Abstract

INTRODUCTION: Worms or helminths have historically infected more than half the world's population, but were largely neglected by medical science and public health interventions because they were considered non-fatal and of minimal clinical significance
METHODOLOGY  This study was conducted in the Department of Gastroenterology,
Inclusion criteria:

All subjects who had symptomatic or asymptomatic ascariasis.

Exclusion criteria:

Pregnant females.
Females who were breast feeding.
Children <5 years of age.
Patients who had terminal illness or who were sick because of other comorbidities.
History of hypersensitivity to albendazole, mebendazole, pyrantel pamoate or ivermectin.

The present study was a randomized single blinded trial. A total of 400 patients including children, adolescents and elderly, who were infected with Ascaris lumbricoides and met the inclusion criteria were recruited. Four groups each comprising of 100 patients were randomly allocated to receive albendazole, mebendazole, pyrantel pamoate and ivermectin.



Primary Outcome: Cure rate (CR) which means the percentage of patients who became egg- negative after treatment and egg reduction rate (ERR) which indicated reduction in the geometric mean fecal egg count on follow-up compared to base line at 21-23 days post-treatment was used as a primary outcome measure. Adverse events were monitored 3 hours post treatment. From each patient, two stool samples were examined for the presence and number of A. lumbricoides eggs. The patients were randomly assigned to albendazole, mebendazole, pyrantel pamoate and ivermectin. Three weeks later two more stool samples were analyzed for A. lumbricoides eggs. The stool was examined for ova of Ascariasis. Stool examination for ova of   A. lumbricoides was done by two methods:

Direct Smear method
Concentration method

Worm Load

Stool for worm load was done by Stoll’s Egg- Counting Technique. In our study, the subjects were recruited from outpatient, inpatient, schools, villages and far-flung areas. Potential risks and benefits were explained to all subjects. An informed consent form was distributed to all subjects and their consent was sought.

In addition a questionnaire was administered to each participating subject for obtaining socio-demographic data including sex, age, residence, level of education, occupation, ethnic group, sanitation infrastructure and behavioral data (wearing of shoes, source of drinking water, food consumption and personal hygiene). Patients were grouped as per the socio-economic status into high, middle and low income groups. This classification was based on modified B. G Prasad’s classification (2013)
RESULTS: Helminthis infect 25-30% of world’s population. Common intestinal helminthic infection presents important health problem in the school-age population. Of the infected children, majority had Ascariasis with worm load of light, moderate and heavy intensity. This finding has important implications for morbidity and transmission rates. The periodic administration of antihelmintic drugs to at-risk population is the global strategy for controlling morbidity due to soil-transmitted helminthic infection. The goal of control program is to eliminate childhood illness caused by soil-transmitted helminthic infection, i.e., to decrease the prevalence of moderate and heavy infection intensity among school-age children to less than 1%. The population of the developing countries across the globe suffers not only as a direct result of these infections but also due to comorbidity such as anemia, malnutrition and reduced immunity status. It has been seen that well targeted drug delivery, particularly via community chemotherapy, can substantially decrease aggregate morbidity and mortality and also improve growth rates, physical fitness and activity, cognitive school performance, and social well being. Improvement in appetite is likely to be the single most important mechanism through which a variety of physiological improvement occurs.Lastly, to conclude, large scale treatment and control of helminthes and treatment of individual cases when diagnosed are now truly urgent