Intestinal parasitic infections in schoolchildren in different settings of Côte d'Ivoire: effect of diagnostic approach and implications for control - PubMed (original) (raw)

Intestinal parasitic infections in schoolchildren in different settings of Côte d'Ivoire: effect of diagnostic approach and implications for control

Jean T Coulibaly et al. Parasit Vectors. 2012.

Abstract

Background: Social-ecological systems govern parasitic infections in humans. Within the frame of assessing the accuracy of a rapid diagnostic test for Schistosoma mansoni in Côte d'Ivoire, three different endemicity settings had to be identified and schoolchildren's intestinal parasitic infection profiles were characterized.

Methods: In September 2010, a rapid screening was conducted in 11 schools in the Azaguié district, south Côte d'Ivoire. In each school, 25 children were examined for S. mansoni and S. haematobium. Based on predefined schistosome endemicity levels, three settings were selected, where schoolchildren aged 8-12 years were asked to provide three stool and three urine samples for an in-depth appraisal of parasitic infections. Triplicate Kato-Katz thick smears were prepared from each stool sample for S. mansoni and soil-transmitted helminth diagnosis, whereas urine samples were subjected to a filtration method for S. haematobium diagnosis. Additionally, a formol-ether concentration method was used on one stool sample for the diagnosis of helminths and intestinal protozoa. Multivariable logistic regression models were employed to analyse associations between schoolchildren's parasitic infections, age, sex and study setting.

Results: The prevalences of S. mansoni and S. haematobium infections in the initial screening ranged from nil to 88% and from nil to 56%, respectively. The rapid screening in the three selected areas revealed prevalences of S. mansoni of 16%, 33% and 78%. Based on a more rigorous diagnostic approach, the respective prevalences increased to 33%, 53% and 92% S. haematobium prevalences were 0.8%, 4% and 65% (rapid screening results: 0.0%, 0.0% and 54%). Prevalence and intensity of Schistosoma spp., soil-transmitted helminths and intestinal protozoan infections showed setting-specific patterns. Infections with two or more species concurrently were most common in the rural setting (84%), followed by the peri-urban (28%) and urban setting (18%).

Conclusions: More sensitive diagnostic tools or rigorous sampling approaches are needed to select endemicity settings with high fidelity. The observed small-scale heterogeneity of helminths and intestinal protozoan infections has important implications for control.

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Figures

Figure 1

Figure 1

Map showing the district of Azaguié in south Côte d’Ivoire. Indicated are Azaguié town and its surrounding villages. Among the 11 schools included in the pre-screening, five were located in the surrounding villages and six were located in the Azaguié town area. The three settings selected for the in-depth studies (i.e. Azaguié M’Bromé/Azaguié Makouguié, rural; Abbé-Bégnini, peri-urban; Azaguié Gare, urban) are emphasised with red asterisks.

Figure 2

Figure 2

Flow chart detailing the study participation and adherence. Children were selected from three different settings in Azaguié district, south Côte d’Ivoire in October and November 2010. KK, Kato-Katz technique; UF, urine filtration method; EthC, ether-concentration method.

Figure 3

Figure 3

Multiple intestinal parasitic infections among schoolchildren aged 8–12 years in three settings of Azaguié district, south Côte d’Ivoire, in October and November 2010. Blue bars indicate rural Azaguié M’Bromé/Azaguié Makouguié; purple bars indicate peri-urban Abbé-Bégnini; and yellow bars indicate urban Azaguié Gare. (A) Number of helminth species diagnosed per child; (B) number of intestinal protozoa species diagnosed per child; (C) number of intestinal parasites (helminths and intestinal protozoa) diagnosed per child.

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