The impact of an integrated intervention program combining drug therapy with water, sanitation, and hygiene (WASH) education on reinfection with intestinal parasitic infections among the Karen hill tribe in northern Thailand.
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Abstract
Background: Intestinal parasitic infections (IPIs) are a major health problem among the Karen hill tribe in Thailand. This study aimed to evaluate the effect of an integrated intervention program of drug therapy combined with water, sanitation, and hygiene (WASH) education on reinfection with IPIs among the Karen hill tribe in an endemic area of northern Thailand.
Methods: A quasi-experimental study was conducted in two Karen villages, involving 691 residents, in Omkoi District, Chiang Mai Province; one village was designated as the intervention group and the other as the control group. Baseline information was collected regarding the infections and participants' knowledge, attitudes, and practices (KAP) related to prevention and control of IPIs. Detection of benzimidazole resistance linked to the beta-tubulin gene mutation in soil-transmitted helminths (STH) was performed using polymerase chain reaction (PCR) amplification and DNA sequencing. Mass drug administration (MDA) with albendazole was applied to both groups. The intervention group received WASH education, whereas the control group did not. Follow-up assessments were conducted at 3 and 6 months.
Results: Baseline data revealed a 36.0% (123/342) prevalence of IPIs in the intervention group and 36.8% (96/261) in the control group. The most common helminth and pathogenic protozoan were Trichuris trichiura and Giardia lamblia, respectively. No non-synonymous mutations in the beta-tubulin gene were found. Post-intervention at 3-month and 6-month follow-ups revealed that the prevalence of IPIs in the intervention group was significantly decreased to 23.6% (P = 0.002) and 23.1% (P = 0.002), and the prevalence of pathogenic IPIs was reduced from 9.4% to 3.9% (P = 0.013) and 2.4% (P = 0.002), respectively. In contrast, no significant changes in the prevalence of IPIs were observed in the control group. The intervention group showed significant improvements in KAP scores, which were significantly higher than those in the control group.
Conclusions: MDA alone is not effective for controlling IPIs among the Karen people due to rapid reinfection related to behavioral factors and socioeconomic conditions. We demonstrated for the first time that integration of WASH education increased KAP scores and consequently significantly reduced IPI reinfection among the Karen hill tribe in northern Thailand.
期刊介绍：
Parasites & Vectors is an open access, peer-reviewed online journal dealing with the biology of parasites, parasitic diseases, intermediate hosts, vectors and vector-borne pathogens. Manuscripts published in this journal will be available to all worldwide, with no barriers to access, immediately following acceptance. However, authors retain the copyright of their material and may use it, or distribute it, as they wish.
Manuscripts on all aspects of the basic and applied biology of parasites, intermediate hosts, vectors and vector-borne pathogens will be considered. In addition to the traditional and well-established areas of science in these fields, we also aim to provide a vehicle for publication of the rapidly developing resources and technology in parasite, intermediate host and vector genomics and their impacts on biological research. We are able to publish large datasets and extensive results, frequently associated with genomic and post-genomic technologies, which are not readily accommodated in traditional journals. Manuscripts addressing broader issues, for example economics, social sciences and global climate change in relation to parasites, vectors and disease control, are also welcomed.
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