R ev is t a d a S o c i e d a d e B r as ile ir a d e M e d ic in a T r o p ic al 2 9 ( 5 ) :4 2 5 - 4 3 0 , se t - o u t , 1 9 9 6 .
CO N TR O L OF P ARASITIC I N F E CTI O N S AM O N G
SCH O O L CH ILDREN IN TH E PERI-URBAN AREA
OF BO TU CATU , SÃO PAULO, BRAZIL
Regina Coeli Cunha D órea, Ednir Salata, Carlos Roberto
Padovani and Gilberto Lupi dos Anjos
Tide p rev alen c e o f in testin al p arasitosis iv as in v estig ated in a p r im aiy sc ho o l lo c at ed in R u biâo Jú n ior, a p eri- u rban district o f Botu catu , São P au lo slate, Braz il, in o rder to assess the effec t o f treatm en t an d p r ac t ic al m easu res o f pro p hy lax is in the c o n tro l o f p arasit ic in fection s am o n g 7-to- 18 - y ear- old sc ho o l c hildren o f a low so c io - ec o n o m ic status. The fir s t series o f p arasit o lo g ic al ex am in atio n s in c lu ded 2 1 9 sc ho o l children , e f w hich 1 2 3 ( 56.1 % ) w ere fo u n d to be in fec ted with o n e o r m o re p arasit e species. Eighty -fo u r c hildren c an y in g p at ho g en ic p arasit es w ere su bm itted to v ariou s an ti- parasitic treatm en t schedu les. W e re- ev alu ated 15 ( 8 9 % ) students aft er 4 to 6 m on ths post-chem otherapy . The results in dic at e that the c o m bin atio n o f treatm en t w ith p ro p hy lac tic m easu res has been su cc essfu l in the c o n tro l o f p arasit ic in fections, sin c e rein fec tion rates w ere g en erally low (< 5-3 % ), ex cept f o r G iardia lamblia in fection s ( 1 8 .6 %), an d a m ar ke d redu c tion oti the p r e v ale n c e rates w as o bs e w e d with a sig n ific an t p erc en t ag e o f c u re (> 73-1 % ) in c hildren in fec t ed with most p arasit e species. The reaso n s f o r the ap p aren t failu r e in the con trol o f in fection s c au sed by H ym enolepis nana an d Strongyloides stercoralis ar e discu ssed.
Key -w ords: In testin al p arasitosis. P rev alen c e. Treatm ent. P rophy lax is. Sc hool children .
Intestinal p arasitic in fec tio ns are am o ng st the m o st w id esp read d iso rd ers that affect scho o l- ag e ch ild ren liv ing in p o o r u rb an co m m u nities, d e s p ite e f f o r ts f ro m s o m e p u b l ic h e a lth au tho rities to im p ro v e p rim ary health c are and sanitatio n co nd itio ns4. D u e to th e av ailab ility o f relativ ely sim p le, cheap and accurate d iag no stic techniq ues, a nu m b er o f surveys has inv estig ated the p re v alen c e o f p arasitic in fec tio ns, as a d eterm inant o f child health status515. Tem p o rary m easu res su c h as th e u se o f an tip ro to z o an and anthelm intic d rugs m ay hav e so m e im p act in the red u ctio n o f in fec tio n rates. H o w ev er, p articu larly fo r lo w -in c o m e child ren, the risk o f in fec tio n in c reases w ith the sho rtag e o f c lean d rinking w ater, lac k o f c are in p rep aring raw v eg etab les, in ad eq u ate g arb ag e rem o v als
D epartam entos de Parasitologia e de Bioestatística do Instituto de Biociências, Secretaria Estadual de Saúde e Faculdade de M edicina, U niversidade Estadual Paulista (UN ESP), Botucatu, SP
A ddress to: D r“. Regina C.C. D órea. D epartam ento de C i ê n ci as B io l ó g icas / FC L / U N ES P. C ai xa P o s tal : 3 3 5 , 1 9 8 0 0 - 0 0 0 , A ssis, SP
Recebid o p ara p u blicação em 27/ 09/ 95.
and p o o r stand ard s o f p u b lic and p erso n al hy g iene. In d ev elo p ing co u ntries, so m e o f these co nd itio ns m ay o c c u r in sc h o o l env iro nm ents an d are p ro n e to c h an g e u n d e r p ro p er g u id elines. It is therefo re essential to g en erate ep id em io lo g ic al d ata o n p arasitic in fec tio ns at the lo c al lev el in o rd er to fo rm u late su itab le c o ntro l p ro g ram m es17.
Earlier stud ies fro m Bo tu c atu , w estern São Pau lo State, Braz il hav e fo c u sed the p o p u latio n o f u rb an areas, w h ere p rev alen c e o f p arasitic infectio ns w as fo u nd to rang e b e tw e e n 47% and 82% 7 12 15. This w o rk w as d esig n ed to in v e stig a te th e e f f e c t o f tre a tm e n t an d p ro p hy lactic m easu res o n th e p re v alen c e o f intestinal p arasites am o n g sc h o o l c hild ren liv ing in the o u tskirts o f Bo tu c atu .
M A TERIA L A N D M ETH O D S
W e su rv ey ed a sam p le o f 219 c h ild ren w h o w e re reg u larly re g iste re d at EEPG Jo ã o Q u eiro z M arq u es, a p rim ary p u b lic sc h o o l in Ru b ião Jú n io r d istrict, lo c ate d 6km fro m d o w nto w n Bo tu c atu . That sam p le w as taken o u t o f a to tal o f 525 stu d ents and rep resen ted
the n u m b er o f c hild ren ( 4 2 % ) w h o p ro v id ed
D ô rea RCC, Salãta E, Pticloixivit CR, A njos GL. C on trol o f p arasit ic in fection s am o n g sc ho o l c hildren in the p eri u rban ar e a o fB o t u c at u , São P au lo, Braz il. Rev ista d a So c iedade Brasileira d e M edicin a T ropic al 2 9 :4 2 5
-430, set-out, 1996.
alo ng w ith their p arents o n the p ro jec t aim s. Stud y p articip ants w ere 107 m ales and 112 fem ales w ith ag es rang ing fro m 7 to 18 y ears. A ll o f th e m resid ed in p o o rly u rb aniz ed areas n eig h b o ring the sc h o o l.
Fo r e ac h child , o n e fresh sto o l sp ec im en w as o b tain e d and im m ed iately p ro c e ssed thro u g h th e m eth o d s o f Fau st et al6, H o ffm an et a l10 and Rug ai et aP1. Th e first series o f p arasito lo g ical exam inatio ns w as carried o u t
b e tw e e n A u g u st and O c to b e r, 1991- A ll
c hild ren fo u nd to b e in fec ted w ith p ath o g en ic
p arasites w ere treated as fo llo w s: (i) fo r G.
lam b t ia in fec tio ns, it w as u sed m etro nid az o le at a d o se o f 20m g / kg b o d y w eig ht, tw ic e d aily fo r 10 d ay s; (ii) f o r A . lu m b r ic o id e s infectio ns, w e u sed lev am iso le in a sing le d o se o f 80m g (7 yrs o ld ) o r 150m g (> 7y rs o ld ); (iii) fo r S. s t e r c o r alis infectio ns, thiab end az o le w as u sed at a sing le d o se o f 30m g / kg b o d y w eig ht and
(iv ) fo r all o th e r h elm in th in fe c tio n s,
m eb en d az o le w as u sed at a d o se o f lOOmg, tw ic e d aily fo r 3 d ay s. Th o se d ru gs w ere ad m inistered o rally at h o m e and o ffered free b y CEM E (C entral d e M ed icam ento s)/ M inistry o f H ealth , Braz il. Sc h o o l p e rso n n e l and in fec ted c hild ren w e re taug ht o f p ractical m easu res fo r p ro p h y laxis and a v id eo w as p resen ted at the u niv ersity facilities, as a m eans to ex p lain p arasite transm issio n and aw ake health aw areness.
Fo r re-ev alu atio n p u rp o ses, a se c o n d series o f p arasito lo g ic al exam in atio ns w as p erfo rm ed b e tw e e n Feb ru ary and M arch, 1992. Cure rates w ere e x p re sse d fo llo w ing treatm ent, as the p erc e n tag e o f c hild ren w ith o n e n eg ativ e sto o l exam in atio n, in relatio n to the to tal nu m b er o f c hild ren fo u n d to b e in fec ted w ith a p articu lar p arasite sp e c ies b e fo re treatm ent.
T h e p re v alen c e rates b e tw e e n g ro u p s o f interest w ere c o m p ared b y the G o o d m an test89 and sig n ific an c e w as set at p < 0.05.
RESULTS
A to ta l o f 1 2 3 ( 5 6 .1 % ) o f th e s tu d y p articip ants w ere fo u nd to b e in fec ted w ith o n e o r m o re p arasites listed in Tab le 1.
In fe c tio n rates fo r the p ro to z o an E n t am o e b a
c o l i ( 2 8 .3 % ) an d th e h e lm in th T r ic h u r is t r ic h iu r a (16.4% ) w ere sig nificantly hig her c o m p ared to th o se fo u n d fo r h o o kw o rm (6.8% ), H y m en o lep is n a n a (6.8% ), S t r o n g y lo ide s s t e r c o r alis (4.1% ) an d E n t e r o b iu s v e r m ic u lar is (3.7% ).
T able I - P r e v ale n c e r at es ac c o r d in g to p ar as it e s p ec ie s am o n g 2 1 9 s c h o o l c h ild r e n fr o m t h e p e ii- u r b a n a r e a o fB o t u c at u . S ão P au lo . B r az il.
Parasite sp ecies Po sitiv e exam inatio ns*
n- %
N egativ e exam inatio ns
na %
E. c o li 62 28.3c** 157 71.7
G. lam b lia 22 10.Gab 197 90.0
A . lu m b r ic o id e s 26 11.5ab 193 88.5
H o o kw o rm 15 6.8a 204 93.2
T. t r ic hiu r a 36 l6.4b c 183 83.6
E. v e r m ic u lar is 8 3.7a 211 96.3
S. s t e r c o r alis 9 4.1a 210 95.9
H .n an a 15 6.8a 204 93-2
* Po sitiv e exam inatio ns inclu d e b o th single and m ultip le infectio ns. ** Prev alence rates w ere co m p ared b y the G o o d m an rest: n o n significant d ifferences are ind icated b y eq ual letters, w hereas fo r p arasitic infectio ns rep resented by d ifferent letters, p ‘ < 0.05.
A s sh o w n in Fig u re 1, th e g ro u p m o re freq u en tly p arasitiz ed w as that o f sc h o o l child ren w ith ag es b e tw e e n 7 and 10. Fo r the tw o o ld er g ro u p s, d ifferences b e tw e e n p o sitiv e and neg ativ e p arasito lo g ical find ing s w ere n o t statistically sig nificant (p > 0.05).
Results o f p re v alen c e rates ac c o rd in g to se x are d ep ic ted o n Tab le 2. Th e m ale gro up ten d ed to p resen t hig her p re v alen c e rates than the fem ale g ro u p . T h e rates w e re h o w ev er sig nificantly d ifferent o nly fo r A .lu m b rico id es (m = 76.9% ; f = 23.1% ) and h o o kw o rm (m = 73.3% ; f = 26.7% ). W h en th e n u m b er o f sing le o r m ultip le p arasitic in fec tio ns w as c o m p ared b y se x (Fig u re 2), a sig nificant d ifferen c e w as f o u n d f o r m u l tip l e p a r a s i ti c i n f e c ti o n s p red o m inating in m ales (27.7% ) rather than in fem ales (13.8% ). Parasitic asso c iatio n s m o re freq u ently en c o u n te re d w^ere th o se w h ic h in clu d ed A . lu m b r ic o id e s p lu s T. t r ic h iu r a and E. c o li p lu s T. t r ic h iu r a. Fo r b o th asso c iatio ns, in d iv id u al f re q u e n c ie s am o u n te d 10.5% , c o rresp o nd ing to 13 in fec ted c hild ren eac h .
T able 2 - P o sitiv e s t o o l e x am in at io n s ac c o r d in g t o p a r a s it e s p e c ie s a n d s e x am o n g s c h o o l c h id r e n f r o m t he p e ii- u r b a n a r e a o f B o t u c at u . S ão P au lo. B r az il.
Po sitiv e exam inatio ns
Parasite sp ecies M ales Ferm ales To tal
ne % n2 %
E. c o li 31 50.0 31 50.0 62
G . lam b lia 12 54.5 10 45.5 22
A . lum brico id es 20 76.9* 6 23-1 26
H o o kw o rm 11 73.3* 4 26.7 15
T. t r ic hiu r a 22 6 1.1 14 3 8 9 36
E. v e r m ic u lar is 4 50.0 4 50.0 8
S. s t e r c o r alis 4 44.4 5 55-6 9
H .n an a 8 53.3 7 46.7 15
* p < 0.05 - m ales v s. fem ales.
D ó re a R CC , Salat a E, P a do v aiii CR, A njo s GL. C o nt ro l o f p ara s it ic infect io ns a m o n g s cho o l c h ild re n in t he p e ri u rb a n a re a o fB o t u ca t u , São P aulo , B raz il. R ev ista d a S o c ie da de B ras ileira d e M e d ic in a T ro pical 2 9 : 4 2 5
-4 3 0 , set- o ut, 1 9 9 6 .
F i g u re 2 - F re q u e n c y o f po s itiv e sto o l e x a m in a t i o n s a c c o rd i n g to t he n u m b e r o f p a ra s it ic infe ct io n s a n d s e x a m o n g s cho o l c h ild re n f ro m t he p e ri - u rb a n a re a o f B o t uca t u, São P aulo , B ra z il.
Eig hty -fo u r c hild ren carry ing p ath o g en ic p arasites w ere su b m itted to treatm ent. O f these, w e re-ev alu ated 75 (89% ) after 4 to 6 m o nths p o st-c h em o th erap y . H o u seho ld s o f the 75 sc h o o l c hild ren w e re su rv ey ed w ithin the sam e tim e fram e, as an attem p t to ev alu ate their liv ing c o n d itio ns. It w as no ted that: (i) 59 ( 7 9 % ) c h ild re n b e lo n g e d to lo w - in c o m e fam ilies o f 6 p e o p le o n av erag e; (ii) 38 (50% ) h o u ses w ere serv ed w ith se w ag e lines; (iii) fo r 51 ( 68% ) fam ilies d rinking -w ater so u rces w ere restricted to tap w ater, w itho u t fu rther treatm ent
and (iv ) the m ajo rity o f h o u seh o ld s w as no t assisted b y ad eq u ate g arb ag e rem o v al.
Results o f p arasito lo g ical exam inatio ns after treatm ent are sh o w n in Tab le 3- A to tal o f 36 (48% ) sc h o o l c hild ren tu rned o u t neg ativ e. Statistical analy ses rev ealed that c u re w as
attained fo r in fec tio ns w ith G . la m b lia (73-7% ), -
A . lu m b ri c o i d e s (86.4 % ), ho o kw o rm (100% ),
T. t ri c h i u ra (7 3 - 1 % ) an d E. v e rm i c u l a ri s (85.7% ); w h ereas o nly 50 % o f the ind iv id uals
D ó r e a R C C , S alat a E, P a d o v a n i CR, A n jo s G L. C o n t r o l o f p a r a s it i c in fe c t io n s a m o n g s c h o o l c h ild r e n in t h e p e r i u r b a n a r e a o fB o t u c a t u , S ão P au lo , B r az il. R ev is t a d a S o c i e d a d e B r as ile ir a d e M e d ic in a T r o p ic al 2 9 : 4 2 5
-430, set - o u t , 1 9 9 6 .
(n o t sig nificant). Fo r H . n a n a infectio ns, n o n
cu re w as g reater than c u re (p < 0.05) and this m ay reflec t that the anthelm intic d rug u sed (m e b e n d az o le ) w as n o t effectiv e. Reinfectio ns
b y G . la m b lia w ere p articu larly freq u ent (14
o u t o f 75 c hild ren; 18.6% ), b ut in fec tio n rates v aried fro m 1.3% to 5.3% fo r o th er p arasite sp e c ies (Tab le 3).
T able 3 - R esu lt s o f s t o o l e x am in at io n s aft e r t r eat m en t ac c o r d in g to p a r a s it e s p e c ie s am o n g s t 7 5 s c h o o l c h ild r e n f r o m the p e r i- u r b an
a r e a o f B o t u c at u . S ao y au lo . B r az il.
Results after treatm ent Reinfectio n
Parasite sp ecies Cure N o n-cure rates
nQ % n- % n- %
G . lam b lia 1 4 /1 9 73.7a 5/ 19 26.3 14/ 75 18.6
A . lu m b r ic o id e s 19/ 22 86.4a 3/ 22 13.6 4/ 75 5.3
H o o kw o rm 11/ 11 100.0a 0/ 11 0.0 1/ 75 1-3
T. t r ic hiu r a 19/ 26 73.1a 7/ 26 26.9 1/ 75 1.3
E. v e r m ic u lar is 6/ 7 85.7a 1/ 7 14.3 2/ 75 2.6
S sterco raUs 3/ 6 50.0 3/ 6 50.0 2/ 75 2.6
H .n an a 2/ 13 15.4b 11/ 13 84.6 2/ 75 2.6 a cure > no n-cu re ( p < 0.05).
^ cure < no n-cu re ( p < 0.05).
D ISCUSSIO N
It b e c am e ap p arent that ev en tho u g h nearly 2 0 y e a r s h a v e e l a p s e d f r o m p r e v i o u s stud ies71215 the p rev alen ce o f intestinal p arasites is still hig h in a p o o r su b u rb an c o m m u nity o f Bo tu c atu , ac c o u n tin g fo r as m any as 56.1% infec ted child ren o f the to tal nu m b er stud ied . This is c o n sisten t w ith the o v erall p rev alence rate o f 55.3% fo r p arasitic in fec tio ns o b tained by C am p o s & Briq u e s’ in a co u ntry w id e su rv ey targ eted at 7-to -l4-y e ar-o ld sc h o o l c hild ren in Brazil.
Pre -tre atm e n t v alu e s p o in te d o u t that
in fec tio n rates rang ed fro m 3.7% to 2 8 .8 % fo r 2
p ro to z o an sp e c ies and 6 helm inth sp e c ies d e te c te d . Ir r e s p e c ti v e o f th e d e g r e e o f p arasitism , it is im p o rtant to no te that w e ex am in ed ev ery sto o l sp ec im en thro u g h 3 c o p ro lo g ic al tec h niq u es, w h o se sc o p e w as b ro ad en o u g h to d etec t all cy sts o f p ro to z o ans and m o st helm inth eg g s and larv ae that are fre q u e n tly d is c h a rg e d in h u m an s to o ls. H o w ev er, sin c e sp ec ial tec h n iq u es su c h as anal sw ab exam in atio ns hav e no t b e e n p erfo rm ed fo r the hig h lev el o f c o o p e ratio n req u ired , w e
p resu m e that in fec tio ns w ith E. v e r m ic u lar is
h erein rep o rted are u nd erestim ated . Fo r sim ilar
reaso n s, altho u g h T ae n ia sp . o v a hav e b e e n
u n d etec ted , w e c an n o t ex c lu d e this p arasito sis
in the sam p le stud ied . W e w o u ld e x p e c t the p rev alen ces fo r b o th p arasito sis to b e lo w ho w ev er, as ju d g ed b y earlier w o rk71215 in the
sam e area that d em o nstrated p r e v a le n c e rates
< 3-7% an d < 1.62% to re sp e c tiv e ly E.
v e r m ic u lar is and T ae n ia sp.
That sing le o r m u ltip le in fec tio ns w ith E.
c o li, T. t r ic hiu r a, A . lu m b r ic o id e s and G. la m b lia w ere the m o st p rev alent o n es is no t u n e xp ec te d , sin c e th e se p arasite sp e c ies share, to a c ertain extent, the m o d e o f transm issio n and are likely to b e co ntam inating b o th the sc h o o l and d o m estic env iro nm ents, w here infec tiv e eg g s o r cy sts c an b e in g ested b y the sc h o o l child ren.
Th e g ro u p o f 7-to -10-y ear-o ld c hild ren w as fo u nd to b e the m o st freq u ently p arasitiz ed . A ltho u g h this g ro u p has clearly o u tnu m b ered th e o th e r tw o a g e g ro u p s , th e d e g r e e o f exp o su re to so il-transm itted p arasites seem s to b e h ig h er fo r c hild ren up to 10 y ears o ld in the p resent stud y. This is p articu larly ev id ent fo r sin g le in f e c tio n s w ith A . l u m b r i c o i d e s o r ho o kw o rm , w h ic h w ere fo u n d to p red o m inate sig nificantly in m ales rather than in fem ales. D esp ite the fac t that p o o r stand ard s o f hy g iene are w id esp read am o n g c hild ren o f a lo w so c io e c o n o m ic status, so m e ind icatio n o f activ ity - b ased d ifferen ces b e tw e e n b o th se x e s c o m es fro m the o b serv atio ns in the sc h o o l p lay area, w h ere m ainly b o y s u sed to p lay o n so il g ro u nd b efo re an d after c lasses. This in c o n ju n c tio n w ith th e irreg ular u se o f fo o tw e ar m ig ht hav e serv ed to p ro m o te their c o n tac t w ith infectiv e stag es, in sp ite o f the fact that all c hild ren stud ied w ere asy m p to m atic.
T h e c o m b i n a ti o n o f tr e a tm e n t w ith p ro p hy lactic m easu res o f p rac tic al im p o rtance u sed in this stu d y hav e p ro v id ed an effectiv e m eans fo r c o n tro l o f p arasitic in fec tio ns at the sc h o o l lev el. N o t o nly 48% o f the sc h o o l child ren hav e sh o w n neg ativ e p arasito lo g ical exam inatio ns, b u t also w e h av e o b tain ed cure rates that w ere sig nificantly hig h (> 73-1% ) fo r m o st p arasite sp e c ie s. A p art fro m so m e d ifferences in the therap eu tic sc h ed u les u sed , o u r results hav e co nfirm ed the find ing s o f p rev io u s sm aller stud ies in wTh ic h cu re rates o f p arasitic infectio ns w ere fo u n d to b e h ig h er am o ng sc h o o l child ren, o n ly w h en treatm ent w as asso c iated w ith ad eq u ate p ro p h y laxis".
Th e d ata reg ard ing in fec tio ns w ith H . n a n a
w e r e b y f a r l e s s s a t i s f a c t o r y . In f a c t , m e b e n d az o le w as the an th e lm in tic ag e n t
D ó r e a R C C , S alat a E, P a d o v a n i CR, A n jo s GL. C o n t r o l o f p a r a s it i c in fe c t io n s a m o n g s c h o o l c h ild r e n in t h e p e r i u r b a n a r e a o f B o t u c at u , S ão P au lo , B r az il. R ev is t a d a S o c i e d a d e B r as ile ir a d e M e d ic in a T r o p ic al 2 9 : 4 2 5
-4 3 0 , se t- o u t, 1 9 9 6 .
c h o se n fo r its b ro ad -sp ectru m o f activ ity and fo r the n u m b er o f child ren fo u nd to b e in fec ted w ith tw o o r m o re helm inth sp e c ies
(o th e r than 5. s t e r c o r alis ) w as as hig h as 20
(27% ) ch ild ren o u t o f 75. O n the o th er hand , the lo w -c u re rates o b tain ed (15.4 % ) su g g ests
that m eb en d az o le w as in effec tiv e fo r H . n a n a
in f e c tio n s , e v e n ta k in g in to a c c o u n t th at a s e c o n d c o u rs e o f tre a tm e n t h av e b e e n rec o m m end ed fo r all stu d y p articip ants. This co nfirm s the find ing s o f C am arg o et al2 and Sc h e n o n e e t a l16, w h o d e m o n stra te d th at m eb en d az o le ex h ib ited resp ectiv ely n o n e o r p artial ac tio n ag ainst that helm inth. A cco rd ing to Rey 13, the treatm ent o f in fec tio ns c au sed by H . n a n a is m ad e d ifficult, since self-infectio ns are n o t u n c o m m o n and the cy stic erco id larv ae are k n o w n to rem ain fo r sev eral d ays d eep ly in the intestinal villi, w here they c an b e p ro teceted fro m lu m inal d ru gs. A d ult w o rm b u rd ens w o u ld thu s b e e x p e c te d to in c rease rap id ly after treatm ent, as larv al w o rm s m ature.
Fo r in fec tio ns w ith S. s t e r c o r alis , child ren h av e b e e n treated w ith th iab e n d az o le in ad d itio n to any fu rther treatm ent fo r o ther p arasitic in fec tio n ev entu ally n eed ed . Th e 50% cure rate o b tain ed fo r su c h in fec tio ns w as so m e h o w u nexp ec ted . The reaso ns fo r this are unclear, b u t the inap p ro p riate co nsu m p tio n o f th e r e c o m m e n d e d d r u g ( s ) c a n n o t b e o v erlo o ked , sin c e all m ed ic atio n has b e e n ad m inistered at h o m e.
O f i n te r e s t a re th e o b s e r v a ti o n s th a t reinfec tio n rates w e re g en erally lo w fo r the m ajo rity o f p arasite sp e c ies d etected . This reinfo rces the no tio n that p ro p hy lactic m easu res hav e b e e n u sefu l fo r the child ren surv ey ed . R e in f e c tio n ra te s f o r G . l a m b l i a w e re an ex c e p tio n and c an b e attrib u ted to its m o d e o f transm issio n, w ith cy sts b ein g easily ing ested eith er b y c o n tam in ated fo o d o r fro m d rinking - w ater so u rc es that w e re co n su m ed insid e o r o u tsid e the ho u ses.
This stu d y illu strates the im p o rtance o f treatm ent co m b ined w ith p ro p hy lactic m easu res fo r the c o n tro l o f p arasitic in fec tio ns u sing a sc h o o l-b ased ap p ro ac h. In the lo ng run, a reg u lar c o ntro l m ay b e env isag ed thro ug h activ e ac tio n s o f the c o m m u nity itself, as w ell as b y th e re late d h e alth au th o rities in im p ro v ing to lo c al co m m u nities p erm anent b en efits su ch as ed u c atio n , m ed ical care, sanitatio n and ad eq u ate refu se rem o v al.
RESUM O
P r ô c e d e u - s e o e s t u d o d a p r e v a l ê n c i a d e en teroparasitoses en tre esc o lares d e 7 a 1 8 an os, de
c o n diç õ es sõ c io - ec o n ô m ic as baix as e residen tes n o distrito p eri- u rban o d e R u bião Jú n ior, m u n ic ípio de Botu catu , São P au lo, c om o objetiv o de an alis ar o p ap e l d e m edidas p ro filát ic as e t erapêu tic as n o con trole das p arasito ses diag n o stic adas. D os 2 1 9 a l u n o s e s t u d a d o s n a p r i m e i r a a v a l i a ç ã o p arasitolõg ic a, 12 3 (56.1% ) m ostraram - se positiv os p ar a u n ia ou m ais parasitoses. O tratam en to f o i ap lic ad o p a r a 8 4 esc o lares, p o r serem estes
p o rt ado res d e p arasit o s p atog ên ic os. A seg u n da av aliaç ão p arasit o lõ g ic a f o i r e aliz ada 4 a 6 meses ap ó s o tratam en to em 75 (89% ) esc o lares. Os resu lt ado s in dic am q u e o u so c o m b in ad o do tratam en to e m edidas p ro filát ic as f o i c ap az de lim itar a o c o rrên c ia de n ov as in fec ç õ es p ar a nív eis
< 5 .3 % — ex ceto p ar a G iardia lamblia, qu e in c idiu sobre 18.6% dos caso s— e redu z ir sig n ificativ am en te a p rev alên c ia, j á qu e tax as de c u ra > 73-1% fo r am en c o n t radas p ar a a m aio ria das parasit o ses, ex ceto n as in fec ç ões p o r H ym enolepis nana e Strongyloides
stercoralis, discu tin do- se as raz õ es prov áv eis.
P alav ras- chav es: En teroparasitoses. P rev alên c ia. T ratam en to. P rofilax ia. Escolares.
A CKN O W LED G EM EN TS
W e are g ratefu l to the p e rso n n el and sc h o o l chid ren o f th e EEPG Jo ã o Q u eiro z M arq u es and the m ed ic ai stu d ents (X X V III c lass) o f the U n iv ersid ad e Estad u al Pau lista “Jú lio d e M esq uita Filh o ”, UNESP, Bo tu c atu fo r their c o llab o ratio n. W e are also in d eb ted to Mr. Jo ã o M ilto n M eneg u in and M rs. M aria A p arecid a M o ntanha Ram o s fo r their tec h n ic al assistance.
REFEREN CES
1. Biolley MA, G ambos C,A stete S, Ulloa R. Infección intestinal p o r parásitos y / o co m en sales en escolares de la IX Región, Chile. Boletín Chileno
de Parasitología 4 5 :8 6 - 9 0 ,1 9 7 2 .
2. Camargo PAM, D iamante R, Basques SA ,Tonelli E. C om paração da eficácia terapêutica do Pam oato de pirantel e do m ebendazole na ascaridíase, ancilostom íase e tricocefalíase, avaliada p elo m étodo de M cM aster. Pediatria Prática 45:
189-1 9 4 ,189-1 9 7 4 .
3. Campos R, Briques W. Levantamento m ulticêntrico de parasitoses intestinais no Brasil. O s resultados
D ó r e a R C C , S alat a E, P a d o v a n i CR, A n jo s GL. C o n t r o l o f p a r a s it i c in fe c t io n s a m o n g s c h o o l c h ild r e n in t he p e r i- u r b a n a r e a o f B o t u c at u , S ão P a u lo, B r az il. R ev is t a d a S o c i e d a d e B r as ile ir a d e M e d ic in a T r o p ic al 2 9 :4 2 5
-430, se t - o u t , 1 9 9 6 .
4. C rom pton DW T, Savioli L. Intestinal parasitic
infections and urbanization. Bulletin o f the W orld H ealth O rganization OMS 7 1 :1 - 7 ,1 9 9 3 .
5. Espinosa JN , Cadena EN, Rom ero CE, D e La Pena JE. Prevalencia de parasitosis intestinal en la p o b lació n infantil de Santiago Jam iltep ec, O axaca. Revista M édica, Instituto M exicano del
Seguro Social 3 1 :1 5 7 1 6 1 ,1 9 9 3
-6. Faust EC, 11’A ntoni JS, O dromV , M iller M J,Peres C, Sawitz W ,Thom en LF,Tobie J, W alker JH . A critical study of clinical lab oratory techniq ues for the diagnosis o f protozoans, cysts and helminth eggs in feces. A m erican Journal of Tropical M edicine
(Law rence) 18: 1 6 9 - 1 8 3 ,1 9 3 8 .
7. G onçalves A, A ndrade JCR, G iribola L, O liveira M C. Levantam ento das parasitoses intestinais e condições sócio-econôm icas e sanitárias em um bairro de Botucatu, S.P. Revista da Sociedade Brasileira de M edicina Tropical 7 :2 5 - 4 4 ,
1973-8. G oodm an LA. Simultaneous confidence intervals
for contrasts am ong multinomial populations. A nnals of M athem atics and Statistics 3 5 :7 1 6 - 7 2 5 ,
1964.
9. G oodm an LA. O n sim ultaneous con f id en ce i n te rv a l s f o r m u l tin o m ial p ro p o rti o n s .
T echnom etrics 7: 2 4 7 - 2 5 4 ,1 9 6 5 .
10. H offman W A, Pons JA Jan e r JL.The sedimentation-concentration method in schistosomiasis mansoni Puerto Rico. Journal o f Public H ealth 9 :2 8 3 - 2 9 1 , 1934.
11. M ace d o M FA B, C o rrê a FJP, M u n h o z JJS . D iagnóstico, tratamento e profilaxia de verm inoses em am biente restrito de nível escolar. Revista Brasileira de M edicina 2 9 :4 7 0 - 4 7 4 ,1 9 7 2 .
12. O liveira MR, Barbosa MA, Salata E, Sogayar MITL, S o g ay ar R, C o rrê a FM A . Pre v al ê n cia d e enterop arasitas na p o p u lação urbana do 2°
subdistrito de Botucatu. Revista de Saúde Pública, São Paulo 8: 2 1 3 - 2 3 4 ,1 9 7 4 .
13. Rey L. Parasitologia. G uanabara K oogan, 2a edição, Rio de janeiro, p. 4 6 4 ,1 9 9 1 .
14. Rugai E, M attos T, Brisola AH N ova técnica para is o l a r l arv as d e n e m a tó i d e s d as f e z e s -m odificação do -m étodo de Baer-mann. Revista do Instituto A dolfo Lutz 1 4 :5 - 8 ,1 9 5 4 .
15. Salata E, C orrêa FMA, Sogayar R, Sogayar MIL, Barbosa MA. Inquérito parasitológico na CECA P -distrito sede de Botucatu, Estado de São Paulo, Brasil. Revista de Saúde pública, São Paulo 6: 385-3 9 2 ,1 9 7 2 .
16. Schenone H, O rfali A , G aldames M , D oren G,
Inzunza E, Jim énez M, Rom ero E, Pinto CG, A nrique B. T ratam iento de las helm intiasis
intestinales hum anas co n m ebendazole. Boletín
Chileno de Parasitologia 2 9 :2 - 5 ,1 9 7 4 .
17. W orld H ealth O rganization. Prevention and
' control of intestinal parasitic infections. W orld H ealth O rganization,Technical Report Series, N o.
749, G eneva, p. 5 7 - 5 9 ,1 9 8 7 .
