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Water, Sanitation and Hygiene (WASH) and environmental risk factors for soil-transmitted helminth intensity of infection in Timor-Leste, using real time PCR

BACKGROUND: No investigations have been undertaken of risk factors for intensity of soil-transmitted helminth (STH) infection in Timor-Leste. This study provides the first analysis of risk factors for intensity of STH infection, as determined by quantitative PCR (qPCR), examining a broad range of wa...

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Autores principales: Campbell, Suzy J., Nery, Susana V., Wardell, Rebecca, D’Este, Catherine A., Gray, Darren J., McCarthy, James S., Traub, Rebecca J., Andrews, Ross M., Llewellyn, Stacey, Vallely, Andrew J., Williams, Gail M., Clements, Archie C. A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5383321/
https://www.ncbi.nlm.nih.gov/pubmed/28346536
http://dx.doi.org/10.1371/journal.pntd.0005393
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author Campbell, Suzy J.
Nery, Susana V.
Wardell, Rebecca
D’Este, Catherine A.
Gray, Darren J.
McCarthy, James S.
Traub, Rebecca J.
Andrews, Ross M.
Llewellyn, Stacey
Vallely, Andrew J.
Williams, Gail M.
Clements, Archie C. A.
author_facet Campbell, Suzy J.
Nery, Susana V.
Wardell, Rebecca
D’Este, Catherine A.
Gray, Darren J.
McCarthy, James S.
Traub, Rebecca J.
Andrews, Ross M.
Llewellyn, Stacey
Vallely, Andrew J.
Williams, Gail M.
Clements, Archie C. A.
author_sort Campbell, Suzy J.
collection PubMed
description BACKGROUND: No investigations have been undertaken of risk factors for intensity of soil-transmitted helminth (STH) infection in Timor-Leste. This study provides the first analysis of risk factors for intensity of STH infection, as determined by quantitative PCR (qPCR), examining a broad range of water, sanitation and hygiene (WASH) and environmental factors, among communities in Manufahi District, Timor-Leste. METHODS: A baseline cross-sectional survey of 18 communities was undertaken as part of a cluster randomised controlled trial, with additional identically-collected data from six other communities. qPCR was used to assess STH infection from stool samples, and questionnaires administered to collect WASH, demographic, and socioeconomic data. Environmental information was obtained from open-access sources and linked to infection outcomes. Mixed-effects multinomial logistic regression was undertaken to assess risk factors for intensity of Necator americanus and Ascaris infection. RESULTS: 2152 participants provided stool and questionnaire information for this analysis. In adjusted models incorporating WASH, demographic and environmental variables, environmental variables were generally associated with infection intensity for both N. americanus and Ascaris spp. Precipitation (in centimetres) was associated with increased risk of moderate-intensity (adjusted relative risk [ARR] 6.1; 95% confidence interval [CI] 1.9–19.3) and heavy-intensity (ARR 6.6; 95% CI 3.1–14.1) N. americanus infection, as was sandy-loam soil around households (moderate-intensity ARR 2.1; 95% CI 1.0–4.3; heavy-intensity ARR 2.7; 95% CI 1.6–4.5; compared to no infection). For Ascaris, alkaline soil around the household was associated with reduced risk of moderate-intensity infection (ARR 0.21; 95% CI 0.09–0.51), and heavy-intensity infection (ARR 0.04; 95% CI 0.01–0.25). Few WASH risk factors were significant. CONCLUSION: In this high-prevalence setting, strong risk associations with environmental factors indicate that anthelmintic treatment alone will be insufficient to interrupt STH transmission, as conditions are favourable for ongoing environmental transmission. Integrated STH control strategies should be explored as a priority.
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spelling pubmed-53833212017-05-03 Water, Sanitation and Hygiene (WASH) and environmental risk factors for soil-transmitted helminth intensity of infection in Timor-Leste, using real time PCR Campbell, Suzy J. Nery, Susana V. Wardell, Rebecca D’Este, Catherine A. Gray, Darren J. McCarthy, James S. Traub, Rebecca J. Andrews, Ross M. Llewellyn, Stacey Vallely, Andrew J. Williams, Gail M. Clements, Archie C. A. PLoS Negl Trop Dis Research Article BACKGROUND: No investigations have been undertaken of risk factors for intensity of soil-transmitted helminth (STH) infection in Timor-Leste. This study provides the first analysis of risk factors for intensity of STH infection, as determined by quantitative PCR (qPCR), examining a broad range of water, sanitation and hygiene (WASH) and environmental factors, among communities in Manufahi District, Timor-Leste. METHODS: A baseline cross-sectional survey of 18 communities was undertaken as part of a cluster randomised controlled trial, with additional identically-collected data from six other communities. qPCR was used to assess STH infection from stool samples, and questionnaires administered to collect WASH, demographic, and socioeconomic data. Environmental information was obtained from open-access sources and linked to infection outcomes. Mixed-effects multinomial logistic regression was undertaken to assess risk factors for intensity of Necator americanus and Ascaris infection. RESULTS: 2152 participants provided stool and questionnaire information for this analysis. In adjusted models incorporating WASH, demographic and environmental variables, environmental variables were generally associated with infection intensity for both N. americanus and Ascaris spp. Precipitation (in centimetres) was associated with increased risk of moderate-intensity (adjusted relative risk [ARR] 6.1; 95% confidence interval [CI] 1.9–19.3) and heavy-intensity (ARR 6.6; 95% CI 3.1–14.1) N. americanus infection, as was sandy-loam soil around households (moderate-intensity ARR 2.1; 95% CI 1.0–4.3; heavy-intensity ARR 2.7; 95% CI 1.6–4.5; compared to no infection). For Ascaris, alkaline soil around the household was associated with reduced risk of moderate-intensity infection (ARR 0.21; 95% CI 0.09–0.51), and heavy-intensity infection (ARR 0.04; 95% CI 0.01–0.25). Few WASH risk factors were significant. CONCLUSION: In this high-prevalence setting, strong risk associations with environmental factors indicate that anthelmintic treatment alone will be insufficient to interrupt STH transmission, as conditions are favourable for ongoing environmental transmission. Integrated STH control strategies should be explored as a priority. Public Library of Science 2017-03-27 /pmc/articles/PMC5383321/ /pubmed/28346536 http://dx.doi.org/10.1371/journal.pntd.0005393 Text en © 2017 Campbell et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Campbell, Suzy J.
Nery, Susana V.
Wardell, Rebecca
D’Este, Catherine A.
Gray, Darren J.
McCarthy, James S.
Traub, Rebecca J.
Andrews, Ross M.
Llewellyn, Stacey
Vallely, Andrew J.
Williams, Gail M.
Clements, Archie C. A.
Water, Sanitation and Hygiene (WASH) and environmental risk factors for soil-transmitted helminth intensity of infection in Timor-Leste, using real time PCR
title Water, Sanitation and Hygiene (WASH) and environmental risk factors for soil-transmitted helminth intensity of infection in Timor-Leste, using real time PCR
title_full Water, Sanitation and Hygiene (WASH) and environmental risk factors for soil-transmitted helminth intensity of infection in Timor-Leste, using real time PCR
title_fullStr Water, Sanitation and Hygiene (WASH) and environmental risk factors for soil-transmitted helminth intensity of infection in Timor-Leste, using real time PCR
title_full_unstemmed Water, Sanitation and Hygiene (WASH) and environmental risk factors for soil-transmitted helminth intensity of infection in Timor-Leste, using real time PCR
title_short Water, Sanitation and Hygiene (WASH) and environmental risk factors for soil-transmitted helminth intensity of infection in Timor-Leste, using real time PCR
title_sort water, sanitation and hygiene (wash) and environmental risk factors for soil-transmitted helminth intensity of infection in timor-leste, using real time pcr
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5383321/
https://www.ncbi.nlm.nih.gov/pubmed/28346536
http://dx.doi.org/10.1371/journal.pntd.0005393
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