Association between water, sanitation, and hygiene access and the prevalence of soil-transmitted helminth and schistosome infections in Wolayita, Ethiopia

Abstract

Background The Geshiyaro project is a 5-year intervention to assess the impact of community- and school-based water, sanitation, and hygiene (WaSH) interventions on reducing infection with soil-transmitted helminths (STH) and schistosome parasites in combination with deworming in Wolayita zone, Ethiopia. Methods A population-based, cross-sectional census and parasitological mapping activity was conducted between 2018 and 2019. Individuals in the census were identified using either a registered study ID card or biometric fingerprint to enable linkage of their household WaSH data with baseline STH and schistosome prevalence for risk analysis. Results Prevalence of STH was 15.5% for any STH species, 9.47% for Ascaris lumbricoides, 1.78% for Trichuris trichiura, and 7.24% for hookworm. Intestinal schistosomiasis (Schistosoma mansoni) infection prevalence was 0.85% by Kato Katz, 21.6% by POC-CCA trace positive (Tr +), and 13.3% trace negative (Tr-). Microhaematuria was 2.77%, with 0.13% of people examined with S. haematobium eggs detected by urine filtration. At the household level, increased (> 30 min) time taken to collect drinking water, sharing a latrine, and lack of handwashing facilities were all associated with a greater risk of A. lumbricoides, hookworm, and S. mansoni infection. Not disposing of infant stool at the household and clothes washing/recreational freshwater contact were significantly associated with higher risk of schistosomiasis infection. Aggregating WaSH data at the community level showed odds of A. lumbricoides, hookworm, and T. trichiura infection were significantly lower as both community sanitation coverage and access to improved drinking water improved. Conclusions The principal finding of this study is that lack of access to WaSH, such as improved drinking water and shared toilet and hand-washing facilities, were linked to an increased risk of infection with STH and schistosome parasites. These associations are difficult to establish at an individual household level because of wide variability in access between houses but are detectable when coverage is aggregated at the community level. Maintenance of WaSH facilities as well as increased access within the whole community is important in influencing the community-wide prevalence of infection with STH and schistosome parasites. Graphical Abstract

Baseline soil-transmitted helminth and schistosome infection in the Geshiyaro project, Ethiopia: A unique transmission interruption project using biometric fingerprinting for longitudinal individual analysis

“…A separate paper has been published on the associations found between WaSH access and the prevalence of STH and SCH found at baseline in the Geshiyaro project [ 19 ]. Definitions for household WaSH status are in line with the World Health Organization and United Nations Children’s Fund (WHO/UNICEF) Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) guidelines [ 27 ].…”

Soil-transmitted helminth (STH) infections in the Wolaita zone in Southern Ethiopia. Mid-stage evaluation of the Geshiyaro project and progress towards the interruption of transmission

“…A baseline parasitological mapping survey was conducted in all arms in 2018, to determine the prevalence and intensity of STH infection in the identi ed community, strati ed by age and gender. The baseline data showed low levels of schistosome parasite (both Schistosoma mansoni and Schistosoma haematobium) infection in all study sites by using Kato Katz (KK) diagnostic method (15). The focus of this paper will be on the control of STH infection.…”

Review of Recent Prevalence of Urogenital Schistosomiasis in Sub-Saharan Africa and Diagnostic Challenges in the Field Setting

“…Every year, hundreds of articles are published on schistosomiasis. Table 2 summarizes the recently reported prevalence of UGS in SSA that was indexed in PubMed [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 ,…”

“…One population-based survey of 19,250 SAC in Benin confirmed that UGS was predominant, with a 17.6% prevalence [ 8 ]. In Ethiopia, a mapping of 15,133 SAC in 2018–2019 reported a prevalence of 0.13% [ 21 ], while Camara et al reported a prevalence of 4.2% among 10,434 SAC in 2014 in Gambia [ 27 ]. Similarly, mapping in Sudan reported a prevalence of 5.2% among 100,726 SAC in 2016–2017 [ 61 ], and a cross-sectional study in Tanzania reported a prevalence of 5.3% through a population-based mapping in 2006–2007 [ 72 ].…”