Intestinal Parasitic Infection: Prevalence, Risk Factors and Consequences for Child Growth, Iron Status and Development in Rural Ecuador.
Sackey, Mamie Eleanor
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Intestinal parasitic infections (IPI's) are considered to be a public health problem of global importance by the World Health Organization. The present epidemiologic survey study investigated the prevalence, risk factors, and consequences of pathogenic IPI's on the growth, nutrition and psychomotor development of 244 Ecuadorian children aged 0.2-14 years. The study was conducted in five rural hamlets located in a tropical rainforest area in northwest Ecuador. The study data were obtained by means of a structured questionnaire, a developmental screening examination, anthropometry, and lab analysis of blood and fecal samples. Data analysis was conducted using appropriate bivariate and multivariate statistical techniques. The study results revealed that 90% of the child subjects were infected with at least one pathogenic IPI species. Fifty-one percent were identified with helminthic infections, 37.6% with protozoal infections, and 21.4% were infected with both. The most common intestinal parasites detected were Ascaris lumbricoides (39.7%), Giardia intestinalis (25.2%), Trichuris trichiura (19.7%), Entamoeba histolytica/dispar (18.5%), Blastocystis hominis (13.3%), and Ancylostoma duodenale (1.7%). The prevalence of growth stunting (40%) and iron-deficiency anemia (26%) also was high. Children infected with Giardia exhibited a risk for stunted growth that was twice that of their non-infected counterparts (51.7% vs. 33.1%; OR=2.16, 95% C.I.= 1.13-4.15; p= 0.01). They also had significantly reduced mean blood hemoglobin levels compared to non-infected children 11.8 + 1.5.g/dL vs. 12.2 + 1.4g/dL; p= 0.023) but the proportion with iron-deficiency anemia was slightly but not significantly increased (29.4% vs. 24.3%). The characteristic most consistently associated with risk for pathogenic protozoal IPI's was a high density of domestic animals living in and around the home. Children who lived in such households had a risk for infection that was 2-5 times greater than others. This suggests that domestic animals were important reservoirs for IPI infection in the child group studied. Contrary to the a priori hypothesis, no gender, ethnic, nor age differences in infection risk were identified except for Trichuris infection, which was reduced in younger children contrary to expectations. Mass or targeted chemotherapy combined with health education and promotion are needed to reduce the cycle of infection and re-infection and the negative impact of these on child growth and iron status. Health education and promotion messages can be incorporated into other types of programs already in place in local schools and by the Ecuadorian Ministries of Public Health, Education, and Social Welfare and other agencies.
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