Efficacy of Albendazole in Reducing Fecal Egg Counts of Soil Transmitted Helminths in School Children.

Vipin Sam, Alexander (2011) Efficacy of Albendazole in Reducing Fecal Egg Counts of Soil Transmitted Helminths in School Children. Masters thesis, Christian Medical College, Vellore.


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INTRODUCTION : Soil transmitted helminths (STH) are a group of intestinal nematodes whose infective forms undergo development in the soil, and cause infection in humans when they come in contact with the contaminated soil. Ascaris lumbricoides, Trichuris trichiura and hookworms are the most important and the most prevalent soil transmitted helminths. Infection with these worms is acquired by ingestion of eggs (A. lumbricoides and T. trichiura) from contaminated soil or by penetration of the skin by larvae in the soil (hookworms). They affect over 2 billion people in the world, majority of them residing in the tropical and subtropical regions of the world. STH infections are endemic in Africa, South-East Asia, Indian subcontinent, China, and Central and South America (de Silva, Brooker et al. 2003). In India, the prevalence of the three STH varies widely from 0 to 91%. In this study, we assessed the efficacy of single dose 400 mg albendazole in terms of cure rates and egg reduction rates on schoolchildren infected with STH (Hookworms, A. lumbricoides and T. trichiura) from two districts–Vellore (an area whose residents has been receiving MDA with Albendazole for several years) and Thiruvannamalai (an area where MDA with Albendazole was started only recently). For this purpose, stool samples in school children from the two districts were screened for the presence of STH. AIMS AND OBJECTIVES : Aim: To assess the efficacy of albendazole in the treatment of Soil transmitted helminths (STH) in school children, living in areas that were or were not part of an annual mass drug administration with albendazole. Objectives: 1. To assess the change in fecal egg counts (FEC) in school age children, between 10 and 14 days following treatment with a single dose 400 mg of albendazole. 2. To monitor efficacy by determining the Cure Rate (CR) and Egg Reduction Rate (ERR). 3. To evaluate the suitability of the fecal egg count reduction test (FECRT) as a standard tool to monitor efficacy i.e. to develop a robust analytical approach that accounts for possible confounding factors. 4. To compare the relative performance of the Kato Katz and the McMaster egg counting technique. MATERIAL AND METHODS : Schools were randomly selected from each district for carrying out the study after obtaining permission from the relevant government authorities. A detailed health education was given to children belonging to the selected schools regarding soil transmitted helminths, their transmission and prevention. Informed consent form was translated into the local language, Tamil and was provided to the selected children. The children were asked to show it to their parents or guardians to obtain their consent for participation in the study. The children who agreed to participate in the study were provided with a screw capped plastic container. A field worker went the next day to the child’s home to collect the container. The stool samples, thus collected were sent to the laboratory within 3- 4 hours of collection. All children who provided a stool sample which was positive were treated with albendazole in a single dose of 400 mg under direct supervision. The study subjects were selected based on the following inclusion and exclusion criteria. Inclusion Criteria: 1. Age 6-14 years, 2. Ova of Ascaris lumbricoides, hookworm and Trichuris trichiura seen on microscopic examination of stool, 3. Resident of Vellore district (for Albendazole MDA group) or resident of area where no government MDA program is administered (non-MDA group), 4. Willing to participate in the study and give informed consent and follow-up sample. Exclusion Criteria: 1. Age <6 years, >14 years, 2. No ova of Ascaris lumbricoides, hookworm and Trichuris trichiura seen in stool, 3. Not willing to participate, 4. Unable to give samples for follow up. RESULTS : Of the 100 samples, McMaster’s was positive in 43 and Kato-Katz in 48 for the detection of at least one STH in each sample. Overall, at least one STH was detected in 52 samples by either McMaster or Kato Katz technique. Hookworm was the most common STH (36%), followed by A. lumbricoides (12%) and T. trichiura (9%). SUMMARY : In the pilot study, the McMaster’s method had a slightly lower sensitivity when compared to the Kato-Katz method in the detection of the STHs. However, the McMaster’s method was found to be a simple and more appropriate technique for an accurate estimation of FEC. The prevalence of STH in Vellore District and Thiruvannamalai district was found to be 6.8% and 7.1% respectively. There was no significant difference between the prevalence of STH between the two districts, but the prevalence of individual STH worms varied significantly between the two districts. The cure rate of hookworms, T. trichiura and A. lumbricoides was found to be 83.6%, 84.6% and 100% respectively. The egg reduction rates for hookworms, T. trichiura and A. lumbricoides were 96%, 76% and 100% respectively. A significant change was found between the pre-treatment and post-treatment fecal egg counts of all the three STHs in both the districts, with no indication of a difference in response to treatment with albendazole in the two districts.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Albendazole ; Fecal Egg Counts ; Soil Transmitted Helminths ; School Children.
Subjects: MEDICAL > Microbiology
Depositing User: Subramani R
Date Deposited: 14 Aug 2017 01:19
Last Modified: 14 Aug 2017 01:19
URI: http://repository-tnmgrmu.ac.in/id/eprint/1326

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