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Determining Soil-transmitted Helminth Infection Status and Physical Fitness of School-aged Children
Published on: August 22, 2012
The epidemiology of soil-transmitted helminths in Bihar State, India
Katie Greenland1, Ruth Dixon2, Shabbir Ali Khan3
1Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Insights
Soil-transmitted helminth (STH) infections are highly prevalent in Bihar, India, affecting 68% of school children. Key risk factors include open defecation and poor hygiene, highlighting the need for targeted deworming and sanitation interventions.
Area of Science:
- Public Health
- Infectious Diseases
- Epidemiology
Background:
- Soil-transmitted helminths (STHs) pose a significant global health burden, affecting over a billion people.
- In India, STH infections impact millions of children, necessitating interventions to prevent adverse health and developmental outcomes.
- A school-based deworming campaign in Bihar State targeted 17 million children, preceded by a study to assess STH prevalence and risk factors.
Purpose of the Study:
- To determine the prevalence of soil-transmitted helminth infections among school-aged children in Bihar.
- To identify risk factors associated with STH infections, including socio-demographic and hygiene practices.
- To inform the development of targeted interventions and public health messaging for STH control.
Main Methods:
- A cross-sectional survey was conducted in 20 schools in Bihar.
- Stool samples were collected from 1279 school children (aged 4-17) for STH identification.
- Questionnaires were administered to 1157 children to assess defecation and hand-hygiene practices and explore risk factors.
Main Results:
- Overall STH prevalence was 68%, with significant variation across schools (10-86%).
- Prevalence rates for ascariasis, hookworm, and trichuriasis were 52%, 42%, and 5%, respectively.
- 95% of children practiced open defecation, and 61% used soil for hand cleansing; increasing age, low maternal literacy, and certain castes were linked to hookworm infection; lack of school hand-washing stations correlated with A. lumbricoides.
Conclusions:
- The high prevalence of STH in Bihar strongly supports the need for mass deworming programs in school-aged children.
- Widespread open defecation and the use of soil for hand hygiene are critical issues requiring attention.
- Findings underscore the importance of integrating water, sanitation, and hygiene (WASH) interventions and tailoring health messages for mothers with limited literacy to effectively control helminth infections.
Background:
Soil-transmitted helminths (STHs) infect over a billion individuals worldwide. In India, 241 million children are estimated to need deworming to avert the negative consequences STH infections can have on child health and development. In February-April 2011, 17 million children in Bihar State were dewormed during a government-led school-based deworming campaign. Prior to programme implementation, a study was conducted to assess STH prevalence in the school-age population to direct the programme. The study also investigated risk factors for STH infections, including caste, literacy, and defecation and hygiene practices, in order to inform the development of complementary interventions.
Methods:
A cross-sectional survey was conducted among children in 20 schools in Bihar. In addition to providing stool samples for identification of STH infections, children completed a short questionnaire detailing their usual defecation and hand-hygiene practices. Risk factors for STH infections were explored.
Results:
In January-February 2011, 1279 school children aged four to seventeen provided stool samples and 1157 children also completed the questionnaire. Overall, 68% of children (10-86% across schools) were infected with one or more soil-transmitted helminth species. The prevalence of ascariasis, hookworm and trichuriasis was 52%, 42% and 5% respectively. The majority of children (95%) practiced open defecation and reported most frequently cleansing hands with soil (61%). Increasing age, lack of maternal literacy and certain castes were independently associated with hookworm infection. Absence of a hand-washing station at the schools was also independently associated with A. lumbricoides infection.
Conclusions:
STH prevalence in Bihar is high, and justifies mass deworming in school-aged children. Open defecation is common-place and hands are often cleansed using soil. The findings reported here can be used to help direct messaging appropriate to mothers with low levels of literacy and emphasise the importance of water and sanitation in the control of helminths and other diseases.
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