Prevalence of intestinal parasitic infections versus knowledge, attitudes and practices of male residents in Brazilian urban slums: a cross-sectional study

ABSTRACT Intestinal parasitic infections (IPIs) are neglected diseases caused by helminths and protozoa, with the relationships between parasite, host and environment having the potential to produce high morbidity and incapacity to work and mortality in vulnerable areas. This study assessed the prevalence of IPIs concerning socio-environmental conditions and analyzed the knowledge, attitudes and practices related to these diseases among men living in the slums of Rio de Janeiro city, Rio de Janeiro State, Brazil. A cross-sectional study was conducted in an agglomeration of urban slums between 2018 and 2019, with men aged between 20 and 59 years. A socioeconomic status questionnaire and an IPIs knowledge, attitudes and practices questionnaire (KAPQ) were applied. Coproparasitological diagnoses (n=454) were performed using four methods and samples of water for household consumption (n=392) were subjected to microbiological and physicochemical analysis. A total of 624 participants were enrolled. About 40% of the households had "water unsuitable for consumption". Only one Major Area, MA 3 was not statistically significant for IPIs (AOR=0.75; 95% CI: 0.30-1.88; p=0.55). The overall prevalence of IPIs was 23.8%. Endolimax nana (n=65, 14.3%) and hookworm (n=8, 1.7%) were the most frequently identified parasites. The analysis of the frequency of responses to the KAPQ has shown that men reported to seeking medical care if they were suspicious of IPIs, and around 35% would self-medicate. The results have shown the need to adopt integrated health education practices targeting male residents in urban slums to qualify the care with water for human consumption and promote self-care about IPIs. The household can be considered strategic for Primary Health Care activities for men.

Parasitosis intestinal y estado inmunológico en pacientes adultos con infección por VIH del Centro Médico Naval "Cirujano Mayor Santiago Távara" / Parasitic intestinal diseases and immune status in adult patients with HIV infection at the Peruvian Naval Medical Center "Cirujano Mayor Santiago Távara"

Objetivo: Describir los tipos parasitosis intestinales y el estado inmunológico en pacientes portadores del virus de la inmunodeficiencia humana (VIH +). Materiales y métodos: Se realizó un estudio descriptivo, comparativo y retrospectivo, a través de la selección de 81 historias clínicas pertenecientes al Servicio de Infectología del Centro Médico Naval "Cirujano Mayor Santiago Távara", con el permiso de las autoridades del centro. Las historias contaban con el único criterio de inclusión considerado en la investigación que fue diagnóstico de infección por VIH. Los datos que se obtuvieron fueron los resultados de examen coproparasitológico y citometría de flujo para linfocitos T CD4, la presencia o ausencia de sintomatología intestinal, y pertenencia al programa de tratamiento antirretroviral de alta actividad (TARGA) o al tratamiento antirretroviral convencional. Resultados: El 37 % presentaron parasitosis intestinal. Se observó con mayor frecuencia a Entamoeba coli (20 %), que es no patógeno para el ser humano. Entre los patógenos hallados se encuentran Isospora belli (15,6 %), Giardia lamblia (15,6 %), Blastocystis hominis (11,2 %) y Cryptosporidium sp. (11,2 %). El 32,1 % de los casos presentaron diarrea, mientras que el 67,9 % fueron asintomáticos. En el grupo de asintomáticos, el promedio de CD4 es de 280 células/μL, mientras en los que tuvieron diarrea fue de 195 células/μL. Conclusiones: Los enteroparásitos Isospora belli, Cyclospora cayetanensis, Blastocystis hominis son hallados con mayor frecuencia en recuentos de CD4 <199 células/uL. Los parásitos no patógenos Entamoeba coli, Endolimax nana, Trichomonas hominis, Chilomastix mesnili se encuentran con mayor frecuencia en pacientes con recuentos de CD4 >200 células/uL

Objective: To describe the types of parasitic intestinal diseases and the immune status in human immunodeficiency virus-positive (HIV+) patients. Materials and methods: A descriptive, comparative and retrospective study was carried out through the selection of 81 medical records from the Infectious Disease Service of the Naval Medical Center "Cirujano Mayor Santiago Távara", with the authorization of the pertinent authorities. Said medical records included the only inclusion criterion considered in the research: the diagnosis of HIV infection. The following data was obtained: results from a copro-parasitological examination and a flow cytometry for CD4 T lymphocyte count, presence or absence of gastrointestinal symptoms, and participation in the Highly Active Antiretroviral Therapy (HAART) program or the conventional antiretroviral treatment program. Results: Thirty-seven percent (37 %) of the patients presented parasitic intestinal diseases, with Entamoeba coli being the most frequently observed parasite (20 %), which is not pathogenic for humans. Among the pathogens, Isospora belli (15.6 %), Giardia lamblia (15.6 %), Blastocystis hominis (11.2 %) and Cryptosporidium sp. (11.2 %) were found. Thirty-two point one percent (32.1 %) of the subjects had diarrhea, while 67.9 % were asymptomatic. In the asymptomatic group, the average CD4 cell count was 280 cells/μL, while in those with diarrhea it was 195 cells/μL. Conclusions: Enteroparasites Isospora belli, Cyclospora cayetanensis and Blastocystis hominis are most frequently found at CD4 cell counts <199 cells/uL. Non-pathogenic parasites Entamoeba coli, Endolimax nana, Trichomonas hominis and Chilomastix mesnili are most frequently found in patients with CD4 cell counts >200 cells/μL

Anemia, estado nutricional y parasitosis intestinales en niños pertenecientes a hogares vulnerables de Montevideo / Anemia, nutritional status and intestinal parasites in children from vulnerable homes of Montevideo / Anemia, estado nutricional e parasitoses intestinais em crianças de lares vulneráveis em Montevidéu

Resumen: Introducción: la anemia ferropénica, las alteraciones nutricionales y las parasitosis intestinales, principalmente giardiasis y helmintiasis transmitidas por el suelo (HTS) son problemas prevalentes en Uruguay, que determinan consecuencias en la salud individual y colectiva. Objetivo: determinar prevalencia de anemia, alteraciones nutricionales y enteroparasitosis en niños de 6-48 meses, de una población vulnerable de Montevideo, establecer posibles sinergismos y analizar presencia de factores de riesgo. Material y métodos: estudio descriptivo, transversal. Población: niños de 6-48 meses pertenecientes a un programa de apoyo a hogares vulnerables de Montevideo. Estudiantes y docentes de Medicina y Nutrición capacitados concurrieron a los domicilios y mediante encuestas recolectaron variables demográficas, ambientales, epidemiológicas, clínicas y hábitos, entre octubre/2014 a mayo/2015. Realizaron medidas antropométricas, hemoglobina capilar y coproparasitario. Análisis de datos: EPIinfo2000 complementada con SPSS19. Análisis estadístico: uni o multivariados. Asociaciones entre dos variables: test de Z o chi². Asociaciones entre más de dos variables: regresiones múltiples. Protocolo aprobado por el Comité de Ética de la Facultad de Medicina. Resultados: N: 136 niños. Prevalencia de anemia: 33%, bajo peso: 3,7%, retraso de talla: 18% y sobrepeso/obesidad: 4,5%. Albergaban parásitos patógenos: 60% de los estudiados; giardiasis: 46% y HTS: 23%, poliparasitados: 13%. Condiciones que presentaron asociación con HTS: zona inundable, alternativas de saneamiento no mejorado y eliminación de residuos a cielo abierto. Asociaciones significativas encontradas: entre HTS y anemia; y entre HTS y déficit de talla (grupo de 1-2 años). Conclusiones: los resultados son preocupantes dada la alta prevalencia de anemia, alteraciones nutricionales y parasitosis en esta población. Urge la planificación y ejecución de medidas con participación multidisciplinaria, interinstitucional y comunitaria.

Summary: Introduction: iron deficiency anemia, nutritional alterations and intestinal parasitic diseases, mainly giardiasis and soil-transmitted helminthiasis (HTS) are prevalent problems in Uruguay, which determine consequences for individual and collective health. Objective: to determine the prevalence of anemia, nutritional alterations and enteroparasitosis in children of 6-48 months of a vulnerable population of Montevideo, to establish possible synergisms and to analyze the presence of risk factors. Material and methods: descriptive, cross-sectional study. Population: children aged 6-48 months belonging to a program to support vulnerable homes in Montevideo. Students and teachers of Medicine and Nutrition trained, attended the homes and through surveys, collected demographic, environmental, epidemiological, clinical and habits variables, between October / 2014-May / 2015. They performed anthropometric measures, capillary hemoglobin and coproparasitary. Data analysis: EPIinfo2000 complemented with SPSS19. Statistical analysis: uni or multivariate. Associations between 2 variables: test of Z or chi². Associations between more than 2 variables: multiple regressions. Protocol approved by the Ethics Committee of the School of Medicine. Results: N: 136 children. Prevalence of anemia: 33%, low weight: 3.7%, size retardation: 18% and overweight / obesity: 4.5%. They harbored pathogenic parasites: 60% of those studied; Giardiasis: 46% and HTS: 23%, polyparasites: 13%. Conditions that presented association with HTS: flood zone, alternatives of sanitation not improved and elimination of open pit. Significant associations found: between HTS and anemia; and between HTS and height deficit (group of 1-2 years). Conclusions: the results are worrying given the high prevalence of anemia, nutritional alterations and parasites in this population. The planning and implementation of measures with multidisciplinary, inter-institutional and community participation is urgently needed.

Resumo: Introdução: a anemia ferropênica, as alterações nutricionais e as parasitoses intestinais, principalmente giardíase e helmintíase transmitida pelo solo (HTS) são problemas prevalentes no Uruguai e têm consequências para a saúde individual e coletiva. Objetivo: determinar a prevalência de anemia, alterações nutricionais e enteroparasitoses em crianças de 6 a 48 meses numa população vulnerável em Montevidéu, estabelecer possíveis sinergias e analisar a presença de fatores de risco. Material e métodos: estudo descritivo, transversal. População: crianças de 6 a 48 meses pertencentes a um programa de apoio a famílias vulneráveis em Montevidéu. Alunos e professores de Medicina e Nutrição foram treinados, frequentaram as residências e por meio de pesquisas coletaram variáveis demográficas, ambientais, epidemiológicas, clínicas e de hábito, entre outubro de 2014 e maio de 2015. Realizaram medidas antropométricas, hemoglobina capilar e coproparasitológico. Análise de dados: EPIinfo2000 complementado com SPSS19. Análise estatística: uni ou multivariada. Associações entre duas variáveis: teste de Z ou chi². Associações entre mais de duas variáveis: regressões múltiplas. Protocolo aprovado pelo Comitê de Ética da Faculdade de Medicina. Resultados: N: 136 crianças. Prevalência de anemia: 33%, baixo peso: 3,7%, atraso na altura: 18% sobrepeso / obesidade: 4,5%. Parásitos patogênicos: 60%; Giardíase: 46% e HTS: 23%, poliparasitizados: 13%. Condições que apresentaram associação com HTS: zonas de inundação, alternativas precárias de saneamento e disposição de resíduos a céu aberto. Associações significativas encontradas: entre HTS e anemia; e entre HTS e déficit de altura (grupo de 1-2 anos). Conclusões: os resultados são preocupantes, dada a alta prevalência de anemia, alterações nutricionais e parasitoses nessa população. É fundamental o planejamento e execução de medidas tais como participação multidisciplinar, interinstitucional e comunitária.

Is there evidence that Kudoa septempunctata can cause an outbreak of acute food poisoning? / 한국역학회지

After publishing results of a study that revealed diarrheagenic and emetic activity in 4-5-day old mice infected with Kudoa septempunctata (K. septempunctata) spores, the Korea Centers for Disease Control and Prevention reported 11 events of “Kudoa food poisoning” in 2015. The epidemiological design of the previous study was descriptive rather than analytical; therefore, this study aimed to further investigate the pathogenicity of K. septempunctata. Academic articles showing evidence of the pathogenicity of K. septempunctata were searched via PubMed using the citation discovery tool. Information regarding the kinds of experimental animals and inoculum spores used, as well as study results were extracted. Four articles evaluating the pathogenicity of Myxospran parasites were selected; the first article suggested the pathogenicity of K. septempunctata, while the remaining three articles reported no abnormal symptoms or histopathologic changes. Our findings indicate that there is weak evidence supporting the pathogenicity of K. septempunctata. Further studies evaluating the pathogenicity of K. septempunctata are needed urgently.

Relationship between shipping amounts of olive flounder aquacultured from Jejudo and the reported events of acute food poisoning by Kudoa septempunctata in 2015, South Korea: an ecological study / 한국역학회지

OBJECTIVES: Confirmation of Kudoa septempunctata (K. septempunctata) as the pathogenic agent causing acute food poisoning remains under debate owing to inconsistencies in the reproducibility of experimental evidence. Higher intake of olive flounder infected with K. septempunctata would result in increased diagnosis of food poisoning by K. septempunctata, if the latter was one of the causal agents of acute food poisoning. The aim was to evaluate the relationship between the shipping amount of olive flounder aquacultured from Jejudo and the incidence of K. septempunctata food poisoning in 2015, Korea.METHODS: Data of shipping amounts between March 2014 and February 2016 and of monthly reported events of Kudoa food poisoning were taken from Jejudo Fish-Culture Fisheries Cooperatives and Korea Centers for Disease Control and Prevention, respectively. Non-parametric correlation analyses were conducted.RESULTS: Shipping amounts indicated the seasonal changes according to variation of consumption. Spearman's rho and Kendall's tau-a between the monthly shipping amounts and the reported events in 2015 were 0.39 (p=0.21) and 0.27 (p=0.20), respectively.CONCLUSIONS: An independent relationship was noted between the shipping amount and the reported events, which contrasted with the claim that the virulence of K. septempunctata caused acute food poisoning.

Is there evidence that Kudoa septempunctata can cause an outbreak of acute food poisoning? / 한국역학회지

After publishing results of a study that revealed diarrheagenic and emetic activity in 4-5-day old mice infected with Kudoa septempunctata (K. septempunctata) spores, the Korea Centers for Disease Control and Prevention reported 11 events of “Kudoa food poisoning” in 2015. The epidemiological design of the previous study was descriptive rather than analytical; therefore, this study aimed to further investigate the pathogenicity of K. septempunctata. Academic articles showing evidence of the pathogenicity of K. septempunctata were searched via PubMed using the citation discovery tool. Information regarding the kinds of experimental animals and inoculum spores used, as well as study results were extracted. Four articles evaluating the pathogenicity of Myxospran parasites were selected; the first article suggested the pathogenicity of K. septempunctata, while the remaining three articles reported no abnormal symptoms or histopathologic changes. Our findings indicate that there is weak evidence supporting the pathogenicity of K. septempunctata. Further studies evaluating the pathogenicity of K. septempunctata are needed urgently.

Relationship between shipping amounts of olive flounder aquacultured from Jejudo and the reported events of acute food poisoning by Kudoa septempunctata in 2015, South Korea: an ecological study / 한국역학회지

OBJECTIVES: Confirmation of Kudoa septempunctata (K. septempunctata) as the pathogenic agent causing acute food poisoning remains under debate owing to inconsistencies in the reproducibility of experimental evidence. Higher intake of olive flounder infected with K. septempunctata would result in increased diagnosis of food poisoning by K. septempunctata, if the latter was one of the causal agents of acute food poisoning. The aim was to evaluate the relationship between the shipping amount of olive flounder aquacultured from Jejudo and the incidence of K. septempunctata food poisoning in 2015, Korea. METHODS: Data of shipping amounts between March 2014 and February 2016 and of monthly reported events of Kudoa food poisoning were taken from Jejudo Fish-Culture Fisheries Cooperatives and Korea Centers for Disease Control and Prevention, respectively. Non-parametric correlation analyses were conducted. RESULTS: Shipping amounts indicated the seasonal changes according to variation of consumption. Spearman's rho and Kendall's tau-a between the monthly shipping amounts and the reported events in 2015 were 0.39 (p=0.21) and 0.27 (p=0.20), respectively. CONCLUSIONS: An independent relationship was noted between the shipping amount and the reported events, which contrasted with the claim that the virulence of K. septempunctata caused acute food poisoning.

Situación del parasitismo intestinal en preescolares de un hogar infantil estatal en Popayán, Colombia / Situation of intestinal parasitism in preschools of a state child's home in Popayan, Colombia

deficientes. Se describen prevalencias a nivel nacional de este mayores al 80%, con predominio de protozoos. Objetivo: describir la situación de parasitismo intestinal en preescolares de un hogar infantil estatal de Popayán (Colombia) y su relación con variables sociodemográficas. Materiales y métodos: se realizó un estudio descriptivo de corte transversal, entre mayo y septiembre de 2013, en 187 niños de 1 a 5 años de edad, matriculados en un hogar infantil estatal de Popayán (Colombia). Se realizó una encuesta sociodemográfica y análisis parasitológico de muestras de materia fecal mediante examen directo y método de concentración modificado de Ritchie-Frick. Se calcularon prevalencias, distribuciones de frecuencia y asociaciones de factores sociodemográficos con la presencia de parasitismo intestinal utilizando regresiones logísticas. Resultados: se identificó una prevalencia de parasitismo intestinal de 43,3%. La especie encontrada con mayor frecuencia fue Blastocystis spp. (24,6%), seguida por Entamoeba coli (13,4%) y Giardia intestinalis (11,8%). En ninguna de las muestras se observaron helmintos. Conclusiones: la prevalencia encontrada de parasitismo intestinal se aproxima al promedio nacional, de acuerdo con reportes para población preescolar en otros municipios del país. La ausencia de helmintos y el predominio de especies de protozoos respaldan la necesidad de futuras investigaciones que permitan conocer la epidemiología local. Además, se identificaron condiciones sociodemográficas de riesgo para infecciones en la población estudiada, algunas de ellas asociadas a la presencia de protozoos intestinales

Intestinal parasitism, generally asymptomatic problem but with important repercussions at socioeconomic and health field, mainly affects children with poor sanitary conditions. Their nationwide prevalence is higher than 80% with predominance of protozoa. Objective: To describe the situation of intestinal parasitism in preschools of a statechild's home in Popayan (Colombia) and its relationship with socio-demographic variables. Materials and methods: A cross - sectional descriptive study was carried out, between May and September 2013, with 187 children between 1 and 5 years of age, enrolled in a statechild's home in Popayan (Colombia). A sociodemographic survey was applied and parasitological analysis of stool samples was performed by direct examination and by the modified Ritchie-Frick concentration method. Prevalence and frequency distributions were calculated as well as logistic regression of associations of sociodemographic factors with the presence of intestinal parasitism. Results: The prevalence of intestinal parasites was 43.3%. The most frequently species was Blastocystis spp. (24.6%), followed by Entamoeba coli (13.4%) and Giardia instestinalis (11.8%). Helminths were not observed in any of the samples. Conclusions: The identified prevalence of intestinal parasites is close to the national average, according with previous reports for pre-school children in other municipalities in the country. The absence of helminths and the predominance of the protozoan species support the need for future research that allows knowing the local epidemiology. In addition, it was identified that the studied population is continuously exposed to different sociodemographic risk conditions that increase the possibility of acquiring enteroparasitosis

Parásitos intestinales y factores de riesgo en escolares de una institución educativa rural de Tunja (Colombia) en el año 2015 / Intestinal parasites and risk factors in schoolchildren of a rural school from Tunja (Colombia) in 2015

Introducción: una de las enfermedades infecciosas más común es el parasitismo intestinal, encontrándose ampliamente distribuido a nivel mundial, especialmente en las personas más vulnerables. Objetivo: determinar la prevalencia de parásitos intestinales y los factores de riesgo en escolares de una institución educativa rural de la ciudad de Tunja (Colombia). Materiales y métodos: se llevó a cabo una investigación de tipo descriptivo transversal, en la cual aceptaron participar 89 niños con previa firma del asentimiento y consentimiento informado por parte de sus padres. Se recolectaron muestras de heces fecales de cada uno de los niños y se les practicó examen coprológico y análisis por medio de la técnica de concentración formol-éter. Los factores de riesgo se evaluaron con la ayuda de una encuesta que contempló preguntas sobre los hábitos higiénico-sanitarios y las características de las viviendas. Resultados: la prevalencia general de parásitos intestinales fue del 74,2%, siendo Entamoeba histolytica/dispar (90,9%), Endolimax nana (66,7%) y Entamoeba coli (60,6%) las especies más frecuentes. Dentro de los factores de riesgo se destacan la medicación en casa, el contacto con animales, la disposición de aguas residuales al aire libre, jugar con tierra y caminar descalzos. No se encontró relación estadísticamente significativa entre los factores de riesgo y el parasitismo intestinal. Conclusiones: la proporción de parásitos intestinales en los escolares estudiados fue alta (74,2%), con predominio de los protozoos y los parásitos no patógenos. Es importante continuar incrementando las actividades educativas encaminadas a prevenir el parasitismo intestinal. (AU)

Introduction: Parasitic intestinal diseases are one of the most predominant among infectious diseases, finding distributed worldwide, especially in most vulnerable people. Objective: To determine the prevalence of intestinal parasites and the risk factors in schoolchildren of rural educational institution from Tunja (Colombia). Materials and methods: A transversal descriptive study has been carried out in 89 schoolchildren that agreed to participate with the prior written informed consent and assent from their parents. Stool samples from each child were collected and coprological test and analysis by formalin-ether concentration technique were conducted. The risk factors were assessed by a survey, which included questions about hygiene habits and housing characteristics. Results: The overall infection of intestinal parasites was 74.2 % being Entamoeba histolytica/dispar (90.9%), followed by Endolimax nana (66.7%), and Entamoeba coli (60.6%) the most frequent species. Risk factors include self-medication, animal contact, outdoor sewage disposing, play with soil, and walking barefoot. It was not found a significant relationship between risk factors and intestinal parasites. Conclusions: The proportion of intestinal parasites in schoolchildren was high (74.2%), with the protozoa and non-pathogenic parasites as most predominant. It is important to continue increasing educational efforts to prevent intestinal parasites. (AU)

Esquistosomiasis intestinal: reporte de un caso / Intestinal Schistosomiasis: a case report

Introducción: la esquistosomiasis intestinal es una parasitosis ocasionada por helmintos de la clase trematode del género Shistosoma, que se caracteriza por presentar en su fase aguda diarreas, dermatitis y dolores abdominales, con alta incidencia en los países pobres con problemas de insalubridad. El factor desencadenante de esta parasitosis está asociado al contacto con agua contaminada por los huevos de shistosomas. Puede prevenirse con medidas de saneamiento ambiental dirigidas al control de las fuentes de abasto de agua. Existe en la actualidad elevada morbilidad principalmente en el África subsahariana. Se persigue como objetivo explicar la epidemiología de esta enfermedad. Presentación del caso: se presenta el caso de un adulto mayor de 60 años de edad, del sexo femenino, sin antecedentes de esta enfermedad, que se encontraba prestando ayuda colaboración en la provincia de Cunene en la hermana República de Angola. Presentó síntomas clínicos durante los meses de enero a marzo del 2012, siendo confirmado por el laboratorio como esquistosomiasis intestinal. Se aplicó a la paciente el medicamento específico y actualizado: praziquantel, con evolución satisfactoria. Conclusiones: la literatura describe fallos del tratamiento en los que se ha requerido más de un ciclo de praziquantel, lo cual no es muy frecuente, pero ocurrió en el caso que se presenta. Se le orientó a la paciente tomar el medicamento acompañado de alimentos. No refirió presentar efectos secundarios.

Introduction: intestinal schistosomiasis is a parasitic disease caused by helminths of the class trematode and genus Schistosoma, characterized by presenting in its acute stage diarrhea, dermatitis and abdominal pain, with high incidence in poor countries with insalubrity problems. The triggering factor of this parasitosis is associated to exposure to water contaminated by schistosomes eggs. It can be prevented with sanitation measures aimed at controlling sources of water supply. There is now high morbidity mainly in sub-Saharan Africa. The objective aimed at is explaining the epidemiology of this disease. Case report: the case of an adult female aged over 60 years is presented, with no history of the disease, which was on a medical collaboration in the province of Cunene in the sister Republic of Angola. She showed clinical symptoms during the months of January to March 2012, and it was confirmed by the laboratory as intestinal schistosomiasis. The specific and updated medication (praziquantel) was administered to the patient, with satisfactory results. Conclusions: the literature describes treatment failures in which it has been required more than one cycle of praziquantel, which is not very common, but occurred in the case presented. The patient was assigned to take the medication together with food. No side effects were referred as presented.

Parasitismo intestinal en niños de círculos infantiles en un municipio / Intestinal parasitism in children from daycare centers of a municipality

Introducción: el parasitismo intestinal representa un importante problema de salud mundial por su alta prevalencia y distribución universal. Constituye una importante causa de morbilidad y mortalidad en lactantes y niños de todo el orbe. Objetivo: identificar la prevalencia de las principales especies parasitarias intestinales en círculos infantiles del municipio La Palma. Método: se realizó un estudio observacional descriptivo transversal, durante los meses de octubre y noviembre 2012, en el que se estudiaron 495 niños asistentes a los seis círculos infantiles del municipio La Palma. Fueron recolectadas por cada niño, 3 muestras fecales frescas, en días alternos, las que se procesaron con los métodos coproparasitológicos de examen directo y técnica de concentración de Ritchie- Willis. Resultados: el 48,3% de la muestra estaba parasitada, con una mayor prevalencia en el quinto año de vida (58,8%), predominó el sexo masculino (54,8%). Las especies más frecuentes fueron Giardia lamblia (38,1%), Entamoeba histolytica (30,1%) y Enterobius vermicularis (19,2%). El poliparasitismo se apreció (12,2%) de los niños, la asociación de parásitos muestra a Giardia lamblia en tres combinaciones. Junto al Enterobius vermicularis (37,2 %), con Entamoeba histolytica/E dispar (33,3 %) y los tres a la vez (29,4%). Conclusiones: aproximadamente la mitad de los niños estudiados se encontraban parasitados, estos resultados fueron más frecuentes a partir del cuarto año de vida, con una mayor prevalencia en el sexo masculino en todas las especies parasitarias, predominado las infecciones por protozoarios, con mayor frecuencia Giardia lamblia y asociaciones de parásitos en varios casos.

Introduction: intestinal parasitism is a major global health problem because of its high prevalence and universal distribution. It is an important cause of morbidity and mortality in infants and children around the world. Objective: to identify the prevalence of major intestinal parasitic species in daycare centers of La Palma. Method: an observational descriptive study was conducted during the months of October and November of 2012, in which 495 children were studied, attending the six daycare centers of La Palma Municipality. Three fresh fecal samples were collected from each child, on alternate days, and processed with direct parasitological methods and technical examination of Ritchie-Willis concentration. Results: 48.3% of the samples were parasitized, with a higher prevalence in the fifth year of life (58.8%), the male sex was the predominant one (54.8%). The most frequent species were Giardia lamblia (38.1%), Entamoeba (30.1%) and Enterobius vermicularis (19.2%). Polyparasitism was observed in 12.2% of the children, being the association of parasites Giardia lamblia shown in three combinations. Together with Enterobius vermicularis (37.2%), with histolytica Entamoeba (33.3%), and with the three of them at the same time (29.4%). Conclusions: about half of the children studied were parasitized; these results were more frequent after the fourth year of life, with a higher prevalence in male children and all parasitic species, with a predominance of protozoal infections, most often Giardia lamblia parasite associations in several cases.

Nivel de pobreza y estado nutricional asociados a parasitosis intestinal en estudiantes, Huánuco, Perú, 2010 / Poverty and nutritional status-related intestinal parasitism in students, Huanuco, Peru, 2010

Introducción: Se ha encontrado una prevalencia alta de parasitosis en escolares de la amazonía; pese a ello, no hay estudios realizados que revisen su asociación con el nivel socioeconómico y estado nutricional. Objetivos: Determinar la relación entre nivel de pobreza y estado nutricional con la presencia de parásitos intestinales en estudiantes escolares del caserío Venenillo, Huánuco. Diseño: Estudio transversal-analítico. Lugar: Caserío de Venenillo, Huánuco. Participantes: Estudiantes escolares de la única institución educativa del centro poblado. Intervenciones: A 42 estudiantes se les realizó examen coproparasitológico mediante observación directa con lugol y técnica de sedimentación rápida de Lumbreras. El nivel de pobreza fue determinado mediante el índice de necesidades básicas insatisfechas (NBI); y el grado de desnutrición, por medio del índice de Waterlow. El análisis estadístico fue realizado mediante el coeficiente gamma de Goodman y Kruskal. Principales medidas de resultados: Relación de parasitosis intestinal con pobreza y estado nutricional. Resultados: Los parásitos intestinales estuvieron presentes en 97,6%. Se encontró asociación significativa entre el nivel de parasitismo y el nivel de pobreza (p=0,02; gamma=0,82). No se encontró asociación significativa entre nivel de desnutrición y parasitismo (p=0,77). Conclusiones: La parasitosis intestinal se asoció al nivel de pobreza, no así con el nivel de desnutrición en la población de estudio.

Introduction: Studies have reported high prevalence of parasitic disease in students from the jungle although none has associated it with poverty and nutritional factors. Objectives: To determine the relationship between poverty and nutritional factors with the presence of intestinal parasites in students from a Huanuco village. Design: Cross-sectional study. Setting: Venenillo hamlet, Huanuco, Peru. Participants: Students from the only school in Venenillo. Interventions: Parasitological examination by Lugol’s iodine direct examination and Lumbreras' fast sedimentation technique was performed in 42 students. Level of poverty was determined by the unsatisfied basic needs index and degree of malnutrition by the Waterlow index. Statistical analysis was performed using Goodman and Kruskal’s gamma coefficient. Main outcome measures: Intestinal parasitosis association with poverty and nutritional status. Results: Presence of intestinal parasites was 97.6%. A strong association was found between parasitism and level of poverty (p=0.02, gamma=0.82). There was no significant association between level of malnutrition and parasitism. Conclusions: Association between intestinal parasitosis and poverty was encountered in the studied population.

El sentido de las enfermedades por parásitos intestinales en poblaciones americanas, identificando dilemas bioéticos / The sense of intestinal parasitic diseases in american populations, identifying bioethical dilemmas / O sentido de parasitoses intestinais em populações americanas, identificando dilemas bioéticos

Objetivo: Identificar sentidos que pueblos del continente americano le asignan a las parasitosis intestinales y plantear posibles conflictos o dilemas en las tomas de decisiones en diferentes actividades de salud producto del encuentro de valores distintos, campo de acción de la bioética. Metodología: Revisión bibliográfica de artículos sobre parasitosis intestinales que cumplieran los criterios de inclusión establecidos y suministraran aportes para la comprensión hermenéutica de las parasitosis intestinales y permitieran identificar dilemas bioéticos para actividades en salud resultantes del contacto entre las visiones émica y ética (de la biomedicina). Resultados: La construcción social de las parasitosis intestinales influye en su percepción de causalidad, nocividad y como problema de salud, lo cual afecta las acciones que la gente emprenda ante ellas. Se advierte que tales construcciones sociales pueden no coincidir con la perspectiva biomédica. Se observó que en algunas poblaciones la construcción social del cuerpo se relaciona con la percepción de efectos benéficos de los parásitos. La gente reconoce factores de riesgo pero esto no necesariamente conduce a comportamientos preventivos. Algunos estudios reconocen que la educación ha sido de tipo informativo, sin participación comunitaria, lo cual impide que la gente se identifique con ella y se sienta motivada a transformar su realidad. Se identificaron diversos dilemas bioéticos producto del contacto entre visiones de las poblaciones, y la biomedicina. Conclusiones: La aproximación émica permite entender la lógica de la población sobre las parasitosis intestinales e identificar disyuntivas bioéticas. Aunque la gente reconozca los riesgos de infección, la falta de comprensión de la perspectiva émica de los parasitismos por parte del personal de salud y las deficientes condiciones de vida permiten que no se produzcan transformaciones que incidan en la disminución de sus prevalencias. Eso mismo afectará el éxito de programas de atención, prevención, promoción y educación en la salud. Pero el análisis de la visión émica, aunque es fundamental, no lo es todo. En el problema de las parasitosis intestinales intervienen también condiciones infraestructurales, que conllevan situaciones conflictivas para los profesionales de la salud, como agentes externos a las comunidades. Se pueden hacer campañas de educación que efectivamente mejoren la prevención, pero realidades socio-económicas (por ejemplo, pobreza, participación comunitaria, empoderamiento,) y políticas (compromisos y acciones de líderes y gobiernos a diferentes niveles) pueden incidir para que lo que se aprendió no surta el efecto deseado o que se modifiquen las condiciones estructurales que generan los problemas. En este punto se generan problemas morales que deberían ser analizados por la bioética.

Objective: Identifying meanings that American populations assign to parasitic intestinal diseases and raising potential conflicts or dilemmas in making-decision in various health activities result of the contact between traditional and biomedical perspectives. Methodology: Bibliographic review on intestinal parasites that met the inclusion criteria and supply insights for hermeneutics understanding of intestinal parasites and allow identify bioethical dilemmas for health activities resulting from contact between the emic and ethical visions (of biomedicine). Results: The social construction of parasitic intestinal diseases influences their perception of causality, harmfulness and as a health problem. This affects actions that people undertake to these diseases. People's perception of the diseases can be different to the health professionals. Sometimes ethnoanatomy is related to beneficial effects from the parasites. People recognize risk factors but this does not necessarily lead to preventive behaviors. Some researches recognize informative education without community participation is not successful because people do not feel motivated to transform your reality. There were established various bioethical dilemmas arising from contact between emic and biomedical perspectives. Conclusions: Emic approach allows us to understand people's logic about intestinal parasites. Although people recognize infection risks from an etic perspective, health officers' lack of understanding of emic perspective of parasitic intestinal diseases, and the poor living conditions cannot produce changes that affect the reduction on prevalence rates. Those facts will affect the success of care, prevention, promotion and health education programs. The emic perspective is not definitely. There are a lot of infrastructural conditions that developed different conflict situations for the work of the health professionals. They can provide elements for prevention and promotion strategies and programs, but depending on the socio-economical (poverty, community participation and empowerment) and political (i.e. leadership, formal commitments) conditions can be used or not. The last conclusion is that many ethical and moral problems must be analyzed by bioethics.

Objetivo: Identificar sentidos que povos das Américas atribuem às parasitoses intestinais e formular potenciais conflitos ou dilemas nas tomada de decisões em várias atividades de saúde produto do encontro de valores diferentes, o escopo da bioética. Metodologia: pesquisa de artigos sobre parasitoses intestinais que atenderam aos critérios de inclusão e forneceram contribuições para a compreensão hermenêutica das parasitoses intestinais e permitiram identificar dilemas bioéticos para atividades de saúde decorrentes do contato entre as visões émicas e éticas (da biomedicina). Resultados: A construção social das parasitoses intestinais influencia na sua percepção de causalidade, nocividade e como um problema de saúde, o que afeta as ações que as pessoas empreendem diante deles. Você é avisado de que tais construções sociais podem não corresponder à perspectiva biomédica. Observouse que em algumas populações, a construção social do corpo está relacionada com a percepção de efeitos benéficos dos parasitas. As pessoas reconhecem fatores de risco, mas isso não conduz necessariamente a comportamentos preventivos. Alguns estudos reconhecem que a educação tem sido do tipo informativo, sem a participação da comunidade, o que impede que as pessoas se identifiquem com ela e se sinta motivada para mudar sua realidade. Identificaramse vários dilemas bioéticos produto do contato entre as visões das populações e da biomedicina. Conclusões: A abordagem émica permite entender a lógica das pessoas sobre os parasitas intestinais, e identificar os dilemas bioéticos. Embora as pessoas reconheçam os riscos de infecção, a falta de compreensão da perspectiva émica dos parasitismos por parte do pessoal de saúde e as condições de vida precárias permitem que não haja transformações que afetem na diminuição das suas prevalências. Isso mesmo afetará o sucesso de programas de atenção, prevenção, promoção e educação em saúde. Mas, a análise da visão émica, embora seja essencial, não é tudo. No problema das parasitoses intestinais também interferem condições de infraestrutura, que implicam situações conflitivas para os profissionais de saúde, e para agentes de fora para as comunidades. Você pode fazer campanhas de educação que efetivamente melhorem a prevenção, mas realidades socioeconômicas (por exemplo, pobreza, participação da comunidade, empoderamento) e políticas (compromissos e ações de líderes e governos em diferentes níveis) podem influenciar para que o que é se aprendeu não dei o efeito pretendido ou que se modifiquem as condições estruturais que criam os problemas. Neste momento são gerados questões morais que deveriam ser analisados pela bioética.

Factors influencing growth and intestinal parasitic infections in preschoolers attending philanthropic daycare centers in Salvador, Northeast Region of Brazil / Crescimento linear e infecções parasitárias intestinais em pré-escolares matriculados em creches filantrópicas de Salvador, Nordeste do Brasil

Poor growth and intestinal parasitic infections are widespread in disadvantaged urban children. This cross-sectional study assessed factors influencing poor growth and intestinal parasites in 376 children aged three to six years in daycare centers in Salvador, in the Northeast Region of Brazil. Data was obtained from seven daycare centers on child weight, height, socio-economic status, health and intestinal parasites in stool samples. Prevalence of moderate underweight (< -1SD > -2SD), wasting and stunting was 12%, 16% and 6% respectively. Socioeconomic status, birth order, and maternal weight were predictors of poor anthropometric status. Almost 30% of children were infected with more than one intestinal parasite. Helminths (17.8%), notably Trichuris trichiura (12%) and Ascaris lumbricoides (10.5%), and protozoan Giardia duodenalis (13%) were the most common types of parasites detected. One percent of children had hookworm and Cryptosporidium sp. and 25% had non-pathogenic protozoan cysts. Boys from families with very low socio-economic status had lower linear growth and presented a greater risk of helminth infection. Deworming is considered an alternative for reducing the prevalence of intestinal parasitic infections in this age group.

Déficit de crescimento e parasitoses são comuns entre crianças residentes em periferias. Em estudo transversal com 376 pré-escolares (3-6 anos) de creches em Salvador, Nordeste do Brasil, avaliamos fatores predisponentes para déficit de crescimento e parasitose. Obtiveram-se dados em sete creches sobre peso da criança, altura, nível socioeconômico, estado de saúde e parasitos em amostras de fezes. Prevalência de baixo peso (-1 < DP > -2), desnutrição e baixa estatura foram 12%, 16%, e 6%, respectivamente; nível socioeconômico, ordem de nascimento e peso materno foram preditores da antropometria. Aproximadamente 30% estavam infectados com ≥ 1 parasita. Helmintos (17.8%), notavelmente Trichuris trichiura (12%) e Ascaris lumbricoides (10.5%) e protozoário Giardia duodenalis (13%) foram os mais comuns; < 1% tinha ancilostomíase e Cryptosporidium sp.; 25% apresentaram protozoários cistos não patogênicos. Meninos de famílias muito pobres tiveram menor crescimento e maior risco de helmintose. A desparasitação pode ser considerada uma alternativa para a redução da prevalência de parasitoses intestinais nesse grupo etário.

Parasitismo intestinal infantil: factores epidemiológicos en Orange Walk, Belice / Intestinal parasitism in children: epidemiological factors in Orange Walk, Belize

El parasitismo intestinal (PI) continúa siendo un problema de salud en Centroamérica y el Caribe. Se realizó una investigación aplicada, epidemiológica, descriptiva, transversal, en el Distrito urbano de Orange Walk, (Belice), año 2009, con el objetivo de identificar los factores causales de riesgo epidemiológico. El universo lo constituyeron los 566 niños de 0 - 4 años, la muestra fue 400 niños; mediante un muestreo no probabilístico intencional se realizó el examen directo de heces fecales, constituyéndose dos estratos muestrales. Fueron utilizados los métodos empíricos de investigación: cuestionario, guía de observación y teóricos; utilizando para el procesamiento de datos la estadística descriptiva, frecuencias absolutas, relativas, proporción, índice y riesgo relativo, comparación de dos y k- proporciones, prueba no paramétrica ji cuadrado. Resultaron más heces fecales positivas que negativas, no estuvo relacionado el sexo con aparición de parásitos, edad predominante de 3 - 4 años, índice de atenciones médicas de 41.34/100 habitantes, parásito más frecuente: Giardia lamblia. Las manifestaciones clínicas predominantes: dolor abdominal, diarrea y la pérdida de peso. Principales factores causales epidemiológicos: no hervir el agua, disposición inadecuada de residuales y juegos con tierra, hubo una recurrencia de 2 episodios/niño y un riesgo relativo de contraer PI de 1.3 veces, más elevado para niños en condiciones higiénicas desfavorables, población con una educación sanitaria no adecuada y baja escolaridad de padres. Se concluyó que el PI constituye un problema de salud.

Intestinal parasitism (IP) is still a health problem in Central America and Caribbean Countries. An applied, epidemiological, descriptive, cross-sectional research was conducted at the urban district of «Orange Walk¼, Belize in 2009 with the purpose of identifying the causal factors of epidemiological risk. The target group was comprised of 566 children (0-4 years old), the sample (400 children) was taken by means of intentional non-probabilistic sampling and a direct feces examination; representing two sampling strata. Empiric methods of investigation were used: questionnaires, observation guidebook and theoretical. To process the data, descriptive statistics, absolute and relative frequencies were used; ratios, rate with relative risk, comparison of two and k-proportions, plus non-parametric chi square test as well. More positive feces prevailed over negative ones, observing no relation to the sex and the onset of parasites, children of 3-4 years old prevailed. The rate of medical care was 41.34/100 inhabitants, Giardia lamblia was the most frequent parasite found. The clinical signs of: abdominal pain, diarrhea, weight loss. The main causal epidemiological factors were: no water boiling, inadequate sewage disposal and plays on the ground. Recurrence had 2 events per child and a relative risk of suffering from the infection of 1.3 times, greater for children living in unfavourable hygienic situation: inhabitants with poor sanitary education and parents with low-schooling level. Intestinal Parasitism constitutes a health problem.

Prevalência de parasitoses intestinais entre crianças de 4-12 anos no Crato, estado do Ceará: um problema recorrente de saúde pública / Prevalence of intestinal parasite infections among 4- to 12-year-old children in Crato, Ceará State

Nesse estudo, foi estimada a frequência de parasitoses intestinais em 383 crianças do bairro Pinto Madeira em Crato, Estado do Ceará. Os dados foram obtidos por meio de inquérito domiciliar e de exame coproparasitológico abrangendo residências com crianças de quatro a 12 anos, foram utilizados os métodos de Kato-Katzo e Faust. Foi identificada uma associação de parasitoses intestinais com saneamento, disponibilidade e manuseio da água, com prevalência de Ascaris lumbricoides dentre os helmintos e Entamoeba sp. dentre os protozoários. Os dados obtidos demonstraram ainda a que prevalência de helmintos e protozoários foi significativamente maior para as crianças do sexo masculino de 4-5 anos e feminino de 6-7, filhos de mães com menor escolaridade, residentes nos domicílios com piores condições de abastecimento d’água e menor condições de higiene corporal e saneamento básico. Estes resultados sugerem que investimentos em infraestrutura básica e a adoção de políticas voltadas para melhorar a educação familiar poderiam contribuir significativamente na redução da prevalência das parasitoses intestinais em crianças.

In this study, we estimated the frequency of intestinal parasites in 383 children in the Pinto Madeira neighborhood of Crato-Ceará State. A survey was conducted covering households with 4- to 12-year-old children, including interviews and coprological surveys using the Kato-Katz and Faust methods. An association was identified between intestinal parasitosis and sanitation, forms of use and availability of water. The prevalence of Ascaris lumbricoides and Entamoeba sp was demonstrated. The data also showed that the prevalence of helminths and protozoa was significantly higher for 4- to 5-year-old boys and 6- to 7-year-old girls, children of mothers with less education, living in households with poor conditions of water supply, hygiene and sanitation. These results suggest that investments in sanitary structure and the adoption of policies to improve family education could help significantly in reducing the prevalence of intestinal parasites in children.