| Objectives To define the current situation of soil-transmitted helminth (STH) infections among 5-14 years old children and to evaluate STH infections impact on children growth and development, nutritional status, cognitive ability, quality of life. To calculate and establish STH infections disability weight (DW) system and to use disability-adjusted life years (DALY) to measure burden of disease (BOD) of STH infections among 5-14 years old children. In order to provide evidence and evaluation method in make health policy, resource allocation and prevention measure and intervention effect of this disease.Methods (1) The cross-sectional survey was carried out in two rural areas in Rongshui County of Guangxi Autonomous Regional and Dingan County of Hainan Province, China. Which showed high infection rates of three major STH. Study population were from 14 primary schools. All the school-age children among 5-14 years old from grades one to six took part in this study. Stool samples were examined by the Kato-Katz technique, to check the number of eggs per gram stool (EPG) of STH infections. To understand these areas STH infections status among 5-14 years old children and risk factors by questionnaire surveys and stool checking for eggs of three major STH infections. Questionnaire surveys contained detailed information on personal, parental and socio-economic status. Questions included age, sex, education level and occupation of parents and household income, etc. (2) To measure children height and weight, in order to estimate growth and development and nutritional status using Z score. (3) To draw blood from vein for haematoglobin detection, understand anaemia state of children. (4) To use WISC-Ⅳassessment children cognitive ability of STH infections. (5) To use Short From 12-item Health Survey (SF-12) to assess Quality of Life (QoL) of STH infections children. (6) To lay DW of STH co-infections, to establish STH infections DW system that meet our conditions, this is the key to quantization BOD. (7) To use DALY to measure BOD of STH infections.Results (1) The infection rate of STH was 40.5%. The infection rate of boys was 37.8%. The infection rate of girls was 43.4%. The infection rates of Ascaris, hookworm and Trichuris were 20.7%,17.3% and15.7%, respectively. And infection rate of STH co-infections was 10.8%. Logistic regression risk factors for STH infections were education level of mother, drinking unboiled water, eating raw vegetables, play in the ground on bare foot, applying un-ripening manure. Protect factor was washing hands before meal.(2) Among STH infections children, the prevalence of malnutrition was 28.8%, was higher than non-infection (P＜0.05). Among STH infections children, the prevalence of stunting was 17.6%, was higher significant than non-infection (P＜0.05). HAZ of STH co-infections group was lower than non-infection group (P＜0.05). STH co-infections children suffered stunting were 1.636 times than non-infection. HAZ of moderate-heavy STH infection group was lower than light STH infection group and non-infection group (P＜0.05).(3) Intelligence level of STH infections children was in normal range and in border level. Moderate-heavy STH infection impair intelligence level and cognitive function, and soil-transmitted helminth infections children had cognition deficit in VCI, WMI, PSI. In hookworm infection group, WMI was lower than ascariasis and trichuriasis infections groups (P＜0.05). In trichuriasis infection group, PSI was lower than ascariasis (P＜0.05). In STH co-infections group, there were five children that intelligence quotient (IQ) was lower than 80 scores, and mean±tandard deviation was 96.74±5.78, also be lower than other groups.(4) Among STH infections children, the prevalence of anemia was higher than non-infection (P＜0.05). Among moderate-heavy STH infection, haemoglobin concentration was lower than non-infection (P＜0.05). It was showed that STH co-infections or moderate-heavy STH infection all degrade haemoglobin concentration, and to cause children anemia further.(5) PCS scores and MCS scores among moderate-heavy STH infection group were 14.32±3.69,16.08±4.17, respectively. They were lower than light intensity infection group 15.54±3.37 and 17.30±4.39 and non-infection group 16.86±3.37,18.68±3.84 (P＜0.001). The risk factors for children quality of life were STH infection, no washing hands before meal, no washing hands after bowel movement, usually stomach-ache in resently four weeks, with disease in resently four weeks.(6) The study had established DW system of STH infections including ascariasis, trichuriasis, hookworm and STH co-infections. The study had proved that GBD underestimate DW of ascariasis, trichuriasis and hookworm infections. Result:STH infections DW of 5-14 years old children was 0.114±0.130, boys DW and girls DW were 0.117±0.139,0.110±0.121, respectively. DW of Ascariasis infection, trichuriasis infection, hookworm infection was 0.109±0.132,0.119±0.117,0.116±0.146, respectively. They were higher than GBD data about DW. DW of STH co-infections was 0.136±0.119, boys DW and girls DW was 0.123±0.111, 0.150±0.126, respectively. (7) In 2004, years lived with disability (YLD) of Ascariasis infection in 5-14 years old children was 1328.274, per capita loss was 0.109; YLD of hookworm infection was 280.007, per capita loss was 0.119; YLD of trichuriasis infection was 591.368, per capita loss was 0.116. In 2009, years lived with disability (YLD) of STH infections in 5-14 years old children was 47.424 and YLD of STH co-infections was 15.504 in Baiyun countryside. In 2009, years lived with disability (YLD) of STH infections in 5-14 years old children was 55.518 and YLD of STH co-infections was 17.136 in Xinzhu and Longzhou countryside.Conclusion (1) This study obtain DW of Ascariasis infection, trichuriasis infection, hookworm infection were 0.109±0.132,0.119±0.117,0.116±0.146, respectively. They were higher than GBD data about DW:0.006-0.024. To prove GBD underestimate DW of ascariasis, trichuriasis and hookworm infections in 5-14 years old children..(2) To determine DW of STH co-infections of 5-14 years old children was 0.136±0.119, boy was 0.123±0.111 and girl was 0.150±0.126 at first time through field investigation study.(3) To lay DW system of STH infections of 5-14 years old children at first time, include ascariasis, trichuriasis, hookworm infections and STH co-infections.(4) Use YLD to assess STH infections children years lived with disability, in order to compare with other diseases. The results of YLDs supply gap in China. The results of YLDs provide informations in order to institute health policy and to throw into health fund. At the same time, the results of YLDs provide informations to institute control strategy of children STH infections, to decrease the infection rate and intensity, improve children quality of life.
|
PDF Full Text Request