Association of community sanitation usage with soil-transmitted helminth infections among school-aged children in Amhara Region, Ethiopia

• Type of Material: Article
• Authors: William E. Oswald, London School of Hygiene and Tropical Medicine; Aisha E.P. Stewart, The Carter Center; Michael Kramer, Emory University; Tekola Endeshaw, The Carter Center; Mulat Zerihun, The Carter Center; Berhanu Melak, The Carter Center; Eshetu Sata, The Carter Center; Demelash Gessese, The Carter Center; Tesfaye Teferi, The Carter Center; Zerihun Tadesse, The Carter Center; Birhan Guadie, Amhara Regional Health Bureau; Jonathan D. King, The Carter Center; Paul Emerson, Emory University; Elizabeth K. Callahan, The Carter Center; Matthew Freeman, Emory University; William Flanders, Emory University; Thomas Clasen, Emory University; Christine Moe, Emory University
• Language: English
• Date: 2017-02-17
• Publisher: BioMed Central
• Publication Version: Final Published Version
• Copyright Statement: © 2017 The Author(s). The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s13071-017-2020-0
• Title of Journal or Parent Work: Parasites and Vectors
• ISSN: 1756-3305
• Volume: 10
• Issue: 1
• Start Page: 91
• End Page: 91
• Grant/Funding Information: This work was supported by the Lions-Carter Center Sight-First Initiative; Emory University Laney Graduate School; and ARCS Foundation Atlanta.; This study was made possible thanks to the generous support of the American People through the United States Agency for International Development (USAID) and the ENVISION project led by RTI International in partnership with The Carter Center.
• Keywords: Ethiopia; Soil-transmitted helminths; Sanitation
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Hygiene; Biology, Parasitology

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.