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

Abstract

BackgroundGlobally, 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.MethodsData 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.ResultsPrevalence 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%.ConclusionsWe 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s13071-017-2020-0) contains supplementary material, which is available to authorized users.

National mapping of soil-transmitted helminth and schistosome infections in Ethiopia

“…To our knowledge, this will be the rst large-scale survey conducted at national level. There have been many small-scale studies in different parts of the country that reported prevalence for STH and SCH [9,11,12,14,15,26]. However, none of those studies were conducted at a national scale.…”

“…They are generally dated (early 1970s to 2015; [5,9,13]), nor do they cover the entire country. Moreover, they differ considerably in sample size, design and diagnostic method utilized hindering direct comparison [9,12,14,15], which further complicates effectively designing and implementing MDA programs. Since 2000, the Ethiopian government has implemented STH deworming of children in under ve as part of an integrated vitamin A supplementation programme.…”

Pit Toilets (Latrines)

“…The relationship between use of pit toilets and decreased incidence of disease and helminth infection compared to open defecation has been addressed in the literature. Pit toilet usage can protect public health in two ways: 1) it can protect the health of the members of the household that uses the pit toilet (individual effect) or 2) it can protect the health of the community members surrounding the household that uses the pit toilet (community effect) (Komarulzaman et al, 2017;Jung et al, 2017;Oswald et al, 2017). It is unknown whether the individual effect or the community effect has greater influence.…”

Hookworm infection and associated risk factors among clinically confirmed podoconiosis patients and healthy residents in Debre Elias district, East Gojjam Zone

“…Anslostoma duodenale and Necater americanus are the common hookworm species. Humans become infected through skin penetration by infective larvae in the soil [1][2][3]. It mainly affects adults than preschool and school aged children.…”