Effectiveness of Anthelmintic Therapy and Determinants of Ascaris lumbricoides Infection among School-Aged Children: A Community-Based Cross-Sectional Study in Rural Khyber Pakhtunkhwa, Pakistan

Abstract

Background

Human ascariasis a soil-transmitted helminthiasis (STH) is still considered a neglected tropical disease by the World Health Organization continues to pose a serious public health concern, particularly in developing nations with poor sanitation, hygiene, and health awareness. Unlike prior prevalence studies relying solely on fecal analysis, this study utilized an innovative strategy to assess drug efficacy. The study aimed to assess the effectiveness of anthelmintic therapy and identify risk factors associated with Ascaris lumbricoides infection among school-aged children in rural Khyber Pakhtunkhwa, Pakistan.

Methods

This was a prospective, community-based interventional study in which 1,675 school-aged children were randomly allocated to receive one of three anthelmintic drugs: pyrantel pamoate (n = 592), mebendazole (n = 553), or albendazole (n = 530). The primary outcome, deworming efficacy, was measured by the post-treatment expulsion and identification of Ascaris lumbricoides worms in stool samples collected within 1–2 days. A well-structured questionnaire was administrated to evaluate key environmental, behavioral, and socioeconomic risk factors contributing to ascariasis.

Results

The overall prevalence of A. lumbricoides infection was found to be 15.1%, univariate logistic regression analysis identified several statistically significant predictors of Ascaris lumbricoides infection. Age was a significant factor, individuals aged 8–14 years had lower odds (OR = 0.58, 95% CI: 0.42–0.80, p < 0.001) and those ≥ 14 years had higher odds (OR = 1.47, 95% CI: 1.04–2.06, p = 0.03) than children aged 0–7 years. Drug regimen was the most influential factor: children treated with Pyrantel pamoate exhibited markedly elevated odds (OR = 6.76; 95% CI: 4.49–10.18; p < 0.001), followed by those receiving Mebendazole (OR = 1.50; p = 0.03), relative to Albendazole. Significant district-level differences exist, with Mardan (OR = 0.06, p < 0.001) and Swabi (OR = 0.04, p < 0.001) having significantly lower risk of ascariasis than Abbottabad. Battagram had comparable odds to Abbottabad, indicating no significant difference (OR = 1.01 p = 0.98). Key protective factors included wearing footwear (OR = 0.32; p < 0.001), clean fingernails (OR = 0.54; p < 0.001), access to a washroom (OR = 0.47; p < 0.001), and drinking tap water (OR = 0.44; p = 0.01). Conversely, middle household income (OR = 2.26; p < 0.001) and participation in deworming programmes (OR = 5.75; p = 0.03) were associated with increased infection risk, possibly reflecting selection bias and high-risk areas. Similarly, Multivariable logistic regression model revealed independent effects of age ≥ 14 years (AOR = 6.64; p < 0.001), middle income (AOR = 1.79; p < 0.001), rural location (AOR = 1.78; p = 0.01), and district (e.g., Battagram: AOR = 1.82; p = 0.03). Mebendazole (AOR = 7.73) and Pyrantel pamoate (AOR = 7.37) were significant predictors (p < 0.001). Gender, hygiene behaviours, and other factors did not indicate a statistically significant connection (p > 0.05).

Conclusions

The low prevalence of A. lumbricoides infection in the current study was due to evidence-based method, which provides precise evaluation of infection burden and treatment efficacy. To reduce the incidence of ascariasis in endemic locations, the study emphasizes the critical need for efficient public health interventions, such as health education, better sanitation infrastructure, frequent deworming campaigns, and community-based awareness initiatives.