Mapping Soil-Transmitted Helminth Infections of Children in Sub-Saharan Africa, 2000-2018

Sartorius, Benn; Cano, Jorge; Simpson, Hope; Tusting, Lucy S.; Marczak, Laurie B.; Miller-Petrie, Molly K.; Kinvi, Bonface; Zouré, Honorat; Mwinzi, Pauline; Hay, Simon I; Rebollo, Maria P.; Pullan, Rachel L

doi:10.2139/ssrn.3543579

Cited by 3 publications

(7 citation statements)

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“…Consistent with previous studies [3,12,[22][23][24], our findings also highlight inter-and intra-country variations in the prevalence of malaria-helminth co-infections. Across Central and West Africa subregions, a high prevalence of P.falciparum and high hookworm co-infection was predominant, while the burden of P. falciparum-A .lumbricoides and P.falciparum-T-trichiura co-infections was higher in Central Africa than in neighbouring sub-regions.…”

Section: Discussionsupporting

confidence: 92%

“…Lack of survey data is a plausible reason for this observation. [3] Additionally, a substantial proportion of the data we used for our analysis was collected prior to the commencement of mass preventive treatments with albendazole and SMC. Many countries have tailored the frequency of mass drug administration with preventive chemotherapy to their STH prevalence, but annual SMC implementation during the period of high malaria transmission is still being given as a single intervention.…”

Section: Discussionmentioning

confidence: 99%

“…While programmatic implementation of preventive chemotherapy and seasonal malaria chemoprevention (SMC) have contributed to a significant reduction in the burden of STH and malaria in many countries, inherent challenges such as logistical burden, medication adherence, and incomplete coverage have been reported to be responsible for the persistently high burden of malaria and STH in the spatial areas identified in our study. [14,15] Taken together the geographical overlap and spatial co-existence of malaria and STH, favoured largely by environmental factors [1,3], could be exploited to achieve effective control and elimination agendas through integration of the vertical programmes designed for malaria and STH into a more comprehensive and sustainable community-based paradigm, that includes other preventive care such as hand hygiene and water sanitation. The WHO 2030 NTD road map recommends concrete actions within integrated platforms for delivery of the interventions needed to improve the cost-effectiveness, coverage and geographical reach of these integrated programmes.…”

Section: Discussionmentioning

confidence: 99%

“…[2] Similarly, a disproportionately high burden of STH has been reported in many countries in SSA with large concentrations of moderate-to-heavy intensity infections in Nigeria, Democratic Republic of the Congo, Ethiopia, Cameroon, Angola, Mozambique, Madagascar, Equatorial Guinea, and Gabon. [3] In these malaria-STH co-endemic countries, estimating the national burden of the co-infection poses a public health challenge because national surveillance systems are often sub-optimal. [4] For example, deworming through mass drug administration (MDA) of anthelminthics is widely regarded as a costeffective strategy.…”

Section: Introductionmentioning

confidence: 99%

“…However, the impact of these MDA programmes on the changing prevalence and intensity of STH in children, is often hindered by a lack of comprehensive baseline data before MDA initiation, because of financial challenges or as a result of the administration of the drugs via undocumented channels. [3] Nevertheless, recent WHO reports [1,4] indicate that considerable progress has been made in reducing the overall burden of malaria and STH in many countries including some in SSA. To sustain the gains of past decades and move the control efforts towards elimination, WHO has recommended a paradigm shift from disease-specific to an integrated approach.…”

Section: Introductionmentioning

confidence: 99%

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Estimating the burden of malaria and soil-transmitted helminth co-infection in sub-Saharan Africa: a geospatial study

Afolabi

Adebiyi²,

Cano

et al. 2022

Preprint

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BackgroundLimited understanding exists about the interactions between malaria and soil-transmitted helminths (STH), their potential geographical overlap and the factors driving it. This study characterised the geographical and co-clustered distribution patterns of malaria and STH infections among vulnerable populations in sub-Saharan Africa (SSA).Methodology/Principal findingsWe obtained continuous estimates of malaria prevalence from the Malaria Atlas Project and STH prevalence surveys from the WHO-driven Expanded Special Project for the Elimination of NTDs (ESPEN) covering 2000-2018 and used spatial autocorrelation methods to identify statistically significant clusters for both diseases across SSA. We used the inverse distance weighted kriging (interpolation) methods to estimate STH prevalence. We calculated the population-weighted prevalence of malaria and STH co-infection, and used the bivariate local indicator of spatial association (LISA analysis) to explore potential co-clustering of both diseases at the implementation unit levels.Our analysis shows spatial variations in the estimates of the prevalence of Plasmodium falciparum-STH co-infections and identified hotspots across many countries in SSA with inter-and intra-country variations. High P. falciparum and high hookworm co-infections were more prevalent in West and Central Africa, whereas high P. falciparum, high Ascaris lumbricoides, high P. falciparum, and high Trichuris trichiura co-infections were more predominant in Central Africa, compared to other sub-regions in SSA.Conclusions/SignificanceWide spatial heterogeneity exists in the prevalence of malaria and STH co-infection within the regions and within countries in SSA. The geographical overlap and spatial co-existence of malaria and STH could be exploited to achieve effective control and elimination agendas through the integration of the vertical programmes designed for malaria and STH into a more comprehensive and sustainable community-based paradigm.Author SummaryMalaria and worms frequently co-exist together among children living in the poorest countries of the world, but little is known about the specific locations of the combined infections involving the two major parasitic diseases and how they interact and change over the years.We used open access data collected by two public registries, that is, the Malaria Atlas Project and Expanded Special Project for the Elimination of NTDs, to understand the overlap of the two diseases in different parts of Africa, where their burden are more predominant.We found significant differences in the distributions of the combined diseases across different parts of Africa, with large concentrations identified in Central and West Africa. For example, double infections with malaria and hookworm were more common in West and Central Africa, whereas malaria and roundworm, and malaria and whipworm were predominantly found in Central Africa. A large collection of the dual infections was also found in some localities within the countries which appeared to have low burden of the two diseases.These findings provide a useful insight into the areas which could be serving as a reservoir to propagating the transmission of the two diseases. The results of this study could also be used to develop and implement integrated control programmes for malaria and worms, and this could help to achieve the WHO NTD roadmap to ending the neglect to attain Sustainable Development Goals by 2030.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Estimating the burden of malaria and soil-transmitted helminth co-infection in sub-Saharan Africa: a geospatial study

Afolabi

Adebiyi²,

Cano

et al. 2022

Preprint

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A comprehensive evaluation of an artificial intelligence based digital pathology to monitor large-scale deworming programs against soil-transmitted helminths: a study protocol

Ward,

Roose,

Ayana

et al. 2023

Preprint

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BackgroundManual screening of a Kato-Katz (KK) thick stool smear remains the current standard to monitor the impact of large-scale deworming programs against soil-transmitted helminths (STHs). To improve this diagnostic standard, we recently designed an artificial intelligence based digital pathology system (AI-DP) for digital image capture and analysis of KK thick smears. Preliminary results of its diagnostic performance are encouraging, and a comprehensive evaluation of this technology as a cost-efficient end-to-end diagnostic to inform STH control programs against the target product profiles (TPP) of the World Health Organisation (WHO) is the next step for validation.MethodsHere, we describe the study protocol for a comprehensive evaluation of the AI-DP based on its (i) diagnostic performance, (ii) repeatability/reproducibility, (iii) time-to-result, (iv) cost-efficiency to inform large-scale deworming programs, and (v) usability in both laboratory and field settings. For each of these five attributes, we designed separate experiments with sufficient power to verify the non-inferiority of the AI-DP (KK2.0) over the manual screening of the KK stool thick smears (KK1.0). These experiments will be conducted in two STH endemic countries with national deworming programs (Ethiopia and Uganda), focussing on school-age children only.DiscussionThis comprehensive study will provide the necessary data to make an evidence-based decision on whether the technology is indeed performant and a cost-efficient end-to-end diagnostic to inform large-scale deworming programs against STHs. Following the protocolized collection of high-quality data we will seek approval by WHO. Through the dissemination of our methodology and statistics, we hope to support additional developments in AI-DP technologies for other neglected tropical diseases in resource-limited settings.Trial registrationThe trial was registered onClinicaltrials.gov(ID:NCT06055530).Author summaryMillions of deworming tablets are annually administered to children to reduce the morbidity caused by intestinal worms. To monitor the progress of these large-scale deworming programs, periodic assessments are made regarding the occurrence and prevalence of intestinal worm infections. Manual examination of a stool smear through a compound microscope remains the current diagnostic standard. We recently developed a device that utilizes artificial intelligence (AI) to scan smears and recognize eggs of intestinal worms. Encouraging preliminary results of the diagnostic performance warrant additional and more research, essential for obtaining necessary approvals to support wide-scale adoption.Here, we describe the study protocols we will employ for a comprehensive evaluation of this AI-based device. The generated results will provide health decision-makers with evidence-based data to assess whether the tool can be recommended for informing large-scale deworming programs against intestinal worms. Additionally, we provide full access to our study documentation which may be relevant for evaluating other AI-based devices for intestinal worms.

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Epidemiology of soil-transmitted helminthiasis among school-aged children in pastoralist communities of Kenya: A cross-sectional study

Kihoro,

Mulewa,

Okoyo

et al. 2024

PLoS ONE

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Introduction Soil-transmitted helminthiasis (STH) are a major public health problem in Sub-Saharan Africa. In Kenya, the National School Based Deworming Program (NSBDP) was launched in 2012 with a goal of reducing STH prevalence in school-aged children (SAC) to <1%, however monitoring and evaluation results have consistently showed > 20% prevalence in Narok County. We conducted a study to investigate factors associated with STH infections among SAC in Narok County. Methodology A cross-sectional study was conducted among 514 SAC from five schools in Trans Mara West sub-county, Narok County. The sub-county was selected because it had participating schools within the NSBDP with a high prevalence of STH infection. Participants were selected using systematic random sampling. Stool samples collected from participants were examined for STH eggs using Kato-Katz technique. An open data kit questionnaire was used to collect socio-demographics, household, and STH knowledge information from 139 of the 514 SAC. Descriptive statistics was used to summarize the data, prevalence and mean intensity of infections were calculated, and logistic regression used to determine factors associated with STH infections. Results The overall prevalence of any STH infection was 24.6% (95%CI: 21.1–28.6). Trichuris trichiura 14.4% (95%CI: 11.7–17.8), Ascaris lumbricoides 12.5% (95%CI: 9.9–15.7) and hookworm 0%. From multivariable analysis the only factors significantly associated with increased risk of STH infection were, children attending Karda and Nkarano schools with aOR = 5.29 (95%CI: 1.45–19.24); p = 0.011 and aOR = 4.53 (95%CI: 1.29–15.97); p = 0.019 respectively. For A. lumbricoides, children attending Nkarano School were associated with a significant risk of infection with aOR = 7.81 (95%CI: 1.81–33.63); p = 0.006. Conclusions Despite the ongoing work of NSBDP, the STH prevalence is still ≥ 20% in Trans Mara West sub-county Narok County, among SAC. This underscores the need for continued annual MDA. Additionally, if possible, drug combinations may effectively manage T. trichiura, the region’s most common helminth. The study found a correlation between children attending specific schools and STH infection risk, suggesting the importance of health education and improved water, sanitation, and hygiene practices holistically both in schools and associated catchment areas that can act as STH reservoirs to alleviate the burden of STH.

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Mapping Soil-Transmitted Helminth Infections of Children in Sub-Saharan Africa, 2000-2018

Cited by 3 publications

References 0 publications

Estimating the burden of malaria and soil-transmitted helminth co-infection in sub-Saharan Africa: a geospatial study

Estimating the burden of malaria and soil-transmitted helminth co-infection in sub-Saharan Africa: a geospatial study

A comprehensive evaluation of an artificial intelligence based digital pathology to monitor large-scale deworming programs against soil-transmitted helminths: a study protocol

Epidemiology of soil-transmitted helminthiasis among school-aged children in pastoralist communities of Kenya: A cross-sectional study

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