Belizario Vicente Y, Liwanag Harvy Joy C, Naig June Rose A, Chua Paul Lester C, Madamba Manuel I, Dahildahil Roy O
Department of Parasitology, College of Public Health, University of the Philippines Manila, 625 Pedro Gil St., Ermita, Manila 1000, Philippines; Neglected Tropical Diseases Study Group, National Institutes of Health, University of the Philippines Manila, 623 Pedro Gil St., Ermita, Manila 1000, Philippines.
Neglected Tropical Diseases Study Group, National Institutes of Health, University of the Philippines Manila, 623 Pedro Gil St., Ermita, Manila 1000, Philippines; Ateneo School of Medicine and Public Health, Ateneo de Manila University, Ortigas Campus, Pasig City 1605, Metro Manila, Philippines.
Acta Trop. 2015 Jan;141(Pt A):16-24. doi: 10.1016/j.actatropica.2014.09.008. Epub 2014 Sep 22.
While preventive chemotherapy remains to be a major strategy for the prevention and control of soil-transmitted helminthiases (STH), improvements in water, sanitation, and hygiene (WASH) comprise the long-term strategy to achieve sustained control of STH. This study examined the parasitological and nutritional status of school-age and preschool-age children in four villages in Southern Leyte, Philippines where two of the villages attained Open-Defecation-Free (ODF) status after introduction of Community-Led Total Sanitation (CLTS). A total of 341 children (89.0% of the total eligible population) submitted stool samples which were examined using the Kato-Katz technique. Results showed that 27.9% of the total stool samples examined had at least one type of STH (cumulative prevalence), while 7.9% had moderate-heavy intensity infections. Between the two villages where CLTS was introduced, Buenavista had a significantly higher cumulative prevalence of STH at 67.4% (p<0.001) and prevalence of moderate-heavy intensity STH at 23.5% (p=0.000), while Caubang had a significantly lower cumulative prevalence at 4.9% and prevalence of moderate-heavy intensity at 1.8%. On the other hand, the non-CLTS villages of Bitoon and Saub had similar rates for cumulative prevalence (16.7% and 16.8%, respectively; p=0.984) and prevalence of moderate-heavy intensity STH (2.0% and 3.1%, respectively; p=1.000). The findings may be explained by factors that include possible reversion to open defecation, non-utilization of sanitary facilities, and mass drug administration (MDA) coverage, although further studies that can accurately assess the impact of CLTS are recommended. While this study was descriptive, the data indicate no clear pattern among the parasitological and nutritional parameters, as well as the presence of CLTS in the village, suggesting the need to monitor the ODF status of villages on a regular basis even after the end of CLTS activities to ensure the sustainability of the CLTS approach. In order to achieve effective control of STH, deeper collaboration between the WASH and STH sectors are recommended where partners can work together in the area of monitoring and evaluation that may include improved parasitological and nutritional status in high-risk groups, as well as sustainable behavior change as outcome indicators.
虽然预防性化疗仍然是预防和控制土源性蠕虫病（STH）的主要策略，但改善水、环境卫生和个人卫生（WASH）是实现STH持续控制的长期策略。本研究调查了菲律宾南莱特省四个村庄的学龄儿童和学龄前儿童的寄生虫学和营养状况，其中两个村庄在引入社区主导的全面卫生（CLTS）后实现了无露天排便（ODF）状态。共有341名儿童（占 eligible 总人口的89.0%）提交了粪便样本，使用加藤厚涂片法进行检测。结果显示，在检测的全部粪便样本中，27.9%至少感染一种STH（累积患病率），而7.9%为中度至重度感染。在引入CLTS的两个村庄中，布埃纳维斯塔的STH累积患病率显著较高，为67.4%（p<0.001），中度至重度STH患病率为23.5%（p=0.000），而考邦的累积患病率显著较低，为4.9%，中度至重度患病率为1.8%。另一方面，未实施CLTS的比通和绍布两个村庄的累积患病率相似（分别为16.7%和16.8%；p=0.984），中度至重度STH患病率也相似（分别为2.0%和3.1%；p=1.000）。这些结果可能由多种因素解释，包括可能恢复露天排便、未使用卫生设施以及群体服药（MDA）覆盖率等，不过建议开展进一步研究以准确评估CLTS的影响。虽然本研究属于描述性研究，但数据表明寄生虫学和营养参数以及村庄中CLTS的存在之间没有明确模式，这表明即使在CLTS活动结束后，也需要定期监测村庄的ODF状态，以确保CLTS方法的可持续性。为了有效控制STH，建议WASH和STH部门进行更深入的合作，合作伙伴可以在监测和评估领域共同努力，这可能包括改善高危人群的寄生虫学和营养状况，以及将可持续行为改变作为结果指标。
