”

“…Study procedures and the characteristics of the 622 children have previously been reported (Staudacher et al, 2014). Briefly, we conducted a cross-sectional study in May 2012 alongside routine school-based deworming activities in the area of Butare (population, 100,000), Huye district, southern province of Rwanda.…”

“…Most indicators of socio-economic status were significantly lower for rural as compared to urban children (Staudacher et al, 2014), and analysis was therefore performed separately. Overall, only few factors were associated with G. duodenalis infection (Table 2).…”

Loop-Mediated Isothermal Amplification: An Advanced Method for the Detection of Giardia

“…This includes neglected tropical diseases (NTDs). The geohelminths (soil-transmited helminths [STHs]) and the intestinal G. duodenalis parasite alone infect hundreds of millions of people in SSA [32,33].…”