安哥拉威热省、比耶省和扎伊尔省在校儿童感染血吸虫病和土壤传播性蠕虫感染的负担和相关因素。
Burden and factors associated with schistosomiasis and soil-transmitted helminth infections among school-age children in Huambo, Uige and Zaire provinces, Angola.
机构信息
Global Health Program, Kirby Institute, University of New South Wales, New South Wales, Australia.
Department of Life Sciences, Natural History Museum, Wolfson Wellcome Biomedical Laboratories, London, UK.
出版信息
Infect Dis Poverty. 2022 Jun 25;11(1):73. doi: 10.1186/s40249-022-00975-z.
BACKGROUND
Schistosomiasis and soil-transmitted helminths (STHs) contribute high disease burdens amongst the neglected tropical diseases (NTDs) and are public health problems in Angola. This study reports the prevalence, intensity and risk factors for schistosomiasis and STH infection in Huambo, Uige and Zaire provinces, Angola, to inform a school-based preventive chemotherapy program.
METHODS
A two-stage cluster design was used to select schools and schoolchildren to participate in parasitological and water, sanitation and hygiene (WASH) surveys across Huambo, Uige, and Zaire provinces. Point-of-care circulating cathodic antigen and urinalysis rapid diagnostic tests (RDTs) were used to determine the prevalence of Schistosoma mansoni and S. haematobium, respectively. Kato-Katz was used to identify and quantify STH species and quantify and compare with RDTs for S. mansoni. Urine filtration was used to quantify and compare with RDTs for S. haematobium. Descriptive statistics were used for prevalence and infection intensity of schistosomiasis and STH infection. Performance of RDTs was assessed through specificity and Cohen's Kappa agreement with microscopy. A multivariate regression analysis was used to determine demographic and WASH factors associated with schistosomiasis and STH infection.
RESULTS
A total 575 schools and 17,093 schoolchildren participated in the schistosomiasis survey, of which 121 schools and 3649 schoolchildren participated in the STH survey. Overall prevalence of S. mansoni was 21.2% (municipality range 0.9-74.8%) and S. haematobium 13.6% (range 0-31.2%), with an overall prevalence of schistosomiasis of 31.4% (range 5.9-77.3%). Overall prevalence of Ascaris lumbricoides was 25.1% (range 0-89.7%), hookworm 5.2% (range 0-42.6%), and Trichuris trichiura 3.6% (range 0-24.2%), with an overall prevalence of STH infection of 29.5% (range 0.8-89.7%). Ecological zone and ethnicity were factors associated with schistosomiasis and STH infection, with older age and female sex additional risk factors for S. haematobium.
CONCLUSIONS
Most municipalities met World Health Organization defined prevalence thresholds for a schistosomiasis preventive chemotherapy program. A STH preventive chemotherapy program is indicated for nearly all municipalities in Uige and select municipalities in Huambo and Zaire. The association between ecological zone and ethnicity with schistosomiasis and STH infection necessitates further evaluation of home and school environmental, sociodemographic and behavioural factors to inform targeted control strategies to complement preventive chemotherapy programs.
背景
血吸虫病和土壤传播性蠕虫（STHs）在被忽视的热带病（NTDs）中造成了很高的疾病负担，也是安哥拉的公共卫生问题。本研究报告了安哥拉万博、威热和扎伊尔三省的血吸虫病和 STH 感染的流行率、强度和危险因素，为基于学校的预防性化疗计划提供信息。
方法
采用两阶段聚类设计选择学校和学童参加万博、威热和扎伊尔三省的寄生虫学和水、环境卫生和个人卫生（WASH）调查。使用即时循环阴离子抗原和尿液分析快速诊断检测（RDT）来确定曼氏血吸虫和埃及血吸虫的流行率。加藤氏粪便检查用于确定和量化 STH 种类，并与 RDT 进行比较以确定曼氏血吸虫的数量。尿液过滤用于与 RDT 进行比较以确定埃及血吸虫的数量。采用描述性统计方法对血吸虫病和 STH 感染的流行率和感染强度进行描述。通过特异性和科恩氏 Kappa 一致性评估 RDT 对显微镜检查的性能。采用多变量回归分析确定与血吸虫病和 STH 感染相关的人口统计学和 WASH 因素。
结果
共有 575 所学校和 17093 名学童参加了血吸虫病调查，其中 121 所学校和 3649 名学童参加了 STH 调查。曼氏血吸虫的总体流行率为 21.2%（直辖市范围为 0.9-74.8%），埃及血吸虫为 13.6%（范围为 0-31.2%），血吸虫病的总体流行率为 31.4%（范围为 5.9-77.3%）。蛔虫的总体流行率为 25.1%（范围为 0-89.7%），钩虫为 5.2%（范围为 0-42.6%），鞭虫为 3.6%（范围为 0-24.2%），STH 感染的总体流行率为 29.5%（范围为 0.8-89.7%）。生态区和种族是与血吸虫病和 STH 感染相关的因素，年龄较大和女性是埃及血吸虫的额外危险因素。
结论
大多数直辖市都符合世界卫生组织定义的预防性化疗方案的流行率阈值。几乎所有威热省的直辖市和万博省和扎伊尔省的部分直辖市都需要开展 STH 预防性化疗方案。生态区和种族与血吸虫病和 STH 感染之间的关联需要进一步评估家庭和学校环境、社会人口学和行为因素，以为补充预防性化疗方案的有针对性的控制策略提供信息。
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