Cabello Rocio Karina S A A, Beck Lilian C N H, Massara Cristiano L, Murta Felipe L G, Guimarães Ricardo J P S, Pieri Otávio S, Schall Virginia T, Favre Tereza C
Laboratory of Environmental and Health Education, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil.
Research Group on Helminthology and Medical Malacology, René Rachou Research Centre, Fiocruz, Minas Gerais, Brazil.
Acta Trop. 2016 Dec;164:208-215. doi: 10.1016/j.actatropica.2016.09.015. Epub 2016 Sep 16.
As a signatory to World Health Assembly Resolution WHA65.21 on eliminating schistosomiasis, the Brazilian Ministry of Health (MoH) recommends early identification and timely treatment of the infection carriers for morbidity control, plus complementary preventive measures, such as health education, for transmission control. This study reports infection and awareness of schistosomiasis among schoolchildren before the implementation of school-based educational actions in an endemic municipality with persisting moderate prevalence levels despite successive control campaigns since the late 1990s. A questionnaire was applied in April 2013 to schoolchildren in the middle years of schooling (6th to 8th year) of Malacacheta municipality to assess baseline knowledge and risk behaviour related to schistosomiasis. A stool survey was conducted in May/June 2013 in 2519 schoolchildren from all years of fundamental education (first to 9th year) to identify the infection carriers, as well as to assess baseline prevalence and intensity of infection using the Kato-Katz method (one sample, two slides). The infected schoolchildren were treated promptly with single-dose praziquantel 60mg/kg and followed up after 45days for treatment efficacy. Relevant outcomes from baseline stool survey, treatment and follow-up were statistically evaluated in relation to area of residence (rural/urban), gender, age group (<11/≥years) and infection. Adherence to baseline survey was 81.2%, and prevalence of infection was 21.4%. Of the 539 positives, 60 (11.1%) had ≥400 eggs per gram of faeces (heavy-intensity infection). Prevalence of infection was significantly higher among rural residents and≥11year olds, whereas intensity of infection was higher among rural residents,≥11year olds and boys. Adherence by the positives to treatment was 93.3% and adherence by the treated children to 45-day follow-up was 72.2%. At 45days after treatment, 97.0% of the 363 children surveyed were egg-negative; the egg reduction rate was 99.4%. Of the 924 children who responded to the questionnaire, 95.5% showed awareness of schistosomiasis, although 76.2% reported contact with natural, unsafe bodies of water. Reported contact with water was significantly more frequent among infected than non-infected, and boys than girls. The results show persisting infection and risk behaviour among schoolchildren, regardless of their basic knowledge about schistosomiasis. These are grounds for implementing specific educational actions to improve awareness and behavioural change, jointly with other control measures, to attain the MoH goals.
作为世界卫生大会关于消除血吸虫病的第WHA65.21号决议的签署国，巴西卫生部建议尽早识别并及时治疗感染携带者以控制发病率，同时采取补充性预防措施，如健康教育，以控制传播。本研究报告了在一个地方病流行的市镇实施学校教育行动之前，学童中的血吸虫病感染情况和知晓率。自20世纪90年代末以来，尽管开展了连续的防治运动，但该地区的流行率仍维持在中等水平。2013年4月，对马拉卡谢塔市中学阶段（六年级至八年级）的学童进行了问卷调查，以评估与血吸虫病相关的基线知识和风险行为。2013年5月/6月，对来自基础教育各年级（一年级至九年级）的2519名学童进行了粪便调查，以识别感染携带者，并使用加藤厚涂片法（一份样本，两张涂片）评估感染的基线流行率和强度。对感染的学童立即给予单剂量吡喹酮60mg/kg进行治疗，并在45天后进行随访以评估治疗效果。对基线粪便调查、治疗和随访的相关结果，按居住地区（农村/城市）、性别、年龄组（<11岁/≥11岁）和感染情况进行了统计学评估。基线调查的依从率为81.2%，感染率为21.4%。在539名阳性者中，60名（11.1%）每克粪便中有≥400个虫卵（重度感染）。农村居民和≥11岁儿童的感染率显著更高，而农村居民、≥11岁儿童和男孩的感染强度更高。阳性者对治疗的依从率为93.3%，接受治疗的儿童对45天随访的依从率为72.2%。治疗后45天，接受调查的363名儿童中有97.0%粪便虫卵转阴；虫卵减少率为99.4%。在924名回答问卷的儿童中，95.5%知晓血吸虫病，尽管76.2%报告接触过天然的、不安全的水体。报告的接触水的情况在感染者中比未感染者更频繁，在男孩中比女孩更频繁。结果表明，无论学童对血吸虫病的基本知识如何，他们中仍存在感染和风险行为。这些情况表明有必要实施具体的教育行动，以提高知晓率和改变行为，同时结合其他控制措施，以实现卫生部的目标。
