School-based control of soil-transmitted helminthiasis in western Visayas, Philippines.

We evaluated the effect of a local government unit-led, school-based, teacher-assisted mass drug administration (MDA) treatment of soil-transmitted helminthiasis (STH) on the morbidity of school children in selected provinces of western Visayas, the Philippines. Parasitological assessment was done on stool samples using the Kato-Katz technique. Nutritional status and school performance were also evaluated using secondary data from the Department of Education. The overall prevalence of STH decreased from 71.1% to 44.3% (p < 0.0001) and the prevalence of heavy infection with STH decreased from 40.5% to 14.5% (p < 0.0001), after two years of biannual MDA. The prevalence of underweight children decreased from 26.2% to 17.8% (p < 0.0001) and the prevalence of stunted children decreased from 20.9% to 16.6% (p < 0.0001) after two years of biannual MDA. School performance improved on standardized testing from a mean percentage of 53.8% to 64.6%. Advocacy, social mobilization, strong local government support and intersectoral collaboration with other agencies probably contributed to the success of the program.

Field evaluation of malaria rapid diagnostic tests for the diagnosis of P. falciparum and non-P. falciparum infections.

The objective of this study was to evaluate various malaria rapid diagnostic tests as a tool in the detection of P. falciparum and non-P. falciparum infections in field conditions. Four field surveys were conducted in malaria-endemic areas of Palawan and Davao del Norte, Philippines to validate the various rapid diagnostic tests, namely Diamed OptiMAL 48 (DiaMed AG, Switzerland), ParaHIT f (Span Diagnostics, India), Orchid OptiMAL, and Paracheck Pf (both from Orchid Biomedical Systems, India). The results of the various rapid diagnostic tests were compared to those of microscopy. Sensitivity, specificity and detection rates according to the level of parasitemia were used as parameters to describe the performance of the various rapid diagnostic tests in the field. Practical and operational assessments were also done. The results of the study show that the sensitivity and detection rates were generally lower than previously reported, with sensitivities ranging from 4.8% to 20.6%, except for Diamed OptiMAL 48, which had sensitivities of 78.8% to 96.8%, and detection rates of 50.0% to 96.8%. The rest had detection rates ranging from 0.0% to 50.0%. All the specificities ranged from 18.2% to 100.0%. Improper conditions at the time of manufacturing, storage, transport, and utilization may affect the validity of the results. Rapid diagnostic tests for malaria provide practical means of detecting malarial infections, especially in endemic areas. However, issues regarding variability in performance must to be addressed before they can be used as mainstream diagnostic tools.

A comparison of the efficacy of single doses of albendazole, ivermectin, and diethylcarbamazine alone or in combinations against Ascaris and Trichuris spp.

OBJECTIVE: To determine the efficacy of single doses of albendazole, ivermectin and diethylcarbamazine, and of the combinations albendazole + ivermectin and albendazole + diethylcarbamazine against common intestinal helminthiases caused by Ascaris and Trichuris spp. METHODS: In a randomized, placebo-controlled trial, infected children were randomly assigned to treatment with albendazole + placebo, ivermectin + placebo, diethylcarbamazine + placebo, albendazole + ivermectin, or albendazole + diethylcarbamazine. The Kato-Katz method was used for qualitative and quantitative parasitological diagnosis. The chi2 test was used to determine the significance of cure rates, repeated measures analysis of variance for the comparison of mean log egg counts, the Newman-Keuls procedure for multiple comparison tests, and logistic regression for the comparison of infection rates at days 180 and 360 after treatment. FINDINGS: Albendazole, ivermectin and the drug combinations gave significantly higher cure and egg reduction rates for ascariasis than diethylcarbamazine. For trichuriasis, albendazole + ivermectin gave significantly higher cure and egg reduction rates than the other treatments: the infection rates were lower 180 and 360 days after treatment. CONCLUSION: Because of the superiority of albendazole + ivermectin against both lymphatic filariasis and trichuriasis, this combination appears to be a suitable tool for the integrated or combined control of both public health problems.

Intestinal heterophyidiasis: an emerging food-borne parasitic zoonosis in southern Philippines.

Heterophyidiasis is an infection of the small bowel by minute intestinal flukes of the genus Heterophyes or related members of the family Heterophyidae. To provide a better understanding of this rarely reported condition, this study attempted to determine the infection rate, intensity of infection as well as the clinical spectrum of heterophyid infection. A stool survey was conducted in barangay San Isidro, Monkayo, Compostela Valley. Thirty-six percent of patients with history of bowel disturbance (abdominal discomfort/pain and/or diarrhea) in the past 4 weeks were found to have heterophyidiasis. All age groups were infected, with the youngest patient being 1 year 7 months of age, while the oldest patient was 73 years of age. Prevalence was highest in the 15 to 30 years old group at 55.3%. The most common clinical manifestations of heterophyidiasis were signs and symptoms of acid peptic or peptic ulcer disease. Early diagnosis and treatment are important to ensure prompt resolution of heterophyid infection, hence, decreased morbidity and decreased chances for complications like heart or brain involvement. Proficiency of laboratory staff should be enhanced to ensure accurate diagnosis which will then make appropriate treatment possible.

Compostela Valley: a new endemic focus for Capillariasis philippinensis.

A 20 year old female from Compostela Valley Province in the Philippines, presenting with chronic diarrhea, borborygmi, bipedal edema, anorexia and weight loss was seen at Davao Regional Hospital. Her stool specimen, suspected by a local medical technologist to have Capillaria philippinensis ova, was forwarded to the Diagnostic Parasitology Laboratory of the College of Public Health, University of the Philippines Manila. It was examined and found to contain Capillaria philippinensis adults, larvae and eggs. Twelve deaths among people coming from the same barangay, affected by a similar illness with no definite diagnosis except "gastroenteritis" were also reported. These prompted health officials to send a team that would investigate the etiology of the disease outbreak labeled as a "Mystery Disease". Seventy-two stool samples from symptomatic patients were examined. Fifty-three (73.6%) individuals were proven to harbor at least one parasite with 16 (22.2%) individuals positive for Capillaria philippinensis infection. Ocular inspection, interviews and focus group discussions revealed that the people's eating habits are not much different from the habits of those from the Ilocos provinces where capillariasis was initially described. In both areas, people are fond of eating kinilaw or raw fish. They also eat raw shrimps, crabs and snails. Furthermore, the people defecate in the field or in the same body of water where they get the fishes, shrimps, crabs and snails that they eat, thus completing the life cycle of Capillaria philippinensis. Fish-eating birds were likely to have spread this parasite to the area. This is the first report of a capillariasis outbreak in Compostela Valley Province, and this should alert health authorities to consider embarking on serious efforts for developing proficiency of laboratory and clinical diagnosis especially in government health facilities where the poor and marginalized sectors of society are likely to consult.