Cutaneous Larva Migrans among Devotees of the Nallur Temple in Jaffna, Sri Lanka

Background: Many cases of Cutaneous Larva Migrans (CLM) have been observed among devotees, during and immediately after the annual festival at the Nallur Hindu temple in Jaffna. Objective: To ascertain the risk factors associated with infestation and devotees ’ knowledge and practices regarding the condition. Methodology/Principal Findings: A cross-sectional study using an interviewer-administered questionnaire and observation was conducted in August 2010. Out of 200 selected devotees 194(97%) responded. Soil and dog faecal samples were collected from the temple premises and examined for the presence of nematode larva and egg respectively. Among 194 male respondents, 58.2%(95 % CI: 51.2%–65.0%) had lesions of CLM. One hundred and thirty (67%) respondents performed the ritual everyday; whereas 33 % did so on special days. One hundred and twelve (57.7%) participants performed the ritual before 5.00am and remaining 42.3 % performed after 5.00am. Among the participants, 77(36.7%) had the similar condition in previous years. One hundred and fifty seven (80.9%) were aware about this disease and 52(27%) devotees adopted some kind of precautionary measures. Bivariate analysis showed significant association between occurrence of CLM lesions and frequency of performing the ritual (p,0.001, OR-15.1; 95 % CI:7.2-32.0), the timing of ritual performance (p = 0.022, OR-1.96; 95 % CI:1.10–3.52), similar condition in previous year (p,0.001, OR-6.83; 95 % CI: 3.39–13.76) and previous awareness of th

A simple intervention to prevent cutaneous larva migrans among devotees of the Nallur Temple in Jaffna, Sri Lanka.

BACKGROUND: A cross sectional study conducted during the annual festival at Nallur temple in Jaffna, Sri Lanka, in 2010, showed that the prevalence of cutaneous larva migrants (CLM) among the devotees who performed the side roll ritual was 58.2% (95%CI: 51.2%-65.0%). OBJECTIVE: To test the hypothesis that the deworming stray dogs around the temple premises effectively reduces the prevalence of CLM among devotees. METHODOLOGY/PRINCIPAL FINDINGS: All stray dogs (8) in the vicinity of the temple were treated, with mebendazole (100 mg) crushed and filled into sausages, 10 days before the commencement of festival in 2011. The same procedure was repeated a week later to ensure complete coverage. A cross-sectional study was conducted among 200 systematically selected devotees in August 2011 using an interviewer-administered questionnaire and the clinical examination of the skin. Baermann's technique was used for the recovery of nematode larvae from 40 soil samples collected from the temple premises. Ten samples of dog faeces collected from the same premises were also examined for nematode eggs. Prevalence of CLM among devotees in 2010 (Pre intervention) and 2011(Post intervention) were compared to test the hypothesis. Prevalence of CLM declined from 58% to 8% (Chi-square = 112.90, p<0.001) following the intervention. None of the subjects practiced new precautionary measures compared to the previous year. Soil and fecal samples were negative for parasites. CONCLUSIONS/SIGNIFICANCE: Regular dog deworming is an important and effective method for the prevention of CLM among the devotees doing side roll ritual and represents a pragmatic intervention that municipal authorities could perform on annual basis

Comparison of study population before and after intervention.

<p>Comparison of study population before and after intervention.</p

Devotees performing the ‘side-roll’ ritual.

<p>Devotees performing the ‘side-roll’ ritual.</p

Risk factors associated with the infestation of Cutaneous Larva Migrans.

<p>Risk factors associated with the infestation of Cutaneous Larva Migrans.</p

Outcome variables before and after intervention.

<p>Outcome variables before and after intervention.</p

Typical cutaneous larva migrans lesion on a devotee's hand.

<p>Typical cutaneous larva migrans lesion on a devotee's hand.</p