Said Khadija, Hella Jerry, Knopp Stefanie, Nassoro Tatu, Shija Neema, Aziz Fatma, Mhimbira Francis, Schindler Christian, Mwingira Upendo, Mandalakas Anna M, Manji Karim, Tanner Marcel, Utzinger Jürg, Fenner Lukas
Ifakara Health Institute, Bagamoyo Research and Training Centre, Bagamoyo, Tanzania.
Swiss Tropical and Public Health Institute, Basel, Switzerland.
PLoS Negl Trop Dis. 2017 Nov 6;11(11):e0006017. doi: 10.1371/journal.pntd.0006017. eCollection 2017 Nov.
Despite the high prevalence of helminth infections among preschool-aged children, control programs in sub-Saharan countries primarily focus on school-aged populations. We assessed the prevalence of helminth infections and determined risk factors for infection among preschool-aged children in the urban setting of Dar es Salaam, Tanzania.
Starting in October 2015, we conducted a 12-month prospective study among tuberculosis (TB)-exposed children under the age of 5 years and unexposed controls from neighboring households. At the time of recruitment, we collected medical histories, assessed development and cognitive functions, and performed medical examinations. We performed full blood cell counts and screened for HIV and malaria. Point-of-care circulating cathodic antigen (POC-CCA), urine filtration, Kato-Katz, FLOTAC, and Baermann tests were employed to detect helminth infections in urine and stool. Helminth infections were stratified for Schistosoma and other helminths to identify risk factors, using logistic regression.
We included 310 children with a median age of 26 months (inter quartile range 17-42 months) in the study. Among these, 189 were TB-exposed and 121 TB-unexposed. Two thirds of the children were anemic (hemoglobin level <11 g/dl) and the HIV prevalence was 1.3%. Schistosoma spp. was the predominant helminth species (15.8%; 95% confidence interval [CI] 12.1-20.3%). Other helminth infections were less frequent (9.0%, 95% CI 6.3-12.8%). Poor hygiene, use of household water sources, and TB-exposure were not associated with helminth infection. Development and cognitive scores did not significantly differ in helminth-infected and uninfected peers, but hemoglobin levels were significantly lower in helminth-infected children (10.1 g/dl vs. 10.4 g/dl, p = 0.027).
CONCLUSIONS/SIGNIFICANCE: In Dar es Salaam, a city with more than 4 million inhabitants, the prevalence of Schistosoma spp. infection among preschool-aged children was unexpectedly high. Setting-specific interventions that target preschool-aged children and urban settlements should be considered to reduce the transmission of Schistosoma and other helminth infections and to improve children's health.
尽管学龄前儿童中蠕虫感染的患病率很高，但撒哈拉以南国家的防控项目主要针对学龄人口。我们评估了坦桑尼亚达累斯萨拉姆市城区学龄前儿童蠕虫感染的患病率，并确定了感染的风险因素。
从2015年10月开始，我们对5岁以下接触结核病（TB）的儿童以及来自相邻家庭的未接触儿童进行了为期12个月的前瞻性研究。在招募时，我们收集了病史，评估了发育和认知功能，并进行了体格检查。我们进行了全血细胞计数，并筛查了艾滋病毒和疟疾。采用即时检测循环阴极抗原（POC-CCA）、尿液过滤、加藤-卡茨法、FLOTAC法和贝尔曼法检测尿液和粪便中的蠕虫感染。使用逻辑回归对血吸虫和其他蠕虫的感染进行分层，以确定风险因素。
我们纳入了310名儿童，中位年龄为26个月（四分位间距17 - 42个月）。其中，189名儿童接触过结核病，121名未接触过结核病。三分之二的儿童贫血（血红蛋白水平<11 g/dl），艾滋病毒感染率为1.3%。血吸虫属是主要的蠕虫种类（15.8%；95%置信区间[CI] 12.1 - 20.3%）。其他蠕虫感染频率较低（9.0%，95% CI 6.3 - 12.8%）。卫生条件差、使用家庭水源以及接触结核病与蠕虫感染无关。蠕虫感染儿童和未感染儿童的发育和认知得分无显著差异，但蠕虫感染儿童的血红蛋白水平显著较低（10.1 g/dl对10.4 g/dl，p = 0.027）。
结论/意义：在拥有400多万居民的达累斯萨拉姆市，学龄前儿童中血吸虫属感染的患病率出乎意料地高。应考虑针对学龄前儿童和城市居民区的特定干预措施，以减少血吸虫和其他蠕虫感染的传播，并改善儿童健康。
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