Kepha Stella, Mazigo Humphrey D, Odiere Maurice R, Mcharo Carlos, Safari Th'uva, Gichuki Paul M, Omondi Wykcliff, Wakesho Florence, Krolewiecki Alejandro, Pullan Rachel L, Mwandawiro Charles S, Oswald William E, Halliday Katherine E
Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya.
Department of Medical Parasitology and Entomology, School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, United Republic of Tanzania.
IJID Reg. 2024 Mar 20;11:100352. doi: 10.1016/j.ijregi.2024.03.007. eCollection 2024 Jun.
Kenya has implemented a national school-based deworming program, which has led to substantial decline in the prevalence of soil-transmitted helminths (STHs), although some pockets of infections remain. To effectively design an STH control program that leads to significant reductions of there is a need to understand the drivers of persistent infection despite ongoing treatment programs.
This study was conducted between July and September 2019 at the south coast of Kenya, using a two-stage sampling design. First, a school-based cross-sectional survey was conducted in 2265 randomly selected school children from selected schools in areas known to be endemic for . After this, we conducted a nested case-control study wherein all children positive for (142) were matched to 148 negative controls based on age and village. A household survey was then conducted with all household members of cases and controls. In addition, a subsample of 116 children found to be infected with were followed up to assess the efficacy of albendazole at day 21 post-treatment. The predictors of presence of were investigated through multilevel logistic regression, considering clustering of infection.
Overall, 34.4% of the children were infected with at least one STH species; was the most common (28.3%), 89.1% of those with had light-intensity infections. The prevalence of was significantly higher in male children and was positively associated with younger age and number of people infected with in a household. The parasitological cure rate and egg reduction rate of were 35% and 51%, respectively. Other STHs identified were hookworm (9.6%) and (5.7%).
remains a significant public health challenge in the study area with albendazole treatment efficacy against the parasite, remaining lower than the World Health Organization-recommended thresholds. Because of the observed focal transmission of in the current area, control efforts tailored to local conditions and targeting lower implementation units should be used to achieve optimal results on transmission.
肯尼亚实施了一项全国性的校内驱虫计划，该计划已使土壤传播性蠕虫（STH）的感染率大幅下降，不过仍有一些感染聚集区存在。为了有效设计一项能大幅降低STH感染率的控制计划，有必要了解尽管有持续的治疗计划，但仍存在持续性感染的驱动因素。
本研究于2019年7月至9月在肯尼亚南部海岸进行，采用两阶段抽样设计。首先，对来自已知为STH流行地区选定学校的2265名随机抽取的学童进行了校内横断面调查。在此之后进行了一项巢式病例对照研究，其中所有STH检测呈阳性的儿童（142名）根据年龄和村庄与148名阴性对照进行匹配。然后对病例和对照的所有家庭成员进行了家庭调查。此外，对116名被发现感染STH的儿童进行了随访，以评估治疗后第21天阿苯达唑的疗效。考虑到感染的聚集性，通过多水平逻辑回归研究了STH存在的预测因素。
总体而言，34.4%的儿童感染了至少一种STH物种；蛔虫最为常见（28.3%），89.1%的蛔虫感染者为轻度感染。男性儿童的蛔虫感染率显著更高，且与年龄较小以及家庭中感染蛔虫的人数呈正相关。蛔虫的寄生虫学治愈率和虫卵减少率分别为35%和51%。鉴定出的其他STH包括钩虫（9.6%）和鞭虫（5.7%）。
在研究地区，蛔虫仍然是一项重大的公共卫生挑战，阿苯达唑对该寄生虫的治疗效果仍低于世界卫生组织推荐的阈值。由于在当前地区观察到蛔虫的局部传播，应采用针对当地情况并以较低实施单位为目标的控制措施，以在传播方面取得最佳效果。
