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Epidemiology of helminth infections: implications for parasite control programmes, a South African perspective

Published online by Cambridge University Press:  02 January 2007

CC Jinabhai ,
M Taylor ,
A Coutsoudis ,
HM Coovadia ,
AM Tomkins  and
KR Sullivan
CC Jinabhai*
Affiliation:
Department of Community Health, Nelson R Mandela School of Medicine, University of Natal, Private Bag 7, Congella 4013, South Africa
M Taylor
Affiliation:
Department of Community Health, Nelson R Mandela School of Medicine, University of Natal, Private Bag 7, Congella 4013, South Africa
A Coutsoudis
Affiliation:
Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of Natal, South Africa
HM Coovadia
Affiliation:
Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of Natal, South Africa
AM Tomkins
Affiliation:
Institute of Child Health, Centre for International Child Health, University College London, London, UK
KR Sullivan
Affiliation:
Institute of Child Health, Centre for International Child Health, University College London, London, UK
*
*Corresponding author: Email [email protected]
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Abstract

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Objectives:

To determine the epidemiology of helminthic infections and the efficacy of parasite treatment among rural South African primary school children in the province of KwaZulu-Natal. To assess the South African government's parasite control policy.

Methods:

The study recruited 268 school children, aged 8 to 10, and randomly allocated them into treatment and placebo groups (treatment consisted of a single dose of albendazole (400 mg) and praziquantel (40 mg/kg)). Anthropometric measurements and the prevalence and intensity of helminth infections were taken at baseline (prior to treatment) and 16 weeks post treatment. Two weeks after treatment prevalence and intensity were again measured for an approximate 50% sub-sample of the children to investigate efficacy of treatment. An analysis of the South African government's policies concerning parasite control is assessed in the light of these epidemiological findings.

Results:

Low levels of both stunting and wasting were observed throughout the study (approximately 10% and 1%, respectively), but did not vary significantly across either treatment group or time period (P>0.50). At baseline the observed prevalences for the three main helminths found in this study among the treated children were Ascaris lumbricoides 29.5%, Trichuris trichiura 51.9% and Schistosoma haematobium 22.3%. These prevalences declined significantly to 4.7% (P<0.0005), 38.0% (P<0.03) and 3.3% (P<0.0002), respectively, 16 weeks post treatment. The majority of infections observed at baseline were of light intensity, namely A. lumbricoides (50%), T. trichiura (80%) and S. haematobium (100%), and following treatment these levels were reduced significantly (P<0.0001, P<0.05 and P<0.005, respectively). The levels of both prevalence and intensity in the untreated group remained constant. The cure rates over the first two weeks of the study were found to be 94.4% for A. lumbricoides, 40% for T. trichiura and 72.2% for S. haematobium.

Conclusion:

The benefits of targeted, school-based treatment in reducing the prevalence and intensity of infection supports the South African government's focus of using school-based interventions as part of an integrated parasite control programme. These strategies and programmes are consistent with recommendations of the World Health Organization (WHO) and The United Nations Children's Fund (UNICEF).

Keywords

Parasite controlAscaris lumbricoidesTrichuris trichiuraSchistosoma haematobiumAlbendazolePraziquantelInterventionRural school childrenPolicy
Type
Research Article
Information
Public Health Nutrition , Volume 4 , Issue 6 , December 2001 , pp. 1211 - 1219
Copyright
Copyright © CABI Publishing 2001

References

1Development Bank of Southern Africa. South Africa's Nine Provinces: A Human Development Profile. Midrand: Development Bank of Southern Africa, 1994.Google Scholar
2Department of Health. 1998 National HIV Seroprevalence Survey of Women Attending Public Antenatal Clinics in South Africa. Summary Report. Pretoria: Health Systems Research and Epidemiology Directorate, Department of Health, February 1999.Google Scholar
3Department of Health. Annual Report. Pretoria: Department of Health, 1994.Google Scholar
4Taylor, M, Pillai, G, Kvalsvig, JD. Targeted chemotherapy for parasite infestations in rural black preschool children. S. Afr. Med. J. 1995; 85(9): 870–4.Google ScholarPubMed
5Savioli, L, Bundy, D, Tomkins, A. Intestinal parasitic infections: a soluble public health problem. Trans. Roy. Soc. Trop. Med. Hygiene 1992; 86: 353–4.CrossRefGoogle ScholarPubMed
6Montresor, A, Crompton, DWT, Bundy, DAP, Hall, A, Savioli, L. Guidelines for the Evaluation of Soil-transmitted Helminthiasis and Schistosomiasis at Community Level. WHO/CTD/SIP/98.1. Geneva: World Health Organization, 1998.Google Scholar
7Schutte, CHJ, Fripp, PJ, Evans, AC. An assessment of the schistosomiasis situation in the Republic of South Africa. S. Afr. J. Epidemiol. Infect. 1995; 10(2): 37–43.Google Scholar
8Fincham, JE, Evans, AC, Woodrof, CW, Seager, JR, Benade, AJS, Appleton, CC. Feed the children, not the parasites – an essential part of primary health care in South Africa. S. Afr. Med. J. 1996; 86(6): 647–9.Google Scholar
9Evans, AC, due Preez, L, Maziya, SP, van der Merwe, CA, Schutte, CHJ. Observations on the helminth infections in black pupils of the Eastern Transvaal Lowveld of South Africa. S. Afr. J. Epidemiol. Infect. 1987; 2: 7–14.Google Scholar
10Kvalsvig, JD, Cooppan, RM, Connolly, KJ. The effects of parasite infections on cognitive processes in children. Ann. Trop. Med. Parasitol. 1991; 85(5): 551–68.CrossRefGoogle ScholarPubMed
11Department of Health. Primary School Nutrition Programme – National Policy Framework and Operational Guidelines. Pretoria: Department of Health, 1994.Google Scholar
12Schutte, CHJ, van Deventer, JMG, Eriksson, IM. Parasitic infections in black children in an endemic schistosomiasis area in Natal. S. Afr. Med. J. 1977; 51: 268–12.Google Scholar
13Hamill, PVV, Drizd, TA, Johnson, CL, Reed, RB, Roche, AF, Moore, WM. Physical growth: National Center for Health Statistics percentiles. Am. J. Clin. Nutr. 1979; 32: 607–29.CrossRefGoogle ScholarPubMed
14Gyorkos, TW, Maclean, JD, Law, CG. Absence of significant differences in intestinal parasite prevalence estimates after examination of either one or two stool specimens. Am. J. Epidemiol. 1989; 130: 976–80.CrossRefGoogle ScholarPubMed
15Ritchie, LS. An ether sedimentation technique for routine stool examination. Bull. USA Army Med. Dept. 1948; 8: 326–8.Google Scholar
16Visser, PS, Pitchford, RJ. A simple apparatus for rapid recovery of helminth eggs from excreta with special reference to Schistosoma mansoni. S. Afr. Med. J. 1972; 46: 1344–6.Google Scholar
17Department of Health. An Integrated Nutrition Strategy for South Africa. Report of the Nutrition Committee. Pretoria: Department of Health, 1994.Google Scholar
18Republic of South Africa. White Paper for the Transformation of the Health System in South Africa. Government Gazette 17910. Pretoria: Republic of South Africa, 16 04 1977.Google Scholar
19KwaZulu-Natal Department of Health. Integrated Nutrition Programme – Business Plan 2000–2001. Pietermaritzburg: KwaZulu-Natal Department of Health, 2000.Google Scholar
20UNICEF. Promoting Child Development through Helminth Control Programmes. Report of a workshop held in February 1997. New York: UNICEF, 1997.Google Scholar
21Dickson, R, Awasthi, S, Demmellweek, C, Williamson, P. Anthelminthic drugs for treating worms in children – effects on growth and cognitive performance (Cochrane Review). The Cochrane Library. Issue 2. Oxford: Update Software, 1999.Google Scholar
22Albonico, M, Smith, PG, Hall, A, Chwaya, HM, Alawa, KS, Savioli, L. A randomized controlled trial comparing mebendazole and albendazole against Ascaris, Trichuris and hookworm infections. Trans. Roy. Soc. Trop. Med. Hygiene 1994; 88(5): 585–9.CrossRefGoogle ScholarPubMed
23Bartoloni, A, Guglielmetti, P, Cancrini, G, Gamboa, H, Roselli, M, Nicoletti, A, Paradisi, F. Comparative efficacy of a single 400mg dose of albendazole or mebendazole in the treatment of nematode infections in children. Trop. Geograph. Med. 1993 45(3): 114–6.Google ScholarPubMed
24Magnussen, P, Muchiri, E, Mungai, P, Ndzovu, M, Ouma, J, Tosha, S. A school-based approach to the control of urinary schistosomiasis and intestinal helminth infections in children in Matuga, Kenya: impact of a two-year chemotherapy programme on prevalence and intensity of infections. Trop. Med. Int. Health 1997; 2(9): 825–31.CrossRefGoogle Scholar
25Albonico, M, Stoltzfus, RJ, Savioli, L, Chwaya, HN, d'Harcourt, E, Tielsch, JM. A controlled evaluation of two-school-based anthelminthic chemotherapy regimens on intensity of intestinal helminth infections. Int. J. Epidemiol. 1999; 28(3): 591–6.CrossRefGoogle ScholarPubMed
26Hall, A, Nahar, Q. Albendazole and infections with Ascaris lumbricoides and Trichuris trichiura in children in Bangladesh. Trans. Roy. Soc. Trop. Med. Hygiene 1994; 88(1): 110–2.CrossRefGoogle ScholarPubMed
27Booth, M, Bundy, DA. Comparative prevalences of Ascaris lumbricoides, Trichuris trichiura and hookworm infections and the prospects for combined control. Parasitology. 1992; 105(1): 151–7.CrossRefGoogle ScholarPubMed
28Guyatt, HL. Mass chemotherapy and school-based anthelminthic delivery. Trans. Roy. Soc. Trop. Med. Hygiene 1999; 93: 12–3.CrossRefGoogle ScholarPubMed
29Bundy, DAP, Wong, MS, Lewis, LL, Horton, J. Control of geohelminths by delivery of targeted chemotherapy through schools. Trans. Roy. Soc. Trop. Med. Hygiene 1990; 84: 115–20.CrossRefGoogle ScholarPubMed