Roegner Amber, Orozco Mónica N, Jarquin Claudia, Boegel William, Secaira Clara, Caballeros Marlin E, Al-Saleh Lujain, Rejmánková Eliška
Center For Global Health, University of Oregon, Eugene, OR, United States of America.
Department of Environmental Science and Policy, University of California, Davis, Davis, CA, United States of America.
PeerJ. 2021 Nov 17;9:e12331. doi: 10.7717/peerj.12331. eCollection 2021.
Lake Atitlán has experienced a decline in water quality resulting from cultural eutrophication. Indigenous Mayans who already face disproportionate health challenges rely directly on the lake water. Our objectives were to: (1) estimate prevalence of shedding of water-borne fecal parasites among children 5 years of age and younger, (2) assess household-reported incidence of gastrointestinal illness in children, and (3) characterize water sources, treatment, and sanitation conditions in households. We hypothesized that household use of untreated lake water results in increased risk of shedding of parasites and gastrointestinal symptoms. A cross-sectional fecal sampling and physical exam of 401 children were conducted along with WASH surveys in partnership with healthcare providers in seven communities. Fecal samples were screened for and using a rapid ELISA, with a portion examined by microscope. The prevalence of parasite shedding was 12.2% (9.7% for ; 2.5% for ). Risk factors for shedding included age 3 years or older (3.4 odds ratio, z-stat = 2.781 = 0.0054), low height-for-age z-score (2.3 odds ratio, z-stat = 2.225, = 0.0216), lack of any household water treatment (2.5 odds ratio, z-stat = 2.492, < 0.0012), and open access to household latrine (2.04 odds ratio, z-stat = 1.992, = 0.0464). The majority (77.3%) of households reported water treatment, boiling and gravity fed filters as the most widespread practices. The vast majority of households (92%) reported usage of a latrine, while 40% reported open and shared access beyond their household. An overwhelming majority of households reported diarrhea and fever several times per year or greater, with approximately half reporting vomiting at that frequency. Lake water use was identified as a risk factor for households reporting frequent gastrointestinal symptoms (odds ratio of 2.5, 4.4, and 2.6; z-stat of 3.10, 3.65, and 3.0; -values of 0.0021, 0.0003, and 0.0028, for diarrhea, vomiting, and fever, respectively) in children 5 years of age and younger. The frequency of gastrointestinal illness with a strong link to lake drinking water cannot be explained by the prevalence of protozoa, and risk from other enteropathogens must be explored. Improving access to water treatment and sanitation practices could substantially reduce the parasite burden faced by developing children in the region.
阿蒂特兰湖因文化富营养化而水质下降。已经面临不成比例健康挑战的玛雅原住民直接依赖湖水。我们的目标是：（1）估计5岁及以下儿童中水源性粪便寄生虫的携带率，（2）评估家庭报告的儿童胃肠道疾病发病率，以及（3）描述家庭的水源、处理方式和卫生条件。我们假设家庭使用未经处理的湖水会增加寄生虫携带和胃肠道症状的风险。我们与七个社区的医疗服务提供者合作，对401名儿童进行了横断面粪便采样和体格检查，并开展了水、环境卫生和个人卫生（WASH）调查。粪便样本通过快速酶联免疫吸附测定（ELISA）检测 和 ，一部分样本通过显微镜检查。寄生虫携带率为12.2%（ 为9.7%； 为2.5%）。 携带的风险因素包括3岁及以上年龄（优势比为3.4，z统计量=2.781， =0.0054）、年龄别身高z评分低（优势比为2.3，z统计量=2.225， =0.0216）、家庭未进行任何水处理（优势比为2.5，z统计量=2.492， <0.0012）以及家庭厕所无门（优势比为2.04，z统计量=1.992， =0.0464）。大多数家庭（77.3%）报告进行水处理，煮沸和重力供水过滤器是最普遍的做法。绝大多数家庭（92%）报告使用厕所，而40%报告家庭以外有开放式共用厕所。绝大多数家庭报告每年腹泻和发烧几次或更频繁，约一半家庭报告呕吐频率相同。湖水使用被确定为5岁及以下儿童家庭报告频繁出现胃肠道症状的风险因素（腹泻、呕吐和发烧的优势比分别为2.5、4.4和2.6；z统计量分别为3.10、3.65和3.0； 值分别为0.0021、0.0003和0.0028）。与饮用湖水有密切关联的胃肠道疾病频率无法用原生动物的流行率来解释，必须探索其他肠道病原体带来的风险。改善水处理和卫生设施的可及性可以大幅减轻该地区发育中儿童面临的寄生虫负担。
