Background
Parasitic worms are a major global health concern, infecting millions worldwide and causing chronic, potentially lifelong infections leading to significant disease and disability including growth and mental stunting in children, anaemia, and malnutrition. Intestinal helminths infect billions, with the majority of infections caused by soil-transmitted helminths (STH) (1.5 billion), schistosomiasis (250 million), and strongyloidiasis (600 million). A significant concern are zoonotic which complicate control and elimination programs due to animal reservoirs present, and potential increases in prevalence and changes in distribution of these parasites due to climate change.
There is also decreasing expertise in morphological parasite diagnosis despite their significant health burden. Microscopy with Kato-Katz (KK) is a mainstay of national surveys for STH and schistosomiasis but lacks sensitivity, particularly in low prevalence areas, and is highly dependent on microscopist skill. This has led to under-reporting of parasite prevalence and missing new or rare parasites. Molecular tools have greater sensitivity and have been used in prevalence surveys to identify parasites, while an AI-based microscope platform recently demonstrated increased sensitivity over human slide readers while decreasing slide read time to only 10 minutes for STH.
Sarawak province in Malaysia is a heavily forested area with unique biodiversity with increasing deforestation for farming, plantations and residential development leading to increased risk of parasitic zoonoses infections. Few helminth surveys have been performed in Sarawak province, however small cohort studies on longhouse communities report prevalence >14% for STH, 11% for strongyloidiasis, and 4-11% for schistosomiasis. Non-human primates are also present in Sarawak and have previously been found to be infected with a range of zoonotic helminths including Capillaria, Oesophagostomum, Strongyloides, Trichuris, Ascaris and Hookworm.
There is great potential for increased transmission and emergence of new zoonotic helminth disease in Sarawak, and epidemiological surveys of humans, animals, and the environment utilising new diagnostic tools and genetic analysis will be crucial to understanding transmission and controlling infection there.
Aim
Aim 1: To collect stool samples from humans and animals (dogs, cats, non-human primates), along with soil and water samples, in endemic villages of Sarawak.
Aim 2: To perform molecular diagnostics on collected stool and environmental samples to identify helminth parasites.
Aim 3: To develop and optimise a method for an AI-based microscopy platform detection of Strongyloides spp. and compare with conventional microscopy and molecular diagnostics.
Aim 4: To perform haplotyping and population genetic analysis for Strongyloides spp., Hookworm, and Schistosoma spp. identified in human, animal, and environmental samples.
Aim 5: To identify environmental, economic, and social characteristics of high helminth prevalence areas combined with results of parasite surveys to map transmission hot-spots in Sarawak province.