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Abstract：
BACKGROUND: Hookworm infection and schistosomiasis are two of sub-Saharan Africa\'s most common neglected tropical diseases. An annual mass drug administration (MDA) program against schistosomiasis and soil-transmitted helminths (STHs), including hookworm, has been implemented in Mayuge district, Uganda, since 2003 to date. However, hookworm and schistosomiasis remain prevalent in Mayuge district. Understanding the factors that predispose children to these infections in the context of MDA could inform interventions to reduce prevalence in Uganda and similar settings.
METHODS: This cross-sectional study took place in 33 randomly selected primary schools in the Mayuge district from January to February 2022. Children in primary classes 4 or 5, in the selected schools provided single stool samples and completed questionnaires. Stool specimens were examined using the Kato-Katz method to determine the prevalence of hookworm and schistosomiasis. We performed univariable and multivariable logistic regression to assess the associations of each infection with potential risk factors.
RESULTS: A total of 1,617 students (mean age 12.1 years, 50.1% male) were enrolled. The prevalence of hookworm infection and schistosomiasis was 21.8% (95% confidence interval (CI): 19.8-23.9%) and 18.7% (95% CI: 16.8-20.7%), respectively. In multivariable analysis, longer water fetching time (over 30 min versus less than 30 min) and working daily in the soil were associated with increased odds of hookworm infection (adjusted odds ratio (AOR): 1.49, 95% CI: 1.13-1.96 and 1.37, 95% CI: 1.03-1.82, respectively). Higher odds of schistosomiasis were linked to proximity to water bodies within a one-hour walking distance (AOR: 1.84, 95% CI: 1.35-2.50), and not always washing hands before eating (AOR: 2.00, 95% CI: 1.50-2.67). Swimming, bathing, or washing in water bodies twice a week, compared to never, also increased schistosomiasis odds (AOR: 2.91, 95% CI: 1.66-5.13).
CONCLUSIONS: Consistent with the mechanisms of acquisition, hookworm infection increased with exposure to soil, and schistosomiasis increased with exposure to unclean water. Our findings highlight the importance of Water, Sanitation, and Hygiene programs and strategies aimed at reducing exposure within the framework of Neglected Tropical Disease elimination programs.
METHODS: This cross-sectional study took place in 33 randomly selected primary schools in the Mayuge district from January to February 2022. Children in primary classes 4 or 5, in the selected schools provided single stool samples and completed questionnaires. Stool specimens were examined using the Kato-Katz method to determine the prevalence of hookworm and schistosomiasis. We performed univariable and multivariable logistic regression to assess the associations of each infection with potential risk factors.
RESULTS: A total of 1,617 students (mean age 12.1 years, 50.1% male) were enrolled. The prevalence of hookworm infection and schistosomiasis was 21.8% (95% confidence interval (CI): 19.8-23.9%) and 18.7% (95% CI: 16.8-20.7%), respectively. In multivariable analysis, longer water fetching time (over 30 min versus less than 30 min) and working daily in the soil were associated with increased odds of hookworm infection (adjusted odds ratio (AOR): 1.49, 95% CI: 1.13-1.96 and 1.37, 95% CI: 1.03-1.82, respectively). Higher odds of schistosomiasis were linked to proximity to water bodies within a one-hour walking distance (AOR: 1.84, 95% CI: 1.35-2.50), and not always washing hands before eating (AOR: 2.00, 95% CI: 1.50-2.67). Swimming, bathing, or washing in water bodies twice a week, compared to never, also increased schistosomiasis odds (AOR: 2.91, 95% CI: 1.66-5.13).
CONCLUSIONS: Consistent with the mechanisms of acquisition, hookworm infection increased with exposure to soil, and schistosomiasis increased with exposure to unclean water. Our findings highlight the importance of Water, Sanitation, and Hygiene programs and strategies aimed at reducing exposure within the framework of Neglected Tropical Disease elimination programs.
摘要：
背景：钩虫感染和血吸虫病是撒哈拉以南非洲最常见的两种被忽视的热带病。针对血吸虫病和土壤传播蠕虫（STHs）的年度大规模药物管理（MDA）计划，包括钩虫,已经在Mayuge区实施了，乌干达，自2003年至今。然而,钩虫和血吸虫病在Mayuge地区仍然很普遍。了解在MDA的背景下使儿童易患这些感染的因素可以为干预措施提供信息，以降低乌干达和类似环境的患病率。
方法：这项横断面研究于2022年1月至2月在Mayuge地区的33所随机选择的小学中进行。在选定的学校中，小学4或5班的儿童提供了单个粪便样本并完成了问卷调查。使用Kato-Katz方法检查粪便标本，以确定钩虫和血吸虫病的患病率。我们进行了单变量和多变量逻辑回归，以评估每种感染与潜在危险因素的关联。
结果：共有1,617名学生（平均年龄12.1岁，50.1%男性）入组。钩虫感染和血吸虫病的患病率分别为21.8％（95％置信区间（CI）：19.8-23.9％）和18.7％（95％CI：16.8-20.7％），分别。在多变量分析中，更长的取水时间(超过30分钟对少于30分钟)和每天在土壤中工作与钩虫感染几率增加相关(分别为调整比值比(AOR):1.49,95%CI:1.13-1.96和1.37,95%CI:1.03-1.82).血吸虫病的较高几率与一小时步行距离内接近水体有关（AOR：1.84，95％CI：1.35-2.50），并且在进食前并不总是洗手（AOR：2.00，95%CI：1.50-2.67）。游泳,洗澡,或者每周洗两次水，与从未相比，也增加了血吸虫病的几率（AOR：2.91，95%CI：1.66-5.13）。
结论：与获取机制一致，钩虫感染随着暴露于土壤而增加，血吸虫病随着暴露于不干净的水而增加。我们的发现强调了水的重要性，环卫,以及旨在在被忽视的热带病消除计划框架内减少暴露的卫生计划和策略。
方法：这项横断面研究于2022年1月至2月在Mayuge地区的33所随机选择的小学中进行。在选定的学校中，小学4或5班的儿童提供了单个粪便样本并完成了问卷调查。使用Kato-Katz方法检查粪便标本，以确定钩虫和血吸虫病的患病率。我们进行了单变量和多变量逻辑回归，以评估每种感染与潜在危险因素的关联。
结果：共有1,617名学生（平均年龄12.1岁，50.1%男性）入组。钩虫感染和血吸虫病的患病率分别为21.8％（95％置信区间（CI）：19.8-23.9％）和18.7％（95％CI：16.8-20.7％），分别。在多变量分析中，更长的取水时间(超过30分钟对少于30分钟)和每天在土壤中工作与钩虫感染几率增加相关(分别为调整比值比(AOR):1.49,95%CI:1.13-1.96和1.37,95%CI:1.03-1.82).血吸虫病的较高几率与一小时步行距离内接近水体有关（AOR：1.84，95％CI：1.35-2.50），并且在进食前并不总是洗手（AOR：2.00，95%CI：1.50-2.67）。游泳,洗澡,或者每周洗两次水，与从未相比，也增加了血吸虫病的几率（AOR：2.91，95%CI：1.66-5.13）。
结论：与获取机制一致，钩虫感染随着暴露于土壤而增加，血吸虫病随着暴露于不干净的水而增加。我们的发现强调了水的重要性，环卫,以及旨在在被忽视的热带病消除计划框架内减少暴露的卫生计划和策略。
