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Epidemiology of helminth infections: implications for parasite control programmes, a South African perspective

  • CC Jinabhai (a1), M Taylor (a1), A Coutsoudis (a2), HM Coovadia (a2), AM Tomkins (a3) and KR Sullivan (a3)
  • DOI: http://dx.doi.org/10.1079/PHN2001180
  • Published online: 01 January 2007
Abstract
AbstractObjectives:

To determine the epidemiology of helminthic infections and the efficacy of parasite treatment among rural South African primary school children in the province of KwaZulu-Natal. To assess the South African government's parasite control policy.

Methods:

The study recruited 268 school children, aged 8 to 10, and randomly allocated them into treatment and placebo groups (treatment consisted of a single dose of albendazole (400 mg) and praziquantel (40 mg/kg)). Anthropometric measurements and the prevalence and intensity of helminth infections were taken at baseline (prior to treatment) and 16 weeks post treatment. Two weeks after treatment prevalence and intensity were again measured for an approximate 50% sub-sample of the children to investigate efficacy of treatment. An analysis of the South African government's policies concerning parasite control is assessed in the light of these epidemiological findings.

Results:

Low levels of both stunting and wasting were observed throughout the study (approximately 10% and 1%, respectively), but did not vary significantly across either treatment group or time period (P>0.50). At baseline the observed prevalences for the three main helminths found in this study among the treated children were Ascaris lumbricoides 29.5%, Trichuris trichiura 51.9% and Schistosoma haematobium 22.3%. These prevalences declined significantly to 4.7% (P<0.0005), 38.0% (P<0.03) and 3.3% (P<0.0002), respectively, 16 weeks post treatment. The majority of infections observed at baseline were of light intensity, namely A. lumbricoides (50%), T. trichiura (80%) and S. haematobium (100%), and following treatment these levels were reduced significantly (P<0.0001, P<0.05 and P<0.005, respectively). The levels of both prevalence and intensity in the untreated group remained constant. The cure rates over the first two weeks of the study were found to be 94.4% for A. lumbricoides, 40% for T. trichiura and 72.2% for S. haematobium.

Conclusion:

The benefits of targeted, school-based treatment in reducing the prevalence and intensity of infection supports the South African government's focus of using school-based interventions as part of an integrated parasite control programme. These strategies and programmes are consistent with recommendations of the World Health Organization (WHO) and The United Nations Children's Fund (UNICEF).

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*Corresponding author: Email jinabhai@med.und.ac.za
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5L Savioli , D Bundy , A Tomkins . Intestinal parasitic infections: a soluble public health problem. Trans. Roy. Soc. Trop. Med. Hygiene 1992; 86: 353–4.

22M Albonico , PG Smith , A Hall , HM Chwaya , KS Alawa , L Savioli . A randomized controlled trial comparing mebendazole and albendazole against Ascaris, Trichuris and hookworm infections. Trans. Roy. Soc. Trop. Med. Hygiene 1994; 88(5): 585–9.

24P Magnussen , E Muchiri , P Mungai , M Ndzovu , J Ouma , S Tosha . A school-based approach to the control of urinary schistosomiasis and intestinal helminth infections in children in Matuga, Kenya: impact of a two-year chemotherapy programme on prevalence and intensity of infections. Trop. Med. Int. Health 1997; 2(9): 825–31.

25M Albonico , RJ Stoltzfus , L Savioli , HN Chwaya , E d'Harcourt , JM Tielsch . A controlled evaluation of two-school-based anthelminthic chemotherapy regimens on intensity of intestinal helminth infections. Int. J. Epidemiol. 1999; 28(3): 591–6.

26A Hall , Q Nahar . Albendazole and infections with Ascaris lumbricoides and Trichuris trichiura in children in Bangladesh. Trans. Roy. Soc. Trop. Med. Hygiene 1994; 88(1): 110–2.

28HL Guyatt . Mass chemotherapy and school-based anthelminthic delivery. Trans. Roy. Soc. Trop. Med. Hygiene 1999; 93: 12–3.

29DAP Bundy , MS Wong , LL Lewis , J Horton . Control of geohelminths by delivery of targeted chemotherapy through schools. Trans. Roy. Soc. Trop. Med. Hygiene 1990; 84: 115–20.

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  • ISSN: 1368-9800
  • EISSN: 1475-2727
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