Prevalence and Risk Factors of Soil-Transmitted Helminthic Infections in the Pediatric Population in India: A Systematic Review and Meta-Analysis

Abstract

Soil-transmitted helminths (STH) is a major healthcare challenge in the pediatric age group affecting poor and deprived parts of our community. The main species that infect people are roundworm (AL, Ascaris lumbricoides ), whipworm (TT, Trichuris trichiura ), and hookworms (HW, Ancylostoma duodenale and Necator americanus ). We aimed to estimate the pooled prevalence of STH infections in India in the pediatric age group (< 18 years) and assess the risk factors associated with STH in this age group. Three databases were searched (PubMed, Scopus, and Embase) up to February 16, 2021 with deliberate and inclusive search terms for original research articles estimating the prevalence of either of the three STH in India. Data extracted included individual prevalence of the three STH, prevalence of double or triple infections, and associated risk factors. We identified systematically 1,408 publications, of which 44 were included for the final analysis, including studies from 20 states covering 34,590 children. In our study, the prevalence of AL ranged from 0.8 to 91% with a pooled prevalence of 25%, prevalence of TT ranged from 0.3 to 72% with a pooled prevalence of 13%, and for HW prevalence ranged from 0.2 to 80% with pooled prevalence of 10%. Two most important risk factors with higher odds ratio were open defecation practices or open latrine (odds ratio: 5.2) and washing hands without soap using water only (odds ratio: 2.49). Knowledge of areas with high prevalence of STH and associated risk factors would help in designing effective control strategies in the high-risk groups to prevent infection and aid in a drastic reduction of morbidity in children.

Keywords: Ascaris; Trichuris; hookworm; prevalence; soil-transmitted helminth.

Fig. 1

Flowchart of selection of studies for the review. STH, soil transmitted helminths.

Fig. 2

Forest plots showing pooled prevalence of ( A ) Ascaris, ( B ) Trichuris, ( C ) hookworm, ( D ) double soil transmitted helminthic infection, ( E ) triple soil transmitted helminthic infection. CI, confidence interval; ES, economic status.

Fig. 3

Map of India showing percentage prevalence of Ascaris .

Fig. 4

Map of India showing percentage prevalence of Trichuris .

Fig. 5

Map of India showing percentage prevalence of hookworm.

Fig. 6

Forest plots of risk factor analysis for soil transmitted helminthic infection showing odds ratio of ( A ) Males versus females. ( B ) Open latrine versus sanitary latrine. ( C ) Hand washing after defecation with water only versus with soap and water. ( D ) Socioeconomic status lower versus upper and middle. ( E ) Mother education below primary/ illiterate versus above primary. ( F ) Walking barefoot versus walking with footwear. ( G ) Recent deworming negative to recent deworming done. ( H ) Nails untrimmed versus trimmed. ( I ) Flooring earthen versus cemented. ( J ) Religion: Hindu versus other religions. ( K ) Poor hand wash habits versus good hand wash. CI, confidence interval; OR, odds ratio.