Elsevier

Acta Tropica

Volume 214, February 2021, 105783
Acta Tropica

Intestinal parasites in segregated minority communities of Slovakia: results from a cross-sectional survey in children

https://doi.org/10.1016/j.actatropica.2020.105783Get rights and content

Abstract

In Slovakia, the Roma population forms the second-largest ethnic minority. A large part of the Roma is semi-nomadic or lives in segregated settlements with poor living standards and limited access to health facilities. More than 40 years ago, a cross-sectional survey revealed a high prevalence of parasitic infections. There is a paucity of recent data, and hence, we designed a study to investigate the current status of intestinal parasitic infections in this population. Overall, 259 children aged 7 months to 18 years from 32 different segregated settlements provided faecal samples for microscopic examination using a sodium acetate-acetic acid-formalin concentration and the Paraprep L technique. Almost 40% of the samples yielded a positive result, with Ascaris lumbricoides (27.4%) and Giardia intestinalis (9.3%) being the most frequent helminth and intestinal protozoa species, respectively. Many children younger than 2 years were found to be infected, which suggests that community transmission is important. In view of our findings, there is a pressing need for targeted action to improve the health status of this neglected population.

Introduction

The Roma are one of the largest ethnic minorities in Europe (Foldes and Covaci, 2012). In Slovakia, the Roma form the second-largest ethnic minority after the Hungarians. According to the Atlas of Roma communities (Mušinka et al., 2014), there are 803 Roma settlements in Slovakia with more than 215,000 people. The highest number of Roma communities is found in Košice self-governing region (58.2%), living mostly in segregated settlements with poor living conditions, low personal hygiene and abundant presence of waste, rodents and insects. Electricity is available in 91% of the settlements, but only 42% have a public sewer system (Mušinka et al., 2014). Up to one third of the settlements in this region do not have access to clean drinking water, and hence, water has to be collected from streams or creeks. In some parts, the people live together with domestic animals without proper disposal of animal and human faeces, posing a considerable risk for infection with soil-transmitted helminths and other intestinal parasites (Plutzer et al., 2018; Speich et al., 2016; Strunz et al., 2014).

In a cross-sectional survey conducted in 1978 in the eastern part of Slovakia, 4,840 children aged 0-15 years were examined for a broad range of parasitic infections (Giboda, 1981). High prevalence rates were found for the two helminth species Trichuris trichiura (27%) and Ascaris lumbricoides (17%) and the intestinal protozoon Giardia intestinalis (16%). These infection rates were considerably higher than observed elsewhere in Slovakia.

In view of the preexisting high burden of parasitic infections and the prevailing poor living conditions, there is a pressing need to update the epidemiological situation, so that targeted control measures can be initiated should the situation of this ethnic minority population not have improved markedly. Hence, our aim was to investigate the current status of intestinal parasitic infections among the Roma population in eastern Slovakia and compare the results with data from the late 1970s.

Section snippets

Study area and population

The study was carried out in 32 segregated villages and settlements in Košice and Prešov self-governing regions from September to December 2019. The study population consisted of 259 individuals aged between 7 months and 18 years. During the survey, social workers responsible for the respective villages were present and served as linkage persons between the research team and the villagers. Village elders were informed by the designated social workers about the planned study and were invited to

Results

A total of 259 children were included in the study and examined microscopically for the presence of intestinal parasites. Overall, 101 children (39.0%) were found to be infected with at least one species of intestinal parasites. The predominant intestinal parasite was the soil-transmitted helminth A. lumbricoides (71 positive samples, prevalence 27.4%). Cysts of the intestinal protozoon G. intestinalis were detected in 24 of the participants (9.3%). Eggs of the soil-transmitted helminth

Discussion

The prevalence of intestinal parasites in Slovakia in the general population is relatively low, which is explained by environmental characteristics (i.e. the country is situated in temperate and continental climate zones with cold, cloudy and humid winters) and overall good hygiene conditions. A recent study found prevalence rates for A. lumbricoides, T. trichiura and G. intestinalis of 3.8%, 0.8% and 0.7%, respectively in the general population (Dudlová et al., 2016). However, in socially

Declarations

Funding: The study was supported by a grant from the World Health Organization (WHO) (registration 2018/842184-0)

Conflicts of interest/competing interests: None

Ethics approval: The proposal was reviewed and approved by the ethical commission of Košice self-governing region (document no. 5436/2019/ODDZ-25820)

Consent to participate: Participation was voluntarily. Participants signed a written informed consent after having been informed about the purpose and procedures of the study, including

Author statement

All authors have read and approved the revised version of the manuscript.

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