Abstract
BackgroundInfections with helminths and other intestinal parasites are an important but neglected problem in children in developing countries. Accurate surveys of intestinal parasites in children inform empirical treatment regimens and can assess the impact of school based drug treatment programmes. There is limited information on this topic in Cambodia.MethodsIn a prospective study of intestinal parasites in symptomatic children attending Angkor Hospital for Children, Siem Reap, Cambodia, April-June 2012, samples were examined by microscopy of a direct and concentrated fecal sample. Two culture methods for hookworm and Strongyloides stercoralis were employed when sufficient sample was received. Demographic, clinical and epidemiological data were collected.Principal FindingsWe studied 970 samples from 865 children. The median (inter-quartile range) age of the children was 5.4 (1.9-9.2) years, 54% were male. The proportion of children with abdominal pain was 66.8%, diarrhea 34.9%, anemia 12.7% and malnutrition 7.4%. 458 parasitic infections were detected in 340 (39.3%) children. The most common parasites using all methods of detection were hookworm (14.3%), Strongyloides stercoralis (11.6%) and Giardia lamblia (11.2%). Giardia lamblia was most common in children aged 1-5 years, hookworm and Strongyloides stercoralis were more common with increasing age. Hookworm, Strongloides stercoralis and Giardia lamblia were more common in children living outside of Siem Reap town. In a multivariate logistic regression increasing age was associated with all three infections, defecating in the forest for hookworm infection, the presence of cattle for S. stercoralis and not using soap for handwashing for G. lamblia.Conclusions/SignificanceThis study confirms the importance of intestinal parasitic infections in symptomatic Cambodian children and the need for adequate facilities for laboratory diagnosis together with education to improve personal hygiene and sanitation.
Highlights
An estimated one billion people in sub-Saharan Africa, Asia and the Americas are infected with one or more types of helminth [1,2]. This includes 576–740 million people infected with hookworm [3,4] and 30–100 million people infected with Strongyloides stercoralis (S. stercoralis) [5]
Seven samples were received from over-age patients, 40 samples were received from other health care facilities in Siem Reap and consent was missed for 231 samples
There were no significant differences in the age, sex and range of parasites detected between the patients in whom consent was or was not obtained
Summary
An estimated one billion people in sub-Saharan Africa, Asia and the Americas are infected with one or more types of helminth [1,2]. This includes 576–740 million people infected with hookworm [3,4] and 30–100 million people infected with Strongyloides stercoralis (S. stercoralis) [5]. One study performed by the National Center for Parasitology, Entomology and Malaria Control (NMC, MoH, Cambodia) examined more than 6,600 school children over a five-year period and found the prevalence of soil-transmitted helminths (STH) consistently above 50% and in many areas more than 70% [11]. Accurate surveys of intestinal parasites in children inform empirical treatment regimens and can assess the impact of school based drug treatment programmes.
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