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Urban/rural differences in prevalence and risk factors for intestinal helminth infection in southern Malawi
K Phiri1, C J Whitty, S M Graham
1Department of Community Health, College of Medicine, University of Malawi, Chichiri, Blantyre. kamija@sdnp.org.mw
Insights
Urbanization significantly increases intestinal helminth infections in Malawian children, particularly Ascaris lumbricoides. Key risk factors include poor sanitation, lack of footwear, and lower maternal education, highlighting the need for urban-focused interventions.
Area of Science:
- Public Health
- Infectious Diseases
- Epidemiology
Background:
- Urbanization is a growing global phenomenon.
- Increased urbanization may lead to altered disease transmission patterns.
- Intestinal helminth infections remain a significant public health concern, especially in developing regions.
Purpose of the Study:
- To investigate the prevalence, intensity, and risk factors of intestinal helminth infections in children residing in urban versus rural communities in southern Malawi.
- To determine the specific helminth species associated with urbanization.
- To identify demographic and environmental factors contributing to helminthiasis in urban settings.
Main Methods:
- A cross-sectional survey was conducted among children aged 3-14 years in comparable urban and rural communities in southern Malawi.
- Stool samples were collected from 553 children (273 urban, 280 rural) for helminthological examination.
- Statistical analysis, including odds ratios and confidence intervals, was used to identify risk factors.
Main Results:
- The overall prevalence of helminth infection was substantially higher in urban children (16.5%) compared to rural children (3.6%) (P < 0.001).
- Ascaris lumbricoides was the predominant helminth species driving the urban-rural disparity.
- Living in an urban community was a significant risk factor (OR = 5.3). Identified urban risk factors included proximity to water/sewage pools, not wearing shoes, not attending school, and maternal age/education.
Conclusions:
- Urban environments in southern Malawi present a significantly higher risk for intestinal helminth infections among children.
- Environmental factors (poor sanitation, lack of footwear) and socioeconomic factors (maternal education, maternal age) are critical determinants of infection risk in urban areas.
- Intervention strategies should prioritize reducing the geohelminth burden in urban settings to mitigate infection risks.
Abstract:
Urbanization may increase the risk of human infection with intestinal helminths. A cross-sectional survey was conducted to investigate the prevalence, intensity and potential risk factors of acquiring such infection, among children aged 3-14 years in similar urban and rural communities in southern Malawi. Stool samples were collected from 553 children (273 urban and 280 rural). The overall prevalence of helminth infection was significantly higher in the urban subjects than in the rural (16.5% v. 3.6%; P < 0.001), mostly because of differences in the prevalence of Ascaris lumbricoides infection. Living in an urban community was associated with a significantly higher risk of infection [odds ratio (OR) = 5.3; 95% confidence interval (CI) = 2.6-12.1], even after controlling for potential confounding factors. In the urban community, risk factors included having pools of water/sewage around houses (OR = 3.0; CI = 1.4-6.5), not wearing shoes (OR = 7.1; CI = 2.7-19.2), not attending school (OR = 2.8; CI = 1.2-6.5), having mothers with 4-8 years of education (OR = 5.2; CI = 2.0-14.0), and having mothers below 35 years of age (OR = 4.09; CI = 1.39-16.28). In this part of Africa, efforts to reduce helminth infections may best be focused on reducing geohelminth burden in urban areas.