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Association of community sanitation usage with soil-transmitted helminth infections among school-aged children in Amhara Region, Ethiopia.
Parasit Vectors. 2017 02 17; 10(1):91.PV

Abstract

BACKGROUND

Globally, in 2010, approximately 1.5 billion people were infected with at least one species of soil-transmitted helminth (STH), Ascaris lumbricoides, Trichuris trichiura, hookworm (Ancylostoma duodenale and Necator americanus). Infection occurs through ingestion or contact (hookworm) with eggs or larvae in the environment from fecal contamination. To control these infections, the World Health Organization recommends periodic mass treatment of at-risk populations with deworming drugs. Prevention of these infections typically relies on improved excreta containment and disposal. Most evidence of the relationship between sanitation and STH has focused on household-level access or usage, rather than community-level sanitation usage. We examined the association between the proportion of households in a community with latrines in use and prevalence of STH infections among school-aged children.

METHODS

Data on STH prevalence and household latrine usage were obtained during four population-based, cross-sectional surveys conducted between 2011 and 2014 in Amhara, Ethiopia. Multilevel regression was used to estimate the association between the proportion of households in the community with latrines in use and presence of STH infection, indicated by > 0 eggs in stool samples from children 6-15 years old.

RESULTS

Prevalence of STH infection was estimated as 22% (95% CI: 20-24%), 14% (95% CI: 13-16%), and 4% (95% CI: 4-5%) for hookworm, A. lumbricoides, and T. trichiura, respectively. Adjusting for individual, household, and community characteristics, hookworm prevalence was not associated with community sanitation usage. Trichuris trichuria prevalence was higher in communities with sanitation usage ≥ 60% versus sanitation usage < 20%. Association of community sanitation usage with A. lumbricoides prevalence depended on household sanitation. Community sanitation usage was not associated with A. lumbricoides prevalence among households with latrines in use. Among households without latrines in use, A. lumbricoides prevalence was higher comparing communities with sanitation usage ≥ 60% versus < 20%. Households with a latrine in use had lower prevalence of A. lumbricoides compared to households without latrines in use only in communities where sanitation usage was ≥ 80%.

CONCLUSIONS

We found no evidence of a protective association between community sanitation usage and STH infection. The relationship between STH infection and community sanitation usage may be complex and requires further study.

Authors+Show Affiliations

Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK. william.oswald@lshtm.ac.uk. Department of Epidemiology, Emory University, Atlanta, GA, USA. william.oswald@lshtm.ac.uk.The Carter Center, Atlanta, GA, USA.Department of Epidemiology, Emory University, Atlanta, GA, USA.The Carter Center, Addis Ababa, Ethiopia.The Carter Center, Addis Ababa, Ethiopia.The Carter Center, Addis Ababa, Ethiopia.The Carter Center, Addis Ababa, Ethiopia.The Carter Center, Addis Ababa, Ethiopia.The Carter Center, Addis Ababa, Ethiopia.The Carter Center, Addis Ababa, Ethiopia.Amhara Regional Health Bureau, Bahir Dar, Ethiopia.The Carter Center, Atlanta, GA, USA. World Health Organization, Geneva, Switzerland.The Carter Center, Atlanta, GA, USA. International Trachoma Initiative, Atlanta, GA, USA.The Carter Center, Atlanta, GA, USA.Department of Environmental Health, Emory University, Atlanta, GA, USA.Department of Epidemiology, Emory University, Atlanta, GA, USA.Department of Environmental Health, Emory University, Atlanta, GA, USA.Hubert Department of Global Health and Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, GA, USA.

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28212668

Citation

Oswald, William E., et al. "Association of Community Sanitation Usage With Soil-transmitted Helminth Infections Among School-aged Children in Amhara Region, Ethiopia." Parasites & Vectors, vol. 10, no. 1, 2017, p. 91.
Oswald WE, Stewart AE, Kramer MR, et al. Association of community sanitation usage with soil-transmitted helminth infections among school-aged children in Amhara Region, Ethiopia. Parasit Vectors. 2017;10(1):91.
Oswald, W. E., Stewart, A. E., Kramer, M. R., Endeshaw, T., Zerihun, M., Melak, B., Sata, E., Gessese, D., Teferi, T., Tadesse, Z., Guadie, B., King, J. D., Emerson, P. M., Callahan, E. K., Freeman, M. C., Flanders, W. D., Clasen, T. F., & Moe, C. L. (2017). Association of community sanitation usage with soil-transmitted helminth infections among school-aged children in Amhara Region, Ethiopia. Parasites & Vectors, 10(1), 91. https://doi.org/10.1186/s13071-017-2020-0
Oswald WE, et al. Association of Community Sanitation Usage With Soil-transmitted Helminth Infections Among School-aged Children in Amhara Region, Ethiopia. Parasit Vectors. 2017 02 17;10(1):91. PubMed PMID: 28212668.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of community sanitation usage with soil-transmitted helminth infections among school-aged children in Amhara Region, Ethiopia. AU - Oswald,William E, AU - Stewart,Aisha E P, AU - Kramer,Michael R, AU - Endeshaw,Tekola, AU - Zerihun,Mulat, AU - Melak,Berhanu, AU - Sata,Eshetu, AU - Gessese,Demelash, AU - Teferi,Tesfaye, AU - Tadesse,Zerihun, AU - Guadie,Birhan, AU - King,Jonathan D, AU - Emerson,Paul M, AU - Callahan,Elizabeth K, AU - Freeman,Matthew C, AU - Flanders,W Dana, AU - Clasen,Thomas F, AU - Moe,Christine L, Y1 - 2017/02/17/ PY - 2016/12/13/received PY - 2017/02/07/accepted PY - 2017/2/19/entrez PY - 2017/2/19/pubmed PY - 2017/9/19/medline KW - Ethiopia KW - Sanitation KW - Soil-transmitted helminths SP - 91 EP - 91 JF - Parasites & vectors JO - Parasit Vectors VL - 10 IS - 1 N2 - BACKGROUND: Globally, in 2010, approximately 1.5 billion people were infected with at least one species of soil-transmitted helminth (STH), Ascaris lumbricoides, Trichuris trichiura, hookworm (Ancylostoma duodenale and Necator americanus). Infection occurs through ingestion or contact (hookworm) with eggs or larvae in the environment from fecal contamination. To control these infections, the World Health Organization recommends periodic mass treatment of at-risk populations with deworming drugs. Prevention of these infections typically relies on improved excreta containment and disposal. Most evidence of the relationship between sanitation and STH has focused on household-level access or usage, rather than community-level sanitation usage. We examined the association between the proportion of households in a community with latrines in use and prevalence of STH infections among school-aged children. METHODS: Data on STH prevalence and household latrine usage were obtained during four population-based, cross-sectional surveys conducted between 2011 and 2014 in Amhara, Ethiopia. Multilevel regression was used to estimate the association between the proportion of households in the community with latrines in use and presence of STH infection, indicated by > 0 eggs in stool samples from children 6-15 years old. RESULTS: Prevalence of STH infection was estimated as 22% (95% CI: 20-24%), 14% (95% CI: 13-16%), and 4% (95% CI: 4-5%) for hookworm, A. lumbricoides, and T. trichiura, respectively. Adjusting for individual, household, and community characteristics, hookworm prevalence was not associated with community sanitation usage. Trichuris trichuria prevalence was higher in communities with sanitation usage ≥ 60% versus sanitation usage < 20%. Association of community sanitation usage with A. lumbricoides prevalence depended on household sanitation. Community sanitation usage was not associated with A. lumbricoides prevalence among households with latrines in use. Among households without latrines in use, A. lumbricoides prevalence was higher comparing communities with sanitation usage ≥ 60% versus < 20%. Households with a latrine in use had lower prevalence of A. lumbricoides compared to households without latrines in use only in communities where sanitation usage was ≥ 80%. CONCLUSIONS: We found no evidence of a protective association between community sanitation usage and STH infection. The relationship between STH infection and community sanitation usage may be complex and requires further study. SN - 1756-3305 UR - https://www.unboundmedicine.com/medline/citation/28212668/Association_of_community_sanitation_usage_with_soil_transmitted_helminth_infections_among_school_aged_children_in_Amhara_Region_Ethiopia_ L2 - https://parasitesandvectors.biomedcentral.com/articles/10.1186/s13071-017-2020-0 DB - PRIME DP - Unbound Medicine ER -