03680nas a2200397   4500000000100000008004100001653003900042653003800081653002000119653000900139653001600148653001300164100001300177700001400190700001400204700001500218700001400233700001200247700001100259700001400270700001300284700001400297700001300311700001100324700001400335700001600349700001500365700001500380700001300395700001000408245014300418300000700561490000700568520269300575022001403268       2017                            d10aNeglected tropical diseases (NTDs)10aSoil-Transmitted Helminths (STHs)10aSchool children10aWASH10aCommunities10aEthiopia1 aOswald W1 aStewart A1 aKramer MR1 aEndeshaw T1 aZerihun M1 aMelak B1 aSata E1 aGessese D1 aTeferi T1 aTadesse Z1 aGuadie B1 aKing J1 aEmerson P1 aCallahan EK1 aFreeman MC1 aFlanders D1 aClasen T1 aMoe C00aAssociation of community sanitation usage with soil-transmitted helminth infections among school-aged children in Amhara Region, Ethiopia.  a910 v103 a<p><strong>BACKGROUND: </strong>Globally, 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.</p>

<p><strong>METHODS: </strong>Data 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 &gt; 0 eggs in stool samples from children 6-15&nbsp;years old.</p>

<p><strong>RESULTS: </strong>Prevalence 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 &lt; 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 &lt; 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%.</p>

<p><strong>CONCLUSIONS: </strong>We 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.</p>
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