Centre for Health Informatics, Biostatistics and Epidemiology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
Lancet Glob Health. 2019 Sep;7(9):e1237-e1246. doi: 10.1016/S2214-109X(19)30253-0. Epub 2019 Jul 19.
In Sri Lanka, deworming programmes for soil-transmitted helminth infections became an integral part of school health in the 1960s, whereas routine antenatal deworming with mebendazole started in the 1980s. A 2003 national soil-transmitted helminth survey done among schoolchildren found an overall prevalence of 6·9%. In our study, we aimed to reassess the national prevalence of soil-transmitted helminth infections to enable implementation of a more focused control programme that targets smaller administrative areas at risk of continued transmission.
We did a cross-sectional, school-based, national survey using multistage stratified cluster sampling, covering all nine provinces as well as populations at high risk of soil-transmitted helminth infections living in urban slums and in plantation-sector communities. Our study population was children aged 5-7 years attending state schools. Faecal samples were collected and analysed with duplicate modified Kato-Katz smears. We modelled the risk of soil-transmitted helminth infection using generalised linear mixed-effects models, and we developed prevalence maps to enable informed decision making at the smallest health administrative level in the country.
Between Jan 23 and May 9, 2017, we recruited 5946 children from 130 schools; 4276 (71·9%) children provided a faecal sample for examination. National prevalence of soil-transmitted helminth infection was 0·97% (95% CI 0·63-1·48) among primary schoolchildren. Prevalence in the high-risk communities surveyed was higher than national prevalence: 2·73% (0·75-6·87) in urban slum communities and 9·02% (4·29-18·0) in plantation sector communities. Our prevalence maps showed that the lowest-level health administrative regions could be categorised into low risk (prevalence <1%), high risk (prevalence >10%), or intermediate risk (1-10%) areas.
Our survey findings indicate that the national prevalence of soil-transmitted helminth infection has continued to decline in Sri Lanka. On the basis of WHO guidelines, we recommend discontinuation of routine deworming in low-risk areas, continuation of annual deworming in high-risk areas, and deworming once every 2 years in intermediate-risk areas, for at least 4 years.
Task Force for Global Health and WHO.
在斯里兰卡，针对土壤传播性蠕虫感染的驱虫方案于 20 世纪 60 年代成为学校卫生计划的重要组成部分，而常规的产前驱虫则始于 20 世纪 80 年代。2003 年，一项针对学童的全国性土壤传播性蠕虫感染调查发现，总体流行率为 6.9%。在我们的研究中，我们旨在重新评估全国土壤传播性蠕虫感染的流行率，以便实施更有针对性的控制方案，将目标对准有持续传播风险的较小行政区域。
我们采用多阶段分层聚类抽样，对全国九个省以及居住在城市贫民窟和种植园社区的高危土壤传播性蠕虫感染人群进行了一项基于学校的横断面全国性调查。我们的研究人群为就读于国立学校的 5-7 岁儿童。采集粪便样本，并用双份改良加藤厚涂片进行分析。我们使用广义线性混合效应模型对土壤传播性蠕虫感染的风险进行建模，并绘制流行率地图，以便在该国最小的卫生行政区域做出明智的决策。
2017 年 1 月 23 日至 5 月 9 日，我们从 130 所学校招募了 5946 名儿童；其中 4276 名（71.9%）儿童提供了粪便样本进行检查。小学生的全国土壤传播性蠕虫感染流行率为 0.97%（95%CI 0.63-1.48）。调查的高危社区的流行率高于全国流行率：城市贫民窟社区为 2.73%（0.75-6.87），种植园部门社区为 9.02%（4.29-18.0）。我们的流行率地图显示，最低级别卫生行政区域可分为低风险（流行率<1%）、高风险（流行率>10%）或中风险（1-10%）地区。
我们的调查结果表明，斯里兰卡的全国土壤传播性蠕虫感染流行率继续下降。根据世界卫生组织的指导方针，我们建议在低风险地区停止常规驱虫，在高风险地区继续每年驱虫，在中风险地区每两年驱虫一次，至少持续 4 年。
全球卫生工作队和世界卫生组织。
