167
1- RA AJID Dr Eslahi 167 RTG.pdf
1- RA AJID Dr Eslahi 167 RTG.pdf
1- RA AJID Dr Eslahi 167 RTG.pdf
1- RA AJID Dr Eslahi 167 RTG.docx
Cover letter.pdf
Manuscript.docx
170
10.60141/ajid.167
Precision Public Health Approaches to Intestinal Parasitic Infections in Children under Five: A Policy Brief
<p>The majority of the burden of childhood disease and delayed development worldwide is attributed to one of the most neglected diseases, intestinal parasitic infections (IPIs). Helminth and protozoan infections continue to disproportionately affect under 5-year-old children, especially in low and low-middle income countries. These infections contribute to childhood diarrhea, malnutrition, growth failure, anemia, poor cognitive development, and preventable death. Nearly a third of all under 5 children globally have IPIs; however, this estimate could actually be significantly underestimated given low diagnostic sensitivity. This policy brief provides a comprehensive review of existing evidence on the global burden and causes of IPIs among under-fives, and identifies a range of evidence-based policy actions for governments, international organizations and development partners. Three proposed interconnected policy priorities are targeted geographically specific mass drug administration (MDA) and surveillance in high burden hotspots; climate-smart and context specific Water and sanitation and hygiene (WASH) interventions; and enhanced diagnostic and surveillance capacity for improved burden estimation and targeting resources. Despite the need for it, implementation is severely hampered by insufficient funding, under-developed health systems, inadequate inter-sectoral coordination, continuing environmental transmission environments, and under-diagnosis arising from use of low-sensitivity diagnostics. The challenge posed by IPIs in children under five will necessitate a shift from broad-based control plans to more precision public health approaches. These will include the implementation of hotspot targeting, environmentally tailored WASH interventions and enhanced diagnostic surveillance.</p>
https://creativecommons.org/licenses/by/4.0
Aida Vafae Eslahi, Ioannis Adamopoulos
2026
Intestinal parasites Infection
Neglected tropical disease
Children under five years
Policy brief
Mass drug administration
Aida
Vafae Eslahi
Medical Microbiology Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
IR
vafaeeslahia@gmail.com
https://orcid.org/0000-0001-5399-0552
Ioannis
Adamopoulos
Department of Public Health Policy, Sector of Occupational and Environmental Health, School of Public Health, University of West Attica, Athens, Greece.
GR
iadamopoulos@uniwa.gr
196
PDF
0
Animaw Z, Melese A, Demelash H, Seyoum G, Abebe A. Intestinal parasitic infections and associated factors among pregnant women in Ethiopia: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2021;21(1):474.
Jourdan PM, Lamberton PH, Fenwick A, Addiss DG. Soil-transmitted helminth infections. The lancet. 2018; 391(10117):252-65.
Garcia LS, Procop GW. Diagnostic medical parasitology. Man Commer Methods Clin Microbiol Int Ed. 2016;284–308.
Fauziah N, Aviani JK, Agrianfanny YN, Fatimah SN. Intestinal parasitic infection and nutritional status in children under five years old: a systematic review. Trop Med Infect Dis. 2022;7(11):371.
Mahmoud EA, Ahmed AM, Osman HI, Fadel EF. Intestinal Parasitic Infections and Malnutrition among Under-Five Children: A Narrative Review. Sohag Med J. 2026;30(2.):1–7.
Taherahmadi H, Olfatifar M, Mosawi SH, Habibi M, Babaei A, Adamopoulos I, Samiee-Rad F, Gharibi Z, Mohammadi F, Hatam-Nahavandi K, Eslahi AV. Global prevalence and public health impact of intestinal parasitic infections in children under five: a systematic review and meta-analysis. BMC Public Health. 2026;26:2095 ;
Hall A, Hewitt G, Tuffrey V, De Silva N. A review and meta-analysis of the impact of intestinal worms on child growth and nutrition. Matern Child Nutr. 2008;4:118–236.
Stephenson LS, Latham MC, Ottesen EA. Malnutrition and parasitic helminth infections. Parasitology. 2000;121(S1):S23--S38.
Strunz EC, Addiss DG, Stocks ME, Ogden S, Utzinger J, Freeman MC. Water, sanitation, hygiene, and soil-transmitted helminth infection: a systematic review and meta-analysis. PLoS Med. 2014;11(3):e1001620.
Carlson CJ, Burgio KR, Dougherty ER, Phillips AJ, Bueno VM, Clements CF, et al. Parasite biodiversity faces extinction and redistribution in a changing climate. Sci Adv. 2017;3(9):e1602422.
Chammartin F, Guimarães LH, Scholte RGC, Bavia ME, Utzinger J, Vounatsou P. Spatio-temporal distribution of soil-transmitted helminth infections in Brazil. Parasit Vectors. 2014;7(1):440.
World Health Organization. Helminth control in school-age children: a guide for managers of control programmes. World Health Organization; 2011. https://www.who.int/publications/i/item/9789241548267
World Health Organization. Guideline: preventive chemotherapy to control soil-transmitted helminth infections in at-risk population groups. 2017. https://www.who.int/publications/i/item/9789241550116
Vlaminck J, Cools P, Albonico M, Ame S, Chanthapaseuth T, Viengxay V, Do Trung D, Osei-Atweneboana MY, Asuming-Brempong E, Karim MJ, Al Kawsar A. Piloting a surveillance system to monitor the global patterns of drug efficacy and the emergence of anthelmintic resistance in soil-transmitted helminth control programs: a Starworms study protocol. Gates open research. 2020 Mar 10;4:28.
Anderson RM, Truscott JE, Pullan RL, Brooker SJ, Hollingsworth TD. How effective is school-based deworming for the community-wide control of soil-transmitted helminths? PLoS Negl Trop Dis. 2013;7(2):e2027.
Lo NC, Bogoch II, Blackburn BG, Raso G, N’Goran EK, Coulibaly JT, et al. Comparison of community-wide, integrated mass drug administration strategies for schistosomiasis and soil-transmitted helminthiasis: a cost-effectiveness modelling study. Lancet Glob Heal. 2015;3(10):e629--e638.
Jia TW, Melville S, Utzinger J, King CH, Zhou XN. Soil-transmitted helminth reinfection after drug treatment: a systematic review and meta-analysis. PLoS Negl Trop Dis. 2012;6(5):e1621.
Vercruysse J, Albonico M, Behnke JM, Kotze AC, Prichard RK, McCarthy JS, et al. Is anthelmintic resistance a concern for the control of human soil-transmitted helminths? Int J Parasitol Drugs Drug Resist. 2011;1(1):14–27.
World Health Organization. Regional Strategic Framework for sustaining, accelerating and innovating to end NTDs in the South-East Asia Region 2023–2030. World Health Organization. Regional Office for South-East Asia; 2023 Sep 24. https://iris.who.int/items/0afee54b-1f5c-40ee-825e-cad5eea02a9d
World Health Organization. Climate-resilient water safety plans: managing health risks associated with climate variability and change. World Health Organization; 2017 Aug 15. https://www.who.int/publications/i/item/9789241512794
World Health Organization. Progress on household drinking water, sanitation and hygiene 2000-2020: five years into the SDGs. World Health Organization; 2021 Sep 13. https://iris.who.int/items/c1ec4c60-a934-40eb-b65b-55cf35b0bb7c
Ziegelbauer K, Speich B, Mäusezahl D, Bos R, Keiser J, Utzinger J. Effect of sanitation on soil-transmitted helminth infection: systematic review and meta-analysis. PLoS Med. 2012;9(1):e1001162.
Freeman MC, Garn J V, Sclar GD, Boisson S, Medlicott K, Alexander KT, et al. The impact of sanitation on infectious disease and nutritional status: a systematic review and meta-analysis. Int J Hyg Environ Health. 2017;220(6):928–49.
Hutton G, Chase C. The knowledge base for achieving the sustainable development goal targets on water supply, sanitation and hygiene. Int J Environ Res Public Health. 2016;13(6):536.
World Health Organization. A compendium of indicators for monitoring and evaluating progress of the road map for neglected tropical diseases 2021–2030. World Health Organization; 2023 Jan 6. https://iris.who.int/items/a09a0513-7b5f-4e6f-b85e-97ceaa9df8e9
Khurana S, Singh S, Mewara A. Diagnostic techniques for soil-transmitted helminths--recent advances. Res Rep Trop Med. 2021;181–96.
Hotez PJ, Fenwick A, Savioli L, Molyneux DH. Rescuing the bottom billion through control of neglected tropical diseases. Lancet. 2009;373(9674):1570–5.
Bundy DA, De Silva N, Horton S, Patton GC, Schultz L, Jamison DT. Child and adolescent health and development: realizing neglected potential. Disease control priorities,. 2017 Nov 20;8:1-24.
World Health Organization. Primary health care on the road to universal health coverage: 2019 global monitoring report. https://iris.who.int/items/74295858-b092-4b55-b20a-46dd0f44ed39
Gyapong JO, Gyapong M, Yellu N, Anakwah K, Amofah G, Bockarie M, et al. Integration of control of neglected tropical diseases into health-care systems: challenges and opportunities. Lancet. 2010;375(9709):160–5.
Perry HB, Dhillon RS, Liu A, Chitnis K, Panjabi R, Palazuelos D, et al. Community health worker programmes after the 2013--2016 Ebola outbreak. Bull World Health Organ. 2016;94(7):551.
Wolfe CM, Hamblion EL, Dzotsi EK, Mboussou F, Eckerle I, Flahault A, et al. Systematic review of Integrated Disease Surveillance and Response (IDSR) implementation in the African region. PLoS One. 2021;16(2):e0245457.
Bhutta ZA, Das JK, Rizvi A, Gaffey MF, Walker N, Horton S, et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet. 2013;382(9890):452–77.
Pullan RL, Brooker SJ. The global limits and population at risk of soil-transmitted helminth infections in 2010. Parasit Vectors. 2012;5(1):81.
Jourdan PM, Lamberton PHL, Fenwick A, Addiss DG. Soil-transmitted helminth infections. Vol. 391, The Lancet. 2018. p. 252–65.
Brooker S, Clements ACA, Bundy DAP. Global epidemiology, ecology and control of soil-transmitted helminth infections. Adv Parasitol. 2006;62:221–61.
Freeman MC, Ogden S, Jacobson J, Abbott D, Addiss DG, Amnie AG, et al. Integration of water, sanitation, and hygiene for the prevention and control of neglected tropical diseases: a rationale for inter-sectoral collaboration. PLoS Negl Trop Dis. 2013;7(9):e2439.
Nikolay B, Mwandawiro CS, Kihara JH, Okoyo C, Cano J, Mwanje MT, et al. Understanding heterogeneity in the impact of national neglected tropical disease control programmes: evidence from school-based deworming in Kenya. PLoS Negl Trop Dis. 2015;9(9):e0004108.
Khurana S, Sethi S. Laboratory diagnosis of soil transmitted helminthiasis. Trop Parasitol. 2017;7(2):86–91.
for Disease Control C, Prevention, others. DPDx-Laboratory identification of parasites of public health concern. Pthiriasis Available from URL https//www cdc gov/dpdx/pthiriasis/index html (Accessed March 11, 2020). 2019;
Unicef, Unicef. Strategy for water, sanitation and hygiene 2016-2030. https://www.unicef.org/documents/unicef-strategy-water-sanitation-and-hygiene-2016-2030
Freeman MC, Stocks ME, Cumming O, Jeandron A, Higgins JPT, Wolf J, et al. Systematic review: hygiene and health: systematic review of handwashing practices worldwide and update of health effects. Trop Med Int Heal. 2014;19(8):906–16.
World Health Organization. Ending the neglect to attain the sustainable development goals. One Health: approach for action against neglected tropical diseases 2021-2030. World Health Organization; 2022 Jan 28. https://www.who.int/publications/i/item/9789240042414
Bieri FA, Gray DJ, Williams GM, Raso G, Li YS, Yuan L, et al. Health-education package to prevent worm infections in Chinese schoolchildren. N Engl J Med. 2013;368(17):1603–12.
Asaolu SO, Ofoezie IE. The role of health education and sanitation in the control of helminth infections. Acta Trop. 2003;86(2–3):283–94.
World Health Organization. Water, sanitation, hygiene and health: a primer for health professionals. World Health Organization; 2019. https://www.who.int/publications/i/item/WHO-CED-PHE-WSH-19.149
Salam RA, Maredia H, Das JK, Lassi ZS, Bhutta ZA. Community-based interventions for the prevention and control of helmintic neglected tropical diseases. Infect Dis poverty. 2014;3(1):23.
World Health Organization. Ending the neglect to attain the sustainable development goals: a rationale for continued investment in tackling neglected tropical diseases 2021–2030. World Health Organization; 2022 Sep 26. https://www.who.int/publications/i/item/9789240052932
Knopp S, Mgeni AF, Khamis IS, Steinmann P, Stothard JR. Diagnosis of Soil-Transmitted Helminths in the Era of Preventive Chemotherapy; November 2008;2(11):e331
Strunz EC, Addiss DG, Stocks ME, Ogden S, Utzinger J, Freeman MC. Water, sanitation, hygiene, and soil-transmitted helminth infection: a systematic review and meta-analysis. PLoS medicine. 2014 Mar 25;11(3):e1001620.
World Health Organization. Guidelines for drinking-water quality: incorporating the first and second addenda. World Health Organization; 2022 Mar 21. https://www.who.int/publications/i/item/9789240045064
Fletcher SM, Stark D, Harkness J, Ellis J. Enteric protozoa in the developed world: a public health perspective. Clinical microbiology reviews. 2012 Jul;25(3):420-49.
Savioli L, Albonico M, Daumerie D, Lo NC, Stothard JR, Asaolu S, Tchuem Tchuenté LA, Anderson RM. Review of the 2017 WHO Guideline: Preventive chemotherapy to control soil-transmitted helminth infections in at-risk population groups. An opportunity lost in translation. PLoS neglected tropical diseases. 2018 Apr 26;12(4):e0006296.
Seale AC, Hutchison C, Fernandes S, Stoesser N, Kelly H, Lowe B, Turner P, Hanson K, Chandler CI, Goodman C, Stabler RA. Supporting surveillance capacity for antimicrobial resistance: laboratory capacity strengthening for drug resistant infections in low and middle income countries. Wellcome open research. 2017 Sep 26;2:91.
4
2
2026
Fourth Volume, second issue, July 2026
127-136