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Water, sanitation and hygiene related risk factors for soil-transmitted helminth and Giardia duodenalis infections in rural communities in Timor-Leste.

Abstract

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.

More information

Type
Journal Article
Author
Campbell S
Nery S
D'Este CA
Gray D
McCarthy J
Traub R
Andrews RM
Llewellyn S
Vallely AJ
Williams G
Amaral S
Clements AC