The Comede health care center for political refugees received 4,414 first arrivals fom 70 African, Asian and South American countries in 1989. Many arrived from areas where intestinal parasitic infections are endemic, and where infections by nematodes (Ancyclostoma duodenale, Necator americanus, Ascaris lumbricoides, Trichuris trichiura, Strogyloides stercoralis), trematodes (Schistosomma hematobium, Schistosoma stercoralis) and protozoa (Entamoeba coli) cause significant morbidity. The question that arises is whether we should screen stools and urine only in the case of African refugees, or treat all refugees empirically (mass treatment program). We carried out a retrospective study of 1,425 patients seen for the first time in the Comede from August 1, 1989 to December 31, 1989. Three-quarters of the subjects were men and the mean age was 29 years. 63.2% of the subjects were from 28 African countries, 18.6% fom 8 Asian countries, 10% fom 5 South American countries and the West Indies, and 6.4% from 4 countries of the Mediterranean basin. All the subjects were asked to provide stool and urine specimens at the Paris City Laboratory, which were examined using the merthiolate iodo formol direct methods, two concentration methods (MIF and Kato) and Baermann's technique. Patients with infestations were prescribed appropriate treatment at a second visit, compliance with which was good (86%). The prevalence of intestinal parasite infections was 60%. Albendazole was given to 44% of patients, while 45% of African patients were given praziquantel and 2.7% tinidazole. The cost of the screening and oriented treatment program (two visits with treatment) was 630002 FF, while the cost of a mass treatment program (one visit with treatment) was 361417 FF. Although frequent, such infections do not pose a public health risk; the main aim is thus to treat the individuals concerned. The efficacy of screening is limited by the use of a single stool test, the moderate sensitivity and specificity of the tests, and losses to follow-up. The efficary of mass treatment is similarly limited by the use of albendazole alone, which is poorly effective against S. stercoralis, while thiabendazole cannot be used routinely because of its side effects. For reasons of efficiency and cost, we recommend mass treatment, with parasitological testing for patients who refuse.

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tiabendazole controlled study praziquantel major clinical study protozoon Albendazole parasitosis tinidazole refugee trematode nematode mass screening health care policy Article France human cost effectiveness analysis