title: Soil-transmitted helminths in southern highland Rwanda: associated factors and effectiveness of school-based preventive chemotherapy.
abstract: OBJECTIVE
  Preventive chemotherapy of schoolchildren against soil-transmitted helminths (STHs) is widely implemented in Rwanda. However, data on its actual efficacy are lacking. We assessed prevalence, associated factors and manifestation of STH infection among schoolchildren in southern highland Rwanda as well as cure and reinfection rates.
  
  
  METHODS
  Six hundred and twenty-two children (rural, 301; urban, 321) were included preceding the administration of a single dose of 500 mg mebendazole. Before treatment, and after 2 and 15 weeks, STH infection was determined by Kato-Katz smears and by PCR assays for Ascaris lumbricoides. Clinical and anthropometric data, socio-economic status and factors potentially associated with STH infection were assessed.
  
  
  RESULTS
  Soil-transmitted helminth (STH) infection was present in 38% of rural and in 13% of urban schoolchildren. Ascaris lumbricoides accounted for 96% of infections. Of these, one-third was detected by PCR exclusively. Factors associated with STH infection differed greatly between rural and urban children. Likewise, STH infection was associated with stunting and anaemia only among urban children. The cure rate after 2 weeks was 92%. Among eight non-cleared A. lumbricoides infections, seven were submicroscopic. Reinfection within 3 months occurred in 7%, but the rate was higher among rural children, and with initially present infection, particularly at comparatively high intensity.
  
  
  CONCLUSIONS
  The rural-urban difference in factors associated with STH infection and in reinfection rates highlights the need for targeted interventions to reduce transmission. PCR assays may help in detecting low-level infections persisting after treatment. In southern Rwanda, mebendazole is highly effective against the STH infections predominated by A. lumbricoides.
authors.affiliation: Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Olga
authors.initials: O
authors.lastname: Staudacher
authors.forename: Jakob
authors.initials: J
authors.lastname: Heimer
authors.forename: Florian
authors.initials: F
authors.lastname: Steiner
authors.forename: Yvette
authors.initials: Y
authors.lastname: Kayonga
authors.forename: Jean M
authors.initials: JM
authors.lastname: Havugimana
authors.forename: Ralf
authors.initials: R
authors.lastname: Ignatius
authors.forename: Andre
authors.initials: A
authors.lastname: Musemakweri
authors.forename: Fidele
authors.initials: F
authors.lastname: Ngabo
authors.forename: Gundel
authors.initials: G
authors.lastname: Harms
authors.forename: Jean-Bosco
authors.initials: JB
authors.lastname: Gahutu
authors.forename: Frank P
authors.initials: FP
authors.lastname: Mockenhaupt
mesh_terms: D000740:Anemia / Q000175:diagnosis / Q000453:epidemiology / Q000469:parasitology; D000818:Animals; D000871:Anthelmintics / Q000627:therapeutic use*; D000886:Anthropometry; D001196:Ascariasis / Q000453:epidemiology / Q000469:parasitology / Q000517:prevention & control; D017164:Ascaris lumbricoides / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005243:Feces / Q000469:parasitology; D005260:Female; D006297:Health Services Accessibility; D006373:Helminthiasis / Q000453:epidemiology* / Q000469:parasitology / Q000517:prevention & control; D006801:Humans; D006920:Hygiene; D008297:Male; D008463:Mebendazole / Q000627:therapeutic use*; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D016133:Polymerase Chain Reaction / Q000379:methods; D011203:Poverty; D012424:Rural Population / Q000706:statistics & numerical data; D012432:Rwanda / Q000453:epidemiology; D012499:Sanitation; D012572:School Health Services; D055502:Secondary Prevention; D012680:Sensitivity and Specificity; D012959:Socioeconomic Factors; D012987:Soil / Q000469:parasitology; D014505:Urban Population / Q000706:statistics & numerical data
chemical_list: D000871:Anthelmintics; D012987:Soil; D008463:Mebendazole
keywords: Ascaris; Rwanda; Soil-transmitted helminths; antibiotique; antibióticos; automedicación; automédication; cure rate; estudiantes universitarios; mebendazole; méthode de pratique des attitudes-connaissance; método de conocimientos-actitudes-prácticas; reinfection; uso racional de medicamentos; utilisation rationnelle des médicaments; étudiants universitaires