Intestinal parasitic infection is one of the ten top major public health problems in developing countries, including Yemen. Epidemiological parasitology study of the prevalence and distribution of intestinal parasitic infections among primary schools pupils (aged 7-15 years), was conducted in six primary schools in the period between March and November 2012 in Al-Mahweet Governorate, Yemen in order to determine the prevalence of intestinal parasitic infections and associated factors among primary school children. 200 pupils were selected by using multi-stages sampling technique with the targeted schools in the study area. Stool samples were collected and examined by the Kato-Katz technique and direct method. A semi-structured questionnaire was administered to the study subjects and microscopic examination of stool was done. Chi-square was used to determine if there was any relationship between age and sex on the occurrence of the intestinal parasitic infections. The overall prevalence rate in the present study was 90%. Nine species of intestinal parasitic were identified. The most common diagnosed were Entamoeba histolytica cysts (64%), Schistosoma mansoni (36.5%), amorphous amoebae (22.5%), Trichuris trichiura (18%) and Enterobius vermicularis (13%). Multiple intestinal parasitic infections were recorded (75.5%) having the highest prevalence among the children. Male (46.5%) were more infected than female (43.5%). Also, there was a difference in the percentage of infections observed among the different age groups of the studied children. The study revealed that poor hygienic practices and unsanitary condition were responsible for the high prevalence of intestinal parasites. Deworming of the primary school children and health education on proper hygiene are recommended.

Prevalence of intestinal parasitic infections among school children of Al-Mahweet Governorate, Yemen

Infections with soil-transmitted helminths and pathogenic intestinal protozoa pose a considerable public health burden, particularly in low- and middle-income countries, including Nepal. We assessed the extent of intestinal parasite infections among schoolchildren in two districts of Nepal and determined underlying risk factors. A cross-sectional survey was conducted between March and May 2015 in the districts of Dolakha and Ramechhap, Nepal. A total of 708 children, aged 8–16 years from 16 purposively selected schools, were enrolled. Each child provided a single stool sample that was subjected to a suite of copro-microscopic diagnoses for intestinal protozoa and helminths. Drinking water samples from different sources at schools (n = 29), community places (n = 43) and households (n = 562) were analysed for contamination with thermotolerant coliforms (TTC). A questionnaire was administered to determine individual- and household-level risk factors of intestinal parasite infections. Self-reported symptoms were assessed and a clinical examination was undertaken by a physician. Haemoglobin was measured and used as a proxy for anaemia. Mixed logistic regression models were applied to investigate associations. The overall prevalence of intestinal parasite infections was 39.7%. Trichuris trichiura (30.9%), Giardia intestinalis (30.5%) and hookworm (30.2%) were the predominant intestinal parasite infections. Children from households lacking soap for handwashing were at higher odds of intestinal parasite infections than children who had soap [adjusted odds ratio (aOR) 1.81; 95% confidence interval (CI): 1.13–2.89; P = 0.01]. Children from households without freely roaming domestic animals showed lower odds of G. intestinalis compared to children from households with freely roaming animals (aOR 0.52; 95% CI: 0.33–0.83; P = 0.01). One out of three (31.0%) children suffered from fever and 22.4% had watery diarrhoea within a two-week recall period. Anaemia was diagnosed in 23.6% of the children. Water contamination with TTC showed no clear association with intestinal parasite infection. Intestinal parasites are common among schoolchildren in the two surveyed districts of Nepal. An important risk factor was lack of soap for handwashing. Our findings call for efforts to control intestinal parasite infection and emphasis should be placed on improvements in water, sanitation and hygiene interventions. ISRCTN17968589
 (date assigned: 17 July 2015).

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Intestinal parasite infections and associated risk factors among schoolchildren in Dolakha and Ramechhap districts, Nepal: a cross-sectional study.

Malnutrition and intestinal parasitic infections are common among children in Burkina Faso and Nepal. However, specific health-related data in school-aged children in these two countries are scarce. In the frame of a larger multi-stakeholder project entitled “Vegetables go to School: Improving Nutrition through Agricultural Diversification” (VgtS), a study has been designed with the objectives to: (i) describe schoolchildren’s health status in Burkina Faso and Nepal; and to (ii) provide an evidence-base for programme decisions on the relevance of complementary school garden, nutrition, water, sanitation and hygiene (WASH) interventions. The studies will be conducted in the Centre Ouest and the Plateau Central regions of Burkina Faso and the Dolakha and Ramechhap districts of Nepal. Data will be collected and combined at the level of schools, children and their households. A range of indicators will be used to examine nutritional status, intestinal parasitic infections and WASH conditions in 24 schools among 1144 children aged 8–14 years at baseline and a 1-year follow-up. The studies are designed as cluster randomised trials and the schools will be assigned to two core study arms: (i) the ‘complementary school garden, nutrition and WASH intervention’ arm; and the (ii) ‘control’ arm with no interventions. Children will be subjected to parasitological examinations using stool and urine samples and to quality-controlled anthropometric and haemoglobin measurements. Drinking water will be assessed for contamination with coliform bacteria and faecal streptococci. A questionnaire survey on nutritional and health knowledge, attitudes and practices (KAP) will be administered to children and their caregivers, also assessing socioeconomic, food-security and WASH conditions at household level. Focus group and key-informant interviews on children’s nutrition and hygiene perceptions and behaviours will be conducted with their caregivers and school personnel. The studies will contribute to fill a data gap on school-aged children in Burkina Faso and Nepal. The data collected will also serve to inform the design of school-based interventions and will contribute to deepen the understanding of potential effects of these interventions to improve schoolchildren’s health in resource-constrained settings. Key findings will be used to provide guidance for the implementation of health policies at the school level in Burkina Faso and Nepal. ISRCTN17968589
 (date assigned: 17 July 2015)

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Complementary school garden, nutrition, water, sanitation and hygiene interventions to improve children's nutrition and health status in Burkina Faso and Nepal: a study protocol.

Background In the last two decades there have been several studies describing the prevalence of intestinal parasites in Nepal; however, there is a lack of surveillance data in the country. Methods We searched literature in PubMed, MEDLINE, EMBASE, Google Scholar and local peer-reviewed journals published from 1990 to 2015 for studies describing prevalence of intestinal parasites among school-aged children. We conducted meta-regression to understand the trend over time and pooled the prevalence using 'metaprop' command in STATA 12.1. Results Thirty-one studies examining 12 080 fecal specimens were included. The prevalence of intestinal parasitic infections showed a significantly decreasing trend (OR 0.56; 95% CI 0.43-0.73 for each consecutive 5 years) and was similar in males and females. The pooled prevalence in years 1996-2000, 2001-2005, 2006-2010 and 2011-2015 was 61.1% (95% CI 51.47-70.26), 53.2% (95% CI 20.94-83.99), 32.7% (95% CI 26.57-39.21) and 20.4% (95% CI 15.04-26.25), respectively. The proportion of helminths among total intestinal parasites was higher in rural areas 57.6% (95% CI 43.54-71.61), and proportion of protozoa among total intestinal parasites was higher in urban areas 68.4% (95% CI 63.23-73.62). Poly-parasitism was observed in 7.7% (95% CI 5.57-9.73) of children. Conclusion We observed a significantly decreasing trend in prevalence of intestinal parasitic infections among school-aged children in Nepal over the last two decades.

Decreasing prevalence of intestinal parasitic infections among school-aged children in Nepal: a systematic review and meta-analysis.

Objectives
To assess the trends in prevalence of soil-transmitted helminths (STHs), Entamoeba histolytica and Giardia lamblia among school-aged children in Nepal between 1990 and 2015.

Methods
Systematic literature search in PubMed, MEDLINE, EMBASE, Google Scholar and local peer-reviewed journals for papers published between 1990 and December 2015. We conducted metaregression and meta-analyses to pool studies where applicable.

Results
Thirty-nine studies that examined a total of 14 729 stool specimens were included in the meta-analyses. The metaregression of prevalence of hookworms, roundworm, and whipworm showed a significantly decreasing trend over time. In or after 2004, the pooled prevalence of hookworm infections was 1.53% (95% CI, 0.73–2.59), of roundworm 4.31% (95% CI, 2.52–6.53) and of whipworm 2.89% (95% CI, 1.33–4.97) vs. 16.54% (95% CI, 7.64–27.97) for hookworm, 25.20% (95% CI, 13.59–38.97) for roundworm and 11.54% (95% CI 4.25–21.76) for whipworm in 1993–2003. E. histolytica and G. lamblia had stable prevalence since early 1990s, with a pooled prevalences of 4.12% (95% CI, 2.73–5.77) and 9.40% (95% CI, 7.15–11.92), respectively. The prevalence of G. lamblia was significantly higher in urban areas.

Conclusions
We observed a sharp decrease in prevalence of STHs among school-aged children in Nepal in the past decade with prevalences dropping below 5% for STHs with no variation in prevalence in rural and urban areas. However, the prevalence of E. histolytica and G. lamblia remained stable over time. These results suggest that school-based deworming programmes rolled out during the study period had an observable impact on prevalence of STHs.

https://www.onlinelibrary.wiley.com/doi/pdf/10.1111/tmi.12700

Trends in prevalence of soil-transmitted helminth and major intestinal protozoan infections among school-aged children in Nepal.

Intestinal parasitic infections (IPI) are one of the most prevalent infections in humans residing in developing countries and its burden is high among school aged children. This cross-sectional study was conducted to determine the prevalence of intestinal parasitic infection and types of intestinal parasites in rural public school children of Nepal. It included students from Nursery to Class X of a rural public school located in the northeast part of the Kathmandu Valley, Nepal. Among the 194 participating children, prevalence of intestinal parasitic infection was found as 23.7%; (28.2% for boys; 20.2% for girls). Amongst the infected children, single and mixed parasitic infection was detected in 43 (93.5%) and 3 (6.5%) children respectively. Among protozoan parasites, Giardia lamblia was the most common (58.6%) whereas Hymenolepis nana was the most common (21.7%) among the helminths. Statistically different prevalence of intestinal parasitic infection was observed among children aged above 10 years and children aged below 6 years as well as 6 to 10 years. Gender-wise, there was no statistical difference in prevalence of intestinal parasitic infection. This study suggests the need of health education program in schools along with regular screening of intestinal parasites and treatment for effective management of the intestinal parasites among school children in Nepal.

T Acharya

Papers

Prevalence of intestinal parasitic infections among public school children in a rural village of Kathmandu Valley.