Habib, Azimdine, Andrianonimiadana, Lova, Rakotondrainipiana, Maheninasy, Andriantsalama, Prisca, Randriamparany, Ravaka, Randremanana, Rindra, Rakotoarison, Rado, Vigan‑womas, Inès, Rafalimanantsoa, Armand, Vonaesch, Pascale, Sansonetti, Philippe, Collard, Jean-Marc, Investigators, The Afribiota, Vigan-Womas, Inès, Unité de Bactériologie Expérimentale [Antananarivo, Madagascar] (IPM), Institut Pasteur de Madagascar, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), Unité d’Épidémiologie et de Recherche clinique [Antananarivo, Madagascar], Unité d'immunologie des maladies infectieuses [Antananarivo, Madagascar] (IPM), Unité des Helminthiases [Antananarivo, Madagascar] (IPM), Pathogénie microbienne moléculaire, Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM), PV was supported by an Early Postdoctoral Fellowship (P2EZP3_152159), an Advanced Postdoctoral Fellowship (P300PA_177876) as well as a Return Grant (P3P3PA_17877) from the Swiss National Science Foundation, a Roux-Cantarini Fellowship (2016) and a L'Oréal-UNESCO for Women in Science France Fellowship (2017). The parasitology part of AFRIBIOTA was funded by the Total Foundation (2016) as well as the Fondation Petram (2014)., AFRIBIOTA Investigators (Group authorship in alphabetical order): Annick Robinson, Centre Hospitalier Universitaire Mère Enfant de Tsaralalana, Antananarivo, Madagascar, Aurélie Etienne, Institut Pasteur, Paris, France/ Institut Pasteur de Madagascar, Darragh Duffy, Institut Pasteur, Paris, France, Emilson Jean Andriatahirintsoa, Centre Hospitalier Universitaire Mère Enfant de Tsaralalana, Antananarivo, Francis Allan Hunald, Centre Hospitalier Universitaire Joseph Ravoahangy Andrianavalona (CHU-JRA), Antananarivo, Madagascar, Harifetra Mamy Richard Randriamizao, Centre Hospitalier Universitaire Joseph, Ravoahangy Andrianavalona (CHU-JRA), Antananarivo, Madagascar, Inès Vigan-Womas, Institut Pasteur de Madagascar, Antananarivo, Madagascar, Jean-Chrysostome Gody, Complexe Pédiatrique de Bangui, Bangui, Central, African Republic, Jean-Marc Collard, Institut Pasteur de Madagascar Antananarivo, Madagascar, Laura Schaeffer, Institut Pasteur, Paris, France, Lisette Raharimalala, Centre social Materno-Infantile, Tsaralalana, Antananarivo, Madagascar, Maheninasy Rakotondrainipiana, Institut Pasteur de Madagascar, Antananarivo, Madagascar, Milena Hasan, Institut Pasteur, Paris, France, Pascale Vonaesch, Institut Pasteur, Paris, France, Philippe Sansonetti, Institut Pasteur, Paris, France, Ravoahangy Andrianavalona (CHU-JRA), Antananarivo, Madagascar, Madagascar, Rindra Randremanana, Institut Pasteur de Madagascar, Antananarivo, Madagascar, Serge Ghislain Djorie, Institut Pasteur de Bangui, Bangui, Central African, Republic., and Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM)
Background This study aimed to compare the prevalence of intestinal parasite infestations (IPIs) in stunted children, compared to control children, in Ankasina and Andranomanalina Isotry (two disadvantaged neighborhoods of Antananarivo, Madagascar), to characterize associated risk factors and to compare IPI detection by real-time PCR and standard microscopy techniques. Methodology/Principal findings Fecal samples were collected from a total of 410 children (171 stunted and 239 control) aged 2–5 years. A single stool sample per subject was examined by simple merthiolate-iodine-formaldehyde (MIF), Kato-Katz smear and real-time PCR techniques. A total of 96.3% of the children were infested with at least one intestinal parasite. The most prevalent parasites were Giardia intestinalis (79.5%), Ascaris lumbricoides (68.3%) and Trichuris trichiura (68.0%). For all parasites studied, real-time PCR showed higher detection rates compared to microscopy (G. intestinalis [77.6% (n = 318) versus 20.9% (n = 86)], Entamoeba histolytica [15.8% (n = 65) versus 1.9% (n = 8)] and A. lumbricoides [64.1% (n = 263) versus 50.7% (n = 208)]). Among the different variables assessed in the study, age of 4 to 5 years (AOR = 4.61; 95% CI, (1.35–15.77)) and primary and secondary educational level of the mother (AOR = 12.59; 95% CI, (2.76–57.47); AOR = 9.17; 95% CI, (2.12–39.71), respectively) were significantly associated with IPIs. Children drinking untreated water was associated with infestation with G. intestinalis (AOR = 1.85; 95% CI, (1.1–3.09)) and E. histolytica (AOR = 1.9; 95% CI, (1.07–3.38)). E. histolytica was also associated with moderately stunted children (AOR = 0.37; 95% CI, 0.2–0.71). Similarly, children aged between 4 and 5 years (AOR = 3.2; 95% CI (2.04–5.01)) and living on noncemented soil types (AOR = 1.85; 95% CI, (1.18–2.09)) were associated with T. trichiura infestation. Conclusions/Significance The prevalence of IPIs is substantial in the studied areas in both stunted and control children, despite the large-scale drug administration of antiparasitic drugs in the country. This high prevalence of IPIs warrants further investigation. Improved health education, environmental sanitation and quality of water sources should be provided., Author summary In populations living in adverse conditions due to poverty, a wide variety of intestinal parasite infestations can be observed. These infestations are usually diagnosed by stool microscopy but can be easily overlooked if the procedures used are inaccurate or performed in a suboptimal way. In the present study, we investigated the prevalence of intestinal parasite infestations in stunted and control children aged from 2 to 5 years living in two disadvantaged neighborhoods of Antananarivo Madagascar. We also assessed risk factors for infestations and the diagnostic performance of microscopic techniques and real-time PCR for the detection of parasites. Almost all individuals were found to be infested with at least one parasitic species. Children aged between 4 and 5 years and mothers with low educational levels were found to be associated with infestation. Similarly, children drinking untreated water were associated with G. intestinalis and E. histolytica infestation. This latter species was also associated with moderately stunted children. Children between 4 and 5 years old and with no cemented soil type were associated with T. trichiura infestation. The high prevalence of intestinal parasite infestations among the study participants requires the improvement of health education, environmental sanitation and quality of water sources.