1921
Volume 94, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract

Water, sanitation, and hygiene (WaSH) technologies and behaviors can prevent infection by soil-transmitted helminth species independently, but may also interact in complex ways. However, these interactions are poorly understood. The purpose of this study was to characterize how school and home WaSH exposures were associated with infection and to identify relevant interactions between separate WaSH technologies and behaviors. A study was conducted among 4,404 children attending 51 primary schools in western Kenya. We used multivariable mixed effects logistic regression to characterize how various WaSH exposures were associated with infection after annual school-based deworming. Few WaSH behaviors and technologies were independently associated with infection. However, by considering relevant interdependencies between variables, important associations were elucidated. The association between handwashing and depended largely upon the pupils' access to an improved water source. Among pupils who had access to improved water sources, prevalence was lower for those who handwashed both at school and home compared with neither place (odds ratio: 0.38, 95% confidence interval: 0.18–0.83; = 0.01). This study contributes to a further understanding of the impact of WaSH on infection and shows the importance of accounting for interactions between WaSH technologies and behaviors.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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2016-05-04
2017-09-21
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References

  1. Pullan RL, Smith JL, Jasrasaria R, Brooker SJ, , 2014. Global numbers of infection and disease burden of soil transmitted helminth infections in 2010. Parasit Vectors 7: 37.[Crossref]
  2. Gulani A, Nagpal J, Osmond C, Sachdev HP, , 2007. Effect of administration of intestinal anthelmintic drugs on haemoglobin: systematic review of randomised controlled trials. BMJ 334: 1095.[Crossref]
  3. Sur D, Saha DR, Manna B, Rajendran K, Bhattacharya SK, , 2005. Periodic deworming with albendazole and its impact on growth status and diarrhoeal incidence among children in an urban slum of India. Trans R Soc Trop Med Hyg 99: 261267.[Crossref]
  4. Crompton DW, , 1999. How much human helminthiasis is there in the world? J Parasitol 85: 397403.[Crossref]
  5. Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basanez MG, Baxter A, Bell ML, Benjamin EJ, Bennett D, Bernabe E, Bhalla K, Bhandari B, Bikbov B, Bin Abdulhak A, Birbeck G, Black JA, Blencowe H, Blore JD, Blyth F, Bolliger I, Bonaventure A, Boufous S, Bourne R, Boussinesq M, Braithwaite T, Brayne C, Bridgett L, Brooker S, Brooks P, Brugha TS, Bryan-Hancock C, Bucello C, Buchbinder R, Buckle G, Budke CM, Burch M, Burney P, Burstein R, Calabria B, Campbell B, Canter CE, Carabin H, Carapetis J, Carmona L, Cella C, Charlson F, Chen H, Cheng AT, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahiya M, Dahodwala N, Damsere-Derry J, Danaei G, Davis A, De Leo D, Degenhardt L, Dellavalle R, Delossantos A, Denenberg J, Derrett S, Des Jarlais DC, Dharmaratne SD, Dherani M, Diaz-Torne C, Dolk H, Dorsey ER, Driscoll T, Duber H, Ebel B, Edmond K, Elbaz A, Ali SE, Erskine H, Erwin PJ, Espindola P, Ewoigbokhan SE, Farzadfar F, Feigin V, Felson DT, Ferrari A, Ferri CP, Fèvre EM, Finucane MM, Flaxman S, Flood L, Foreman K, Forouzanfar MH, Fowkes FG, Fransen M, Freeman MK, Gabbe BJ, Gabriel SE, Gakidou E, Ganatra HA, Garcia B, Gaspari F, Gillum RF, Gmel G, Gonzalez-Medina D, Gosselin R, Grainger R, Grant B, Groeger J, Guillemin F, Gunnell D, Gupta R, Haagsma J, Hagan H, Halasa YA, Hall W, Haring D, Haro JM, Harrison JE, Havmoeller R, Hay RJ, Higashi H, Hill C, Hoen B, Hoffman H, Hotez PJ, Hoy D, Huang JJ, Ibeanusi SE, Jacobsen KH, James SL, Jarvis D, Jasrasaria R, Jayaraman S, Johns N, Jonas JB, Karthikeyan G, Kassebaum N, Kawakami N, Keren A, Khoo JP, King CH, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Laden F, Lalloo R, Laslett LL, Lathlean T, Leasher JL, Lee YY, Leigh J, Levinson D, Lim SS, Limb E, Lin JK, Lipnick M, Lipshultz SE, Liu W, Loane M, Ohno SL, Lyons R, Mabweijano J, MacIntyre MF, Malekzadeh R, Mallinger L, Manivannan S, Marcenes W, March L, Margolis DJ, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGill N, McGrath J, Medina-Mora ME, Meltzer M, Mensah GA, Merriman TR, Meyer AC, Miglioli V, Miller M, Miller TR, Mitchell PB, Mock C, Mocumbi AO, Moffitt TE, Mokdad AA, Monasta L, Montico M, Moradi-Lakeh M, Moran A, Morawska L, Mori R, Murdoch ME, Mwaniki MK, Naidoo K, Nair MN, Naldi L, Narayan KM, Nelson PK, Nelson RG, Nevitt MC, Newton CR, Nolte S, Norman P, Norman R, O'Donnell M, O'Hanlon S, Olives C, Omer SB, Ortblad K, Osborne R, Ozgediz D, Page A, Pahari B, Pandian JD, Rivero AP, Patten SB, Pearce N, Padilla RP, Perez-Ruiz F, Perico N, Pesudovs K, Phillips D, Phillips MR, Pierce K, Pion S, Polanczyk GV, Polinder S, Pope CA, 3rd Popova S, Porrini E, Pourmalek F, Prince M, Pullan RL, Ramaiah KD, Ranganathan D, Razavi H, Regan M, Rehm JT, Rein DB, Remuzzi G, Richardson K, Rivara FP, Roberts T, Robinson C, De Leòn FR, Ronfani L, Room R, Rosenfeld LC, Rushton L, Sacco RL, Saha S, Sampson U, Sanchez-Riera L, Sanman E, Schwebel DC, Scott JG, Segui-Gomez M, Shahraz S, Shepard DS, Shin H, Shivakoti R, Singh D, Singh GM, Singh JA, Singleton J, Sleet DA, Sliwa K, Smith E, Smith JL, Stapelberg NJ, Steer A, Steiner T, Stolk WA, Stovner LJ, Sudfeld C, Syed S, Tamburlini G, Tavakkoli M, Taylor HR, Taylor JA, Taylor WJ, Thomas B, Thomson WM, Thurston GD, Tleyjeh IM, Tonelli M, Towbin JA, Truelsen T, Tsilimbaris MK, Ubeda C, Undurraga EA, van der Werf MJ, van Os J, Vavilala MS, Venketasubramanian N, Wang M, Wang W, Watt K, Weatherall DJ, Weinstock MA, Weintraub R, Weisskopf MG, Weissman MM, White RA, Whiteford H, Wiebe N, Wiersma ST, Wilkinson JD, Williams HC, Williams SR, Witt E, Wolfe F, Woolf AD, Wulf S, Yeh PH, Zaidi AK, Zheng ZJ, Zonies D, Lopez AD, AlMazroa MA, Memish ZA, , 2012. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380: 21972223.[Crossref]
  6. Taylor-Robinson DC, Jones AP, Garner P, , 2007. Deworming drugs for treating soil-transmitted intestinal worms in children: effects on growth and school performance. Cochrane Database Syst Rev 4: CD000371.
  7. World Health Organization Expert Committee, 2002. Prevention and control of schistosomiasis and soil-transmitted helminthiasis. World Health Organ Tech Rep Ser 912: ivi, 1–57, back cover.
  8. World Health Organization, 2012. Soil-Transmitted Helminthiases: Eliminating Soil-Transmitted Helminthiases as a Public Health Problem in Children. Geneva, Switzerland: World Health Organization.
  9. Asaolu SO, Ofoezie IE, , 2003. The role of health education and sanitation in the control of helminth infections. Acta Trop 86: 283294.[Crossref]
  10. Bennett A, Guyatt H, , 2000. Reducing intestinal nematode infection: efficacy of albendazole and mebendazole. Parasitol Today 16: 7174.[Crossref]
  11. Yap P, Du ZW, Wu FW, Jiang JY, Chen R, Zhou XN, Hattendorf J, Utzinger J, Steinmann P, , 2013. Rapid re-infection with soil-transmitted helminths after triple-dose albendazole treatment of school-aged children in Yunnan, People's Republic of China. Am J Trop Med Hyg 89: 2331.[Crossref]
  12. Strunz EC, Addiss DG, Stocks ME, Ogden S, Utzinger J, Freeman MC, , 2014. Water, sanitation, hygiene, and soil-transmitted helminth infection: a systematic review and meta-analysis. PLoS Med 11: e1001620.[Crossref]
  13. Ziegelbauer K, Speich B, Mausezahl D, Bos R, Keiser J, Utzinger J, , 2012. Effect of sanitation on soil-transmitted helminth infection: systematic review and meta-analysis. PLoS Med 9: e1001162.[Crossref]
  14. Esrey SA, Potash JB, Roberts L, Shiff C, , 1991. Effects of improved water supply and sanitation on ascariasis, diarrhoea, dracunculiasis, hookworm infection, schistosomiasis, and trachoma. Bull World Health Organ 69: 609621.
  15. Freeman MC, Clasen T, Brooker SJ, Akoko DO, Rheingans R, , 2013. The impact of a school-based hygiene, water quality, and sanitation intervention on soil-transmitted helminth reinfection: a cluster-randomized trial. Am J Trop Med Hyg 89: 875883.[Crossref]
  16. Eisenberg JN, Scott JC, Porco T, , 2007. Integrating disease control strategies: balancing water sanitation and hygiene interventions to reduce diarrheal disease burden. Am J Public Health 97: 846852.[Crossref]
  17. Esrey SA, , 1996. Water, waste, and well-being: a multicountry study. Am J Epidemiol 143: 608623.[Crossref]
  18. Fuller JA, Westphal JA, Kenney B, Eisenberg JN, , 2015. The joint effects of water and sanitation on diarrhoeal disease: a multicountry analysis of the Demographic and Health Surveys. Trop Med Int Health 20: 284292.[Crossref]
  19. Gundry S, Wright J, Conroy R, , 2004. A systematic review of the health outcomes related to household water quality in developing countries. J Water Health 2: 113.
  20. VanDerslice J, Briscoe J, , 1995. Environmental interventions in developing countries: interactions and their implications. Am J Epidemiol 141: 135144.[Crossref]
  21. Gass K, Addiss DG, Freeman MC, , 2014. Exploring the relationship between access to water, sanitation and hygiene and soil-transmitted helminth infection: a demonstration of two recursive partitioning tools. PLoS Negl Trop Dis 8: e2945.[Crossref]
  22. Mwandawiro CS, Nikolay B, Kihara JH, Ozier O, Mukoko DA, Mwanje MT, Hakobyan A, Pullan RL, Brooker SJ, Njenga SM, , 2013. Monitoring and evaluating the impact of national school-based deworming in Kenya: study design and baseline results. Parasit Vectors 6: 198.[Crossref]
  23. Freeman MC, Chard AN, Nikolay B, Garn JV, Okoyo C, Kihara J, Njenga SM, Pullan RL, Brooker SJ, Mwandawiro CS, , 2015. Associations between school- and household-level water, sanitation and hygiene conditions and soil-transmitted helminth infection among Kenyan school children. Parasit Vectors 8: 412.[Crossref]
  24. Nikolay B, Mwandawiro CS, Kihara JH, Okoyo C, Cano J, Mwanje MT, Sultani H, Alusala D, Turner HC, Teti C, Garn J, Freeman MC, Allen E, Anderson RM, Pullan RL, Njenga SM, Brooker SJ, , 2015. Understanding heterogeneity in the impact of National Neglected Tropical Disease Control Programmes: evidence from school-based deworming in Kenya. PLoS Negl Trop Dis 9: e0004108.[Crossref]
  25. Katz N, Chaves A, Pellegrino J, , 1972. A simple device for quantitative stool thick-smear technique in schistosomiasis mansoni. Rev Inst Med Trop Sao Paulo 14: 397400.
  26. Khuroo MS, , 1996. Ascariasis. Gastroenterol Clin North Am 25: 553577.[Crossref]
  27. World Health Organization, UNICEF, 2013. Progress on Sanitation and Drinking-Water—2013 Update Geneva, Switzerland: WHO Press.
  28. World Health Organization Adams J, Bartram J, Chartier Y, Sims J, , 2009. Water, Sanitation and Hygiene Standards for Schools in Low-Cost Settings. , eds. Geneva, Switzerland: WHO Press.
  29. Luoba AI, Wenzel Geissler P, Estambale B, Ouma JH, Alusala D, Ayah R, Mwaniki D, Magnussen P, Friis H, , 2005. Earth-eating and reinfection with intestinal helminths among pregnant and lactating women in western Kenya. Trop Med Int Health 10: 220227.[Crossref]
  30. Bundy DA, Wong MS, Lewis LL, Horton J, , 1990. Control of geohelminths by delivery of targeted chemotherapy through schools. Trans R Soc Trop Med Hyg 84: 115120.[Crossref]
  31. Miguel E, Kremer M, , 2004. Worms: identifying impacts on education and health in the presence of treatment externalities. Econometrica 72: 159217.[Crossref]
  32. Vyas S, Kumaranayake L, , 2006. Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan 21: 459468.[Crossref]
  33. Kleinbaum DG, Klein M, , 2010. Logistic Regression: A Self-Learning Text. New York, NY: Springer, 489597.[Crossref]
  34. Garn JV, Greene LE, Dreibelbis R, Saboori S, Rheingans RD, Freeman MC, , 2013. A cluster-randomized trial assessing the impact of school water, sanitation, and hygiene improvements on pupil enrollment and gender parity in enrollment. J Water Sanit Hyg Dev 3: 592601.[Crossref]
  35. Koopman JS, , 1978. Diarrhea and school toilet hygiene in Cali, Colombia. Am J Epidemiol 107: 412420.[Crossref]
  36. Garn JV, Caruso BA, Drews-Botsch CD, Kramer MR, Brumback BA, Rheingans RD, Freeman MC, , 2014. Factors associated with pupil toilet use in Kenyan primary schools. Int J Environ Res Public Health 11: 96959712.[Crossref]
  37. Greene LE, Freeman MC, Akoko D, Saboori S, Moe C, Rheingans R, , 2012. Impact of a school-based hygiene promotion and sanitation intervention on pupil hand contamination in western Kenya: a cluster randomized trial. Am J Trop Med Hyg 87: 385393.[Crossref]
  38. Mendes MF, Lynch DJ, , 1976. A bacteriological survey of washrooms and toilets. J Hyg (Lond) 76: 183190.[Crossref]
  39. Thomas ME, Tillett HE, , 1973. Sonne dysentery in day schools and nurseries: an eighteen-year study in Edmonton. J Hyg (Lond) 71: 593602.[Crossref]
  40. Clasen T, Boisson S, Routray P, Torondel B, Bell M, Cumming O, Ensink J, Freeman M, Jenkins M, Odagiri M, Ray S, Sinha A, Suar M, Schmidt WP, , 2014. Effectiveness of a rural sanitation programme on diarrhoea, soil-transmitted helminth infection, and child malnutrition in Odisha, India: a cluster-randomised trial. Lancet Glob Health 2: e645e653.[Crossref]
  41. Patil SR, Arnold BF, Salvatore AL, Briceno B, Ganguly S, Colford JM, Jr Gertler PJ, , 2014. The effect of India's total sanitation campaign on defecation behaviors and child health in rural Madhya Pradesh: a cluster randomized controlled trial. PLoS Med 11: e1001709.[Crossref]
  42. Nikolay B, Brooker SJ, Pullan RL, , 2014. Sensitivity of diagnostic tests for human soil-transmitted helminth infections: a meta-analysis in the absence of a true gold standard. Int J Parasitol 44: 765774.[Crossref]
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  • Received : 15 May 2015
  • Accepted : 06 Jan 2016

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