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      Soil-transmitted helminth infections and nutritional status in Ecuador: findings from a national survey and implications for control strategies

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          Abstract

          Objective

          The estimation of prevalence and intensity of soil-transmitted helminth (STH) infections at a country-level is an essential prerequisite for the implementation of a rational control programme. The aim of this present study was to estimate the prevalence and distribution of STH infections and malnutrition in school-age children in rural areas of Ecuador.

          Design

          Cross-sectional study from October 2011 to May 2012.

          Setting

          Eighteen rural schools were randomly selected from the three ecological regions of Ecuador (coastal, highlands and Amazon basin).

          Participants

          920 children aged 6–16 years.

          Main outcome measures

          Prevalence and intensity of STH infections associated with malnutrition (thinness/wasting or stunting).

          Results

          The results showed that 257 (27.9%) children were infected with at least one STH parasite. The prevalence of Trichuris trichiura, Ascaris lumbricoides and hookworm was 19.3%, 18.5% and 5.0%, respectively. Malnutrition was present in 14.2% of children and most common was stunting (12.3%). Compared with other regions, schoolchildren in the Amazon region had the highest STH prevalence (58.9%) of which a greater proportion of infections were moderate/heavy intensity (45.6%) and had the highest prevalence of malnutrition (20.4%). A positive association was observed between moderate to heavy infections with A. lumbricoides and malnutrition (adjusted OR 1.85, 95% CI 1.04 to 3.31, p=0.037).

          Conclusions

          Our estimate of the prevalence of STH infections of 27.9% at a national level in Ecuador is lower than suggested by previous studies. Our data indicate that schoolchildren living in the Amazon region have a greater risk of STH infection and stunting compared with children from other regions. The implementation of school-based preventive chemotherapy and nutritional supplement programmes within the Amazon region should be prioritised. Long-term control strategies require improvements in water, sanitation and hygiene.

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          Most cited references18

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          Soil-transmitted helminth infections: updating the global picture.

          Simon J. Brooker, Peter Hotez, R Fuente … (2003)
          Article 0 comments Cited 190 times – based on 0 reviews     Review now
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            Malnutrition and parasitic helminth infections.

            Camilla Ottesen, M. Latham, Corinne L. Stephenson (1999)
            The Global Burden of Disease caused by the 3 major intestinal nematodes is an estimated 22.1 million disability-adjusted life-years (DALYs) lost for hookworm, 10.5 million for Ascaris lumbricoides, 6.4 million for Trichuris trichiura, and 39.0 million for the three infections combined (as compared with malaria at 35.7 million) (World Bank, 1993; Chan et al. 1994); these figures illustrate why some scarce health care resources must be used for their control. Strongyloides stercoralis is the fourth most important intestinal worm infection; its nutritional implications are discussed, and the fact that its geographic distribution needs further study is emphasized. Mechanisms underlying the malnutrition induced by intestinal helminths are described. Anorexia, which can decrease intake of all nutrients in tropical populations on marginal diets, is likely to be the most important in terms of magnitude and the probable major mechanism by which intestinal nematodes inhibit growth and development. We present a revised and expanded conceptual framework for how parasites cause/aggravate malnutrition and retard development in endemic areas. Specific negative effects that a wide variety of parasites may have on gastrointestinal physiology are presented. The synergism between Trichuris and Campylobacter, intestinal inflammation and growth failure, and new studies showing that hookworm inhibits growth and promotes anaemia in preschool (as well as school-age) children are presented. We conclude by presenting rationales and evidence to justify ensuring the widest possible coverage for preschool-age children and girls and women of childbearing age in intestinal parasite control programmes, in order to prevent morbidity and mortality in general and specifically to help decrease the vicious intergenerational cycle of growth failure (of low-birth-weight/intrauterine growth retardation and stunting) that entraps infants, children and girls and women of reproductive age in developing areas.
            Article 0 comments Cited 81 times – based on 0 reviews     Review now
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              Soil-transmitted helminth infection in South America: a systematic review and geostatistical meta-analysis.

              H Guimarães, Jürg Utzinger, Penelope Vounatsou … (2013)
              The four common soil-transmitted helminth species-Ascaris lumbricoides, Trichuris trichiura, and the two hookworm species Ancylostoma duodenale and Necator americanus-are endemic in South America, but their distribution, infection prevalence, and regional burden are poorly understood. We aimed to estimate the risk and number of people infected with A lumbricoides, T trichiura, and hookworm across South America. We did a systematic review of reports on the prevalence of soil-transmitted helminth infection in South America published up to May 14, 2012. We extracted and georeferenced relevant survey data and did a meta-analysis of the data to assess the geographical distribution of the infection risk with Bayesian geostatistical models. We used advanced Bayesian variable selection to identify environmental determinants that govern the distribution of soil-transmitted helminth infections. We screened 4085 scientific papers and identified 174 articles containing relevant survey prevalence data. We georeferenced 6948 survey locations and entered the data into the open-access Global Neglected Tropical Diseases database. Survey data were sparse for the south of the continent and for the western coast, and we identified no relevant information for Uruguay and little data for smaller countries such as Suriname, Guyana, French Guiana, and Ecuador. Population-adjusted prevalence of infection with A lumbricoides was 15·6%, with T trichiura was 12·5%, and with hookworm was 11·9% from 2005 onwards. Risks of contracting soil-transmitted helminth infection have substantially reduced since 2005 (odds ratio 0·47 [95% Bayesian credible interval 0·46-0·47] for A lumbricoides, 0·54 [0·54-0·55] for T trichiura, and 0·58 [0·58-0·59] for hookworm infection). Our findings offer important baseline support for spatial targeting of soil-transmitted helminthiasis control, and suggest that more information about the prevalence of soil-transmitted helminth infection is needed, especially in countries in which we estimate prevalence of infection to be high but for which current data are scarce. UBS Optimus Foundation and Brazilian Swiss Joint Research Programme (BSJRP 011008). Copyright © 2013 Elsevier Ltd. All rights reserved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open
                Journal ID (iso-abbrev): BMJ Open
                Journal ID (hwp): bmjopen
                Journal ID (publisher-id): bmjopen
                Title: BMJ Open
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2044-6055
                Publication date Collection: 2018
                Publication date (Electronic): 28 April 2018
                Volume: 8
                Issue: 4
                Electronic Location Identifier: e021319
                Affiliations
                [1 ] departmentCentro de Investigación Para la Salud en América Latina (CISeAL) , Pontificia Universidad Católica del Ecuador , Quito, Pichincha, Ecuador
                [2 ] departmentDirección Nacional de Vigilancia Epidemiológica , Ministerio de Salud Pública del Ecuador , Quito, Pichincha, Ecuador
                [3 ] departmentFacultad de Ciencias Médicas , de la Salud y la Vida, Universidad Internacional del Ecuador , Quito, Ecuador
                [4 ] departmentInstitute of Infection and Immunity , St George’s University of London , London, UK
                Author notes
                [Correspondence to ] Dr Ana L Moncayo; amoncayo708@ 123456puce.edu.ec
                Article
                Publisher ID: bmjopen-2017-021319
                DOI: 10.1136/bmjopen-2017-021319
                PMC ID: 5931300
                PubMed ID: 29705768
                SO-VID: 689edfa5-50d6-491d-a2a7-342388b02567
                Copyright statement: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
                License:

                This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

                History
                Date received : 22 December 2017
                Date revision received : 08 March 2018
                Date accepted : 15 March 2018
                Product
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100004440, Wellcome Trust;
                Categories
                Subject: Infectious Diseases
                Subject: Research
                Subject: 1506
                Subject: 1706
                Custom metadata
                special-feature unlocked

                ScienceOpen disciplines: Medicine
                Keywords: soil-transmitted helminths,national survey,ecuador,malnutrition
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: soil-transmitted helminths, national survey, ecuador, malnutrition

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