Funnel plot for adequate adherence to antiretroviral therapy in China.

<p>Panel A: Funnel Plot before study with <30 participants was excluded, Freeman-Tukey Double arcsine transformation was used, Egger’S Linear Regression Test (t = -0.282, P = 0.779); Panel B: Funnel Plot after study with <30 participants was excluded, Egger’S Linear Regression Test (t = -0.365, P = 0.717).</p

Prevalence and risk factors for <i>Taenia solium</i> cysticercosis in school-aged children: A school based study in western Sichuan, People’s Republic of China

<div><p>Background</p><p><i>Taenia solium</i> cysticercosis affects millions of impoverished people worldwide and can cause neurocysticercosis, an infection of the central nervous system which is potentially fatal. Children may represent an especially vulnerable population to neurocysticercosis, due to the risk of cognitive impairment during formative school years. While previous epidemiologic studies have suggested high prevalence in rural China, the prevalence in children as well as risk factors and impact of disease in low-resource areas remain poorly characterized.</p><p>Methodology/Principal findings</p><p>Utilizing school based sampling, we conducted a cross-sectional study, administering a questionnaire and collecting blood for <i>T</i>. <i>solium</i> cysticercosis antibodies in 2867 fifth and sixth grade students across 27 schools in west Sichuan. We used mixed-effects logistic regression models controlling for school-level clustering to study associations between risk factors and to characterize factors influencing the administration of deworming medication. Overall prevalence of cysticercosis antibodies was 6%, but prevalence was significantly higher in three schools which all had prevalences of 15% or higher. Students from households owning pigs (adjusted odds ratio [OR] 1.81, 95% CI 1.08–3.03), from households reporting feeding their pigs human feces (adjusted OR 1.49, 95% CI 1.03–2.16), and self-reporting worms in their feces (adjusted OR 1.85, 95% CI 1.18–2.91) were more likely to have cysticercosis IgG antibodies. Students attending high prevalence schools were more likely to come from households allowing pigs to freely forage for food (OR 2.26, 95% CI 1.72–2.98) and lacking a toilet (OR 1.84, 95% CI 1.38–2.46). Children who were boarding at school were less likely to have received treatment for gastrointestinal worms (adjusted OR 0.58, 95% CI 0.42–0.80).</p><p>Conclusions/Significance</p><p>Our study indicates high prevalences of cysticercosis antibodies in young school aged children in rural China. While further studies to assess potential for school-based transmission are needed, school-based disease control may be an important intervention to ensure the health of vulnerable pediatric populations in <i>T</i>. <i>solium</i> endemic areas.</p></div

Diagram showing the relationship of variables included in the analysis to <i>T</i>. <i>solium</i> taeniasis and human cysticercosis infection.

<p>Diagram showing the relationship of variables included in the analysis to <i>T</i>. <i>solium</i> taeniasis and human cysticercosis infection.</p

Prevalence of <i>T</i>. <i>solium</i> cysticercosis IgG antibiodies in 5^th and 6^th graders in three counties in Sichuan Province.

<p><i>T</i>. <i>solium</i> cysticercosis antibody seropositivity in fifth and sixth graders in 27 schools across Muli (designated as A on map, 12 total schools), Yajiang (designated as B on map, 6 total schools), and Ruoergai (designated as C on map, 9 total schools) counties in western Sichuan. Gray shaded circles represent calculated prevalence and dotted circles represent 95% confidence intervals (CI). Bolded text shows corresponding prevalence and 95% CI. Odds ratios with 95% confidence intervals are displayed in italics for three schools that had a significantly higher prevalence compared to the school closest to the mean prevalence (noted as <i>Ref</i>). Inset shows location of the three study counties within Sichuan Province, People’s Republic of China.</p

Prevalence of self-reported fecal worms and serum <i>T</i>. <i>solium</i> cysticercosis IgG antibodies by county and grade level.

<p>Prevalence of self-reported fecal worms and serum <i>T</i>. <i>solium</i> cysticercosis IgG antibodies by county and grade level.</p

Comparison of demographic and behavioral factors between schools with highest and lower <i>T</i>. <i>solium</i> cysticercosis antibody prevalences.

<p>Proportion of demographic, household environment, and deworming (A); pig ownership and husbandry (B); pork consumption (C); and agricultural (D) factors reported by children or corresponding head of household in the three schools with the highest seroprevalences of <i>T</i>. <i>solium</i> IgG antibiodies (in black) compared to all other lower prevalence schools (in gray). Factors achieving statistical significance by Fisher’s exact test are bolded and the odds ratio (OR) and 95% confidence interval (CI) shown. * = p-value of < 0.05.</p

Demographic and reported exposures and behavioral characteristics of study population.

<p>Demographic and reported exposures and behavioral characteristics of study population.</p

Factors associated with administration of medication for gastrointestinal worms to children.

<p>Factors associated with administration of medication for gastrointestinal worms to children.</p