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Abstract：
BACKGROUND: Helminth infections, including Opisthorchis viverrini, hookworm, and Trichuris trichiura, are prevalent in Khong district, Champasack province, southern Lao People\'s Democratic Republic (PDR). Schistosomiasis caused by Schistosoma mekongi is of public health concern on the islands of the Khong district. This study aimed to assess the impact of an Eco-Health/One-Health approach in combination with mass drug administration (MDA) to reduce these helminth infections.
METHODS: We conducted a community intervention using a stepped-wedge trial approach on two endemic islands (Donsom and Donkhone) of the Khong district, Champasack province, Lao PDR, between April 2012 and March 2013. In each study village, 30-40 households were randomly selected. All members of selected households, who were at home during the study period were invited to participate in the study. A baseline study was conducted to assess helminth infections, knowledge attitudes and practices toward Schistosoma mekongi infection, behavior of open defecation and availability of latrine at home. After the baseline (T0), the Eco-Health/One-Health approach was implemented on Donsom (intervention) and Donkhone island (control). An assessment was conducted in 2014 (T1), one year after the completion of intervention implementation, to assess the short-term impact of the Eco-Health/One-Health approach on helminth infections and compare intervention and control islands. Later in 2015, the Eco-Health/One-Health approach was implemented on control island (Donkhone). After the implementation of intervention, the parasitological assessments were conducted annually in humans in 2015 (T2), in 2016 (T3) and in 2017 (T4), and in dogs in 2017 (T4) to evaluate the long-term impact of the intervention on helminth infections. Frequency was used to describe the prevalence of helminth infections. Logistic regression was applied to associate the KAP (knowledge, attitudes, and practices and open defecation behavior) and the reduction of helminth infections between intervention and control islands. The reduction in prevalence pre- and post-intervention was associated using a McNemar test. A two-independent sample t-test was applied to compare the mean eggs per gram (EPG) of helminth infections between control and intervention islands. A paired t-test test was used to compare the mean EPG of stool samples before (baseline) and after (follow-up) interventions for the two islands separately. A P-value lower than 0.05 was considered statistically significant.
RESULTS: Eco-Health/One-Health approach appears to be associated with reduction in prevalence of S. mekongi by 9.0% [odds ratio (OR) = 0.49, P = 0.003] compared to the use of mass drug administration alone (control island). Additionally, this intervention package significantly reduced O. viverrini infection by 20.3% (OR = 1.92, P < 0.001) and hookworm by 17.9% (OR = 0.71, P = 0.045), respectively. Annual parasitological assessments between 2012 and 2017 showed that the Eco-Health/One-Health approach, coupled with MDA, steadily reduced the prevalence of S. mekongi on the intervention island from 29.1% to 1.8% and on the control island from 28.4% to 3.1%, respectively.
CONCLUSIONS: The study findings suggest that the Eco-Health/One-Health approach appears to be associated with a significant reduction in prevalence of S. mekongi and helminth co-infections, particularly hookworm and T. trichiura. Therefore, implementing the Eco-Health/One-Health approach in schistosomiasis-endemic areas could accelerate the achievement of national goals for transmission interruption by 2025 and elimination by 2030.
METHODS: We conducted a community intervention using a stepped-wedge trial approach on two endemic islands (Donsom and Donkhone) of the Khong district, Champasack province, Lao PDR, between April 2012 and March 2013. In each study village, 30-40 households were randomly selected. All members of selected households, who were at home during the study period were invited to participate in the study. A baseline study was conducted to assess helminth infections, knowledge attitudes and practices toward Schistosoma mekongi infection, behavior of open defecation and availability of latrine at home. After the baseline (T0), the Eco-Health/One-Health approach was implemented on Donsom (intervention) and Donkhone island (control). An assessment was conducted in 2014 (T1), one year after the completion of intervention implementation, to assess the short-term impact of the Eco-Health/One-Health approach on helminth infections and compare intervention and control islands. Later in 2015, the Eco-Health/One-Health approach was implemented on control island (Donkhone). After the implementation of intervention, the parasitological assessments were conducted annually in humans in 2015 (T2), in 2016 (T3) and in 2017 (T4), and in dogs in 2017 (T4) to evaluate the long-term impact of the intervention on helminth infections. Frequency was used to describe the prevalence of helminth infections. Logistic regression was applied to associate the KAP (knowledge, attitudes, and practices and open defecation behavior) and the reduction of helminth infections between intervention and control islands. The reduction in prevalence pre- and post-intervention was associated using a McNemar test. A two-independent sample t-test was applied to compare the mean eggs per gram (EPG) of helminth infections between control and intervention islands. A paired t-test test was used to compare the mean EPG of stool samples before (baseline) and after (follow-up) interventions for the two islands separately. A P-value lower than 0.05 was considered statistically significant.
RESULTS: Eco-Health/One-Health approach appears to be associated with reduction in prevalence of S. mekongi by 9.0% [odds ratio (OR) = 0.49, P = 0.003] compared to the use of mass drug administration alone (control island). Additionally, this intervention package significantly reduced O. viverrini infection by 20.3% (OR = 1.92, P < 0.001) and hookworm by 17.9% (OR = 0.71, P = 0.045), respectively. Annual parasitological assessments between 2012 and 2017 showed that the Eco-Health/One-Health approach, coupled with MDA, steadily reduced the prevalence of S. mekongi on the intervention island from 29.1% to 1.8% and on the control island from 28.4% to 3.1%, respectively.
CONCLUSIONS: The study findings suggest that the Eco-Health/One-Health approach appears to be associated with a significant reduction in prevalence of S. mekongi and helminth co-infections, particularly hookworm and T. trichiura. Therefore, implementing the Eco-Health/One-Health approach in schistosomiasis-endemic areas could accelerate the achievement of national goals for transmission interruption by 2025 and elimination by 2030.
摘要：
背景：蠕虫感染，包括Opissorchisviverrini,钩虫,还有TrichurisTrichiura,在Khong区很普遍，Champasack省,南部老挝人民民主共和国（PDR）。梅孔血吸虫引起的血吸虫病在Khong地区的岛屿上引起了公众的关注。这项研究旨在评估生态健康/单一健康方法与大规模药物管理（MDA）相结合以减少这些蠕虫感染的影响。
方法：我们在Khong区的两个特有岛屿（Donsom和Donkhone）上使用阶梯式楔形试验方法进行了社区干预，Champasack省,老挝,2012年4月至2013年3月。在每个学习村，随机选择30-40户。选定家庭的所有成员，在研究期间在家的人被邀请参加研究。进行了一项基线研究以评估蠕虫感染，对梅本吉血吸虫感染的知识态度和实践，露天排便的行为和家里厕所的可用性。基线（T0）后，在Donsom（干预）和Donkhone岛（控制）实施了生态健康/单一健康方法。2014年（T1）进行了评估，干预实施完成一年后，评估生态健康/单一健康方法对蠕虫感染的短期影响，并比较干预和控制岛屿。2015年晚些时候，在控制岛（Donkhone）实施了生态健康/单一健康方法。实施干预后,寄生虫学评估在2015年(T2)每年在人类中进行，2016年（T3）和2017年（T4），并在2017年（T4）的狗中评估干预对蠕虫感染的长期影响。频率用于描述蠕虫感染的患病率。Logistic回归用于关联KAP(知识，态度，以及实践和开放式排便行为）以及减少干预和控制岛之间的蠕虫感染。使用McNemar检验，干预前后患病率的降低是相关的。应用两个独立的样本t检验来比较对照岛和干预岛之间蠕虫感染的每克平均卵（EPG）。使用配对t检验分别比较两个岛的干预之前（基线）和之后（随访）的粪便样品的平均EPG。低于0.05的P值被认为具有统计学意义。
结果：Eco-Health/One-Health方法与单独使用大量药物给药（对照岛）相比，将S.mekongi的患病率降低9.0％[比值比（OR）=0.49，P=0.003]。此外,该干预方案可显著减少O.viverrini感染20.3%(OR=1.92,P<0.001),减少钩虫17.9%(OR=0.71,P=0.045),分别。2012年至2017年的年度寄生虫学评估表明，生态健康/单一健康方法，再加上MDA，在干预岛上，梅孔吉的患病率从29.1%稳步下降到1.8%，在控制岛上从28.4%下降到3.1%，分别。
结论：研究结果表明，生态健康/单一健康方法似乎与S.mekongi和蠕虫共感染的患病率显着降低有关，尤其是钩虫和T.trichiura.因此,在血吸虫病流行地区实施生态健康/单一健康方法可以加快实现到2025年阻断传播和到2030年消除传播的国家目标。
方法：我们在Khong区的两个特有岛屿（Donsom和Donkhone）上使用阶梯式楔形试验方法进行了社区干预，Champasack省,老挝,2012年4月至2013年3月。在每个学习村，随机选择30-40户。选定家庭的所有成员，在研究期间在家的人被邀请参加研究。进行了一项基线研究以评估蠕虫感染，对梅本吉血吸虫感染的知识态度和实践，露天排便的行为和家里厕所的可用性。基线（T0）后，在Donsom（干预）和Donkhone岛（控制）实施了生态健康/单一健康方法。2014年（T1）进行了评估，干预实施完成一年后，评估生态健康/单一健康方法对蠕虫感染的短期影响，并比较干预和控制岛屿。2015年晚些时候，在控制岛（Donkhone）实施了生态健康/单一健康方法。实施干预后,寄生虫学评估在2015年(T2)每年在人类中进行，2016年（T3）和2017年（T4），并在2017年（T4）的狗中评估干预对蠕虫感染的长期影响。频率用于描述蠕虫感染的患病率。Logistic回归用于关联KAP(知识，态度，以及实践和开放式排便行为）以及减少干预和控制岛之间的蠕虫感染。使用McNemar检验，干预前后患病率的降低是相关的。应用两个独立的样本t检验来比较对照岛和干预岛之间蠕虫感染的每克平均卵（EPG）。使用配对t检验分别比较两个岛的干预之前（基线）和之后（随访）的粪便样品的平均EPG。低于0.05的P值被认为具有统计学意义。
结果：Eco-Health/One-Health方法与单独使用大量药物给药（对照岛）相比，将S.mekongi的患病率降低9.0％[比值比（OR）=0.49，P=0.003]。此外,该干预方案可显著减少O.viverrini感染20.3%(OR=1.92,P<0.001),减少钩虫17.9%(OR=0.71,P=0.045),分别。2012年至2017年的年度寄生虫学评估表明，生态健康/单一健康方法，再加上MDA，在干预岛上，梅孔吉的患病率从29.1%稳步下降到1.8%，在控制岛上从28.4%下降到3.1%，分别。
结论：研究结果表明，生态健康/单一健康方法似乎与S.mekongi和蠕虫共感染的患病率显着降低有关，尤其是钩虫和T.trichiura.因此,在血吸虫病流行地区实施生态健康/单一健康方法可以加快实现到2025年阻断传播和到2030年消除传播的国家目标。
