Prevalence and Geographical Distribution of Single and Multiple Species of Helminth Infestations in Primary School Children in Kisumu Municipality

Abstract

Helminth infestations is one of the neglected tropical diseases that affects over 90 million school aged children in Africa. It is a major public health problem especially in communities with poor sanitation and hygiene practices. In Kenya, approximately 8,661,333 primary school children are at risk of helminths. The degree of morbidity is related to the intensity and the number of species harboured. Control is neccesary because children are at higher risk of infection and may suffer from nutritional deficiencies, cognitive and physical development impairement as well as other serious illnesses. To achieve this, updated epidemiologic data is neccesary to guide policy makers and mass drug administrators. This was a cross-sectional study that aimed to determine the prevalence, intensities of infestation, pattern, relationships and geographical distribution of single and multiple species of helminths in primary school children aged 5-12 years old in Kisumu Municipality. Three stool samples were collected from 1300 pupils selected from 12 schools and analyzed for parasites using Kato-Katz technique. Primary schools were mapped using geographical information system data generated by hand-held geographical global positioning system units. Prevalence and intensities maps were generated using ArcView geographical information system software. Overall, 40.69% (529) of the pupils were infected by at least a species of helminths. The prevalence of single helminths infections for, Ancylostoma duodenale, Ascaris lumbricoides, Trichuris trichiura and Schistosoma mansoni was 2.15% (28), 3% (39), 12.08% (157) and 32.77% (426) respectively. The prevalence of dual coinfections was 7.54% (98), triple helminths co-infestations 0.1% (10) and quadruple coinfestations 0.08% (1). Light intensity was common in all the helminths. Most helminths were more prevalent in 9-12 years age group than in 5-8 years age group, Ascaris lumbricoides P =0.0159 (95% CI = 1.391-24.285, ), Trichuris trichuria P = 0.0002 (95% CI = 1.599-4.541) and S. mansoni P = 0.0001(95% CI = 2.461-4.888) and not significant in Ancylostoma duodenale P = 0.0592 (95% CI = 0.947-17.059). Male pupils were more infested than female pupils with Ancylostoma duodenale (OR 2.83, 95% CI = 1.07-5.04, P = 0.03), Ascaris lumbricoides (OR 2.57, 95% CI =1.28 - 5.13, P = 0.01), Trichuris trichiura (1.43, 95% CI =1.02 - 5.31, P = 0.03) and Schistosoma mansoni (OR 1.40, 95 % CI = 1.40- 1.78, P = 0.01), Chi-square test was used. Mapping showed presence of Schistosoma mansoni and Trichuris trichuria in all the school and the more proximate a school was to the Lake Victoriathe more the number of helminths types present. In conclusion helminths are a public health problem in Kisumu municipality. Schistosoma mansoni and Trichuris trichiura were present in all the schools. The trend of Ancylostoma duodenale being the most prevalent soil transmitted helminth as shown in earlier studies changed to Trichuris trichiura. This could have been attributed by persistent use of albendazole which has less efficacy to Trichuris trichiura, thus alternative use of albendazole and mebendazole should be embraced in mass drug administration. The more proximate the school was to Lake Victoria the more the number of helminths present and all the schools at the periphery had only two helminths species of Schistosoma mansoni and Trichuris trichiura. These results provided current epidemiologic information to the Ministry of Health and stakeholders that could be used in targeted implementation of helminths control and eradication strategies.