The Journal of Infection in Developing Countries <p>A peer-reviewed open access journal, focusing on global health.</p> en-US <p>Authors who publish with this journal agree to the following terms:</p> <ol type="a"> <li>Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a <a title="Creative Commons Attribution License" href="" target="_new">Creative Commons Attribution License</a> that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</li> <li>Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li> <li>Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See <a title="The Effect of Open Access" href="" target="_new">The Effect of Open Access</a>).</li> </ol> (JIDC Central Office) (JIDC Tech Support) Thu, 10 Jan 2019 12:30:06 -0800 OJS 60 Diagnostic accuracy of urinary latex agglutination test (KAtex) for the diagnosis of visceral leishmaniasis: A meta-analysis <p>Latex agglutination test (KAtex) has been used in the last two decades for the diagnosis of visceral leishmaniasis (VL) in different VL-endemic areas. Here, we present a meta-analysis of studies which evaluated the KAtex for the diagnosis of VL to find out its overall diagnostic performance. A database search was performed on PubMed, Scopus, ISI Web of Science, Iranmedex and Google Scholar. The search of databases found 57 papers, of which 17 articles fulfilled our eligibility criteria. Meta-analysis of diagnostic accuracy (MADA) and Hierarchical Summary Receiver Operating Curve (HSROC) packages were used to do the meta-analysis and to obtain pooled estimates of sensitivity and specificity. Fixed effect bivariate analysis was conducted, using Mantel-Haenszel estimator, to measure the performance and diagnosis odds ratio (DOR) of the test. Heterogeneity of the test results was assessed by Chi-squared test.</p> <p>The sensitivity of individual studies ranged from 39.8 to 100%, and the specificity ranged from 64 to100%. The combined sensitivity and specificity estimates of KAtex were 77% (95% CI, 70-83%), and 97% (95% CI, 93-97%), respectively. Comparing the performance of the test by region suggests a significant difference where the lowest and highest sensitivities are reported from Nepal/Tunisia and Europe/Middle East respectively (<em>p</em> &lt; 0.05). On the other hand, the lowest and highest rates of specificity were reported from Sudan and America/Middle East respectively.</p> <p>The overall specificity of KAtex is satisfactory. However, KAtex suffers from low sensitivity and this shortcoming should be improved. The test provides a rapid and simple diagnosis of VL and improvement of its sensitivity deserve further studies.</p> Mohammad Fararouei, Bahador Sarkari, Samaneh Abdolahi Khabisi, Zahra Rezaei ##submission.copyrightStatement## Mon, 31 Dec 2018 00:00:00 -0800 Pulmonary tuberculosis screening and quality of life among migrant workers, Northern Thailand <p>Introduction: The study aimed to estimate the prevalence of tuberculosis (TB) and to assess the quality of life and depression among the migrant workers in northern Thailand.</p> <p>Methodology: A cross-sectional study was conducted to elicit information among migrant workers in Chiang Rai and Pha Yao provinces, northern Thailand. Several standard forms including GeneXpert were used for data collection. A simple random sampling was used to select the companies and the study sample. Interview was conducted in a confidential room. Chi-square was used to detect the association between variables at the significant level α = 0.05.</p> <p>Results: Totally 467 migrant workers were recruited into the study, 97.9% were Myanmar national, 55.7% were males, and 51.4% were aged &gt; 32 years. Only 2.1% were living in Thailand illegally, 23.8% had no health insurance, and 92.1% had monthly income at &lt; 20,000 baht. Eight cases (1.71%) were at risk of TB disease from the screening, only one case was positive for TB disease from GeneXpert, and no multi-drug resistant detected. 47.5% had a low level of knowledge and 28.7% had a negative attitude on TB prevention and care. 10.7% were in a moderate to severe stage of depression. Six variables were found the significant associated with quality of life; ethnicity, sex, marital status, income, length of working in Thailand, and insurance.</p> <p>Conclusions: Besides active TB surveillance system, inter-country public health policy should be developed to cope with depression problem and improve quality of life among the migrant in Thailand</p> Palita Charoensook, Panupong Upala, Amornrat Anuwatnonthakate, Thapakorn Ruanjai, Tawatchai Apidechkul ##submission.copyrightStatement## Mon, 31 Dec 2018 00:00:00 -0800 Biofilm formation by clinically isolated Staphylococcus Aureus from India <p>Introduction: <em>Staphylococcal</em> biofilms are prominent cause for acute and chronic infection both in hospital and community settings across the world. Current study explores biofilm formation by <em>Staphylococcus aureus</em> isolates from clinical samples by different methods.</p> <p>Methodology: Standard techniques used for the characterization of <em>S.aureus.</em> Qualitative and quantitative biofilm formation was assessed by Congo red Agar, Tube and Microtiter plate methods<em>.</em></p> <p>Results: A total of 188 clinical isolates of <em>S.aureus</em> were screened for biofilm formation and 72 (38.29%) of them were found to be biofilm producers, 34 (18.08%) strong, 38 (20.21%) moderate. The remaining 116 (61.7%) were weak/ non biofilm producers. Maximum biofilm formers were recorded in pus samples (39.06%), followed by isolates from blood (38.23%) and urine (34.61%). Statistical analysis for the formation of biofilm indicated that Microtiter plate method is the most sensitive and specific method for screening biofilm production.</p> <p>Conclusions: Biofilm formation is one of the influential virulence factor in <em>staphylococcal</em> pathogenesis and persistence. Microtiter plate and Congo red agar remain as reliable methods for the qualitative and quantitative estimation of biofilm formation. Monitoring of biofilm formation in various etiological agents will help in determining the severity of infection.</p> Alasthimannahalli Gangadhara Triveni, Mendem Suresh Kumar, Chavadi Manjunath, Channappa T Shivannavar, Subhaschandra M Gaddad ##submission.copyrightStatement## Mon, 31 Dec 2018 00:00:00 -0800 Evaluation of the efficacy of two methods for direct extraction of DNA from Mycobacterium tuberculosis sputum <p>Introduction: Whole genome sequencing (WGS) has shown superiority over other bacterial typing methods and can be used to monitor disease transmission. The long culture period hinders use of WGS as a diagnostic tool for TB. The ideal situation would be to efficiently sequence directly from clinical specimens such as sputum. Attempts to sequence directly from <em>Mtb</em> clinical samples have achieved very low coverage (less than 0.7X). We compared DNA extraction methods for direct extraction from Mycobacterium tuberculosis positive sputum and assessed their suitability for Single Molecule Real Time sequencing.</p> <p>Methodology: We evaluated the extraction efficiency of the PrimeXtract kit and an in-house CTAB method by extracting DNA from <em>Mtb</em> sputum. We evaluated the methods on these parameters: ease of use, efficiency (quantity and purity) and the cost per extraction.</p> <p>Results: The PrimeXtract kit was able to isolate 5.93 µg/mL ± 0.94, (Mean ± SEM) concentration of DNA and a yield of 0.2975 µg ± 0.04723, (Mean ± SEM). Comparatively, the CTAB method isolated 1.88 µg/mL ± 0.38 DNA and a yield of 0.09 µg ± 0.02. Both concentration and yield from the kit were significantly (p = 0.0002) higher than those from CTAB. The PrimeXtract kit had a DNA purity ratio of 1.69 ± 0.09 compared to the CTAB’s 1.73 ± 0.14 and this difference was not statistically different.</p> <p>Conclusion: PrimeXtract kit has a superior extraction efficiency than the CTAB method on Mtb sputum in terms of DNA yield although no significant difference by DNA purity was seen.</p> Victor Ndhlovu, Wilson Mandala, Derek Sloan, Mercy Kamdolozi, Maxine Caws, Gerry Davies ##submission.copyrightStatement## Mon, 31 Dec 2018 00:00:00 -0800 Immunophenotyping of circulating mononuclear cells in active pulmonary tuberculosis <p>Introduction: Interpreting the interactions between M. tuberculosis and the host innate and adaptive immune defense mechanisms is mandatory for understanding the pathogenesis of active pulmonary TB (APTB). The aim was to describe the distribution of mononuclear cells in APTB and their relation to disease severity.</p> <p>Methodology: A case-control study of peripheral blood CD4+ T cells, CD8+ T cells, B-lymphocytes, NK cells, T regulatory lymphocytes (Tregs) and monocytes by flow cytometry. The patients had clinical presentations of APTB, positive tuberculin skin tests, acid-fast bacilli smears and sputum cultures using BACTEC 960.</p> <p>Results: There was a significant decrease in the haemoglobin level and the absolute lymphocytic count (p &lt; 0.01), while both the neutrophil count and erythrocyte sedimentation rate showed significant increase in the APTB patients compared to HC with p-values &lt; 0.001 and &lt; 0.0001 respectively. Both the CD4+/CD8+ ratio and the percentages of CD3−CD19+ cells were significantly lower in APTB patients (p = 0.03 and p = 0.005 respectively). The percentages of CD4+, CD8+, CD3−CD19+, CD14+, and CD3−CD (16+56)+ cells showed no significant differences, when comparing either disease severity groups, or cavitated and non-cavitated groups of APTB patients. There was significant increase in the CD4+25+ lymphocytes in the advanced APTB patients than in the mild disease group (p &lt; 0.05).</p> <p>Conclusions: B-lymphocytes and CD4/CD8 ratios were significantly lower in the APTB patients than controls with no association with disease severity. CD4+ CD25+hi Tregs were significantly higher in the advanced versus mild groups.</p> Amany Elkholy, Mirvat El Anany, Ghada Mohamed Ezzat, Fadwa Abd El Reheem, Assem Fouad Elessawy ##submission.copyrightStatement## Mon, 31 Dec 2018 00:00:00 -0800 Bacterial bloodstream infections in level-I trauma intensive care unit in Serbia: incidence, causative agents and outcomes <p>Introduction: We aimed to describe incidence, outcomes and antimicrobial resistance markers of causative agents of bacterial BSI in the intensive care unit (ICU) in a trauma center in Serbia.</p> <p>Methodology: Prospective surveillance was conducted from November 2014 to April 2016 in two trauma-surgical ICUs of the Emergency Department of Clinical center of Serbia. Bloodstream infections were diagnosed using the definitions of Center for Disease Control and Prevention.</p> <p>Results: Out of 406 trauma patients, 57 had at least one episode of BSI (cumulative incidence 14.0%). Overall 62 BSI episodes were diagnosed (incidence rate 11.8/1000 patient/days), of which 43 (69.4%) were primary BSI (13 catheter-related BSI and 30 of unknown origin) and 19 (30.6%) were secondary BSI. The most common isolated pathogen was <em>Acinetobacter </em>spp. [n = 24 (34.8%)], followed by <em>Klebsiella </em>spp. [n = 17 (24.6%)] and <em>P. aeruginosa </em>[n = 8 (1.6%)]. All <em>S. aureus</em> [n = 6 (100%)] and CoNS [n = 3 (100%)] isolates were methicillin resistant, while 4 (66%) of Enterococci isolates were vacomycin resistant. All isolates of <em>Enterobacteriaceae </em>were resistant to third-generation cephalosporins [n = 22 (100%)] while 7 (87.5%) of <em>P. aeruginosa</em> and 23 (95.8%) of <em>Acinetobacter </em>spp. isolates were resistant to carbapenems. All-cause mortality and sepsis were significantly higher in trauma patients with BSI compared to those without BSI (P &lt; 0.001 each).</p> <p>Conclusions: BSI is a common healthcare-associated infection in trauma ICU and it is associated with worse outcome. Better adherence to infection control measures and guidelines for prevention of primary BSI must be achieved.</p> Olivera Djuric, Ljiljana Markovic-Denic, Bojan Jovanovic, Snezana Jovanovic, Vuk Marusic, Vesna Bumbasirevic ##submission.copyrightStatement## Mon, 31 Dec 2018 00:00:00 -0800 The presence of periopathogenic bacteria in subgingival and atherosclerotic plaques – An age related comparative analysis <p>Introduction: There is a known connection between periodontitis and atherosclerosis and the presence of periopathogens in blood vessels. However, changes of the oral microflora related to the aging process and its possible effects on atherosclerosis, have yet to be analyzed. The aim of this study was to assess temporal changes in the frequency of periodontal bacteria in the subgingival plaque and in atherosclerotic blood vessels of patients with atherosclerosis.</p> <p>Methodology:The study included 100 patients with atherosclerosis and periodontitis, divided into two groups, below and over 60 years of age. Clinical examinations were performedand subgingival plaque specimens were collected as well as biopsy specimens from the following arteries: coronary (34), carotid (29), abdominal (10), femoral (10), mammary (13) and iliac (4). Subgingival and artery specimens were subjected to PCR detection of 5 major periodontal pathogens: <em>Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Aggregatibacter actinomycetemcomitans (Aa), Tannerella forsythensis (Tf) and Treponema denticola (Td</em>).</p> <p>Results:<em>Tf</em> was the most and <em>Td</em> the least frequent bacteria in both age groups and in both types of samples. The frequencies of bacteria in subgingival versus atherosclerotic samples were: <em>Tf</em> (76%:53%), <em>Pi</em> (71%:31%), <em>Pg</em> (60%:38%), <em>Aa</em> (39%:14%) and <em>Td</em> (21%:6%). Only <em>Aa</em> and <em>Pi</em> showed a significant difference of prevalence between younger and older patients. The most colonized artery was a. coronaria, followed by a. carotis, a. abdominalis, a. mammaria, and a. femoralis.</p> <p>Conclusions: Patient’s age and the distance of a given blood vessel from the oral cavity influenced microbiological findings in the atherotic plaque.</p> Ibrahim Kannosh, Danijela Staletovic, Bosko Toljic, Milena Radunovic, Ana Pucar, Sanja Matic Petrovic, Ivana Grubisa, Milos Lazarevic, Zlata Brkic, Jelena Knezevic Vukcevic, Jelena Milasin ##submission.copyrightStatement## Mon, 31 Dec 2018 00:00:00 -0800 Cross sectional analysis of vaginal Lactobacillus in asymptomatic women of reproductive age in Mumbai, India <p>Introduction:<em> Lactobacillus</em> dominated vaginal microenvironment is associated with lower risk of genital infections. Numerous studies have reported geographic and ethnic variations in vaginal microbiome structure between healthy individuals from different race and ethnicity. India has a great diversity, so it is intriguing to find out if such divergences exist in vaginal lactobacilli. The present study aimed to investigate predominant <em>Lactobacillus</em> species in vaginas of healthy Indian women and screen isolates for lactic acid and H<sub>2</sub>O<sub>2 </sub>production.</p> <p>Methodology: 203 premenopausal women asymptomatic for any vaginal complaints were recruited. The lactobacilli isolates on MRS agar were identified by Multiplex-PCR and 16sRNA gene sequencing. RAPD was used to differentiate strains of same species. H<sub>2</sub>O<sub>2 </sub>and lactic acid was evaluated on TMB-HRP MRS agar and BCP-MRS agar respectively.</p> <p>Results: Lactobacilli were recovered from 107/109 (98.2%) women with normal microflora. <em>L. iners</em> 64.7% (68), <em>L. crispatus </em>26.7% (28), <em>L. reuteri</em> 21.9% (23), <em>L. jensenii</em> 16.2% (17) and <em>L. gasseri</em> 15.2% (16) were the most frequently occurring vaginal lactobacilli in normal women. The vaginal microflora was dominated by either by a single (80%, n = 84) or a combination (20%, n = 21) of <em>Lactobacillus </em>species. Though most frequently identified, <em>L. iners</em>, coexisted only with other <em>Lactobacillus</em> species. All isolates were acid producers but H<sub>2</sub>O<sub>2 </sub>was produced by 94.2% isolates.</p> <p>Conclusions: Our study reports prevalent vaginal lactobacilli which could be explored as probiotics. Presence of heterogeneous <em>Lactobacillus</em> population highlights the cumulative effects of different lactobacilli maintaining vaginal health. Contrasting observations about <em>L. iners</em> reiterates its puzzling role in vaginal immunity, advocating further research.</p> Rinku Pramanick, Shraddha Parab, Niranjan Mayadeo, Himangi Warke, Clara Aranha ##submission.copyrightStatement## Mon, 31 Dec 2018 00:00:00 -0800 HLA-C*18:01 and KIR2DL2+C1 genetic variants are associated with low viral load in cART naïve HIV-infected adult Zimbabweans <p>Introduction: Polymorphisms in killer cell immunoglobulin-like receptor (<em>KIR</em>) and human leukocyte antigen (<em>HLA</em>) gene families are implicated in differential outcomes of HIV infection. However, research findings on the influence of <em>KIR</em> and <em>HLA-C</em> polymorphism on HIV disease progression remain inconclusive. We thus investigated the association of <em>KIR </em>and<em> HLA-C</em> gene polymorphisms with plasma HIV load (VL) and CD4+ T lymphocyte (CD4) count in 183 chronically HIV-infected, combination antiretroviral therapy (cART) naïve Zimbabweans of Bantu origin.</p> <p>Methodology: The presence or absence of 15 <em>KIR</em> genes were determined using sequence specific primer polymerase chain reaction while <em>HLA-C</em> typing was performed using chain termination DNA sequencing. Plasma VL was determined using the Cavidi Exavir viral load version 3 assay while CD4+ T lymphocytes were enumerated using flow cytometry. VLs and CD4 counts were compared between gene/genotype carriers and non-carriers using Mann-Whitney ranksum test.</p> <p>Results: <em>HLA-C</em>*18:01 allele carriers had a significantly lower median log<sub>10</sub> VL (2.87copies/mL [IQR;2.3-3.2]) than the non-C*18:01 carriers (3.33copies/mL [IQR; 2.74-3.9]), p = 0.018. Further, median log<sub>10</sub> VL was significantly lower in <em>KIR2DL2+C1</em> carriers (2.745 [IQR; 2.590-2.745]) than non-<em>KIR2DL2+C1</em> carriers (3.4 [IQR; 2.746-3.412]), p = 0.041. Comparison of CD4 + T lymphocyte counts between C*08:02 allele carriers and non-C*08:02 carriers showed a significantly higher median CD4 count in C*08:02 carriers (548cells/µL [IQR;410-684]) than in non-carriers (428cells/µL [IQR;388-537]), p = 0.034.</p> <p>Conclusion: We conclude that the <em>HLA-C</em>*18:01 and <em>KIR2DL2+C1</em> genetic variants are associated with low VL while the C*08:02 is associated with high CD4+ T lymphocyte count among cART naïve Zimbabwean adults with chronic HIV infection.</p> Kudakwashe Mhandire, Mqondisi Tshabalala, Lynn Sodai Zijenah, Tommy Mlambo, Doreen Zvipo Mhandire, Cuthbert Musarurwa, Kerina Duri, Hilda Tendisa Matarira, Collet Dandara, Sarah L Rowland-Jones, Babill Stray-Pedersen ##submission.copyrightStatement## Mon, 31 Dec 2018 00:00:00 -0800 Description of respiratory syncytial virus genotypes circulating in Colombia <p>Introduction: Respiratory syncytial virus (RSV) is the most common cause of acute respiratory infections in children younger than two years but also produces infection in older children and even reinfection in people of any age, a characteristic related to the existence of different infecting subtypes and genotypes. Although Colombia has established the surveillance of classical respiratory viruses, there is no information about the RSV genotypes circulating in Colombian patients.</p> <p>Methodology: A subgroup of 227 previously RSV positive respiratory secretion samples were taken from a nationwide surveillance study, amplified and sequenced to define the circulation pattern of RSV subtypes and genotypes during 2000-2009 period in Colombia.</p> <p>Results. RSV exhibited seasonal behavior with an A subtype more prevalent. Both RSV subtypes had low nucleotide variability. During the study period, the GA2 and GA5 genotypes from RSV subtype A and the BA genotype from RSV subtype B were found.</p> <p>Conclusion. In this report, for the first time RSV genotypes circulating in Colombia were described, this information adds valuable information about virus epidemiology helping to understand the RSV epidemic and prepare our country for the introduction of new vaccines.</p> Viviana Avila, Eliana Calvo, Juliana Barbosa, Myriam L Velandia-Romero, Jaime E. Castellanos ##submission.copyrightStatement## Mon, 31 Dec 2018 00:00:00 -0800 Are physicians aware of current HIV / AIDS diagnostic practices? A study from a tertiary centre in Turkey <p>Introduction: Early diagnosis of HIV infection is essential for the reduction of morbidity/mortality rates, health expenditures and the prevention of infection spread. In this study we aimed to test the knowledge of physicians regarding HIV risk groups, AIDS indicator diseases and their current practices about screening.</p> <p>Methodology: A questionnaire was used to collect data from physicians working in a multidisciplinary 170-bed tertiary university hospital in Istanbul, Turkey. The questionnaire measured physician knowledge of the above-mentioned points.</p> <p>Results: Ninety-six physicians replied to the questionnaire. "Preoperative screening" was found to be the most common (65.6%) indication for HIV testing. A large portion of physicians (72.9%) felt comfortable with an HIV test and 71.9% of the physicians had no impeding condition for HIV testing. Physicians were mostly (67.7%) unaware of the current guidelines for HIV testing.</p> <p>Conclusions: Teaching programs are essential to increase knowledge of HIV screening for physicians as this is an essential part of early diagnosis and therefore important for decreasing morbidity and mortality.</p> Elcin Akduman Alasehir, Zuhal Yesilbag, Asli Karadeniz, Gorkem Yaman ##submission.copyrightStatement## Mon, 31 Dec 2018 00:00:00 -0800 Molecular characterization and phylogenetic analysis of porcine epidemic diarrhea virus isolates in Eastern China <p>Introduction: Porcine epidemic diarrhea virus (PEDV) is one of the most common viral pathogens causing swine diarrhea.</p> <p>Methodology: We performed a genetic evolution analysis of the S1 gene of endemic PEDV strains in Eastern China. The S1 genes of 37 PEDV-positive samples were amplified and sequenced, and compared to the standard CV777 strain, 120 nucleotides were found to have mutations.</p> <p>Results: The nucleotide and deduced amino acid homologies between the sequences and those of the CV777 strain were 90%–91% and 88.2%–90%, respectively, and their homologies to the vaccine strain were 88.6%–89.7% and 86.2%–87.8%, respectively. Genetic evolution and variation analyses indicated that the 37 PEDV strains belonged to genogroup 2-1, while the CV777 strain, vaccine strain, and earlier Chinese strains all belonged to genogroup 1-1.</p> <p>Conclusions: The newly emerged clinical PEDV strains indicate that the PEDV CV777 vaccine currently used in China may not fully protect pigs from infection with recent epidemic strains, and will require the development of new vaccine strains.</p> Chunyan Jiang, Xiaoju Zhang, Jianfeng Han, Haijian He, Chaoying Zhang, Hongbing Zhang, Jingjing Jin, Liang Wang, Bingqian Ge, Yanli Wang, Yongjie Liu ##submission.copyrightStatement## Mon, 31 Dec 2018 00:00:00 -0800 Epidemiology of soil-transmitted helminths and Schistosoma mansoni: a base-line survey among school children, Ejaji, Ethiopia <p>Introduction: School children are among the high risk groups for soil-transmitted helminths (STHs) and <em>Schistosoma mansoni</em> (<em>S. mansoni</em>) infections in developing countries. The aim of this study was to determine the prevalence and associated factors of STHs and <em>S. mansoni</em> among primary school children.</p> <p>Methodology: A cross-sectional study was conducted from February 15 to March 30, 2016, involving a total of 340 primary school children (age range 6 to 19 years). Socio-demographic and related data were collected using interviewer-administered questionnaire. Stool samples were collected from each study participant and examined using direct wet mount and modified Kato-Katz thick smear technique. Intensity of the STHs and <em>S. mansoni </em>were determined by estimating the eggs per gram (EPG) of stool. Factors associated with STH and <em>S. mansoni</em> infections were analyzed using multivariable logistic regression model.</p> <p>Results: Prevalence of the STHs and <em>S. mansoni</em> were 38.2% and 12.94%, respectively. The main predictors of STH infections among the children studied were being in the age group of 16-19 years, untrimmed finger nail and household latrine unavailability. Moreover, male children, children with habit of swimming and bathing in the river had significantly higher odds of <em>S. mansoni </em>infection. Most of the children infected with the parasites had light infection.</p> <p>Conclusions: The burden of STHs and <em>S. mansoni</em> was high among the school children. Deworming intervention should be strengthened, along with awareness creation on proper disposal of human excreta and personal hygiene. Regular monitoring of the burden of the parasites and mass drug administration is required.</p> Temam Ibrahim, Endalew Zemene, Yaregal Asres, Dinberu Seyoum, Abebaw Tiruneh, Lealem Gedefaw, Zeleke Mekonnen ##submission.copyrightStatement## Mon, 31 Dec 2018 00:00:00 -0800