Raso Giovanna, Utzinger Jürg, Silué Kigbafori D, Ouattara Mamadou, Yapi Ahoua, Toty Abale, Matthys Barbara, Vounatsou Penelope, Tanner Marcel, N'Goran Eliézer K
Department of Public Health and Epidemiology, Swiss Tropical Institute, Basel, Switzerland.
Trop Med Int Health. 2005 Jan;10(1):42-57. doi: 10.1111/j.1365-3156.2004.01352.x.
Differences 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 Côte 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, quality-controlled methods, for diagnosis of Schistosoma mansoni, soil-transmitted helminths, intestinal protozoa and Plasmodium. Then, a questionnaire survey was carried out for the appraisal of self-reported 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 butschlii) 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 Côte d'Ivoire. These findings call for more equity-balanced parasitic disease control interventions, which in turn might be an important strategy for poverty alleviation.
非洲农村和城市人口的健康状况差异已有描述，但仅有少数研究分析了贫困农村社区内部的不平等现象。我们调查了科特迪瓦西部一个农村地区57所小学4000多名学童在寄生虫感染、自感健康不佳以及获得正规医疗服务方面的差异，这些差异通过他们的社会经济地位来衡量。第一步，我们开展了一项横断面寄生虫学调查。采集粪便标本和手指刺血样本，并采用标准化、质量控制的方法进行处理，以诊断曼氏血吸虫、土壤传播的蠕虫、肠道原生动物和疟原虫。然后，开展问卷调查以评估自我报告的发病指标、住房特征和家庭资产拥有情况。各村庄到最近医疗服务机构的平均出行距离由地区卫生当局提供。较贫困的学童钩虫感染率显著高于较富裕的儿童。然而，随着社会经济地位的提高，肠道原生动物（即人芽囊原虫、微小内蜒阿米巴和布氏嗜碘阿米巴）的感染率更高。社会经济地位与钩虫和曼氏血吸虫的轻度感染强度以及一些自我报告的发病指标之间存在显著的负相关。最贫困的上学儿童比富裕儿童住得离正规医疗服务机构远得多。我们的研究为科特迪瓦一个广大农村地区学童的寄生虫感染状况、自感健康不佳和获得医疗服务方面的不平等提供了证据。这些发现呼吁采取更加公平的寄生虫病控制干预措施，而这反过来可能是减贫的一项重要战略。
