Risk of Soil-Transmitted Helminthiasis Among Agrarian Communities of Kogi
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bioRxiv preprint doi: https://doi.org/10.1101/663237; this version posted June 7, 2019. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY 4.0 International license. 1 1 Long title: 2 Risk of soil-transmitted helminthiasis among agrarian communities of Kogi 3 State, Nigeria: Evaluated in the context of The Soil-Transmitted 4 Helminthiasis Advisory Committee recommendation 2016 5 Short title: 6 Soil-transmitted helminthiasis in Kogi State 7 8 Joy T. Anunobi1, Ikem C. Okoye2*, Ifeanyi Oscar N. Aguzie2*, Yvonne E. Ndukwe2 and 9 Onyekachi J. Okpasuo2 10 1 Science Laboratory Technology Department, Federal Polytechnic, Idah, Kogi State, Nigeria. 11 2Parasitology and Public Health Unit, Department of Zoology and Environmental Biology, 12 University of Nigeria, Nsukka, Enugu State, Nigeria. 13 *Corresponding authors: 14 E-mail: [email protected] (IONA) 15 E-mail: [email protected] (ICO) 16 Authors’ contributions 17 Conceptualization and Methodology: Joy T. Anunobi and Ikem C. Okoye 18 Investigation: Joy T. Anunobi, Yvonne E. Ndukwe and Onyekachi J. Okpasuo 19 Data curation, formal analysis & software: Ifeanyi Oscar N. Aguzie 20 Writing of first draft: Joy T. Anunobi and Ifeanyi Oscar N. Aguzie 21 Supervision: Ikem C. Okoye 22 Final draft: All the authors approved the final draft. 23 Funding 24 The study did not receive external funding 1 bioRxiv preprint doi: https://doi.org/10.1101/663237; this version posted June 7, 2019. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY 4.0 International license. 2 25 Long title: 26 Risk of soil-transmitted helminthiasis among agrarian communities of Kogi 27 State, Nigeria: Evaluated in the context of The Soil-Transmitted 28 Helminthiasis Advisory Committee recommendation 2016 29 Short title: 30 Soil-transmitted helminthiasis in Kogi State 31 32 Abstract 33 Soil-transmitted helminths (STH) have remained a major threat to human especially children 34 in developing countries including Nigeria. Interventions have always been geared towards 35 school-aged children, neglecting preschool-aged children and occupational risk adults. The 36 Soil-Transmitted Helminthiasis Advisory Committee (STHAC) recently suggested 37 incorporating other at-risk groups. In the context of this recommendation, this study assessed 38 the associated risk of STH infection among agrarian communities of Kogi State, Nigeria. A 39 total of 310 individuals of all ages participated in the cross-sectional survey. Stool samples 40 were analyzed using standard Kato-Katz method. A total of 106 (34.2%) individuals were 41 infected with at least one STH. Hookworm was the most prevalent (18.1%); followed by 42 Ascaris lumbricoides (16.8%). Worm intensity was generally light. Prevalence of infection 43 was similar between four age groups considered (preschool, school, ‘women of reproductive 44 age’ and older at-risk group). Poor socio-economic status (SES) was a major risk for STH 45 infection. Using a 20-assets based criteria, 68 (23.1%) and 73 (24.7%) of 295 questionnaire 46 respondents were classified into first (poorest) and fifth (richest) wealth quintiles respectively. 47 Risk of infection with STH was 60% significantly lower in the richest wealth quintile 48 compared to the poorest (Prevalence Ratio (PR) = 0.4843, 95% CI = 0.2704 – 0.8678, p = 2 bioRxiv preprint doi: https://doi.org/10.1101/663237; this version posted June 7, 2019. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY 4.0 International license. 3 49 0.015). Open defecators were more likely to harbour STH than those who did not (PR = 50 1.7878, 95% CI = 1.2366 – 2.5846, p = 0.00201). Pit latrine and water closet toilet each 51 approximately reduced STH infection by 50% (p < 0.05). Preventive chemotherapy for all age 52 groups, health education and provision of basic amenities especially toilets are needed in 53 order to achieve the goal toward the 2020 target of STH control. 54 Keywords: KAP; socio-economic; soil-transmitted helminths; Ascaris lumbricoides; 55 hookworm; Trichuris trichiura; neglected tropical diseases; wealth quintiles. 56 57 Author summary 58 Soil-transmitted helminths (STHs) are major cause of morbidities globally, especially among 59 children in developing countries such as Nigeria. Present World Health Organization 60 recommended control strategy solely require preventive chemotherapy targeting preschool- 61 aged children (PSAC) and school-aged children (SAC), and the recently included women of 62 reproductive age (WRA). The Soil-Transmitted Helminthiasis Advisory Committee (STHAC) 63 which is saddled with responsibility of evaluating STHs status and providing appropriate 64 recommendations proposed that preventive chemotherapy be extended to other at-risk groups. 65 This study evaluates this and some other recommendations of STHAC 2016 using sections of 66 a state in Nigeria where soil-transmitted helminthiasis is endemic. 67 Findings from this study supports recommendations for extension of preventive chemotherapy 68 to other at-risk groups apart from PSAC and SAC. It supports WASH (water, sanitation and 69 hygiene) as integral part of STH control. This finding emphasizes the need for health 70 education and change in attitude which could promote tenets of WASH. And very 71 importantly, the study emphasizes the role of poverty in the persistence of STH transmission. 72 It is the belief of the authors that there is the need for improved socio-economic status for 73 sustainable gains of control efforts. 3 bioRxiv preprint doi: https://doi.org/10.1101/663237; this version posted June 7, 2019. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY 4.0 International license. 4 74 Introduction 75 Soil-transmitted helminths (STH) are intestinal worms whose immature stages require a 76 period of incubation in the soil before becoming infective [1]. The most common are Ascaris 77 lumbricoides, Trichuris trichiura, the hookworms (Ancylostoma duodonale and Necator 78 americanus) and Strongyloides stercoralis [2]. They are transmitted by eggs present in 79 infected human faeces, which contaminate the soil in areas where sanitation is poor. STH 80 infections are included in the list of the world’s neglected tropical diseases, NTDs [3], and are 81 the most common infections among the poorest and most deprived communities [2]. 82 Transmission of A. lumbricoides and T. trichiura is primarily through oral-faecal route 83 (usually by ingestion of parasite eggs in faeces), whereas hookworm species and S. stercoralis 84 are through active skin penetration of infective larva. 85 STH infections are among the most common chronic human infections in most regions of the 86 world; with approximately 1.5 billion people infected globally [2]. It accounts for a global 87 burden of 3.3 million of disability-adjusted life years [4]. Approximately 270 million 88 preschool-aged children (PSAC) and 600 million school-age children (SAC) are at risk of 89 infection. They live in areas where transmission of these parasites is intense and are in need of 90 treatment and preventive interventions [2,5]. 91 Intestinal helminthiasis prevalence in Nigeria has remained unchanged since the 1970s [6]. 92 Nigeria has the highest burden and endemicity [3,7]. A larger fraction of those affected are 93 young children of ages 5 to 14 years living in rural areas and urban slums [6-9]. The major 94 contributors to persistence of infections are cultural, socio-economic and environmental 95 factors [6,7]. Unhygienic and common practice of indiscriminate defecation or dumping 96 excrement have persisted in Nigeria [7,10,11]. There has been little success in the 97 introduction of latrines to rural Nigeria [12]. A temporal data available from 1990 through 98 2015 indicate a marginal decrease in the use of improved sanitation facilities from 38% to 4 bioRxiv preprint doi: https://doi.org/10.1101/663237; this version posted June 7, 2019. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY 4.0 International license. 5 99 29%, and small increase in open defecation from 24% to 25% [13]. Currently, Nigeria is 100 ranked as one of the nations in the world with the highest number of people practicing open 101 defecation, estimated at over 46 million people [14]. 102 In Nigeria, there are still states where there are limited to no epidemiological information on 103 STH infections; Kogi State is one of those with limited information. Majority of the 104 communities in Ibaji and Igalamela-Odolu Local Government Areas (LGAs) of Kogi State are 105 farming communities where children and adults are fully exposed to risks of helminth 106 infection. In agrarian communities, practices such as walking on bare feet, open defecation, 107 eating of fallen fruits and raw unwashed vegetables with unwashed hands in farmlands could 108 predispose individuals to STH infections [9,15]. Majority of the agrarian communities are 109 warm and moist for most of the year creating a good environment for the parasites to develop 110 all year round. 111 Therefore the aim of the present study was to ascertain the associated risk factors of STHs 112 among the agrarian communities of Ibaji and Igalamela-Odolu LGAs.