A health assessment of School-Age Children in Kutch, Gujarat (India) through the lens of Soil-Transmitted Helminth (STH) Infections

Soil-transmitted helminths (STH) are gastrointestinal worm parasites associated with anemia, malnutrition and impaired cognition. Studies estimate that STH infections account for 56 million disability-adjusted life years (DALYs) worldwide, comparable to malaria and tuberculosis. According to the WHO, more than one billion people worldwide are infected with these parasites especially children (5-14 years old) in developing countries. Specifically these are roundworms (Ascaris lumbricoides), hookworms (Ancylostoma duodenale and Necator americanus), and whipworms (Trichuris trichiura). STH infections can be seen as a marker signifying poor sanitation and environmental conditions and poverty especially in developing countries. A cross sectional study of STH Infection in school-age children (SAC) (6-12 years old) was conducted in Kutch, Gujarat, India. This study had a mixed method research design which utilized 5 research tools: (1) Clinical Diagnosis of STH Infection (n=212) (2) Demographic/Risk Factor Surveys (n=212) (3) Focus Groups with parents and children (n=13) (4) Key Informant Interviews with Community Leaders (n=6) (5) Environmental Assessments (n=4) . Four villages were selected: semi-urban, rural irrigated, rural non-irrigated and fishing villages. Stool samples were analyzed for STH egg burdens using the Modified Stoll's technique. Overall, 7% of the study sample showed a positive stool sample (STH/Parasite infection), but the majority (76.5%) of SAC were found to be at medium risk of STH infection as suggested by survey results. STH-related knowledge, attitudes and practice (KAP) increased with age (X²=11.76, p<.003). STH-related health behaviors and sanitation (HBS) differed by villages (X²= 12.81, p<0.005), grade (X²= 5.66, p<0.05) and religion (X²= 6.08, p<0.04). The highest prevalence of STH/Parasite infection was seen in the fishing village of Modhva (21%). Qualitative methods ( Focus Groups, Key Informant Interviews) revealed specific known and perceived risk factors for STH Infection in each of the villages. Environmental assessments illustrated high risk for STH infection in each of the villages illustrated by in-access to clean water supply and latrines. In addition, poor sanitation and waste disposal was evident in both quantitative and qualitative study findings. Study results will be used to develop guidelines for monitoring of STH infection, improving living conditions and health education materials in the selected villages.