Utzinger Jürg, Müller Ivo, Vounatsou Penelope, Singer Burton H, N'Goran Eliézer K, Tanner Marcel
Office of Population Research, Princeton University, Princeton, New Jersey 08544, USA.
J Parasitol. 2003 Aug;89(4):686-92. doi: 10.1645/GE-75R.
Schistosomes and soil-transmitted helminths currently infect a third of the world's human population. An important feature of these parasitic infections is their focal distribution, which has significant implications for control. Only a few studies have been carried out at the microepidemiological scale, comparing infection levels among individuals or households within a single village. In this study, data are presented from a cross-sectional survey, examining all children attending a primary school in rural Côte d'Ivoire over several consecutive days for Schistosoma mansoni, soil-transmitted helminths, and intestinal protozoa. All houses in the main village were mapped, and school children were linked to these households for small-area spatial analyses. Comparison between the 260 school children who live within the main village and the 89 children who reside in nearby settlements revealed significant differences in the overall prevalence and intensity of infections with S. mansoni and hookworm, confirming the focal nature of these 2 parasites. On the other hand, S. mansoni and hookworm infections exhibited random spatial patterns within the main village. The validity of these results is discussed in the context of this epidemiological setting, drawing attention to the issue of scale. Our findings have direct implications for intervention because they call for a uniform, community-wide approach to control schistosomiasis and soil-transmitted helminthiasis. Implementation can be relatively straightforward, and the proposed control approach might be cost-effective and prove sustainable.
血吸虫和土壤传播的蠕虫目前感染着全球三分之一的人口。这些寄生虫感染的一个重要特征是其局灶性分布，这对疾病控制具有重大影响。只有少数研究是在微观流行病学层面开展的，比较单个村庄内个体或家庭之间的感染水平。在本研究中，我们展示了一项横断面调查的数据，该调查连续多日检查了科特迪瓦农村地区一所小学的所有儿童，以检测曼氏血吸虫、土壤传播的蠕虫和肠道原生动物。绘制了主村所有房屋的地图，并将学童与这些家庭关联起来进行小区域空间分析。对居住在主村的260名学童和居住在附近定居点的89名儿童进行比较后发现，曼氏血吸虫和钩虫感染的总体患病率和感染强度存在显著差异，证实了这两种寄生虫的局灶性特征。另一方面，曼氏血吸虫和钩虫感染在主村内呈现出随机的空间分布模式。我们在这种流行病学背景下讨论了这些结果的有效性，同时提请注意规模问题。我们的研究结果对干预措施具有直接影响，因为它们要求采取统一的、全社区范围的方法来控制血吸虫病和土壤传播的蠕虫病。实施起来可能相对简单，而且所提议的控制方法可能具有成本效益且可持续。
