Geohelminth infection and re-infection after chemotherapy among slum-dwelling children in Durban, South Africa

The prevalences and intensities of Ascaris lumbricoides, Trichuris trichiura and hookworm (probably Necator americanus) infection were measured in the young children (aged 2-10 years) living in 10 urban slums in Durban, South Africa. Re-infection was assessed at 4-6 and 12 months post-treatment. The baseline prevalences of A. lumbricoides and T. trichiura were 81.7%-96.3% and 54.5%-86.2%, respectively, and the corresponding geometric mean intensities were 960 and 91 eggs/g faeces. Most (85%) of the children found infected with A. lumbricoides and 23% of those found infected with T. trichiura had moderate-heavy infections. A few of the children investigated had intensities of Ascaris and Trichuris infection that were considerably higher than those previously recorded in South Africa. The baseline prevalences of hookworm infection (0%-20% in individual slums, with a mean of 4.7%) and intensities of such infection (geometric mean = 17 eggs/g) were relatively low. Albendazole proved very effective against A. lumbricoides and hookworm but less so against T. trichiura. Re-infection by A. lumbricoides and T. trichiura reached pre-treatment prevalences by 4-6 months post-treatment in some of the slums and by 12 months in all the other slums. By 12 months post-treatment, the intensities of A. lumbricoides infection had reached their pretreatment levels while those of T. trichiura infection were higher than at baseline. Approximately 50% of children had moderate-heavy T. trichiura infections at 12 months post-treatment compared with approximately 23% at baseline. Hookworm infections did not re-appear after treatment. The results show clearly that urban slums should be included in any future helminth-control programmes in South Africa.