Soil transmitted helminths (STH) infection is a major health problem in tropical countries such as Indonesia. Albendazole is an effective and widely used anthelmintic agent to treat STH; however, it is not effective towards
Soil transmitted helminths (STH) infection is a public health problem especially among rural areas in tropical countries. The most common STH are
The burden of STH is mainly due to its chronic and insidious impact on the health and quality of life rather than mortality. STH infections adversely affect child growth and development, nutritional status, and cognitive capacity [
The best method to interrupt transmission of STH is by providing an effective and efficient sanitation. However, in endemic countries the resources required to sustain infrastructure are rarely available, thus eliminating morbidity is more feasible. WHO [
Southwest Sumba was ranked as the second poorest district in East Nusa Tenggara. Poor hygiene is mainly due to the difficulty in accessing clean water which can only be obtained from artesian well, located far from residential areas. Hence, clean water is only used sparingly for drinking and cooking, rarely for bathing and hand hygiene. In addition, people are used to free defecation as their traditional houses are ill-equipped with latrines and sanitation.
Perobatang village is a small rural community located 70 km from the capital of Southwest Sumba district (Tambolaka). In 2015, it has an area of 4360 hectares with 315 families and a total population of 1459 (498 children, 231 early-adults, and 630 adults aged >40 years). The predominant occupations are fishermen and farmers. There is no primary health centre (PHC) facility in the village. The nearest PHC is located almost 3 km away in Bondokodi subdistrict. The village was chosen due to high risk factors of STH infection (free defecation, poor hand washing habit, inaccessible clean water sources, low socioeconomic status), and the lack of mass drug administration (MDA) program with albendazole conducted in the village.
This study used pre- and post-study design conducted in Perobatang village, Southwest Sumba, Indonesia, in July 2016.
The subjects were all children in the village, aged 1-15 years, who got parental permissions; children with fever were excluded.
The village chief’s residence was converted into a makeshift clinic. Baseline data was collected on the first week of July 2016 prior to treatment and followed up two weeks after treatment (to study the effectiveness of anthelmintic, the best interval between treatment and resampling should be 10-14 days).
On the first day, the subjects and their parents were given informed consent. Demographic characteristics were obtained from the parents or the subjects. They were also given explanation on procedure of collecting the fecal samples.
To collect the fecal samples, thumb-sized feces were put into 10 cc pot. Stool pots were labeled with the identity of the subjects: name, code data, gender, and age. The next day, the subjects were asked to return the samples to the researchers. Kato-Katz thick smears method was prepared from each sample [
The study used WHO guideline for treatment using albendazole [
To determine the effectiveness of albendazole triple dose, we compared the cure rate (CR) and eggs reduction rate (ERR) calculated using the formula below.
The treatment was considered effective if CR was >90% and ERR was >90%. To obtain the prevalence of STH before and after treatment, data was analyzed using McNemar test in SPSS version 20 and the difference of EPG before and after treatment was analyzed using Wilcoxon test. For all tests, a p-value of 0.05 was considered the limit of statistical significance and 95% confidence intervals (CIs) were calculated as appropriate.
This study has obtained ethical approval from Ethical Committee of Faculty of Medicine, Universitas Indonesia (Ref. No. 771/UN2.F1/ethic/2015).
All children (498 children) in the village were recruited. Among those children, 246 returned the pot with the samples and were all examined for STH infection. A total of 192 children were positive for STH and treated at the start of the study. Table
The characteristics of subjects in Perobatang village, 2016.
| | | | |
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| ||||
Male, n=114 | 82 (33%) | 67 (27%) | 67 (27%) | 14 (6%) |
Female, n=132 | 110 (45%) | 90 (37%) | 81 (33%) | 10 (4%) |
| ||||
1 – 4 yo, n=69 | 51 (21%) | 35 (14%) | 40 (16%) | 3 (1%) |
5 – 15 yo, n=177 | 141 (57%) | 122 (50%) | 108 (44%) | 21 (9%) |
| | | | |
Table
The prevalence of STH and cure rate after intervention.
| | | |
---|---|---|---|
| | ||
| 148 (60%) | 5 (2%) | 97% (90–100) |
| 157 (64%) | 62 (25%) | 61% (53–68) |
Hookworms | 24 (10%) | 0 (0%) | 100% (96–100) |
The comparison of EPG before and after intervention.
| | | |
---|---|---|---|
| | ||
| 8.592 | 24 | 100% (99–100) |
| 1.344 | 120 | 91% (88–93) |
Hookworms | 24 | 0 | 100% (99–100) |
The strategy for STH control in endemic areas focuses on morbidity control through large scale administration of single dose anthelminthics to at-risk populations, especially school-age children [
In this study, we show the effectiveness of triple dose albendazole in reducing the prevalence of STH. Prior to the intervention we found that the prevalence of the three types of worms was very high, especially among school-aged children as they spend more time outdoors compared to the younger children. Smaller children tend to spend more time carried by mothers, hence limiting their contact with soil. Prevalence of each species of worm is more than 50%, but not in hookworms (10%) because the prevalence of hookworm infection is higher in adults compared to children. Adults usually work in the farm where the soil is loose while the children play in the yard of the house that is clay. The clay soil is a suitable factor for the development of life cycles of STH, particularly
Our finding is similar to that of Steinman et al. [
Randomized controlled trial conducted by Adegnika et al. [
The reduction and the maintenance of low worm burden have an important impact on the health of the community. The first sign of improvement is parasitological with a reduction of heavy infection, then nutritional, with an increase in iron stores, followed by an increase in hemoglobin level and finally by an increase in growth. At least two years of intervention are normally required before an increase in hemoglobin becomes evident and even longer period is required to exhibit improvement in growth. Improved indicators of school effects (school attendance, reenrollment, retention, and achievement) have been observed: iron load and increasing hemoglobin level, improving physical growth and cognitive capacity, educational achievement, and reduced school absence [
Without significant environmental and health behavioral improvement, reinfection will occur and may reach the same prevalence and intensity prior to the treatment. Jia et al. [
Since it is difficult to change environmental and health behavioral patterns in Perobatang village, mass drug treatment is required every six months for at least five consecutive years to control STH. Tun et al. [
Albendazole is effective in treating
Triple dose albendazole is effective in reducing prevalence of
The data used to support the findings of this study are included with this article.
Authors declare no conflicts of interest.
Funding was obtained from Community Engagement Grant (CEG) from Directorate of Research and Public Services, Universitas Indonesia. Authors would like to thank the head of the Perobatang village and other parties who have supported this study.