坦桑尼亚西北部马拉地区学童肠道血吸虫病与疟疾的合并感染及其与血红蛋白水平和营养状况的关联：一项横断面探索性研究
Coinfection of intestinal schistosomiasis and malaria and association with haemoglobin levels and nutritional status in school children in Mara region, Northwestern Tanzania: a cross-sectional exploratory study.
作者信息
Kinung'hi Safari M, Mazigo Humphrey D, Dunne David W, Kepha Stella, Kaatano Godfrey, Kishamawe Coleman, Ndokeji Samuel, Angelo Teckla, Nuwaha Fred
机构信息
National Institute for Medical Research, Mwanza Centre, P. O. Box 1462, Mwanza, Tanzania.
Department of Medical Parasitology and Entomology, School of Medicine, Catholic University of Health and Allied Sciences, P. O. Box 1464, Mwanza, Tanzania.
出版信息
BMC Res Notes. 2017 Nov 9;10(1):583. doi: 10.1186/s13104-017-2904-2.
BACKGROUND
Schistosomiasis represents a major public health problem in Tanzania despite ongoing national control efforts. This study examined whether intestinal schistosomiasis is associated with malaria and assessed the contribution of intestinal schistosomiasis and malaria on anaemia and undernutrition in school children in Mara region, North-western Tanzania.
METHODS
Stool samples were collected from each of 928 school children randomly selected from 5 schools and examined for intestinal schistosomiasis using the Kato Katz method. Finger prick blood samples were collected and examined for malaria parasites and haemoglobin concentrations using the Giemsa stain and Haemocue methods, respectively. Nutritional status was assessed by taking anthropometric measurements.
RESULTS
The overall prevalence and infection intensity of S. mansoni was 85.6% (794/928) and 192 (100-278), respectively. The prevalence of malaria was 27.4% (254/928) with significant differences among villages (χ = 96.11, p < 0.001). The prevalence of anaemia was 42.3% (392/928) with significant differences among villages (χ = 39.61, p < 0.001). The prevalence of stunting, thinness and underweight was 21, 6.8 and 1.3%, respectively. Stunting varied significantly by sex (χ = 267.8, p < 0.001), age group (χ = 96.4, p < 0.001) and by village (χ = 20.5, p < 0.001). Out of the 825 infected children, 217 (26.4%) had multiple parasite infections (two to three parasites). The prevalence of co-infections occurred more frequently in boys than in girls (χ = 21.65, p = 0.010). Mean haemoglobin concentrations for co-infected children was significantly lower than that of children not co-infected (115.2 vs 119.6; t = 0.01, p = 0.002). Co-infected children were more likely to be stunted than children who were not co-infected (χ = 11.6, p = 0.003). On multivariate analysis, age group, village of residence and severe anaemia were significant predictors of stunting after adjusting for sex and infection status.
CONCLUSIONS
Intestinal schistosomiasis and malaria are prevalent in Mara region. Coinfections of these parasites as well as chronic undernutrition were also common. We recommend Mara region to be included in national schistosomiasis control programmes.
背景
尽管坦桑尼亚一直在开展全国性防治工作，但血吸虫病仍是该国的一个主要公共卫生问题。本研究调查了肠道血吸虫病是否与疟疾相关，并评估了肠道血吸虫病和疟疾对坦桑尼亚西北部马拉地区学童贫血和营养不良的影响。
方法
从5所学校随机抽取928名学童，采集其粪便样本，采用加藤厚涂片法检测肠道血吸虫病。采集手指末梢血样本，分别采用吉姆萨染色法和血红蛋白仪法检测疟原虫和血红蛋白浓度。通过人体测量评估营养状况。
结果
曼氏血吸虫的总体感染率和感染强度分别为85.6%（794/928）和192（100 - 278）。疟疾的感染率为27.4%（254/928），各村之间存在显著差异（χ² = 96.11，p < 0.001）。贫血的感染率为42.3%（392/928），各村之间存在显著差异（χ² = 39.61，p < 0.001）。发育迟缓、消瘦和体重不足的发生率分别为21%、6.8%和1.3%。发育迟缓在性别（χ² = 267.8，p < 0.001）、年龄组（χ² = 96.4，p < 0.001）和村庄（χ² = 20.5，p < 0.001）方面存在显著差异。在825名受感染儿童中，217名（26.4%）有多重寄生虫感染（两到三种寄生虫）。混合感染的发生率在男孩中比女孩中更高（χ² = 21.65，p = 0.010）。混合感染儿童的平均血红蛋白浓度显著低于未混合感染儿童（115.2 vs 119.6；t = 0.01，p = 0.002）。混合感染儿童比未混合感染儿童更易出现发育迟缓（χ² = 11.6，p = 0.003）。多因素分析显示，在调整性别和感染状况后，年龄组、居住村庄和重度贫血是发育迟缓的显著预测因素。
结论
肠道血吸虫病和疟疾在马拉地区普遍流行。这些寄生虫的混合感染以及慢性营养不良也很常见。我们建议将马拉地区纳入国家血吸虫病防治计划。
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