02692nas a2200313   4500000000100000008004100001653003900042653003800081653000900119653002200128653001700150653001500167653002000182100001500202700001100217700001400228700001100242700001500253700001200268700001500280700001600295700001500311700001500326700001300341700001600354245015600370520183800526022001402364       2016                            d10aNeglected tropical diseases (NTDs)10aSoil-Transmitted Helminths (STHs)10aWASH10aRural communities10aRisk Factors10aPrevalence10aSouth-East Asia1 aCampbell S1 aNery S1 aD'Este CA1 aGray D1 aMcCarthy J1 aTraub R1 aAndrews RM1 aLlewellyn S1 aVallely AJ1 aWilliams G1 aAmaral S1 aClements AC00aWater, sanitation and hygiene related risk factors for soil-transmitted helminth and Giardia duodenalis infections in rural communities in Timor-Leste.3 a<p>There is little evidence on prevalence or risk factors for soil transmitted helminth (STH) infections in Timor-Leste. This study describes the epidemiology, water, sanitation and hygiene (WASH), and socioeconomic risk factors of STH and intestinal protozoa among communities in Manufahi District, Timor-Leste. As part of a cluster randomised controlled trial (RCT), a baseline cross-sectional survey was conducted across 18 villages, with data from six additional villages. Stool samples were assessed for STH and protozoal infections using quantitative PCR (qPCR) and questionnaires administered to collect WASH and socioeconomic data. Risk factors for infection were assessed using multivariable mixed-effects logistic regression, stratified by age group (preschool, school-aged and adult). Overall, STH prevalence was 69% (95% Confidence Interval (CI) 67-71%), with Necator americanus being most common (60%; 95% CI 58-62%) followed by Ascaris spp. (24%; 95% CI 23-26%). Ascaris-N. americanus co-infection was common (17%; 95% CI 15%-18%). Giardia duodenalis was the main protozoan identified (13%; 95% CI 11%-14%). Baseline WASH infrastructure and behaviours were poor. Although risk factors varied by age of participants and parasite species, risk factors for N. americanus infection included, generally, age in years, male sex, and socioeconomic quintile. Risk factors for Ascaris included age in years for children, and piped water to the yard for adults. In this first known assessment of community-based prevalence and associated risk factors in Timor-Leste, STH infections were highly prevalent, indicating a need for STH control. Few associations with WASH were evident, despite WASH being generally poor. In our RCT we will investigate implications of improving WASH on STH infection in impoverished communities.</p>
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