Impact of COVID-19 on Depression, Anxiety, Stress, Coping, and Grief in Pre-Health Professional Students in Lima, Peru.

Introduction: Peru had the world's highest death rate of COVID-19 with 213,000+ deaths and counting (Beaubien, 2021). Hospitalization and care for COVID-19 patients with limited resources has added stress to the shortage of frontline workers and resulted in students filling in the gap in acute care clinical settings. The purpose of this study was to examine the impact of COVID-19 on mental health (e.g., depression, anxiety, stress, and coping) and grief on undergraduate nursing and pharmacy students in Lima, Peru. Methods: This was a quantitative, descriptive study that examined students' self-report of mental health and grief at baseline during data collection. Results: Significant findings were reported in coping based on death of family member of COVID-19 (p = .02). Anxiety was positively correlated with grief (Rho = 0.35, p < .001), stress (Rho = 0.53, p < .001), and depression (Rho = 0.76, p < .001). Grief was positively correlated with stress (Rho = 0.25, p < .001) and depression (Rho = 0.39, p < .001). Finally, stress was positively correlated with depression (Rho = 0.51, p < .001). Discussion: This is the first study to explore nursing and pharmacy students' perceptions on how the COVID-19 pandemic impacted their mental health.

Risk Stratification to Guide Prevention and Control Strategies for Arboviruses Transmitted by Aedes aegypti.

Strategies for the prevention of arboviral diseases transmitted by Aedes aegypti have traditionally focused on vector control. This remains the same to this day, despite a lack of documented evidence on its efficacy due to a lack of coverage and sustainability. The continuous growth of urban areas and generally unplanned urbanization, which favor the presence of Ae. aegypti, demand resources, both material and human, as well as logistics to effectively lower the population's risk of infection. These considerations have motivated the development of tools to identify areas with a recurrent concentration of arboviral cases during an outbreak to be able to prioritize preventive actions and optimize available resources. This study explores the existence of spatial patterns of dengue incidence in the locality of Tartagal, in northeastern Argentina, during the outbreaks that occurred between 2010 and 2020. Approximately half (50.8%) of the cases recorded during this period were concentrated in 35.9% of the urban area. Additionally, an important overlap was found between hotspot areas of dengue and chikungunya (Kendall's W = 0.92; p-value < 0.001) during the 2016 outbreak. Moreover, 65.9% of the cases recorded in 2022 were geolocalized within the hotspot areas detected between 2010 and 2020. These results can be used to generate a risk map to implement timely preventive control strategies that prioritize these areas to reduce their vulnerability while optimizing the available resources and increasing the scope of action.

Asociación entre los estilos de crianza y el rol de los adolescentes peruanos en el acoso escolar, 2019 / Association between parenting styles and the role of Peruvian adolescents in bullying, 2019 / Associação entre estilos parentais e o papel de adolescentes peruanos no bullying, 2019

Introducción. Los estilos de crianza determinan la conducta infantil; sin embargo, existe escasa información sobre su repercusión en el acoso escolar. Objetivo: Determinar la fuerza de asociación entre las diferentes tipologías de los estilos de crianza y el rol asumido en el acoso escolar, así como identificar perfiles de los adolescentes según su involucramiento en el acoso escolar. Materiales y métodos. Estudio transversal tipo analítico, realizado en Lima-Perú, en el año 2019. Se aplicó la escala de estilos de crianza de Steinberg y la escala EBIP-Q a 563 escolares de escuelas públicas. Los puntajes fueron obtenidos mediante un análisis factorial confirmatorio. Se empleó el coeficiente de correlación de Spearman, Chi Cuadrado de Pearson y análisis de regresión logística multinomial. Resultados. Existe asociación entre los estilos de crianza y el rol del adolescente en el acoso escolar. El análisis multivariado reportó que ser hombres se asocia con el rol de agresor (OR = 2,73); mientras que acceder a una red social (OR = 2,23), ser hombre (OR = 1,75), los estilos de crianza (negligente [OR = 2,72] y mixto [OR = 0,38] en comparación con autoritario) fueron predictores de asumir el rol de agresor victimizado en el acoso escolar. Discusión. La asociación encontrada en el estudio confirma hallazgos previos; sin embargo, se abre debate sobre la influencia del estilo de crianza negligente en la dinámica del acoso escolar. Conclusión. Tanto el estilo de crianza negligente y autoritario (menor proporción) tienen un efecto positivo y significativo en el rol de agresor victimizado.

Introduction: Parenting styles determine child behavior; however, there is little information on their impact on bullying. Objective: To determine the association between different parenting styles and the role assumed in bullying, as well as to identify adolescents' profiles according to their involvement in bullying. Materials and Methods: A cross-sectional analytical study was conducted in Lima, Peru, in 2019. The Steinberg's Parenting Styles Scale and the European Bullying Intervention Project Questionnaire (EBIP-Q) were administered to 563 students from public schools. Scores were obtained by confirmatory factor analysis. Spearman's correlation coefficient, Pearson's Chi-square test, and multinomial logistic regression analysis were used. Results: There is an association between parenting styles and adolescents' role in bullying. The multivariate analysis reported that being male was associated with the role of the bully (OR: 2.73; 95% CI 1.59­4.68), while access to social media (OR: 2.23; CI 95% 1.11­4.49), being male (OR: 1.75; CI=1.06­2.88), and parenting styles (neglectful [OR: 2.72; 95% CI 1.32­5.59] and mixed [OR: 0.38; 95% CI 0.16­0.91] compared to authoritarian parenting style) were predictors of the role of the victimized bully. Discussion: The association found in the study confirms previous findings; however, it opens the debate on the influence of neglectful parenting style on bullying dynamics. Conclusions: Both neglectful and authoritarian parenting styles (lower proportion) have a positive and significant effect on the role of victimized bully.

Introdução: Os estilos parentais determinam o comportamento das crianças; no entanto, há pouca informação sobre o seu impacto no bullying. Objetivo: Determinar a força da associação entre os diferentes estilos parentais e o papel assumido no bullying; bem como identificar perfis de adolescentes de acordo com seu envolvimento no bullying. Materiais e métodos: Estudo analítico transversal realizado em Lima-Peru em 2019. A escala de estilos parentais de Steinberg e a escala EBIP-Q foram aplicadas a 563 alunos de escolas públicas. Os escores foram obtidos por meio de uma análise fatorial confirmatória. Foram utilizados o coeficiente de correlação de Spearman, o Qui-Quadrado de Pearson e a análise de regressão logística multinomial. Resultados: Existe associação entre os estilos parentais e o papel do adolescente no bullying. A análise multivariada relatou que ser do sexo masculino está associado ao papel de agressor (OR: 2,73; IC 95% 1,59-4,68); ao acessar uma rede social (OR: 2,23; IC 95% 1,11-4,49), ser do sexo masculino (OR: 1,75; IC=1,06-2,88), estilos parentais (negligente [OR: 2,72; IC 95% 1,32-5,59] e misto [OR: 0,38; IC 95% 0,16-0,91] comparado ao autoritário) foram preditores de assumir o papel de agressor vitimizado no bullying. Discussão: A associação encontrada no estudo confirma achados anteriores; no entanto, abre-se um debate sobre a influência do estilo parental negligente na dinâmica do bullying. Conclusão: Tanto o estilo parental negligente quanto o autoritário (menor proporção) têm efeito positivo e significativo no papel do agressor vitimizado.

Conocimiento sobre sistemas de denuncia del acoso escolar y tipo de intervención del adolescente espectador / Knowledge about School Bullying Reporting Systems and the Type of Intervention of the Adolescent Witness

Introducción: El acoso escolar constituye un problema de salud pública por su repercusión en el presente y futuro de los escolares, donde el rol de espectador cobra cada día mayor relevancia. Objetivo: Describir los conocimientos sobre los sistemas de denuncia del acoso escolar y tipo de intervención del adolescente espectador en escuelas públicas de Lima. Métodos: Estudio descriptivo transversal realizado en 668 estudiantes de escuelas públicas ubicadas en Lima, Perú, entre agosto y diciembre del 2019. Muestreo no probabilístico por conveniencia. Mediante la encuesta y empleo de un cuestionario se evaluó el tipo de intervención ante el acoso escolar y el conocimiento sobre sistemas de denuncia del acoso escolar. Para el análisis de los datos se empleó la prueba estadística de Chi Cuadrado de Pearson con un nivel de significancia p < 0,05. Resultados: Presenció una situación de violencia escolar entre pares el 59,82 por ciento, de ellos 63,34 por ciento intervino ante esa situación. Hubo diferencias estadísticamente significativas en el porcentaje de escolares que intervinieron según sexo y año de estudios. El 51,39 por ciento defendió a la víctima o conversó con el agresor. En cuanto al conocimiento de sistemas de reporte de violencia escolar, 24,21 por ciento conocía SiSeve y 64,73 por ciento conocía la DEMUNA. Conclusiones: El principal tipo de intervención de los estudiantes que fueron espectadores ante una situación de acoso escolar fue defender a la víctima o conversar con el agresor. Por otra parte, existe escaso conocimiento de la existencia de SiseVe entre los escolares, aunque la mayoría conocía la DEMUNA(AU)

Introduction: School bullying is a public health concern due to its impact on the present and future of schoolchildren, where the role of bystander becomes more relevant every day. Objective: To describe the knowledge about the systems for reporting bullying and the type of intervention of adolescent bystanders in public schools in Lima. Methods: Cross-sectional and descriptive study carried out with 668 students chosen from public schools in Lima, Peru, by nonprobabilistic convenience sampling between August and December 2019. A survey and a questionnaire permitted to assess the type of intervention in the face of bullying and knowledge about systems for reporting bullying. Pearson's chi-square test was used for data analysis with a significance level of P<0.05. Results: A situation of school violence among peers was witnessed by 59.82 percent of the respondents, 63.34 percent of which intervened in this situation. Based on sex and year of study, there were statistically significant differences in the percentage of schoolchildren who intervened. 51.39 percent defended the victim or talked with the aggressor. Regarding knowledge about school violence reporting systems, 24.21 percent know about the existence of SiSeve, while 64.73 percent knew DEMUNA. Conclusions: The main type of intervention of students who witnessed a bullying situation was to defend the victim or talk with the aggressor. On the other hand, there is little knowledge about the existence of SiseVe among the students, although most of them knew about DEMUNA(AU)

Validation of a Bullying Scale in Peruvian Adolescents and Gender-Specific Differences.

The objective of the study was to evaluate the psychometric properties of the European Bullying Intervention Project Questionnaire (EBIPQ) inPeruvian adolescents and to determine gender-specific differences. The sample comprised 532 students in sixth grade of elementary school to third grade of high school. To validate the instrument, we requested an expert judgement and conducted a pilot test. Subsequently, we performed the exploratory factorial analysis, which showed that all the questions were correctly loaded in both components, an aspect that explained the 48.6%variance. We determined the reliability by means of the internal-consistency method using the Cronbach's alfa (αtotal= .856;αvictimization= .807;αaggression= .828). We found gender-specific differences in bullying roles(p<.001). In conclusion, the factorial structure of the EBIPQ in Peruvian adolescents is similar to the original questionnaire and presents high reliability and construct validity.

El estudio tuvo como objetivo evaluar las propiedades psicométricas del European Bullying Intervention Project Questionnaire (EBIPQ) en adolescentes peruanos y determinar sus diferencias según el género. La muestra estuvo conformada por 532 escolares de sexto grado de Primaria a tercer grado de Secundaria. Para la validez del contenido, se realizó el juicio de expertos y una prueba piloto. Posteriormente, se realizó el análisis factorial exploratorio, el cual mostró que todas las preguntas fueron cargadas en forma correcta en los dos componentes, lo que explica el 48.6% de varianza. La confiabilidad se estableció mediante el método de consistencia interna, a través del Alfa de Cronbach (αtotal=.856;αvictimización= .807;αagresión= .828). Se encontraron diferenciasen el rol de acoso escolar según el género (p<.001).En conclusión, la estructura factorial del EBIPQ en adolescentes peruanos es similar al cuestionario original y presenta elevada confiabilidad y validez de constructo.

Validation of the Steinberg Parenting Styles Scale in Peruvian adolescents.

Introduction: There are numerous scales of parenting styles adapted for Peruvian adolescents. In addition, some report a structural model that does not match the model of the original version. Objective: Evaluate the psychometric properties of the Steinberg's Parenting Styles Scale in Peruvian adolescents. Method: The sample included 563 students. A model of relationships in three dimensions is confirmed: involvement, psychological autonomy, and parental supervision. Results: The analysis suggested the elimination of five items. The resulting scale shows a good fit: χ 2 = 469.051, df = 184, χ 2 /df = 2.54, CFI = .95, TLI = .94, RMSEA = .053, SRMR = .063. Likewise, it shows an optimal internal consistency determined by the McDonald's omega index. Conclusion: The internal structure of the questionnaire was similar to the original questionnaire and presented adequate reliability and construct validity. however, additional studies with larger age range samples and different Peruvian subcultures are required to achieve its generalization.

Introducción: Existen numerosas escalas de estilos de crianza adaptadas para adolescentes peruanos. Además, algunos reportan un modelo estructural que no coincide con el modelo de la versión original. Objetivo: Evaluar las propiedades psicométricas de la escala de estilos de crianza de Steinberg en adolescentes peruanos. Método: La muestra integró 563 estudiantes. Se confirma un modelo de relaciones en tres dimensiones: compromiso, autonomía psicológica y control parental. Resultados: El análisis sugirió la eliminación de cinco ítems. La escala resultante muestra un buen ajuste: χ 2 = 469.051, df = 184, χ 2 /df = 2.54, CFI=.95, TLI=.94, RMSEA=.053, SRMR=.063. Así mismo, da cuenta de una óptima consistencia interna determinada por el índice Omega McDonald. Conclusión: La estructura interna del cuestionario fue similar al cuestionario original y presentó adecuada confiabilidad y validez de constructo. Sin embargo, se requieren estudios adicionales con muestras de mayor rango de edad y diferentes subculturas peruanas para lograr su generalización.

Factores asociados a las actitudes hacia la violencia en escolares de las zonas urbano-marginales de Lima Metropolitana, 2019 / Factors associated with attitudes towards violence in schoolchildren from marginal urban areas of Metropolitan Lima, 2019

RESUMEN Objetivo: Identificar los factores asociados a las actitudes hacia la violencia (AHV) en escolares de instituciones educativas (IE) públicas ubicadas en zonas urbano-marginales de Lima Metropolitana en 2019. Materiales y métodos: Estudio observacional, descriptivo y transversal. Los participantes fueron adolescentes de diez IE mixtas del sexto grado de primaria al tercer año de secundaria. Se empleó el cuestionario de actitudes hacia la violencia (CAHV25). En el análisis bivariado se empleó la prueba de coeficiente de correlación de Spearman, la U de Mann-Whitney y la H de KruskalWallis con post hoc de Dunn, ajustado por método de Bonferroni. Para determinar los factores asociados se realizó el análisis multivariado mediante un modelo de regresión binomial negative. Resultados: El 45,1% de escolares fueron de sexo femenino y el 87,3% recibió información sobre acoso escolar. En el análisis bivariado, se encontraron diferencias estadísticamente significativas entre los puntajes de las AHV con la edad (p=0,003), el sexo (p<0,001), tener una cuenta de red social (p = 0,009) y el año de estudios (p<0,001); sin embargo, en el modelo multivariado, los factores que estuvieron asociados al puntaje total de las AHV fueron la edad (p=0,012) y el sexo (p<0,001). Conclusión: Los factores asociados a las AHV en escolares de IE públicas fueron la edad y el sexo; estos hallazgos indicarían la necesidad de considerar la perspectiva de género en el análisis de la violencia escolar y diferenciar las intervenciones según edad.

ABSTRACT Objective: To identify factors associated with attitudes towards violence (ATV) in schoolchildren from public educational institutions (EI) located in marginal urban areas of Metropolitan Lima in 2019. Materials and methods: Observational, descriptive and transversal study. The sample was made up of adolescents from 10 mixed-gender EIs enrolled between the sixth grade of primary school and the third year of secondary school. The questionnaire of attitudes towards violence (CAHV-25) was used. During the bivariate analysis, the Spearman Correlation Coefficient, the Mann-Whitney U test and the Kruskal-Wallis H test with Dunn's post-hoc adjusted by Bonferroni were used. To determine the associated factors, multivariate analysis was performed using negative binomial regression model. Results: 45.1% of the schoolchildren were female and 87.3% received information on school bullying. In the bivariate analysis, statistically significant differences were found between the ATV scores and age (p = 0.003), sex (p < 0.001), having a social network account (p = 0.009) and year of study (p < 0.001); however, in the multivariate model, the factors associated with the total ATV scores were age (p = 0.012) and sex (p < 0.001). Conclusion: The factors associated with ATV in schoolchildren from public EIs were age and sex, these findings would indicate the need to consider the gender perspective in the analysis of school violence and differentiate interventions according to age.

Factors associated with attitudes towards violence in schoolchildren from marginal urban areas of Metropolitan Lima, 2019. / Factores asociados a las actitudes hacia la violencia en escolares de las zonas urbano-marginales de Lima Metropolitana, 2019.

OBJECTIVE: To identify factors associated with attitudes towards violence (ATV) in schoolchildren from public educational institutions (EI) located in marginal urban areas of Metropolitan Lima in 2019. MATERIALS AND METHODS: Observational, descriptive and transversal study. The sample was made up of adolescents from 10 mixed-gender EIs enrolled between the sixth grade of primary school and the third year of secondary school. The questionnaire of attitudes towards violence (CAHV-25) was used. During the bivariate analysis, the Spearman Correlation Coefficient, the Mann-Whitney U test and the Kruskal-Wallis H test with Dunn's post-hoc adjusted by Bonferroni were used. To determine the associated factors, multivariate analysis was performed using negative binomial regression model. RESULTS: 45.1% of the schoolchildren were female and 87.3% received information on school bullying. In the bivariate analysis, statistically significant differences were found between the ATV scores and age (p = 0.003), sex (p < 0.001), having a social network account (p = 0.009) and year of study (p < 0.001); however, in the multivariate model, the factors associated with the total ATV scores were age (p = 0.012) and sex (p < 0.001). CONCLUSION: The factors associated with ATV in schoolchildren from public EIs were age and sex, these findings would indicate the need to consider the gender perspective in the analysis of school violence and differentiate interventions according to age.

OBJETIVO: Identificar los factores asociados a las actitudes hacia la violencia (AHV) en escolares de instituciones educativas (IE) públicas ubicadas en zonas urbano-marginales de Lima Metropolitana en 2019. MATERIALES Y MÉTODOS: Estudio observacional, descriptivo y transversal. Los participantes fueron adolescentes de diez IE mixtas del sexto grado de primaria al tercer año de secundaria. Se empleó el cuestionario de actitudes hacia la violencia (CAHV25). En el análisis bivariado se empleó la prueba de coeficiente de correlación de Spearman, la U de Mann-Whitney y la H de Kruskal Wallis con post hoc de Dunn, ajustado por método de Bonferroni. Para determinar los factores asociados se realizó el análisis multivariado mediante un modelo de regresión binomial negative. RESULTADOS: El 45,1% de escolares fueron de sexo femenino y el 87,3% recibió información sobre acoso escolar. En el análisis bivariado, se encontraron diferencias estadísticamente significativas entre los puntajes de las AHV con la edad (p = 0,003), el sexo (p < 0,001), tener una cuenta de red social (p = 0,009) y el año de estudios (p < 0,001); sin embargo, en el modelo multivariado, los factores que estuvieron asociados al puntaje total de las AHV fueron la edad (p = 0,012) y el sexo (p < 0,001). CONCLUSIÓN: Los factores asociados a las AHV en escolares de IE públicas fueron la edad y el sexo; estos hallazgos indicarían la necesidad de considerar la perspectiva de género en el análisis de la violencia escolar y diferenciar las intervenciones según edad.

Injuria renal fetal y neonatal: una complicación de la terapia antihipertensiva materna. Reporte de caso / Fetal and neonatal renal injury: a complication of maternal hypertensive therapy: case presentation

Los Inhibidores de la enzima convertidora de angiotensina II (IECAs) y antagonistas de los receptores de angiotensina II (ARA II) son drogas usadas comúnmente en el manejo de hipertensión arterial, sin embargo, su uso en el embarazo está asociado con toxicidad fetal.1, 2 La acción de la angiotensina II requiere su unión a dos receptores; AT1, involucrado en el control de la tensión arterial y AT2, probablemente encargado del crecimiento fetal. 2 La angiotensina II es esencial en la hemodinamia sistémica y la filtración glomerular fetal y neonatal. La disminución de la perfusión placentaria por efecto hipotensor en el bloqueo del sistema renina angiotensina aldosterona materno puede determinar hipotensión fetal sistémica, disminución de la filtración glomerular, oligoamnios e insuficiencia renal, anormalidades tubulares, hipoplasia craneal y alto riesgo de muerte perinatal. 2 Reportamos el caso de prematuro de 30 semanas con oligohidramnios severo y exposición materna a olmesartan. Al nacimiento presentó dificultad respiratoria; imposibilidad de mantener una adecuada tensión arterial a pesar de los esfuerzos para conseguir mejorar su tono vascular; anuria sin respuesta a diuréticos; alteraciones craneales; alteraciones metabólicas severas con consecuencias fatales. El tratamiento de hipertensión materna con inhibidores de la enzima convertidora de angiotensina II y los antagonistas de los receptores de angiotensina II está asociada con toxicidad fetal por lo que su uso debe ser evitado durante el embarazo.

Angiotensin II converting enzyme (ACE) inhibitors and angiotensin II receptor antagonists (ARBs) are drugs for general use in the management of arterial hypertension, however their use in gestational hypertension is related to the Fetal toxicity. 1, 2 The action of angiotensin II requires its binding to two receptors; AT1, involved in the control of blood pressure and AT2, probably responsible for fetal growth.2 Angiotensin II is essential in systemic hemodynamics and fetal and neonatal glomerular filtration. The decrease in placental perfusion due to hypotensive effect in the blockade of the maternal rennin angiotensin aldosterone system can determine systemic fetal hypotension, decreased glomerular filtration, oligohydramnios and renal insufficiency, tubular abnormalities, cranial hypoplasia and high risk of perinatal death. 2 We report the case of prematurity of 30 weeks with a history of severe oligohydramnios and maternal exposure to olmesartan. At birth the patient presented in particular respiratory distress; inability to maintain adequate blood pressure despite efforts to improve your vascular tone; anuria without response to diuretics; cranial alterations; metabolic alterations with fatal consequences. The treatment of maternal hypertension with inhibitors of the angiotensin II convective enzyme and angiotensin II receptor antagonists is associated with fetal toxicity and should therefore be avoided during pregnancy

Arsenic exposure of child populations in Northern Argentina.

Chronic exposure to inorganic arsenic (As) is associated with numerous adverse effects. Argentina is one of the countries affected by arsenicism; however, there are few studies that evaluate inorganic As exposure and its effects on child population. The aim of this study is to evaluate exposure to As through water and food in child populations living in the provinces of Santiago del Estero and Chaco (n = 101), and to determine the impact of this exposure analysing biomarkers of exposure (urine and hair As contents) and effect [8-oxo-7,8-dihydro-2'-deoxyguanosine (8-OHdG)]. The populations selected live in three areas with different levels of As in the drinking water (Santa Teresa de Carballo, 0.925 mg/L; Taco Pozo, 0.210 mg/L; Jumi Pozo, 0.016 mg/L). The As intakes through water and food are especially high in the areas with the greatest As exposure (Santa Teresa de Carballo, 1575 ±â€¯8 µg/day; Taco Pozo, 386 ±â€¯8 µg/day; Jumi Pozo, 39 ±â€¯1 µg/day). The total As contents in most of the samples of hair (0.11-13.11 mg/kg) and urine (31-4258 µg/g creatinine) are higher than the reference values (hair: 1 mg/kg; urine: 50 µg/g creatinine). The increase in the level of As exposure alters the profile of metabolites in urine, with a decrease of dimethylarsinic acid (10%) and an increase in the percentages of monomethylarsonic acid (4%) and inorganic As (6%). The results also show high values of 8-OHdG (3.7-37.8 µg/g creatinine), a oxidative DNA damage marker, in the two areas with greater As exposure.

Albendazole and ivermectin for the control of soil-transmitted helminths in an area with high prevalence of Strongyloides stercoralis and hookworm in northwestern Argentina: A community-based pragmatic study.

BACKGROUND: Recommendations for soil-transmitted helminth (STH) control give a key role to deworming of school and pre-school age children with albendazole or mebendazole; which might be insufficient to achieve adequate control, particularly against Strongyloides stercoralis. The impact of preventive chemotherapy (PC) against STH morbidity is still incompletely understood. The aim of this study was to assess the effectiveness of a community-based program with albendazole and ivermectin in a high transmission setting for S. stercoralis and hookworm. METHODOLOGY: Community-based pragmatic trial conducted in Tartagal, Argentina; from 2012 to 2015. Six communities (5070 people) were enrolled for community-based PC with albendazole and ivermectin. Two communities (2721 people) were re-treated for second and third rounds. STH prevalence, anemia and malnutrition were explored through consecutive surveys. Anthropometric assessment of children, stool analysis, complete blood count and NIE-ELISA serology for S. stercoralis were performed. PRINCIPAL FINDINGS: STH infection was associated with anemia and stunting in the baseline survey that included all communities and showed a STH prevalence of 47.6% (almost exclusively hookworm and S. stercoralis). Among communities with multiple interventions, STH prevalence decreased from 62% to 23% (p<0.001) after the first PC; anemia also diminished from 52% to 12% (p<0.001). After two interventions S. stercoralis seroprevalence declined, from 51% to 14% (p<0.001) and stunting prevalence decreased, from 19% to 12% (p = 0.009). CONCLUSIONS: Hookworm' infections are associated with anemia in the general population and nutritional impairment in children. S. stercoralis is also associated with anemia. Community-based deworming with albendazole and ivermectin is effective for the reduction of STH prevalence and morbidity in communities with high prevalence of hookworm and S. stercoralis.

Effect of Poor Access to Water and Sanitation As Risk Factors for Soil-Transmitted Helminth Infection: Selectiveness by the Infective Route.

BACKGROUND: Soil-transmitted helminth (STH) infections are a public health problem in resource-limited settings worldwide. Chronic STH infection impairs optimum learning and productivity, contributing to the perpetuation of the poverty-disease cycle. Regular massive drug administration (MDA) is the cardinal recommendation for its control; along with water, sanitation and hygiene (WASH) interventions. The impact of joint WASH interventions on STH infections has been reported; studies on the independent effect of WASH components are needed to contribute with the improvement of current recommendations for the control of STH. The aim of this study is to assess the association of lacking access to water and sanitation with STH infections, taking into account the differences in route of infection among species and the availability of adequate water and sanitation at home. METHODS AND FINDINGS: Cross-sectional study, conducted in Salta province, Argentina. During a deworming program that enrolled 6957 individuals; 771 were randomly selected for stool/serum sampling for parasitological and serological diagnosis of STH. Bivariate stratified analysis was performed to explore significant correlations between risk factors and STH infections grouped by mechanism of entry as skin-penetrators (hookworms and Strongyloides stercoralis) vs. orally-ingested (Ascaris lumbricoides and Trichuris trichiura). After controlling for potential confounders, unimproved sanitation was significantly associated with increased odds of infection of skin-penetrators (adjusted odds ratio [aOR] = 3.9; 95% CI: 2.6-5.9). Unimproved drinking water was significantly associated with increased odds of infection of orally-ingested (aOR = 2.2; 95% CI: 1.3-3.7). CONCLUSIONS: Lack of safe water and proper sanitation pose a risk of STH infections that is distinct according to the route of entry to the human host used by each of the STH species. Interventions aimed to improve water and sanitation access should be highlighted in the recommendations for the control of STH.