Assessment of Soil-Transmitted Helminth Infections among Pregnant Women in Western Kenya: A Cross-Sectional Study
Abstract
Intestinal geo-helminths are among the common human infections in the developing world. Preschool and school-age children in Kenya have been targeted for deworming strategies through the National School-Based Deworming Program leaving out vulnerable groups including pregnant women. We conducted this study to assess the prevalence and intensity of worm infections and associated risk factors among pregnant women in Western Kenya. A cross-sectional study was carried out among 250 pregnant women seeking antenatal care services from selected health facilities in Vihiga County. Stool samples were collected and examined for soil transmitted helminths (STH) using the Kato-Katz technique and structured questionnaires were administered to determine associated risk factors. Statistical analysis was done using STATA version 14.1. Differences in proportions by age and health facility were assessed using Chi-square (χ2) test and differences in means using the student t-test. Prevalence of STHs was 12.4% (95%CI: 9.1%-16.9%). Infection caused by hookworm was 2.4% (95%CI: 1.2% - 4.7%), Ascaris lumbricoides 9.6% (95%CI: 6.3% - 14.6%), Trichuris trichiura 2.0% (95%CI: 0.8% - 5.3%). The mean intensity of hookworm infection was 101 (95%CI: 8 -1355), A. lumbricoides 375 (95%CI: 107 - 1308), and T. trichiura 3 (95%CI: 0 - 29). Univariable analysis of factors associated with infection did not reveal any significant associations. Participants with primary level of education had higher odds of T. trichiura infection compared to other participants (OR=2.58, p=0.400). Farming had higher odds of STH and A. lumbricoides infections (OR=3.47, p=0.076) and (OR=3.75, p=0.089) respectively compared to other occupations. Participants in the second trimester of pregnancy had higher odds of hookworm infection (OR=3.36, p=0.272) those with children under three years had higher odds of T. trichiura infection (OR=3.60, p=0.165). The study revealed that STH infection is prevalent among pregnant women in Vihiga although there were no significant risk factors associated with the infection. Therefore, health facilities should conduct deworming and testing for STH also they should provide health education on the risks of getting infected.
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References
Adewale, B., Rahaman, O., Aina, O., & Sulyman, M. A. (2018). Schistosoma mansoni and Soil Transmitted Helminth (STH) Infections among Pregnant Women Attending Primary Health Care Facilities in Lagos Mainland, Nigeria. Journal of Biosciences and Medicines, 06(12), 64–70. https://doi.org/10.4236/jbm.2018.612006
Amuta, E. U., Houmsou, R. S., & Mker, S. D. (2010). Knowledge and risk factors of intestinal parasitic infections among women in Makurdi, Benue State. Asian Pacific Journal of Tropical Medicine, 3(12), 993–996. https://doi.org/10.1016/S1995-7645(11)60016-3
Apili, F., Ochaya, S., Osingada, C. P., Mbalinda, S. N., Mukunya, D., Ndeezi, G., & Tumwine, J. K. (2020). Hookworm Infection among Pregnant Women at First Antenatal Visit in Lira, Uganda: A Cross-Sectional Study. International Journal of Reproductive Medicine, 2020, 1–8. https://doi.org/10.1155/2020/8053939
Asaolu, S. O., & Ofoezie, I. E. (2019). Ascaris spp. In Water and Sanitation for the 21st Century: Health and Microbiological Aspects of Excreta and Wastewater Management (Global Water Pathogen Project). Michigan State University. https://doi.org/10.14321/waterpathogens.41
Baidoo, S. E., Tay, S. C. K., & Abruquah, H. H. (2010). Intestinal helminth infection and anaemia during pregnancy: A community based study in Ghana. African Journal of Microbiology Research, 4(16), 1713–1718. http://www.academicjournals.org/ajmr
Bartsch, S. M., Hotez, P. J., Asti, L., Zapf, K. M., Bottazzi, M. E., Diemert, D. J., & Lee, B. Y. (2016). The Global Economic and Health Burden of Human Hookworm Infection. PLOS Neglected Tropical Diseases, 10(9), e0004922. https://doi.org/10.1371/journal.pntd.0004922
Brooker, S, Bethony, J., Parasitology, P. H.-A. in, & 2004, U. (2004). Human hookworm infection in the 21st century. Ncbi.Nlm.Nih.Gov. https://www.ncbi.nlm.nih.gov/pmc/articles/pmc2268732/
Brooker, Simon, Hotez, P. J., & Bundy, D. A. P. (2008). Hookworm-Related Anaemia among Pregnant Women: A Systematic Review. PLoS Neglected Tropical Diseases, 2(9), e291. https://doi.org/10.1371/journal.pntd.0000291
Dreyfuss, M., Stoltzfus, R., Shrestha, J., Pradhan, E. K., Leclerq, S., Khatry, S. K., Katz, J., Shrestha, S. R., Katz, J., Albonico, M., & West, K. P. (2000). Hookworms, malaria and vitamin A deficiency contribute to anemia and iron deficiency among pregnant women in the plains of Nepal. The Journal of Nutrition. https://academic.oup.com/jn/article-abstract/130/10/2527/4686110
Feleke, B. E., & Jember, T. H. (2018). Prevalence of helminthic infections and determinant factors among pregnant women in Mecha district, Northwest Ethiopia: A cross sectional study. BMC Infectious Diseases, 18(1), 1–6. https://doi.org/10.1186/S12879-018-3291-6/TABLES/3
Gebrehiwet, M. G., Medhaniye, A. A., & Alema, H. B. (2019). Prevalence and associated factors of soil transmitted helminthes among pregnant women attending antenatal care in Maytsebri primary hospital, North Ethiopia. BMC Research Notes, 12(1), 644. https://doi.org/10.1186/s13104-019-4684-3
Guideline: Preventive Chemotherapy To Control Soil-Transmitted Helminth Infections In At-Risk Population Groups. (2017). http://apps.who.int/bookorders.
Hailu, T., Abera, B., Mulu, W., Kassa, S., Genanew, A., & Amor, A. (2020). Prevalence and Factors Associated with Intestinal Parasitic Infections among Pregnant Women in West Gojjam Zone, Northwest Ethiopia. Journal of Parasitology Research, 2020. https://doi.org/10.1155/2020/8855362
Hotez, P. J., & Kamath, A. (2009). Neglected tropical diseases in sub-Saharan Africa: Review of their prevalence, distribution, and disease burden. In PLoS Neglected Tropical Diseases (Vol. 3, Issue 8). PLoS Negl Trop Dis. https://doi.org/10.1371/journal.pntd.0000412
Ivoke, N., Ikpor, N., Ivoke, O., Ekeh, F., Ezenwaji, N., Odo, G., Iyaji, F., Onoja, U., & Eyo, J. (2017). Geophagy as risk behaviour for gastrointestinal nematode infections among pregnant women attending antenatal clinics in a humid tropical zone of Nigeria. African Health Sciences, 17(1), 24–31. https://doi.org/10.4314/ahs.v17i1.5
Katz, N., Chaves, A., … J. P. instituto de medicina tropical, & 1972, U. (1972). A simple device for quantitative stool thick-smear technique in Schistosomiasis mansoni. Cabdirect.Org. https://www.cabdirect.org/cabdirect/abstract/19732900729
Kenya National Bureau of Statistics. (2019). VOLUME I: POPULATION BY COUNTY AND SUB-COUNTY Counting Our People for Sustainable Development and Devolution of Services REPUBLIC OF KENYA.
McClure, E. M., Meshnick, S. R., Mungai, P., Malhotra, I., King, C. L., Goldenberg, R. L., Hudgens, M. G., Siega-Riz, A. M., & Dent, A. E. (2014). The Association of Parasitic Infections in Pregnancy and Maternal and Fetal Anemia: A Cohort Study in Coastal Kenya. PLoS Neglected Tropical Diseases, 8(2). https://doi.org/10.1371/journal.pntd.0002724
Montresor, A., Crompton, D. W. T., Hall, A., Bundy, D. A. P., & Savioli, L. (1998). Guidelines for the evaluation of soil-transmitted helminthiasis and schistosomiasis at community level: a guide for managers of control programmes. https://apps.who.int/iris/bitstream/handle/10665/63821/WHO_CTD_SIP_98.1.pdf
Mupfasoni, D., Mikhailov, A., Mbabazi, P., King, J., Gyorkos, T. W., & Montresor, A. (2018). Estimation of the number of women of reproductive age in need of preventive chemotherapy for soil-transmitted helminth infections. PLoS Neglected Tropical Diseases, 12(2). https://doi.org/10.1371/journal.pntd.0006269
Mwandawiro, C., Okoyo, C., Kihara, J., Simiyu, E., Kepha, S., Campbell, S. J., Freeman, M. C., Brooker, S. J., & Njenga, S. M. (2019a). Results of a national school-based deworming programme on soil-transmitted helminths infections and schistosomiasis in Kenya: 2012-2017. Parasites and Vectors, 12(1), 1–18. https://doi.org/10.1186/S13071-019-3322-1/FIGURES/9
Mwandawiro, C., Okoyo, C., Kihara, J., Simiyu, E., Kepha, S., Campbell, S. J., Freeman, M. C., Brooker, S. J., & Njenga, S. M. (2019b). Results of a national school-based deworming programme on soil-transmitted helminths infections and schistosomiasis in Kenya: 2012–2017. Parasites & Vectors 2019 12:1, 12(1), 1–18. https://doi.org/10.1186/S13071-019-3322-1
Ndibazza, J., Muhangi, L., Akishule, D., Kiggundu, M., Ameke, C., Oweka, J., Kizindo, R., Duong, T., Kleinschmidt, I., Muwanga, M., & Elliott, A. M. (2010). Effects of deworming during pregnancy on maternal and perinatal outcomes in entebbe, Uganda: A randomized controlled Trial. Clinical Infectious Diseases, 50(4), 531–540. https://doi.org/10.1086/649924
Ndyomugyenyi, R., Kabatereine, N., Olsen, A., & Magnussen, P. (2008). Malaria and hookworm infections in relation to haemoglobin and serum ferritin levels in pregnancy in Masindi district, western Uganda. Transactions of the Royal Society of Tropical Medicine and Hygiene, 102(2), 130–136. https://doi.org/10.1016/j.trstmh.2007.09.015
Organization, W. H. (2017). Guideline: preventive chemotherapy to control soil-transmitted helminth infections in at-risk population groups. https://apps.who.int/iris/bitstream/handle/10665/258983/9789241550116-eng.pdf
Salawu, O. T., & Odaibo, A. B. (2014). Maternal schistosomiasis: A growing concern in sub-Saharan Africa. In Pathogens and Global Health (Vol. 108, Issue 6, pp. 263–270). Maney Publishing. https://doi.org/10.1179/2047773214Y.0000000150
Sousa-Figueiredo, J. C., Gamboa, D., Pedro, J. M., Fançony, C., Langa, A. J., Soares Magalhães, R. J., Stothard, J. R., & Nery, S. V. (2012). Epidemiology of Malaria, Schistosomiasis, Geohelminths, Anemia and Malnutrition in the Context of a Demographic Surveillance System in Northern Angola. PLoS ONE, 7(4), e33189. https://doi.org/10.1371/journal.pone.0033189
Speich, B., Ali, S. M., Ame, S. M., Albonico, M., Utzinger, J., & Keiser, J. (2015). Quality control in the diagnosis of Trichuris trichiura and Ascaris lumbricoides using the Kato-Katz technique: Experience from three randomised controlled trials. Parasites and Vectors, 8(1). https://doi.org/10.1186/s13071-015-0702-z
STATE DEPARTMENT OF DEVOLUTION. (2020). VIHIGA COUNTY COUNTY INTEGRATED DEVELOPMENT PLAN 2018-2022.
Steketee, R. W. (2003). Pregnancy, nutrition and parasitic diseases. Journal of Nutrition, 133(5 SUPPL. 1). https://doi.org/10.1093/jn/133.5.1661s
van Eijk, A. M., Lindblade, K. A., Odhiambo, F., Peterson, E., Rosen, D. H., Karanja, D., Ayisi, J. G., Shi, Y. P., Adazu, K., & Slutsker, L. (2009). Geohelminth Infections among Pregnant Women in Rural Western Kenya; a Cross-Sectional Study. PLoS Neglected Tropical Diseases, 3(1), e370. https://doi.org/10.1371/journal.pntd.0000370
W. Gyorkos, M. C. E. et al. (2004). Improving Maternal and New Born Health in Hook Worm—Endemic Areas by Adding a Single-Dose Anthelminthic to Prenatal Care. https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=W.+Gyorkos%2C+M.+Casapia+EG+et+a.+Improving+Maternal+and+New+Born+Health+in+Hook+Worm—Endemic+Areas+by+Adding+a+Single-Dose+Anthelminthic+to+Prenatal+Care.+In%3A+Global+Forum+for+Health+Research.+200
Wekesa, A. W., Mulambalah, C. S., Muleke, C. I., & Odhiambo, R. (2014). Intestinal helminth infections in pregnant women attending antenatal clinic at kitale district hospital, Kenya. Journal of Parasitology Research, 2014. https://doi.org/10.1155/2014/823923
WHO. (2011). Helminth control in school-age children. A guide for managers of control programmes. Geneva: World …, 90. http://www.who.int/neglected_diseases/en
World Health Organization. (2019). WHO | Deworming in pregnant women. WHO. http://www.who.int/elena/titles/deworming_pregnancy/en/
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