Parasitology

Original Articles

Soil-transmitted helminthiasis among mothers and their pre-school children on Unguja Island, Zanzibar with emphasis upon ascariasis

J. R. STOTHARDa1 c1, E. IMISONa2, M. D. FRENCHa3, J. C. SOUSA-FIGUEIREDOa1, I. S. KHAMISa4 and D. ROLLINSONa1

a1 Department of Zoology, Natural History Museum, Cromwell Road, London SW7 5BD, UK

a2 Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK

a3 Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College London, London W2 1PG, UK

a4 Helminth Control Laboratory Unguja, Ministry of Health and Social Welfare, Zanzibar, Tanzania

SUMMARY

Soil-transmitted helminthiasis (STH) is a scourge to the health and well-being of infants and pre-schoolchildren throughout many parts of sub-Saharan Africa. To improve maternal and child health, regular de-worming is recommended and often delivered from mother and child health (MCH) clinics, yet there have been few studies monitoring the progress and impact of interventions on local levels of disease. A cross-sectional parasitological survey, supplemented with questionnaires, was therefore conducted across 10 Ungujan villages examining mothers (n=322) and their pre-school children (n=359). Within children, mean prevalence of ascariasis, trichuriasis and hookworm was 8·6% (95% CI 5·5–11·8), 18·9% (95% CI 14·5–23·4) and 1·7% (95% CI 0·2–3·5) while in mothers mean prevalence was 6·7% (95% CI 3·7–9·7), 11·9% (95% CI 8·0–15·8) and 1·9% (95% CI 0·2–3·5), respectively. There was, however, significant spatial heterogeneity of STH by village, 2 villages having much elevated levels of infection, although general access to anthelminthics and utilization of village MCH clinics was good. Levels of parasite aggregation (k) were determined and a multilevel logistic regression model identified access to a household latrine [OR=0·56 (95% CI 0·32–0·99)] and having an infected household member [OR=3·72 (95% CI 2·22–6·26)] as observed risk factors. To further investigate worm burdens of Ascaris lumbricoides, adult worms were expelled using Combantrin® and measured. A negative relationship between mean worm burden and mean worm mass was found. Villages in the north of Unguja represent locations where there is elevated prevalence of both ascariasis and trichuriasis and it appears that local factors are particularly favourable for transmission of these helminths. From a perspective of control, in such locations, intervention efforts should be stepped up and greater efforts placed upon improving household sanitation.

(Received April 23 2008)

(Revised June 18 2008)

(Accepted June 18 2008)

(Online publication September 08 2008)

Correspondence:

c1 Corresponding author: Department of Zoology, Natural History Museum, Cromwell Road, London SW7 5BD, UK. Tel: +44 2079425490. Fax: +44 2079425518. E-mail: r.stothard@nhm.ac.uk

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