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Domains of transmission and association of community, school, and household sanitation with soil-transmitted helminth infections among children in coastal Kenya

View ORCID ProfileWilliam E Oswald, Katherine E Halliday, Carlos Mcharo, Stefan Witek-McManus, Stella Kepha, Paul M Gichuki, Jorge Cano, View ORCID ProfileKarla Diaz-Ordaz, Elizabeth Allen, Charles S Mwandawiro, Roy M Anderson, Simon J Brooker, Rachel L Pullan, Sammy M Njenga
doi: https://doi.org/10.1101/649509
William E Oswald
1Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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  • For correspondence: william.oswald@lshtm.ac.uk
Katherine E Halliday
1Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Carlos Mcharo
2Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
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Stefan Witek-McManus
1Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Stella Kepha
1Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
2Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
3Pwani University Bioscience Research Centre, Pwani University, Kilifi, Kenya
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Paul M Gichuki
2Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
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Jorge Cano
1Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Karla Diaz-Ordaz
4Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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  • ORCID record for Karla Diaz-Ordaz
Elizabeth Allen
4Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Charles S Mwandawiro
2Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
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Roy M Anderson
5Faculty of Medicine, Department of Infectious Disease Epidemiology, London Centre for Neglected Tropical Disease Research, School of Public Health, St Mary’s Campus, Imperial College London, London, UK
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Simon J Brooker
1Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Rachel L Pullan
1Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Sammy M Njenga
2Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
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Abstract

Introduction Few studies have simultaneously examined the role of sanitation conditions at the home, school, and community on soil-transmitted helminth (STH) infection. We examined the contribution of each domain that children inhabit (home, village, and school) and estimated the association of sanitation in each domain with STH infection.

Methods Using data from 4,104 children from Kwale County, Kenya, who reported attending school, we used logistic regression models with cross-classified random effects to calculate measures of general contextual effects and estimate associations of village, school, and household sanitation with STH infection.

Findings We found reported use of a sanitation facility by households was associated with reduced prevalence of hookworm infection but not with reduced prevalence of T. trichiura infection. School sanitation coverage > 3 toilets per 100 pupils was associated with lower prevalence of hookworm infection. School sanitation was not associated with T. trichiura infection. Village sanitation coverage > 81% was associated with reduced prevalence of T. trichiura infection, but no protective association was detected for hookworm infection. General contextual effects represented by residual heterogeneity between village and school domains had comparable impact upon likelihood of hookworm and T. trichiura infection as sanitation coverage in either of these domains.

Conclusion Findings support the importance of providing good sanitation facilities to support mass drug administration in reducing the burden of STH infection in children.

Author Summary Infection by whipworm and hookworm results from either ingestion of eggs or larvae or through skin exposure to larvae. These eggs and larvae develop in suitable soils contaminated with openly-deposited human faeces. Safe disposal of faeces should reduce transmission of these soil-transmitted helminths (STH), yet evidence of the impact of sanitation on STH transmission remains limited. We used data collected during a large, community-wide survey to measure prevalence of STH infections in coastal Kenya in 2015 to examine the relationship between sanitation conditions at home, school, and village and the presence of STH infection among 4,104 children who reported attending schools. We found that sanitation access at home and school sanitation coverage, but not the overall level of village sanitation coverage, was protective against hookworm infection. In contrast, only high village sanitation coverage, but not home or school sanitation, was protective against whipworm infection. Current STH control strategies emphasise periodic deworming through mass drug administration (MDA) of at-risk populations, including school-age children. Our findings highlight the need for continued efforts, alongside MDA, to extend access to good sanitation facilities at homes, schools, and across communities.

Copyright 
The copyright holder for this preprint is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY 4.0 International license.
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Posted May 24, 2019.
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Domains of transmission and association of community, school, and household sanitation with soil-transmitted helminth infections among children in coastal Kenya
William E Oswald, Katherine E Halliday, Carlos Mcharo, Stefan Witek-McManus, Stella Kepha, Paul M Gichuki, Jorge Cano, Karla Diaz-Ordaz, Elizabeth Allen, Charles S Mwandawiro, Roy M Anderson, Simon J Brooker, Rachel L Pullan, Sammy M Njenga
bioRxiv 649509; doi: https://doi.org/10.1101/649509
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Domains of transmission and association of community, school, and household sanitation with soil-transmitted helminth infections among children in coastal Kenya
William E Oswald, Katherine E Halliday, Carlos Mcharo, Stefan Witek-McManus, Stella Kepha, Paul M Gichuki, Jorge Cano, Karla Diaz-Ordaz, Elizabeth Allen, Charles S Mwandawiro, Roy M Anderson, Simon J Brooker, Rachel L Pullan, Sammy M Njenga
bioRxiv 649509; doi: https://doi.org/10.1101/649509

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