Soil-transmitted helminthiasis in children of a rural community part of a school-based deworming program: a cross-sectional study in the Peruvian Amazon
Authors: Errea Renato A. , Vasquez-Rios George , Calderon María L. , Siu Diego , Duque Kevin R. , Juarez Luciana H. , Gallegos Rodrigo , Uriol Celene , Rondon Claudia R. , Baca Katia P. , Fabian Rosario J. , Canales Marco , Terashima Angelica , Marcos Luis A. , Samalvides Frine 
Published: October 2018

Background

Children in the Peruvian Amazon basin are at risk of soil-transmitted helminthiases (STH). The aim of this study was to determine the prevalence of STH (Ascaris lumbricoides, Trichuris trichiura, hookworm and Strongyloides stercoralis) in children from a rural community in the Peruvian Amazon and associated clinical, maternal, sanitation and hygiene factors associated. The community had an active school-based deworming program with mebendazole.

Methods

A cross-sectional study was carried out in children aged 2–14 years in Iquitos, Peru; by parasitological analysis of their stools through five methods: direct smear examination, Kato-Katz, spontaneous sedimentation in tube, Baermann method modified by Lumbreras and agar plate culture. Mothers of the participating children were also invited to participate in the study. A questionnaire was completed by each participant to collect demographic and epidemiological information of interest.

Results

Among 124 children, 25.8% (32/124) had one or more STH. Prevalence of A. lumbricoides was 16.1% (20/124); S. stercoralis, 10.5% (13/124); hookworm, 1.6% (2/124) and T. trichiura, 1.6% (2/124). STH in mothers was higher in children with any STH than in children without any STH (36.4% vs 14.1%, p<0.02). Prevalence of the common STH (A. lumbricoides, T. trichiura and hookworm) was higher in children aged 2–5 than in older children (31.6% vs 12.8%; p=0.01). Several hygiene and sanitation deficits were identified; of which walking barefoot was significantly associated with STH infection (OR= 3.28; 95% CI= 1.11–12.07).

Conclusions

STH are highly prevalent in children in this community; A. lumbricoides and S. stercoralis infections were the most frequent. Further studies should aim to understand the persistent high prevalence of common STH in endemic areas where massive drug administration is practiced, and to determine the appropriateness of controlling STH in mothers and S. stercoralis infection. Walking barefoot and other hygiene and sanitation conditions need to be addressed in this community.

AUTHOR SUMMARY

Few studies assessing soil-transmitted helminth infections in children and their risk factors have yet been conducted in the Peruvian Amazon. Even fewer reports exist from areas where mass drug administration programs have been initiated. In this study we provide insight to the frequency of soil-transmitted helminths in a setting with an ongoing school-based deworming program.

Besides the most common soil-transmitted helminths (Ascaris lumbricoides, Trichuris trichiura and hookworm), we assessed the prevalence of Strongyloides stercoralis. Excluding the latter from intestinal helminths studies have often underestimate its frequency and impact in children.

We also surveyed for helminth infection in the mothers of the participating children as infection in caregivers could theoretically be associated with infection in children as they both may share same environmental and behavioral factors associated with STH infections. To our knowledge, this is the first Peruvian study assessing children and mother infection together.

In addition, our results highlight the suboptimal hygiene and sanitation conditions in which people from this rural community live. It likely represents the situation of other rural Amazonian communities in Peru. Public efforts are needed to provide these populations with dignified living conditions and to follow the equity global health agenda.