Abstract
BackgroundSoil-transmitted helminthiasis (STH) is endemic in Fiji but its prevalence is not known and likely to have changed after a decade of mass drug administration (MDA) for lymphatic filariasis (LF). By linking with LF transmission assessment surveys (LF-TAS), we undertook the first nation-wide assessment of STH in Fijian primary schools, as well as an analysis of factors associated with STH infections.Methodology/Principal findingsA cross-sectional assessment for STH was conducted in all four Divisions of Fiji from 2014 to 2015. In the Western, Central, and Northern Divisions, schools were sub-sampled after LF-TAS, while, in the Eastern Division, schools were selected via simple random sampling. For the diagnosis of STH, stool samples were examined by coproscopy with a single Kato-Katz thick smear (KK) and the formol-ether-acetate concentration technique, except for the samples from the Eastern Division where only KK was used. Mean prevalence of any STH among class 1–2 students at the national level was 10.5% (95% CI: 6.9–15.5). Across the three Divisions via LF-TAS, the prevalence levels for ascariasis were 8.7% (95% CI: 4.3–16.6), hookworm 3.9% (95% CI: 2.3–6.6) and trichuriasis 0%. In the Eastern Division, ascariasis prevalence was 13.3% (95% CI: 6.4–25.6), and hookworm 0.7% (95% CI: 0.2–2.5), with one case of trichuriasis. Among class 3–8 students, ascariasis prevalence was lower. Lower risk of any STH was associated with wearing shoes (adjusted OR 0.54, 95% CI: 0.32–0.90) and having piped water from the Fiji Water Authority at home (adjusted OR 0.48, 95% CI: 0.25–0.92).ConclusionsAfter a decade of community-based LF-MDA, STH in school-age children in Fiji is now close to 10%, but localities of endemicity remain. Preventive chemotherapy should be maintained in areas with elevated STH prevalence alongside targeted delivery of integrated WASH interventions. LF-TAS has provided an opportunity to develop future public health surveillance platforms.
Highlights
Soil-transmitted helminthiasis (STH) is a global public health problem, typically in areas where poor sanitation and inadequate clean water abound, blighting childhood development [1]
Preventive chemotherapy should be maintained in areas with elevated STH prevalence alongside targeted delivery of integrated WASH interventions
The any STH prevalence among class 1 and 2 students assessed via KK smear was 10.5%; most of the STH were Ascaris spp. (Table 4) and the prevalence of moderate-to- heavy intensity infection with Ascaris spp. was 3.7%
Summary
Soil-transmitted helminthiasis (STH) is a global public health problem, typically in areas where poor sanitation and inadequate clean water abound, blighting childhood development [1]. The frequency of treatment is directly linked to epidemiologic information on the infection, which needs to be updated to permit policy revisions [2]. Lymphatic filariasis (LF) shares with STH the common anthelminthic treatments, albendazole and ivermectin [3]. In light of the above, up-to-date epidemiologic information on STH is needed, especially where LF mass drug administration (MDA) is down-scaling with the declining prevalence of LF. Soil-transmitted helminthiasis (STH) is endemic in Fiji but its prevalence is not known and likely to have changed after a decade of mass drug administration (MDA) for lymphatic filariasis (LF). By linking with LF transmission assessment surveys (LF-TAS), we undertook the first nation-wide assessment of STH in Fijian primary schools, as well as an analysis of factors associated with STH infections
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