Poor WASH (Water, Sanitation, and Hygiene) Conditions Are Associated with Leprosy in North Gondar, Ethiopia

• Type of Material: Article
• Authors: Lisa E. Emerson, Emory University; Puneet Anantharam, Emory University; Feleke M. Yehuala, University of Gondar; Kassahun D. Bilcha, Emory University; Annisa B. Tesfaye, University of Gondar; Jessica Fairley, Emory University
• Language: English
• Date: 2020-09-01
• Publisher: MDPI
• Publication Version: Final Published Version
• Copyright Statement: © 2020 by the authors.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3390/ijerph17176061
• Title of Journal or Parent Work: INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH
• Volume: 17
• Issue: 17
• Start Page: 1
• End Page: 10
• Grant/Funding Information: This research was funded by charitable contributions from the Order of St. Lazarus, U.S. and by the Rollins School of Public Health Global Field Experience Financial Award.
• Keywords: water; Life Sciences & Biomedicine; RISK; hygiene; MYCOBACTERIUM-LEPRAE TRANSMISSION; Public, Environmental & Occupational Health; Environmental Sciences & Ecology; Science & Technology; INCREASE; sanitation; leprosy; Ethiopia; BRAZIL; NTD; Environmental Sciences; WASH
• Research Categories: Biology, Ecology; Health Sciences, Public Health

Abstract

Access to safe water, sanitation, and hygiene (WASH) is critical for preventing the spread of neglected tropical diseases (NTDs) including leprosy. WASH-related transmission factors remain largely unexplored in the leprosy transmission cycle. The aim of this project is to better understand WASH exposures among leprosy cases through a case-control study in North Gondar, Ethiopia. We hypothesized that leprosy cases were more likely to have inadequate WASH access and were more likely to have concurrent schistosomiasis, as schistosomiasis immune consequences may facilitate leprosy infection. Forty leprosy cases (forty-one controls) were enrolled, tested for Schistosoma mansoni, administered a demographic and WASH survey, and assigned a WASH index score. WASH factors significantly associated with leprosy on adjusted analyses included open defecation (aOR = 19.9, 95% CI 2.2, 176.3) and lack of access to soap (aOR = 7.3, 95% CI 1.1, 49.9). S. mansoni was detected in 26% of participants and in stratified analysis those with leprosy had a 3.6 (95% CI (0.8, 15.9)) greater odds of schistosomiasis in districts bordering the lake, compared to 0.33 lower odds of schistosomiasis in districts not bordering the lake (95% CI (0.09, 1.2)). Overall, results suggest that leprosy transmission may be related to WASH adequacy and access as well as to schistosomiasis co-infection.