Ascariasis among Internally Displaced People of Colombia, 2009-2016

Abstract

Background: Ascariasis is a major neglected tropical disease (NTD), highly associated with poverty and social vulnerability, particularly in rural areas. Its assessment in refugees and internally displaced populations (IDPs) is globally scarce, including Latin America. Then, we studied its occurrence in Colombia, the country with the highest number of IDPs in the in the world, and compare it with general population. Methods & Materials: This ecological study assessed incidence and differences, of ascariasis between general population and IDPs in Colombia and its departments (32) during 2009–2016. Epidemiological data were collected from a major health information system (RIPS-SISPRO), retrieving the ICD-10 codes (B77.0-B77.9) for ascariasis in both populations. We estimated ascariasis incidence rates on both populations (cases/100,000 pop), using reference population of the IDPs (official record of the Secretary of Social Welfare) and the general population (from the national statistics institute, DANE). Incidence rates ratios were calculated comparing both populations. Results: In general population, 15,284 cases of ascariasis occurred (32.6 cases/100,000 pop, 95%CI 32.0–33.0) (5% with intestinal complications, 2% with other complications) while 393 among IDPs (177.5 cases/100,000 pop, 95%CI 160.0–195.0) (3% with intestinal complications, 3% with other complications). Ascariasis was 5.4 times higher among IDPs than in general population (p < 0.05) (reaching up to 33.5 times higher in one department, Atlantico). Also, high variation was observed during the period, reaching up to 17.9 times higher among IDPs for the year 2016 (in this year, at Caldas department, ascariasis incidence was 155.6 times higher). Conclusion: This study evidenced a significantly higher ascariasis incidence among IDPs, when compared with general population in the same territories. This would be expectable given the socioenvironmental conditions in which these subjects have lived. This has relevant implications for screening, diagnosis and management among IDPs, especially in rural areas. More studies are required to improve the understanding of this and other NTDs, especially other soil-transmitted helminthiasis, among those vulnerable populations, as well to provide better medical interventions and for the development of public policies in countries, such as Colombia, with this special population (IDPs).