Intestinal Parasitic Infection and Nutritional Status among School Children in Angolela, Ethiopia

Transcription

1 Intestinl Prsitic Infection nd Nutritionl Sttus mong School Children in Angolel, Ethiopi Nm Linh Deprtment Nguyen, Bizu Gelye, Nigussu b Aboset, Aber c Kumie, Yemne b,c Berhne, Michelle A. Willims of Epidemiology, Multidisciplinry Interntionl Reserch Trining Progrm, University of Wshington School of Public Helth, Settle, Wshington, USA baddis Continentl Institute of Public Helth, Addis Abb, ETHIOPIA caddis Abb University, Addis Abb, ETHIOPIA BACKGROUND & OBJECTIVE Tble : Distribution of Children According to Z-score, Angolel Primry School, Ethiopi, October 08 Among Boys Gstrointestinl prsitic infections re mongst the most common infections worldwide. These infections re most prevlent in popultions with low household income, poor hndling of personl nd environmentl snittion, overcrowding, nd limited ccess to clen wter. >0 33 (39.0) 36 (0.6) Anthropometric mesures expressed using the heightfor-ge, weight-for-ge, BMI-for-ge z-scores. 35 (.3) BMI-for-Age 7 (36.) 8 (.6) (35.) 9 (3.) - to - 53 (3.) 80 (3.5) 06 (3.) (6.8) 6 (.9) - to -3 (3.0) (7.0) 53 (5.5) (.0) 33 (0.) 50 (5.5) < -3 (6.5) (3.) 7 (5.0) 9 (5.7) 6 (.9) (5.6) Totl Vlid 9 (00) 33 (97.) 33 (97.) 57 (00) 3 (97.8) 3 (97.8) Figure : WHO child growth stndrds of Weight-for-Age () nd BMI-for-ge (b) mong Angolel Primry School students, Ethiopi, October, 08 by gender. ) Angolel Femles b) 0 Angolel Femles Angolel Mles Efforts should be mde to crete nd expnd school nd community-bsed progrms tht promote inexpensive prctices to prevent the spred of prsitic diseses. Inititives imed t improving the nutritionl sttus of school children re lso needed ACKNOWLEDGEMENTS This reserch ws supported in prt by n wrd from the Ntionl Institutes of Helth, Ntionl Center on Minority Helth nd Helth Disprities (T37-MD BMI (kg/m) BMI (kg/m) One-third of the prticipnts were found to hve protozon infection, while 7. were found to hve helminthic infection. There is high prevlence of intestinl prsitic infections. Stunting, wsting, nd underweightedness were lso prevlent, nd showed ptterns of ssocitions with intestinl prsitic infections. 6 Undernutrition ws observed to be prevlent mong both boys nd girls (figure ) CONCLUSIONS 30 8 Nerly of the students were stunted,.6 were wsted, nd.8 were underweight (tble ). Angolel Mles 3 3 Stunting ws found mong 0. of the boys nd. of the girls, while wsting ws found in.5 of boys nd.7 of girls (tble ). 50 (5.5) 55 (3.5) Continuous vribles were expressed s men ± stndrd error of men. Ctegoricl vribles were expressed s number (percentge, ). Chi-Squre tests were used to evlute the differences in the distribution of ctegoricl vribles for study groups. *Weight-for-Age Height-for-Age 0 to - MATERIALS & METHODS The study popultion consisted of 66 students ged from 6 to yers, from Angolel Primry School. Socio-demogrphic informtion ws collected using structured questionnire. Anthropometric mesurements of weight nd height were tken. Exmintions of fecl smples for helminthic nd protozon prsitic infections were performed. 8 (.6) BMI-for-Age Weight (kg) This cross-sectionl study ws designed to investigte prevlence of prsitic infection nd nutritionl sttus, nd to evlute the extent to which the two re ssocited mong schoolchildren in rurl Ethiopi. Z-score Weight (kg) Since intestinl prsitic infections re ssocited with poor socioeconomic clss nd unsnitry conditions, people living in such settings in rurl Ethiopi re t mjor risk for developing intestinl prsitic infections, nd its implictions. Weight-for-Age Height-for-Age Among Girls RESULTS N

2 Knowledge, Attitudes, nd Prctices (KAP) of Hygiene mong School Children in Angolel, Ethiopi A Vivs, B Deprtment b c Gelye, N Aboset, A bc Kumie, Y Berhne, MA Willims of Epidemiology, Multidisciplinry Interntionl Reserch Trining Progrm, University of Wshington School of Public Helth, Settle, Wshington, USA baddis Continentl Institute of Public Helth, Addis Abb, ETHIOPIA caddis Abb University, Addis Abb, ETHIOPIA Tble : Hnd Wshing Prctices mong Angolel Primry School Children Bckground A lrge mount of the world s illness nd deth is ttributed to communicble diseses. This trend is especilly rmpnt in developing countries where indequte snitry conditions nd poor hygiene ply mjor roles in the incresed burden of disese. Previous studies hve indicted tht students with proper hnd wshing prctices re less likely to report gstrointestinl nd respirtory diseses. Furthermore, study prticipnts from rurl Ethiopi hve poor sttus regrding knowledge, ttitudes, nd prctices (KAP) of hygiene. Simple mesures such s wshing hnds with sop were poorly prcticed. New hnd wshing fcilities, in ddition to wreness nd knowledge bout proper hygiene, hve led to some chnges in behvior nd ttitude, but hnd wshing is still wek in Ethiopi. Objective The objectives of this study re to evlute the KAP of hnd wshing, nd to ssess the extent to which proper knowledge on hygiene prctices is ssocited with personl hygiene chrcteristics mong rurl school children in Angolel, Ethiopi. Methods The study, conducted t Angolel Primry School, consisted of 669 prticipnts from grdes -6 (36 girls, 33 boys). Ech student ws interviewed using structured questionnire consisting of demogrphic informtion, hygiene nd hnd wshing prctices, knowledge bout snittion, personl hygiene chrcteristics, nd presence of gstrointestinl prsitic infection. Frequency tbles, bivrite methods, nd odds rtios (OR) with 95 confidence intervl (CI) were used during dt nlysis. Figure : Mp of Angolel Wored (now known s Bson Weren Wored), locted in the rth Show zone of the Amhr region of Ethiopi Chrcteristics Wshed hnds dy prior to interview Resons for wshing hnd After defection Before mels After mels Mterils used for hnd wshing Sop nd wter Wter only Usully wsh hnds before mel? Usully wsh hnds fter mel? When do you prefer to wsh hnds? Before eting mels After eting mels Don t know Which do you think is importnt? Wshing fter defection Wshing before eting mels Wshing fter eting mels N( Totl=669) Tble : Observed Personl Hygiene Chrcteristics According to Adequte Knowledge of Proper Hygiene Prctices Chrcteristics Adequte Knowledge of Hygiene (N=3) (N=39) Clen cloth Fingernils clen Fingernils trimmed Clen fce Eye dischrge present 8..9 Clen hir *Adjusted for ge (continuous) Undjusted Odds Rtio (95CI) *Adjusted Odds Rtio (95CI) (.3-.76).6 (.-.9) ( ). ( ) ( ). ( ) ( ).3 ( ) ( ) 0.97 (0.6-.5) (.3-.08).5 ( ) Approximtely 5 of students were clssified s hving dequte knowledge of proper hygiene. Most students reported hnd wshing before mels (99.0), but only 36. reported using sop. Although 76.7 of students reported tht wshing hnds fter defection is importnt, only.8 reported ctully following this prctice. Students with dequte knowledge of proper hygiene were more likely to hve clen clothes (AOR.6, CI.-.9) nd to hve lower risk of prsitic infection (AOR 0.78, CI ) lthough sttisticl significnce ws not chieved for the ltter. The findings of our study stress the need for more hnd wshing nd hygiene eduction in schools to decrese the rtes of morbidity nd mortlity ssocited with communicble diseses. To increse the rte of students with proper knowledge of hygiene, helth clubs cn be formed to tech students bout disese custion nd trnsmission nd demonstrte proper hnd wshing nd hygiene prctices. Much of hygiene prctices re contingent upon vilbility of sufficient resources. Well-designed nd well-locted hnd wshing fcilities nd ltrines, in ddition to sop nd wter, re essentil in promoting hygiene. If hygiene intervention progrms utilize these two importnt fctors eduction nd resources the needs of students cn be better trgeted nd cn thereby result in decresed risk of disese. In conclusion, school-bsed hygiene eduction is vitl in order to decrese the rtes of trnsmissible diseses. Children re more receptive to lerning nd re very likely to dopt helthy behviors t younger ge. They cn lso be gents of chnge by spreding wht they hve lerned in school to their fmily nd community members. Future studies regrding KAP should ssess the ttitudes tht students hve towrds hygiene, vilbility of wter nd snittion fcilities, nd the resons behind hnd wshing. Left: Angolel Primry School Right: Newly-built femle ltrines Acknowledgements This reserch ws supported in prt by n wrd from the Ntionl Institutes of Helth, Ntionl Center on Minority Helth nd Helth Disprities (T37-MD009)

3 Mternl Stress, Depression, nd Anxiety Disorders in reltion to Abruptio Plcente Nicole de Pz, Sixto E. Snchez, Luis Humn 3, Michelle A. Willims Multidisciplinry Interntionl Reserch Trining (MIRT) Progrm, University of Wshington, Settle, WA, USA Hospitl Ncionl Dos De Myo, Lim, Peru nd 3 Instituto Especilizdo Mterno Perintl, Lim, Peru Bckground & Objective Abruptio plcente is pregnncy compliction in which the plcent premturely seprtes from the uterine wll before delivery, potentilly resulting in mternl hemorrhge nd shock, fetl distress, stillbirth, nd mternl deth. AP ffects pproximtely of ll pregnncies, but is responsible for significnt mount of mternl nd fetl deths in developing countries. While risk fctors such s multi-fetl gesttions, cogulopthies, nd bdominl trum hve been identified, little is known bout the influence of psychosocil nd psychitric fctors on the risk of AP. The objective of the current study ws to ssess three common relted psychologicl conditions depression, nxiety nd stress disorders s risk fctors for bruptio plcente. Mterils & Methods This cse-control study of 7 pregnnt dult women (373 cses, 368 controls) ws conducted t five helth estblishments in Lim, Peru, between 06 nd 08. Ptients were recruited from Hospitl Ncionl Dos de Myo, Hospitl Sn Brtolomé, Hospitl Rebgliti, Hospitl Hipolito Unnue nd Instituto Especilizdo Mterno Perintl, the mjority of which re run by the government to serve ptients of low socioeconomic sttus. Interviews were used to collect detiled informtion on socio-demogrphic chrcteristics, medicl nd reproductive history, nd specific behviors, such s use of tobcco, lcohol, nd illicit drugs during the nteprtum period. The Ptient Helth Questionnire-9 (PHQ-9) nd modified version of the Depression, Anxiety, nd Stress Scle- (DASS-) were used to ssess subjects experience of symptoms of depression, nxiety, nd stress during the pregnncy. The opertionl definition of AP required one or more of the following four criteri: nteprtum hemorrhge fter weeks gesttion, uterine pin or tenderness, fetl distress or deth, nd retroplcentl blood clot. Study personnel checked vilble ultrsound nd pthology informtion, s well s medicl records, for clinicl informtion nd to confirm the dignosis of AP. Multivrible logistic regression procedures were used to clculte djusted odds rtios (OR) nd 95 confidence intervls (95 CI). Tble. Socio-Demogrphic nd Reproductive Chrcteristics of the Study Popultion, Lim, Peru, Abruptio Plcente Chrcteristics Cses (N=373) Controls (N=368) n n p-vlue Mternl ge t delivery (yers) 8. ± 6.7* 8.0 ± Mternl Age t Delivery (yers) < Missing Primiprous High School Eduction Employed during Pregnncy Plnned Pregnncy Prentl Cre Prentl Vitmin Smoke in Pregnncy Alcohol in Pregnncy Illicit Drugs in Pregnncy Pre-pregnncy Body Mss Index 3.7 ± 3.7* 3. ± (kg/m ) Pre-pregnncy Body Mss Index (kg/m ) < Missing Pre-Gesttionl Chronic Hypertension Infnt Birth Weight (grms)** 7 ± 3306 ± < * 50 Low Birthweight Infnt <0.00 (<500grms)** Gesttionl ge t delivery (weeks) 35.3 ± 3.8* 38.7 ±.8 <0.00 Preterm Delivery Infnt (<37weeks) <0.00 Stillbirth *Men± Stndrd Devition (SD) **Restricted to live births (3 cses, 365 controls) rml (<) Mild PHQ-9 (5-9) Moderte PHQ-9(0-) Modertley Severe PHQ-9 (5+) rml (0-9) Mild Depression (0-3) Moderte Depression (-) Severe Depression (+) rml (0-7) Mild Anxiety (8-9) Moderte Anxiety (0-) Severe Anxiety (5+) rml (0-) Mild Stress (5-) Moderte Stress (-5) Severe Stress (6+) Adjusted OR (95 CI) for Abruptio Plcente PHQ-9 Depression DASS- Depression DASS- Anxiety DASS- Stress Sociodemogrphic nd reproductive chrcteristics of bruptio plcente cses nd controls re presented in Tble. After djustment for confounders, depressive symptoms of incresing severity (using the DASS depression subscle) were ssocited with bruptio plcente risk (p for trend = 0.0) (Figure ). Compred with women with no depressive symptoms, the OR nd (95 CI) for bruptio plcente ssocited with ech level of severity of depression symptoms bsed on the DASS ssessment were s follows: mild.8 ( ); moderte.5 ( ); nd severe.68 (0.98-.) (Figure ). The corresponding ORs nd 95 CIs for mild, moderte, nd modertely severe depressive symptoms bsed on the PHQ ssessment were.0 ( ), 3.3 ( ), nd 5.0 ( ), respectively when compred with the reference group (Figure ). A positive grdient ws observed for bruptio plcente risk with severity of nxiety (trend test p=0.00) nd stress symptoms (trend test p=0.00) (Figure ). Our findings re consistent with those from other studies linking psychitric disorders nd psychosocil stress with dverse pregnncy outcomes, including preterm birth, preeclmpsi, nd low birth weight. Conclusion Mternl mood nd nxiety disorders my be ssocited with incresed risks of bruptio plcente. These observtions must be explored in lrger studies tht llow for more precise evlutions of mternl psychitric helth in reltion to bruptio plcente risk. Potentil public helth efforts to screen nd tret ffected women my lso modify risks of bruptio plcente, s well s other ssocited disorders. This reserch ws supported by n wrd from the Ntionl Institutes of Helth, Ntionl Center on Minority Helth nd Helth Disprities (T37-MD009) Figure. Adjusted Odds Rtios (OR) nd 95 Confidence Intervls (CI) for Abruptio Plcente According to Mternl Symptoms of Depression, Anxiety, nd Stress During Pregnncy, Lim, Peru,

4 Prevlence of Insulin Resistnce nd Its Reltionship with Crdiovsculr Disese Risk Fctors Among Thi Adults Hu D. Do, Vitool Lohsoonthorn, Wiroj Jimjrsrngsi, Somrt Lertmhrit, nd Michelle A. Willims MIRT Progrm, University of Wshington, Settle WA, USA; nd Deprtment of Preventive nd Socil Medicine, Fculty of Medicine, Chullongkorn University, Bngkok, Thilnd Bckground Mterils nd Methods Mny longitudinl studies in dults demonstrted tht insulin resistnce is risk fctor of the development of type dibetes. Given the multitude of serious complictions tht my rise from dibetes, it is impertive to estblish simple nd prcticl method for identifying individuls t high risk for insulin resistnce to initite erly trgeted dibetes prevention strtegies. Homeostsis Model Assessment of Insulin Resistnce (HOMA-IR) uses informtion bout fsting glucose nd insulin concentrtions to derive n estimte for insulin resistnce. HOMA-IR method is simpler nd more prcticl mesurement of insulin resistnce in lrge epidemiologic studies. We conducted cross-sectionl study of 6 men nd,0 women who prticipted in nnul helth exmintions t the King Chullongkorn Memoril Hospitl in Bngkok, Thilnd during the period of August 08 - October 08. Eligible prticipnts were sked to provide informtion bout their ge, mritl sttus, occuption, eductionl ttinment, medicl history, use of nti-hypertensive, nti-dibetic, or lipid lowering medictions, smoking sttus, lcohol consumption hbits, nd physicl ctivity. Prticipnts underwent routine clinicl physicl exmintions which included overnight fsting venous blood smples, nd mesurement of height, weight, wist circumference nd resting blood pressures. The prevlence of insulin resistnce ws estimted using dignostic criteri previously employed in Asin nd other popultions. Spermn s rnk correltion ws used to evlute ssocitions of HOMA-IR with selected crdiovsculr disese risk fctors. Multivrible logistic regression procedures were used to evlute ssocitions of hypertriglyceridemi, low HDL-Cholesterol, nd hypertension with vrying HOMA-IR vlues. Approximtely of Thi (HOMA-IR vlues exceeding.58) nd 3 of Thi women (HOMA-IR vlues exceeding of.5) were clssified s hving insulin resistnce. HOMA-IR vlues were sttisticlly significntly nd positively ssocited with body mss index (BMI), body ft percentge, wist circumference, nd triglycerides; nds were inversely correlted with HDL-Cholesterol (for men, r=-0.7, for women, r=-0.33). When compred with those whose HOMA-IR vlues were within the lowest qurtile (<0.5), men with HOMA-IR vlues in the highest qurtile (.58) hd higher risks of hypertriglyceridemi (djusted OR=.83), low HDL-Cholesterol (djusted OR=.79), nd hypertension (djusted OR=.76). Objectives To estimte the prevlence of insulin resistnce (HOMA-IR) nd to study its reltionship with selected crdiovsculr disese risk fctors mong Thi dults. Tble Socio-demogrphic nd clinicl chrcteristics of study 7 prticipnts, Bngkok, Thilnd, 08 Men Women Chrcteristic (n=7) (n=990) n n Among women, ssocitions of HOMA-IR vlues with hypertriglyceridemi, low HDL-Cholesterol, nd hypertension were observed to hve liner trend component (p-vlues <0.0). After djusting for the confounding fctors, women with HOMA-IR vlues in the upper qurtile hd.-fold increse risk of hving hypertension (djusted OR=., 95 CI.-.03) s compred with those who hd vlues in the lowest qurtile. Tble Spermn s rnk correltion coefficients for HOMA-IR nd selected crdiovsculr disese risk fctors, Bngkok, Thilnd, 08 Among men Among women (n=7) (n=990) Eduction Primry eduction <Bchelor degree Bchelor degree Body mss index (kg/m ) Underweight (<.5) (.5-.9) Overweight ( ) Obesity ( 30.0) Crdiovsculr disese risk fctors r p-vlue r p-vlue <0.00 Body mss index (kg/m ) 0.5 < <0.00 Body ft percentge () 0.5 < <0.00 Wist circumference (cm) 0.89 < <0.00 Systolic blood pressure (mmhg) < <0.00 Distolic blood pressure (mmhg) 0.76 < <0.00 Triglyceride (mg/dl) < <0.00 HDL-Cholesterol (mg/dl) <0.00 Smoking sttus Never smoker Previous smoker Current smoker Alcohol consumption Exercise , <50 minutes/week , 50 minutes/week Men (SD) Men (SD) Body ft percentge ().6 (5.6) 33.3 (6.3) Wist circumference (cm) 86. (9.0) 76. (9.5) Systolic blood pressure (mmhg).7 (3.9) 3.8 (.) Distolic blood pressure (mmhg) 77. (0.5) 7. (9.8) HDL-Cholesterol (mg/dl) 7.0 (.) 60.9 (.7) Insulin resistnce s determined using HOMA-IR ws positively relted with selected crdiovsculr disese risk fctors. Ptients with HOMA-IR vlues in the highest qurtile hd the highest risks of hypertriglyceridemi, low HDL-Cholesterol nd hypertension. The present study indictes tht the prevlence of insulin resistnce ws substntilly higher in obese dults compred with norml-weight dults. HOMA-IR my to be useful method for ssessing insulin resistnce mong Thi dults. Medin (IQR) Medin (IQR) Triglyceride (mg/dl).0 (03.0) 83.0 (5.0) Fsting plsm glucose (mg/dl) 87.0 (.0) 86.0 (9.0) Fsting insulin (µiu/ml) 3.9 (5.). (.6) HOMA-IR 0.9 (.) 0.9 (.0) This reserch ws supported by Rchdpiseksompoj Fculty of Medicine Reserch Fund, Chullongkorn University, Thilnd nd Ntionl Institutes of Helth (T37-MD009), USA

5 Men - REF Men - Tertile Men - Tertile 3 Women - REF Women - Tertile Women - Tertile Adjusted OR (95 CI) 3.6