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TMIH549

Tropical Medicine and International Health

volume 5 no 4 pp 302–307 april 2000

Prevalence and distribution of soil-transmitted helminth (STH)

infections in urban and indigenous schoolchildren in Ortigueira,
State of Paranà, Brasil: implications for control
Carla Scolari1, Carlo Torti1, Anna Beltrame1, Alberto Matteelli1, Francesco Castelli1, Maurizio Gulletta1,
Milton Ribas2, Serenella Morana3 and Carlo Urbani4
1 Department of Infectious and Tropical Diseases, University of Brescia, Italy
2 Hospital Sao Francisco, Fundacao Médica Assistencial dos Trabalhadores Rurais de Ortigueira, Brazil
3 Department of Obstetrics and Gynecology, University of Pavia, Italy
4 Service of Infectious and Tropical Diseases, General Hospital of Macerata, Italy

Summary Soil-transmitted helminth (STH) infections represent a major public health problem in poor and developing
countries. During the period September-October 1998 we conducted an epidemiological survey of STH
infections in schoolchildren of an urban area (group A) and an indigenous reserve (group B), in the Muni-
cipality of Ortigueira, State of Paranà, Brazil, to assess potential benefits of mass treatment. Stool samples
were examined for helminth eggs by quantitative (Kato-Katz) technique to determine the prevalence and
intensity of intestinal parasitic infection. Moreover, we examined the relationship between prevalence and
intensity of STH infections and housing/hygienic factors (by means of a 7-item questionnaire). 236 school-
children aged 5–15 years were enrolled, 136 in group A and 100 in group B. The prevalence of STH infections
was significantly higher in group B (93%) than in group A (22%) (P , 0.001). Detected parasites were: A.
lumbricoides (16.1% prevalence in group A, 88% in group B, P , 0.001), hookworms (5.8% in group A,
52% in group B, P , 0.001) and T. trichiura (5.1% in group A, 2% in group B, P 5 0.2). Heavy infections
were detected in 2.9% and 23% of the children in group A and B, respectively (P , 0.001). Housing/hygienic
indicators were significantly poorer in group B. A statistically significant correlation was observed between
total prevalence of STH infections and prevalence of high-intensity infections with most housing/hygienic
variables. On the basis of these results, mass treatment and educational interventions were suggested for the
indigenous community, whereas target treatment and educational interventions were suggested for the urban
community. Even in a geographically homogeneous area different epidemiological realities can be found,
which in turn can influence infection levels and control programmes.

keywords soil-transmitted helminthiasis, epidemiologic survey, control, schoolchildren, Brazil

correspondence Dr Francesco Castelli, Department of Infectious and Tropical Diseases, University of

Brescia. P. le Spedali Civili 1, 25125 Brescia. Italy. E-mail: castelli@master.cci.unibs.it

1997; Geissier et al. 1998; Machado & Costa-Cruz 1998;

Introduction
The World Health Organization (WHO) estimates that more
than one billion of the world’s population is chronically
affected by STH infections, which are closely correlated with
poverty, poor environmental hygiene and impoverished health
services. Intestinal helmintiases are among the most common
communicable disease of school-age children in certain com-
munities and tend to occur at highest intensity in this age
group (Albonico et al. 1993; Menan et al. 1997; Urbani et al.
Olsen 1998).
High incidence of parasitic infections and polyparasitism
affect the health status (Savioli et al. 1992; Albonico et al.
1998; Ferreira et al. 1998). In particular, there is evidence to
support the relationship between helminth infections, malnu-
trition and child development, with negative consequences for
cognitive function and learning ability (Crompton 1992;
Nokes & Bundy 1994; Oberhelman et al. 1998; Ray 1998;
Saldiva et al. 1999).

302 © 2000 Blackwell Science Ltd

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Tropical Medicine and International Health volume 5 no 4 pp 302–307 april 2000

C. Scolari et al. Soil-transmitted helminth infections in schoolchildren in Ortigueira, Brasil

The WHO has developed a clear policy for the control of A questionnaire composed of seven questions to assess
STH infections (Montresor et al. 1998), recommending that housing/hygienic indicators (i.e. number of cohabiting
any programme aimed at controlling morbidity due to STH people, number of rooms in the house, presence of toilet, in-
infections should begin with a baseline survey. Baseline sur- or outside toilet, sharing the latrine or not, presence of safe
veys provide a sound basis for estimating current status and water, presence of sewage) was filled for each subject. These
needs for future interventions and produce essential data to specific questions were chosen as easily verifiable indicators
guide the development of control programmes at national, of hygienic conditions, rather than as specific risk factors for
regional and district levels (Montresor et al. 1998). Childhood STH infections. Safe water was defined as running treated
diarrhoea has been recognized as public health priority in water. The ratio number of people per house/number of
Ortigueira Municipality, especially among local indio com- rooms per house (i.e. index of overcrowding) has been con-
munities. The main cause was believed to be STH infections, sidered in the analysis. The threshold of 2 for this ratio was
but no data were available to guide public health inter- chosen as it represented the median value for the frequency
ventions. Therefore we conducted an epidemiologic survey to distribution.
determine what kind of interventions should be performed. A field assistant who knew every person in their school
verified answers of the children to the questionnaire. Chil-
dren’s addresses were recorded in order to conduct a sub-
Materials and methods
group analysis within the urban population, with the
The study was conducted in Ortigueira, with 2548 km2 one of objective of verifying any difference between children living
the largest municipalities of Paranà State. The estimated in a large suburban shanty town called Vila Andradina and
number of inhabitants is 55 000, 76% living in rural areas. An other urban children. Sex and age were also recorded for each
indigenous reserve with a population of 400 Queimadas child. Age of each child was verified in the schools’ registers.
indios is located 1 km from the urban centre. Statistical analysis of the data was performed with EpiInfo
Schoolchildren aged 5–15 years were recruited from the (CDC). Continuous data were compared by Anova test; cat-
urban area (group A) and from the indigenous reserve (group egorical data were analysed by use of the Chi square test with
B). Since no more than an estimated 5–10% of school-age Mantel-Haenszel stratified analysis or by use of Fischer’s
children do not attend school regularly, the sample popu- exact test as appropriate. A P-value , 0.05 was considered
lation could be considered representative. The study was car- significant. Individuals with A. lumbricoides, hookworms, or
ried out during the months of September and October 1998. T. trichiura infections were treated with albendazole 400 mg
The sample size was calculated in order to demonstrate a single dose.
difference of 20% in the prevalence of STH infections
between the two study groups (assuming 40% prevalence in
Results
group B and 20% in group A) with a confidence interval of
95% and a precision of 80%. Stool examination was offered to 140 children of group A
To reach target samples we recruited the whole population and 105 children of group B. A total of 236 schoolchildren,
in the indigenous reserve and a randomly selected sample in
the urban area. There is only one school in the indigenous
reserve; the urban sample was selected from the two public
Table 1 Sex and age of urban (Group A) and indigenous (Group B)
schools in town. Within each of these two schools two classes schoolchildren
were selected using a lottery method as suggested by the
WHO guidelines (Montresor et al. 1998). At the beginning of Group A Group B
the study the reasons for the survey and the procedure for n (%) n (%) P-value
stool sample collection were explained to all the participants
and their parents, whose informed consent was obtained. Children 136 100
Each individual was provided with a plastic container Sex
marked with an identification number and with the name of Male 070 (51.4%) 44 (44%)
the subject. Each subject gave one stool sample. Stool Female 066 (48.6%) 56 (56%) 0.25*
samples were examined within 12 h for the evidence of para- Age (years)
05–7 020 (14.7%) 31 (31%)
sitic infections by the Kato-Katz quantitative technique
08–11 100 (73.6%) 52 (52%)
(Montresor 1998). The Kato-Katz slides were examined 12–15 016 (11.7%) 17 (17%) 0.002†
within 1 h to avoid missing evidence of hookworm eggs.
Results are expressed as classes of intensity following recom- *Calculated by Mantel-Haenszel stratified analysis. †Calculated by x2
mendations by WHO (Montresor 1998). uncorrected test.

© 2000 Blackwell Science Ltd 303

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Tropical Medicine and International Health volume 5 no 4 pp 302–307 april 2000

C. Scolari et al. Soil-transmitted helminth infections in schoolchildren in Ortigueira, Brasil

Table 2 Total prevalence of soil-transmitted infections by age in groups remained in all age groups as shown in Table 2.
urban (Group A) and indigenous (Group B) schoolchildren Double infections were found in 2.9% of group A and in
49% of group B (P , 0.001); only one urban child presented
Group A (n 5 136) Group B (n 5 100)
a triple infection.
Age prevalence (%) prevalence (%) P-value
The most common soil-transmitted helminths were A.
lumbricoides, followed by hookworms and T. trichiura. As
05–7 years 03/20 (15%) 26/31 (84%) , 0.001*
shown in Table 3, the prevalence of each parasite in group A
08–11 years 19/100 (19%) 50/52 (96%) , 0.001*
12–15 years 08/16 (50%) 17/17 (100%) , 0.001*
and B, respectively, was: A. lumbricoides 12.1% and 88%
(P , 0.001); T. trichiura 5.1% and 2% (P 5 0.2); hookworms
*Calculated by Mantel-Haenszel stratified analysis. 5.8% and 52% (P , 0.001).
The percentage of heavy infections was 2.9% in group A
and 23% in group B (P , 0.001). The prevalence distribution
of the parasites in the two groups by classes of intensity is
136 in group A and 100 in group B, were examined for soil- shown in Table 3. The association of heavy infections with
transmitted infection and interviewed. Compliance was 97% age was further analysed. While no statistically significant
and 95.2% for group A and B, respectively (P 5 0.43). The difference was found between the prevalence
main characteristics for each of the two groups are shown in of heavy infections in 5–7-year-old children of group A
Table 1. The distribution by sex within the groups was homo- (1/20 5 5%) and of group B (4/31 5 12.9%) (P 5 0.35), a
geneous, while the distribution by age was not (Table1). statistically significant difference was found both in the 8–11
Environment and housing conditions varied between the (3/100 5 3% and 13/52 5 25% in group A and B, respec-
groups: All houses in the indigenous reserve had earth floors, tively; P , 0.0001) and 12–15 (0/16 5 0% and 6/17 5 35.3%;
the urban dwellings had wood floors. Soil also differed in that P 5 0.001) year old children.
in the indigenous reserve there were many basins of stagnant Housing and hygienic conditions also differed significantly
water in which children played. in the two groups (Table 4). By means of a univariate analysis
The prevalence and intensity of STH infections varied sig- we found a correlation between STH infections and housing-
nificantly between the two groups. 22% of group A children /hygienic variables, with the only exception of sharing
and 93% of group B were infected by one parasite or more latrines between families (Table 5). We also found a corre-
(P , 0.001). The difference in the prevalence between the two lation between the prevalence of heavy intensity infection and

Table 3 Total prevalence and prevalence by

Group A Group B P-value class of intensity of soil-transmitted infec-
tions in urban (Group A) and indigenous
(Group B) schoolchildren
N° examined 136 100
A. lumbricoides
Prevalence (%) 012.5 088 , 0.001*
Class of intensity (%)
Light (1–4999 epg^) 007.3 026
Moderate (5000–49 999 epg†) 005.8 044
Heavy (> 50 000 epg) 002.9 018 , 0.001§
T. trichiura
Prevalence (%) 005.1 002 0 00.2‡
Class of intensity (%)
Light (1–999 epg) 004.4 002
Moderate (1000–9999 epg) 000.7 000
Heavy (> 10 000 epg) 0000 000 0 00.4*
Hookworms
Prevalence (%) 005.8 052 , 0.001§
Class of intensity (%)
Light (1–1999 epg) 005.8 038
Moderate (2000–3999 epg) 0000 009
Heavy (> 4000 epg) 0000 005 , 0.001*

†epg, Eggs per gram of faeces. *Calculated by x2 uncorrected test. ‡Calculated by Fisher’s
exact test. §Calculated by Mantel-Haenszel stratified analysis.

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Tropical Medicine and International Health volume 5 no 4 pp 302–307 april 2000

C. Scolari et al. Soil-transmitted helminth infections in schoolchildren in Ortigueira, Brasil

Table 4 Housing/hygienic factors in urban

(Group A) and indigenous (Group B) school- Housing/hygienic factors Group A Group B P-value
children
N° of cohabiting people (mean) 04.5 06.2 , 0.001*
N° of rooms in the house (mean) 03.4 02 , 0.001*
Presence of toilet in the house (%) 98.5 80 , 0.001§
Inside toilet (%) 81.6 05 , 0.001§
Shared toilet (%) 12.5 02 00 0.003§
Safe water (%) 97 01 , 0.001§
Sewage (%) 97.7 54 , 0.001§

*Calculated by Anova test. §Calculated by x2 uncorrected test.

housing/hygienic variables, with the exception of presence of
toilet (Table 5).
In a subgroup analysis, 23 children living in a shanty-town
called Vila Andradina presented a higher prevalence of STH
infections. The overall prevalence of children infected with at
least one parasite in this community was 60.8%, while the
overall prevalence in the other urban agglomerates was 14.1%
(P , 0.001). The prevalence of high-intensity infections was
significantly higher in children living in Vila Andradina
(3/23 5 11.1%) than in other urban children (1/113 5 0.9%)
(P 5 0.001). The subgroup of children living in Vila
Andradina was not significantly different from the other
urban children considering sex and age, but it was with
respect to the house and hygienic conditions.
Discussion
The schoolchildren in Ortigueira city had lower overall preva-
lence and intensity of intestinal helminth infections than
indio children. STH infections represented a more serious
health problem among children in the indigenous reserve,
76% of whom had moderate/heavy infections. This preva-
lence rate is higher than that of other studies in indigenous
communities in Brazil (Santos et al. 1995; Miranda et al.
1998). Interestingly, the difference in the prevalence of heavy
intensity infections between the two groups was limited to
older children (> 8 years). This suggests that chronic expo-
sure to infection in the indio community may lead to
increased intensity of infections.
The most prevalent parasite was A. lumbricoides in all
analysed groups, in agreement with Bundy (1986),
Hanitrasoamampionana et al. (1998) and Saldiva et al.
(1999). While the prevalences of A. lumbricoides and hook-
worms were higher in indigenous than in urban school-
children, the prevalence of T. trichiura was higher in the
urban population, though not to a significant level (P 5 0.2).

Table 5 Correlation of the total prevalence of STH infections and the prevalence of heavy intensity STH infections with housing/hygienic
variables in the study population

Total prevalence of STH infections Prevalence of heavy intensity STH infections

Housing/hygienic ————————————— ————————————————
factors Values RR* CI† RR* CI†

No. of cohabiting people/no. >2 2.62 1.90, 3.61 03.71 1.46, 9.47
of rooms in the house ratio ,2 1
Toilet No 1.78 1.43, 2.21 0§ §
Yes 1
Inside toilet No 3.99 2.77, 5.75 04.25 1.67, 10.85
Yes 1
Shared toilet Yes 0.79 0.46, 1.37 00.91 0.23, 3.57
No 1
Safe water No 4.19 3.02, 5.81 10.33 03.2, 33.36
Yes 1
Sewage No 2.05 1.69, 2.50 01.61 0.75, 3.45
Yes 1

*RR: relative risk. †CI: confidence interval. §data not available because of a null value in the analysis.

© 2000 Blackwell Science Ltd 305


Tropical Medicine and International Health
C. Scolari et al. Soil-transmitted helminth infections in schoolchildren in Ortigueira, Brasil
Indeed, a series of data has demonstrated that T. trichiura is
a typically urban parasite (Bundy 1986; Saldiva et al. 1999).
WHO guidelines for the evaluation of STH infections at
community level (Montresor 1998) recommend periodic treat-
ment rounds for groups with a prevalence of high-intensity
infections of 10% or above, regardless of the prevalence of
overall infections. Therefore our results provide a clear basis
for periodic mass treatment in the indigenous population, as
we suggested to local health authorities. A different approach
(i.e. treatment of positive cases diagnosed by the health unit)
is suggested in case of prevalence , 50% and percentage of
high intensity infections , 10% (Montresor 1998). This was
recommended for the urban population.
However, urban children in Vila Andradina had poorer
housing-hygienic conditions (i.e. answers to the question-
naire) and higher prevalence/intensity of intestinal helminth
infections. These children live in a shantytown where a mass
treatment could be applied, even if the small size of the
sample did not allow us to suggest clear recommendations.
Our data are consistent with a direct effect of the lack of
sanitation on prevalence/intensity of intestinal helminth
infections as suggested by others with more powerful
methods (Feachem et al. 1983; Schulz & Kroeger 1992).
Indeed our observation underscores the importance of reduc-
tion of transmission through interventions based on inform-
ation, education and communication strategies and
improvement of sanitation for all community categories
(Montresor et al. 1998).
Populations living close to each other may have different
risks for STH infections if their social economic status and
their living conditions differ. For an appropriate control strat-
egy it is important to conduct epidemiological surveys which
are able to detect these differences. Our study has certain
limitations, inherent in the representativity of the selected
sample and the type of analysis. Results concerning urban
schoolchildren should not be extended to the child popu-
lation living in the municipality as a whole. School-age chil-
dren not attending schools were excluded from the analysis,
although their proportion was low. Multivariate analysis was
not performed, and this does not allow us to determine the
exact risk of each considered housing-hygienic factors in
determining STH prevalence. However, our survey was basi-
cally aimed at providing the basis for practical public health
interventions to decrease STH infections. The cross-sectional
study design does not allow us to determine the efficacy of
mass-treatment in this population. A longitudinal cohort
study will be necessary to provide this crucial next piece of
information.
Acknowledgements
Funding for this project was provided by College of
306
13653156, 2000, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1046/j.1365-3156.2000.00549.x by Republic of Moldova Hinari NPL, Wiley Online Library on [30/10/2022]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
volume 5 no 4 pp 302–307 april 2000
Physicians, Province of Pavia, Italy. We thank Dr Antonio
Montresor for suggestions and WHO for providing labora-
tory kits for Kato-Katz technique. We also wish to thank the
Queimadas for their support.
References
Albonico M, De Carneri I, Di Matteo L et al. (1993) Intestinal para-
sitic infection of urban and rural children on Pemba Island: implica-
tions for control. Annals of Tropical Medicine and Parasitology 6,
579–583.
Albonico M, Stoltzfus RJ, Savioli L et al. (1998) Epidemiological evi-
dence for a differential effect of hookworms species, Ancylostoma
duodenale or Necator americanus, on iron status of children.
International Journal of Epidemiology 27, 530–537.
Bundy DAP (1986) Epidemiological aspects of Trichuris trichuriasis in
Caribbean communities. Transaction of Royal Society of Tropical
Medicine and Hygiene 80, 706–718.
Crompton DWT (1992) Ascaris and childhood malnutrition.
Transaction of Royal Society of Tropical Medicine and Hygiene 86,
577–579.
Feachem RG, Bradley DJ, Garelick H & Mara DD (1983) Sanitation
and Disease: Health aspects of excreta and wasterwater manage-
ment. Work Bank Study in Water Supply and Sanitation. John
Wiley. New York.
Ferreira RF, Souza W, Perez E et al. (1998) Intestinal helminthiasis and
anemia in youngsters from Matriz da Luz, District of Sao Laurenco
da Mata, state of Pernambuco, Brazil. Memorias Do Instituto
Oswaldo Cruz, Rio de Janeiro 93, 289–293.
Geissier PW, Mwaniki D, Thiong’o F & Friis H (1998) Geophagy as a
risk factor for geohelminth infections: a longitudinal study of
Kenyan primary schoolchildren. Transactions of the Royal Society
of Tropical Medicine and Hygiene 92, 7–11.
Hanitrasoamampionana V, Brutus L, Hebrard G et al. (1998) Etudie
épidémiologique des principales nématodoses intestinales humaines
dans le Moyen-ouest de Madagascar. Bulletin de la Societé de
Pathologie Exotique 91, 77–80.
Machado ER & Costa-Cruz JM (1998) Strongyloides stercoralis and
other enteroparasites in children at Uberlandia City, State of Mina
Gerais, Brazil. Memorias Do Instituto Oswaldo Cruz 93, 161–164.
Menan EIH, Nebavi NGF, Adjetey TAK, Assavo NN, Kiki Barro PC &
Kone M (1997) Profile des helminthiases intestinales chez les enfants
d’age scolaire dans la ville d’Abidjan. Bulletin de la Societé de
Pathologie Exotique 90, 51–54.
Miranda R, Branches Xavier F & Camurca de Manezes R (1998)
Parasitismo intestinal em uma aldeia indigena Parakana, sudeste do
Estado do Parà, Brazil. Cadernos de Saùde Pùblica 14, 507–511.
Montresor A, Crompton DWT, Bundy DAP, Hall A & Savioli L (1998)
Guidelines for the Evaluation of Soil-Transmitted Helminthiasis
and Schistosomiasis at Community Level. WHO, Geneva.
WHO/CTC/SIP/98.1.
Nokes C & Bundy DAP (1994) Does Helminth Infection Affect Mental
Processing and Educational Achievement? Parasitology Today 10,
14–18.
Oberhelman RA, Guerrero ES, Fernandez AM et al. (1998) Correlation
between intestinal parasitosis, physical growth and psychomotor
© 2000 Blackwell Science Ltd

Tropical Medicine and International Health
C. Scolari et al. Soil-transmitted helminth infections in schoolchildren in Ortigueira, Brasil
development among infants and children from rural Nicaragua.
American Journal of Tropical Medicine and Hygiene 58, 470–475.
Olsen A (1998) The proportion of helminth infections in a community
in western Kenia which would be treated by mass chemotherapy of
schoolchildren. Transaction of Royal Society of Tropical Medicine
and Hygiene 92, 144–148.
Ray SM (1998) Intestinal geohelminthiasis and growth in pre-
adolescent primary school children in Northeastern Peninsular
Malaysia. Southeast Asian Journal of Tropical Medicine and Public
Health 29, 112–117.
Saldiva SR, Silveira AS, Philippi ST et al. (1999) Ascaris – Trichuris
association and malnutrition in Brazilian children. Paediatric and
Perinatal Epidemiology 13, 89–98.
© 2000 Blackwell Science Ltd
13653156, 2000, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1046/j.1365-3156.2000.00549.x by Republic of Moldova Hinari NPL, Wiley Online Library on [30/10/2022]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
volume 5 no 4 pp 302–307 april 2000
Santos RV, Coimbra CEA, Flowers NM & Silva JP (1995) Intestinal
parasitism in the Xavante Indians, Central Brazil. Revista Do
Instituto de Medicina Tropical de Sao Paulo 17, 145–148.
Savioli L, Bundy D & Tomkins A (1992) Intestinal parasitic infections:
a soluble public health problem. Transactions of the Royal Society
of Tropical Medicine and Hygiene 86, 353–354.
Schulz S & Kroeger A (1992) Soil contamination with Ascaris
lumbricoides eggs as an indicator of environmental hygiene in urban
areas of north-east Brazil. Journal of Tropical Medicine and
Hygiene 95, 95–103.
Urbani C, Touré A, Hamed AO et al. (1997) Parasitoses intestinales et
schistosomiases dans la vallee du fluve Senegal en republique
Islamique de Mauritanie. Médecine Tropicale 57, 157–160.
307