Abstract

Soil-transmitted helminth (STH) infections remain a major public health concern, particularly among school-aged children in tropical and subtropical regions where inadequate sanitation, unsafe water and poor hygiene facilitate transmission. This narrative review examines the epidemiology of STH infections, reinfection following deworming, anthelmintic treatment efficacy and the potential emergence of drug resistance, with particular emphasis on Nigeria. Relevant evidence was obtained from peer-reviewed articles, clinical studies, review papers and World Health Organization publications. The review highlights Ascaris lumbricoides, Trichuris trichiura and hookworms as the major intestinal STHs affecting children, with Strongyloides stercoralis also recognised as an important soil-transmitted parasite with distinct control requirements. Evidence from Nigeria indicates substantial geographical variation in infection prevalence, with persistent transmission reported in some communities despite repeated mass drug administration. Reinfection remains a major challenge because deworming reduces parasite burdens without eliminating environmental sources of infection. Although albendazole and mebendazole are widely used in preventive chemotherapy, their efficacy varies among parasite species, particularly against T. trichiura. Furthermore, mathematical modelling suggests that prolonged preventive chemotherapy may create conditions favouring the emergence of anthelmintic resistance; however, widespread clinically confirmed benzimidazole resistance in human STHs has not been established. The review emphasises the importance of distinguishing reinfection from treatment failure through longitudinal monitoring, species-specific therapeutic efficacy assessments and appropriate molecular surveillance. It concludes that sustainable STH control requires an integrated approach combining preventive chemotherapy, improved water, sanitation and hygiene (WASH), health education, sensitive diagnostic methods and strengthened epidemiological surveillance, particularly in underserved Nigerian communities.