Soil-transmitted helminth infections among plantation sector schoolchildren in Sri Lanka: prevalence after ten years of preventive chemotherapy.

BACKGROUND: The plantation sector in Sri Lanka lags behind the rest of the country in terms of living conditions and health. In 1992, a sector-wide survey of children aged 3-12 years and women of reproductive age showed >90% prevalence of soil-transmitted helminth infections. Biannual mass de-worming targeting children aged 3-18 years started in 1994 and was continued until 2005. The present study was carried out to assess the status of infection four years after cessation of mass de-worming. METHODS/FINDINGS: A school-based cross-sectional survey was carried out. Faecal samples from approximately 20 children from each of 114 schools in five districts were examined using the modified Kato-Katz technique. Data regarding the school, the child's family and household sanitation were recorded after inspection of schools and households. Multivariate analysis was carried out using logistic regression, to identify risk factors for infection. Faecal samples were obtained from 1890 children. In 4/5 districts, >20% were infected with one or more helminth species. Overall combined prevalence was 29.0%; 11.6% had infections of moderate-heavy intensity. The commonest infection was Ascaris lumbricoides, present in all five districts, as was Trichuris trichiura. Hookworm was not detected in two districts. Multivariate analysis identified low altitude and maternal under-education as risk factors for all three infections. Poor household sanitation was identified as a risk factor for A. lumbricoides and hookworm, but not T. trichiura infections. CONCLUSIONS/SIGNIFICANCE: The results indicate that regular mass de-worming of plantation sector children should be resumed along with more emphasis on better sanitation and health education. They show that even after 10 years of mass chemotherapy, prevalence can bounce back after cessation of preventive chemotherapy, if the initial force of transmission is strong and other long-term control measures are not concomitantly implemented

Geographical location of study schools and laboratories in the districts of Kandy, Kegalle, Nuwara Eliya, Badulla and Ratnapura, together with prevalence of infection with any one or more soil-transmitted helminth infection at each school.

<p>Geographical location of study schools and laboratories in the districts of Kandy, Kegalle, Nuwara Eliya, Badulla and Ratnapura, together with prevalence of infection with any one or more soil-transmitted helminth infection at each school.</p

Prevalence of soil-transmitted helminth infections in plantation sector school children by district.

<p>Prevalence of soil-transmitted helminth infections in plantation sector school children by district.</p

Proportion of infections of moderate – heavy intensity by district.

<p>Proportion of infections of moderate – heavy intensity by district.</p

Predicted prevalence of infection with any one or more soil-transmitted helminth infection among children in the plantation sector in five districts of Sri Lanka.

<p>Predicted prevalence of infection with any one or more soil-transmitted helminth infection among children in the plantation sector in five districts of Sri Lanka.</p

Summary of multivariate analysis for risk of <i>A. lumbricoides</i>, <i>T. trichiura</i> and hookworm infection.

*<p>maximum variance inflation factor was 1.02.</p><p>Numbers within square brackets indicate the number of infected children positive for the given explanatory variable.</p