Malnutrition, anemia, micronutrient deficiency and parasitic infections among schoolchildren in rural Tanzania

BACKGROUND: Malnutrition, anemia, micronutrient deficiency and parasitic infections continue to impact the nutritional status and health of children in lower-income countries, however not enough data concerning this issue is available. The aim of this study was to assess the distribution of nutritional indicators, anemia and micronutrient deficiency and their underlying risk factors among schoolchildren in south-eastern Tanzania. METHOD/PRINCIPAL FINDINGS: This cross-sectional study enrolled primary schoolchildren aged 6-12 years from Kikwawila and Kiberege wards, Tanzania. In total 471 schoolchildren underwent physical examination and provided blood, stool and urine samples for micronutrient level assessment, nutritional and anemia status, and parasitic infection status. We employed bivariate and multivariate logistic regression to determine the association between nutritional statuses, anemia, micronutrient deficiency and parasitic infections. We found that 23.90%, 12.60% and 16.20% of schoolchildren were stunted, underweight and wasted, respectively. About 14% of schoolchildren were found to be anemic and were more likely to be diagnosed with Plasmodium falciparum infection (aOR: 3.95, 95% CI: 2.73-5.67). Vitamin A (34.70%) and vitamin B12 (8.80%) were the most prevalent micronutrients found to be deficient in diagnosed children. Finally, we found that schoolchildren attending the most rural schools were five times more likely to be diagnosed with at least one micronutrient deficiency (aOR: 5.04, 95% CI: 2.38-11.44). CONCLUSIONS/SIGNIFICANCE: Malnutrition, anemia and micronutrient deficiency still pose a significant health burden among schoolchildren living in rural Tanzania. To effectively tackle this burden, health interventions such as deworming, micronutrient supplementation, vector control, health education and access to clean water and improved sanitation should be strengthened and made sustainable

Efficacy and safety of moxidectin and albendazole compared to ivermectin and albendazole co-administration in adolescents infected with Trichuris trichiura: a randomized controlled trial protocol

Background: Infections with soil-transmitted helminths (STHs) predominantly affect impoverished populations in tropical environments. The periodic administration of single dose benzimidazoles (i.e., albendazole, mebendazole) to at-risk individuals in endemic regions is at the center of STH control strategies. Given the low efficacy of these drugs against trichuriasis, investigation of drug combinations including moxidectin and ivermectin has recently been initiated, yet the identification of the best treatment option requires more research. We present the protocol for a trial investigating the efficacy and safety of co-administered moxidectin and albendazole compared to co-administered ivermectin and albendazole against Trichuris trichiura. Methods: We will conduct a randomized controlled trial enrolling 540 T. trichiura-infected adolescents aged 12-19 years on Pemba Island (Tanzania). The trial will be open-label with blinded outcome assessors. The primary objective is to demonstrate non-inferiority of orally co-administered single-dose moxidectin (8 mg)/albendazole (400 mg) compared to orally co-administered single-dose ivermectin (200 microg/kg)/albendazole (400 mg) in terms of egg reduction rates (ERRs) against T. trichiura infections assessed by Kato-Katz at 14-21 days post-treatment. Secondary objectives include the assessment of the drug combinations' superiority compared to their respective monotherapies, of the cure rates (CRs) against T. trichiura, and the safety and tolerability of all treatments, as well as CRs and ERRs against concomitant STH infections ( Ascaris lumbricoides and hookworm). Potential effects of the treatment regimens on follow-up prevalences of STH at 5-6 weeks and 3 months post-treatment and pharmacokinetic/ pharmacodynamic parameters will also be assessed. Conclusions: Results from this trial will help to inform decision- and policymakers on which anthelminthic combination therapy might improve existing deworming programs and provide a valuable adjunct tool for interrupting STH transmission. Clinicaltrials.gov registration: NCT04700423 (07/01/2021)

Efficacy and safety of moxidectin and albendazole compared with ivermectin and albendazole coadministration in adolescents infected with Trichuris trichiura in Tanzania: an open-label, non-inferiority, randomised, controlled, phase 2/3 trial

BACKGROUND: Control efforts against soil-transmitted helminths focus on preventive chemotherapy with albendazole and mebendazole, however these drugs yield unsatisfactory results against Trichuris trichiura infections. We aimed to assess the efficacy and safety of moxidectin and albendazole compared with ivermectin and albendazole against T trichiura in adolescents living on Pemba Island, Tanzania. METHODS: This open-label, non-inferiority, randomised, controlled, phase 2/3 trial was done in four secondary schools (Kilindi, Kwale, Ndagoni [Chake Chake District], and Kiuyu [Wete District]) on Pemba Island, Tanzania. Adolescents aged 12-19 years who tested positive for T trichiura in at least two of four Kato-Katz slides with a mean infection intensity of 48 eggs per gram (EPG) of stool or higher were considered for inclusion. Participants were randomly assigned (21:21:2:2:8) to five treatment groups (8 mg moxidectin and 400 mg albendazole [group 1], 200 mug/kg ivermectin and 400 mg albendazole [group 2], 400 mg albendazole [group 3], 200 mug/kg ivermectin [group 4], or 8 mg moxidectin [group 5]) using a computer-generated randomisation code, stratified by baseline T trichiura infection intensity. Study site investigators and participants were not masked to study treatment; however, allocation was concealed to participants. The primary outcome was egg reduction rate (ERR) of T trichiura 14-21 days after treatment in the available case population. Moxidectin and albendazole was considered non-inferior to ivermectin and albendazole (control group) when the lower limit of the two-sided 95% CI of the difference was higher than the non-inferiority margin of -2 percentage points. This study is registered with ClinicalTrials.gov, NCT04700423. FINDINGS: Between March 1 and April 30, 2021, 771 participants were assessed for eligibility. 221 (29%) of 771 participants were ineligible and a further 14 (2%) were excluded. 207 (39%) of 536 participants were randomly assigned to moxidectin and albendazole, 211 (39%) to ivermectin and albendazole, 19 (4%) to albendazole, 19 (4%) to ivermectin, and 80 (15%) to moxidectin. Primary outcome data were available for all 536 participants. The geometric mean ERR of T trichiura after 14-21 days was 96.8% (95% CI 95.8 to 97.6) with moxidectin and albendazole and 99.0% (98.7 to 99.3) with ivermectin and albendazole (difference of -2.2 percentage points [-4.2 to -1.4]). No serious adverse events were reported during the study. The most reported adverse events were headache (160 [34%] of 465), abdominal pain (78 [17%]), itching (44 [9%]), and dizziness (26 [6%]). INTERPRETATION: Our findings show inferiority of moxidectin and albendazole to ivermectin and albendazole against T trichiura. However, given the high efficacy, moxidectin coadministration might complement treatment progammes, particularly in areas in which ivermectin is not available FUNDING: Bill and Melinda Gates Foundation, reference number OPP1153928

A cross-sectional survey on parasitic infections in schoolchildren in a rural Tanzanian community

Infectious diseases remain the leading cause of death in children in low- and middle-income countries. Infection with helminths and intestinal protozoa cause considerable morbidity. The aim of this study was to assess the health status of schoolchildren in nine villages of the Kilombero district. We conducted a cross-sectional survey and subjected 427 children aged 6-12 years to standardized diagnostic tests. We found that 15% of children were infected with Entamoeba histolytica/Entamoeba dispar/Entamoeba moshkovskii, 12% with Schistosoma mansoni, and 5% with Plasmodium falciparum. The most common soil-transmitted helminth species was Trichuris trichiura (7%). Strongyloides stercoralis, Schistosoma haematobium, Giardia intestinalis and lymphatic filariasis were rare. Having a latrine inside the house was associated with a lower odds of parasite infections (odds ratio (OR) 0.51, 95% confidence interval (CI) 0.27-0.96, p=0.04). Children from households with goats were at higher odds of E. histolytica/E. dispar/E. moshkovskii infection (OR 3.03, 95%CI 1.29-7.10, p=0.01).When compared to a cross-sectional survey conducted in the same district in the 1980s, there seems to have been a substantial reduction in the prevalence and intensity of parasitic infections, except for T. trichiura, which showed a similar prevalence. Our data suggest that the general development, coupled with infectious disease control programmes improved children's health markedly. However, continued efforts to control parasitic diseases, including new approaches of drug combinations, stronger intersectoral collaboration, rigorous surveillance and public health responses tailored to the local settings are needed to move from control to elimination

Emodepside for Trichuris trichiura and hookworm infection

BACKGROUND: Current treatments for soil-transmitted helminth infections in humans have low efficacy against Trichuris trichiura. Emodepside - a drug in veterinary use and under development for the treatment of onchocerciasis in humans - is a leading therapeutic candidate for soil-transmitted helminth infection. METHODS: We conducted two phase 2a, dose-ranging, randomized, controlled trials to evaluate the efficacy and safety of emodepside against T. trichiura and hookworm infections. We randomly assigned, in equal numbers, adults 18 to 45 years of age in whom T. trichiura or hookworm eggs had been detected in stool samples to receive emodepside, at a single oral dose of 5, 10, 15, 20, 25, or 30 mg; albendazole, at a single oral dose of 400 mg; or placebo. The primary outcome was the percentage of participants who were cured of T. trichiura or hookworm infection (the cure rate) with emodepside 14 to 21 days after treatment, determined with the use of the Kato-Katz thick-smear technique. Safety was assessed 3, 24, and 48 hours after the receipt of treatment or placebo. RESULTS: A total of 266 persons were enrolled in the T. trichiura trial and 176 in the hookworm trial. The predicted cure rate against T. trichiura in the 5-mg emodepside group (85% [95% confidence interval CI, 69 to 93]; 25 of 30 participants) was higher than the predicted cure rate in the placebo group (10% [95% CI, 3 to 26]; 3 of 31 participants) and the observed cure rate in the albendazole group (17% [95% CI, 6 to 35]; 5 of 30 participants). A dose-dependent relationship was shown in participants with hookworm: the observed cure rate was 32% (95% CI, 13 to 57; 6 of 19 participants) in the 5-mg emodepside group and 95% (95% CI, 74 to 99.9; 18 of 19 participants) in the 30-mg emodepside group; the observed cure rates were 14% (95% CI, 3 to 36; 3 of 21 participants) in the placebo group and 70% (95% CI, 46 to 88; 14 of 20 participants) in the albendazole group. In the emodepside groups, headache, blurred vision, and dizziness were the most commonly reported adverse events 3 and 24 hours after treatment; the incidence of events generally increased in a dose-dependent fashion. Most adverse events were mild in severity and were self-limited; there were few moderate and no serious adverse events. CONCLUSIONS: Emodepside showed activity against T. trichiura and hookworm infections. (Funded by the European Research Council; ClinicalTrials.gov number, NCT05017194.)

Understanding the Impacts of Short-Term Climate Variability on Drinking Water Source Quality: Observations From Three Distinct Climatic Regions in Tanzania

Climate change is expected to increase waterborne diseases especially in developing countries. However, we lack understanding of how different types of water sources (both improved and unimproved) are affected by climate change, and thus, where to prioritize future investments and improvements to maximize health outcomes. This is due to limited knowledge of the relationships between source water quality and the observed variability in climate conditions. To address this gap, a 20‐month observational study was conducted in Tanzania, aiming to understand how water quality changes at various types of sources due to short‐term climate variability. Nine rounds of microbiological water quality sampling were conducted for Escherichia coli and total coliforms, at three study sites within different climatic regions. Each round included approximately 233 samples from water sources and 632 samples from households. To identify relationships between water quality and short‐term climate variability, Bayesian hierarchical modeling was adopted, allowing these relationships to vary with source types and sampling regions to account for potentially different physical processes. Across water sources, increases in E. coli/total coliform levels were most closely related to increases in recent heavy rainfall. Our key recommendations to future longitudinal studies are (a) demonstrated value of high sampling frequency and temporal coverage (a minimum of 3 years) especially during wet seasons; (b) utility of the Bayesian hierarchical models to pool data from multiple sites while allowing for variations across space and water sources; and (c) importance of a multidisciplinary team approach with consistent commitment and sharing of knowledge

Decentralised treatment solutions for on-site faecal sludge: quantifying the removal efficiencies of two novel systems in an East African city

Pit latrines, leach-tanks and septic tanks are on-site sanitation systems used by approximately 2.7 billion people. For these systems to be safe, the faecal sludge needs to be safely contained or removed and treated off-site. In lower-income countries, affordable and efficient treatment systems are frequently non-existent. One promising treatment technology for faecal sludge is decentralised mesophilic anaerobic digestion, which can operate without energy or chemical inputs. This study presents the first thorough evaluation of loading, rainfall and operational performance of two novel faecal sludge treatment plants (FSTP). The plants serviced approximately 3000 households in urban Dar es Salaam, Tanzania. The faecal sludge was extracted from latrine back-ends and transported to the plants which had loading capacities of 4 m3 d−1 for system 1 and 5 m3 d−1 for system 2. Systems were monitored for 14 consecutive weeks for physical, chemical and microbiological parameter removal through the treatment stages. Overall increased rainfall was not linked to emptying requests from households. System 1 was consistently overloaded while system 2 was under-loaded, due to an operator preference and demand. Overloading for system 1 was correlated with increased TSS in the effluent. Notably, both systems showed significant removal of total suspended solids (TSS), free-ammonia nitrogen (FAN) and E. coli from raw faecal sludge. However, only system 1 recorded significant removal for chemical oxygen demand (COD). As a new technology the standards required for effluent discharged to ground are not clear. However, the digested and dried faecal sludge from system 1 had E. coli concentrations of 2.5 × 106 cfu g−1 and was not recommended for unrestricted agricultural use based on the WHO guidelines. With more consistent operational loading practices, the FSTP evaluated present two sustainable treatment systems for lower-income urban settings. © 2023 The Royal Society of Chemistr