Assessing Prevalence and Intensity of Soil Transmitted Helminth Infections and Schistosomiasis Mansoni During Lymphatic Filariasis Transmission Assessment Survey Collection in Uganda Open Access

Burriss, Rachel (Spring 2018)

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Introduction: This study estimated the prevalence and intensity of Soil Transmitted Helminth (STH) infections during integrated Lymphatic Filariasis (LF) and STH Transmission Assessment Survey (TAS) collection in Uganda. This was a cross-sectional study that sampled preschoolers through adults in multiple sites using systematic sampling. The goal of this study was to investigate the burden of STH infections in an area that had been previously treated with the anthelmintic drugs, ivermectin and albendazole, during mass drug administration (MDA) for LF. The information presented in this thesis will be meaningful for the Ugandan national and district level NTD program’s decision making as they move forward with MDA cutoff determination and consider integration of STH and LF elimination programming. Methodology: Prevalence was evaluated for five species of parasite, Necator americanus/Ancylostoma duodenale (Hookworm), Ascaris lumbricoides, and Trichuris trichiura, Schistosomiasis Mansoni, as well as Circulating Filarial Antigen for LF (CFA). Additionally, intensity information was generated for Necator americanus/Ancylostoma duodenale (Hookworm), Ascaris lumbricoides, and Trichuris trichiura. Results: Overall, the majority of helminth infections identified in the study population did not exceed the >10% prevalence threshold recommended for yearly deworming by the World Health Organization (WHO). However, hookworm infections specifically, exceeded 10% in the overall population. In Bundibugyo district, schistosomiasis and hookworm were well above 10% prevalence, while in Amuria prevalence for all STH infections was below 10%. Where infections existed, intensity as a measure of eggs per gram of stool, was also calculated. Intensity was low for all species apart from some moderate and high hookworm infections in Bundibugyo and Amuria. Discussion: STH infections have diminished overtime presumably as a result of program interventions such as MDA. Still, high prevalence of infection in Bundibugyo persists, particularly for hookworm and schistosomiasis infections. Recommendations: Recommendations for program next steps for Amuria and Ntoroko should be to continue with biennial deworming and other behavioral interventions, while Bundibugyo should consider scaling up deworming annually and to a greater scope of community persons such as Women of Child Bearing Age (WBCA).

Table of Contents

I. Introduction                                                                                                                                     1

II. Literature Review                                                                                                                            3

III. Methodology                                                                                                                                10

IV. Results                                                                                                                                         17

    a. Additional Results                                                                                                                       30

V. Discussion                                                                                                                                    33

VI. Recommendations                                                                                                                        37

VII. Acknowledgments                                                                                                                       38

VIII. References                                                                                                                                 39


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