Han Kay Thwe, Wai Khin Thet, Aye Kyin Hla, Kyaw Khine Wah, Maung Wai Phyo, Oo Tin
Parasitology Research Division, Department of Medical Research (DMR), No. 5 Ziwaka Road, Yangon, 11191 Myanmar.
Trop Med Health. 2019 Jan 4;47:1. doi: 10.1186/s41182-018-0133-6. eCollection 2019.
Myanmar has similar agro-based ecology and environmental risks as others in the Greater Mekong sub-region leading to the broad array of helminthic infections. Basic health staff (BHS) from the public sector forms a key stakeholder group in deworming interventions. The study aimed to ascertain the prevalence and determinants of multiple species helminth infections to promote township-level integrated interventions.
A cross-sectional implementation research study in 2017 covered randomly selected 240 households in four villages of Shwegyin Township. Trained interviewers administered the pre-tested structured questionnaire to either the household head or the assigned person concerning their knowledge, perceptions, practices, food habits, and deworming experience. Concomitantly, the research team collected a single stool sample from each of 698 participants (age range of 8 months to 87 years) from 93% (224/240) of eligible households and examined by Kato-Katz smear microscopy. Eventually, 16 BHS joined the interactive dialogue session based on research evidence and knowledge translated for further validation.
The estimated prevalence of at least one helminth infection was 24% [168/698; 95% CI 21.0-27.0]. Apart from the soil-transmitted helminths (14%), zoonotic helminths especially spp. (0.7%) and spp. (3%) were detected. Almost half of the seasonally mobile gold panning workers (12/25; 48%) and 46% of pre-school-age children had helminth infections. Community risk groups at riverside villages had significantly higher multiple species helminth infection than those from inland villages (AOR = 10.9; 95% CI 4.9-24.2). Gold panning workers had higher infection rates than other categories (AOR = 2.5; 95% CI 0.6-9.5) but not significant. In flood-prone areas, householders failed to follow the guidelines to construct/re-construct specific type of sanitary latrines and challenges remained in disseminating health messages for community engagement. The innovative ideas recapitulated by BHS included the integration of health talks during the sessions for small agricultural loans and to harness advocacy with water, sanitation, and hygiene interventions.
The emerging evidence of neglected zoonotic helminths required attention to introduce the periodic mopping-up and the "selective deworming plan" for vulnerable groups to cover the missed targets. Further multidisciplinary research to confirm the intermediate hosts and vectors of zoonotic helminths in the environment is essential for surveillance and response.
缅甸拥有与大湄公河次区域其他国家相似的以农业为基础的生态环境和环境风险，导致广泛的蠕虫感染。公共部门的基层卫生工作人员（BHS）是驱虫干预措施中的关键利益相关者群体。该研究旨在确定多种蠕虫感染的患病率及其决定因素，以促进乡镇级综合干预措施。
2017年的一项横断面实施研究随机选取了瑞茵镇四个村庄的240户家庭。经过培训的访谈员向户主或指定人员发放预先测试过的结构化问卷，询问他们的知识、认知、做法、饮食习惯和驱虫经历。与此同时，研究团队从93%（224/240）符合条件的家庭中的698名参与者（年龄范围为8个月至87岁）每人采集一份粪便样本，并通过加藤厚涂片显微镜检查。最终，16名基层卫生工作人员基于研究证据和转化的知识参加了互动对话会议，以进行进一步验证。
估计至少感染一种蠕虫的患病率为24%[168/698；95%置信区间21.0 - 27.0]。除了土源性蠕虫（14%）外，还检测到了人兽共患蠕虫，尤其是 属（0.7%）和 属（3%）。几乎一半的季节性流动淘金工人（12/25；48%）和46%的学龄前儿童感染了蠕虫。河边村庄的社区风险群体的多种蠕虫感染率明显高于内陆村庄（比值比=10.9；95%置信区间4.9 - 24.2）。淘金工人的感染率高于其他类别（比值比=2.5；95%置信区间0.6 - 9.5），但差异不显著。在易发生洪水的地区，住户未遵循建造/重建特定类型卫生厕所的指南，在传播社区参与的健康信息方面仍然存在挑战。基层卫生工作人员总结的创新想法包括在小额农业贷款会议期间融入健康讲座，并利用水、环境卫生和个人卫生干预措施进行宣传。
被忽视的人兽共患蠕虫的新证据需要引起关注，以便引入定期清理和针对弱势群体的“选择性驱虫计划”，以覆盖遗漏的目标人群。进一步开展多学科研究以确认环境中人兽共患蠕虫的中间宿主和传播媒介对于监测和应对至关重要。
