Jayakody Nalini Kaushalya, Silva Anjana, Wickramasinghe Susiji, de Silva Nilanthi, Siribaddana Sisira, Weerakoon Kosala Gayan
Department of Parasitology, Faculty of Medicine, Wayamba University of Sri Lanka, Kuliyapitiya, Sri Lanka.
Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka.
PLoS Negl Trop Dis. 2024 Dec 2;18(12):e0012689. doi: 10.1371/journal.pntd.0012689. eCollection 2024 Dec.
Sri Lanka, an island located in South Asia, once experienced a notable prevalence of human intestinal nematode infections (HINIs). With the implementation of control programs, infection prevalence was reduced. Detailed information on prevalence, distribution and temporal trends of HINIs is limited. This review aims to explore Sri Lanka's HINI distribution, trends, diagnostics, control and challenges.
We reviewed published information on HINIs in Sri Lanka in electronic databases, local journals and grey literature from inception to September 2022. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-Scr), a systematic strategy was used for searching, screening, reviewing and data extraction. The screening was initiated with a review of titles and abstracts using specific keywords, followed by a full-text screening based on predefined eligibility criteria. A total of 105 studies were included in the review, with 28 selected for pooled prevalence analysis.
The first nationwide survey in 1924 reported a hookworm infection prevalence of 93.1%. By 2017, soil-transmitted helminth (STH) infection prevalence across the island was 0.97% (ascariasis-0.45%, trichuriasis-0.25%, and hookworm infection-0.29%), and the enterobiasis prevalence between 2003 and 2017 ranged from 0% to 42.5%. Strongyloidiasis had been understudied, with a prevalence of 0.1% to 2%. Over the past two decades, the islandwide pooled HINI prevalence was 13.3%. Within specific demographics, it was 6.96% in the general community, 33.4% in plantation sector, and 11.6% in slum communities. During the colonial period, hookworm infection was the commonest HINI, but ascariasis is now more prevalent. The prevailing data relied solely on microscopy, often utilising single stool smears. Mass deworming programs were widely pursued in the first half of the 20th century, initially targeting antenatal women and schoolchildren, and now focusing on specific community groups. National surveys continue monitoring the three main STH infections.
The significant reduction in STH prevalence in the country over the past ten decades highlights the effectiveness of public health interventions, particularly mass deworming programs. Despite the success, STH prevalence disparities persist in vulnerable populations like plantation and slum communities, where hygiene and living conditions continue to pose challenges. Reliance on single stool smear microscopy highlights the need for more sensitive diagnostics to better assess infections. Fluctuating enterobiasis prevalence and limited strongyloidiasis data underscore the importance of continued surveillance and targeted interventions for sustained control and eventual elimination. Sri Lanka's experiences and control measures offer valuable insights for low-income countries in South Asia and beyond, particularly in managing HINIs with limited resources.
斯里兰卡是位于南亚的一个岛屿，曾经历过人肠道线虫感染（HINIs）的显著流行。随着防控项目的实施，感染率有所下降。关于HINIs的流行率、分布和时间趋势的详细信息有限。本综述旨在探讨斯里兰卡HINI的分布、趋势、诊断、控制及挑战。
我们检索了电子数据库、当地期刊和灰色文献中自起始至2022年9月关于斯里兰卡HINIs的已发表信息。基于系统评价和Meta分析扩展版的范围综述的首选报告项目（PRISMA-Scr），采用系统策略进行检索、筛选、综述和数据提取。筛选首先使用特定关键词对标题和摘要进行审查，然后根据预先定义的纳入标准进行全文筛选。本综述共纳入105项研究，其中28项被选用于合并流行率分析。
1924年的首次全国性调查显示钩虫感染率为93.1%。到2017年，全岛土壤传播性蠕虫（STH）感染率为0.97%（蛔虫病-0.45%，鞭虫病-0.25%，钩虫感染-0.29%），2003年至2017年蛲虫病患病率在0%至42.5%之间。类圆线虫病研究较少，患病率为0.1%至2%。在过去二十年中，全岛合并的HINI患病率为13.3%。在特定人群中，普通社区为6.96%，种植园部门为33.4%，贫民窟社区为11.6%。在殖民时期，钩虫感染是最常见的HINI，但现在蛔虫病更为普遍。现有数据仅依赖显微镜检查，通常使用单份粪便涂片。20世纪上半叶广泛推行群体驱虫项目，最初针对孕妇和学童，现在则侧重于特定社区群体。全国性调查持续监测三种主要的STH感染。
在过去十年中，该国STH患病率显著下降，凸显了公共卫生干预措施的有效性，尤其是群体驱虫项目。尽管取得了成功，但在种植园和贫民窟社区等弱势群体中，STH患病率差异仍然存在，这些地方的卫生和生活条件仍然构成挑战。对单份粪便涂片显微镜检查的依赖凸显了需要更敏感的诊断方法来更好地评估感染情况。蛲虫病患病率波动以及类圆线虫病数据有限，强调了持续监测和针对性干预对于持续控制和最终消除疾病的重要性。斯里兰卡的经验和控制措施为南亚及其他地区的低收入国家提供了宝贵的见解，特别是在资源有限的情况下管理HINIs方面。
