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Mationg MLS, Williams GM, Tallo VL, Olveda RM, McManus DP, Stewart DE, Gray DJ. A review of health education activities targeting schoolchildren for the control of soil-transmitted helminthiasis in Southeast Asia, with emphasis upon the Magic Glasses approach. ADVANCES IN PARASITOLOGY 2024; 123:1-22. [PMID: 38448146 DOI: 10.1016/bs.apar.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Soil-transmitted helminths continue to be a serious problem causing disease and morbidity globally. Children, mostly school-aged, are more at risk of these infections. The main strategy for control remains to be the mass drug administration (MDA) of antihelminthic drugs. With the limitation of MDA to prevent re-infection, the need for additional approaches such as hygiene education and improvements in water, sanitation and hygiene (WASH) infrastructure are required. Although the importance of health education as a crucial component of an integrated approaches to STH control is highlighted, this component has often been disregarded because the other more complex solutions have been the focus of most studies and programmes. We performed literature searches from four bibliographic databases - Scopus, PubMed, Web of Science and Cochrane Library - to determine availability of studies on the impact of health education interventions targeting STH infections on schoolchildren in Southeast Asia. Our review found only three studies that evaluated health education interventions targeting children. The current lack of evidence in this area suggests the need for more studies assessing the impact of health education intervention for STH control. A successful health education programme for STH called "The Magic Glasses" has been developed targeting schoolchildren in China and the Philippines. This public health intervention displayed significant impact in terms of improving knowledge, attitude and practices, reducing prevalence of STH infections in schoolchildren and encouraging compliance to MDA. This article details the successes and benefits of the Magic Glasses programme as a promising control tool for STH in the Southeast Asian region.
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Affiliation(s)
- Mary Lorraine S Mationg
- National Center for Epidemiology and Population Health, Australian National University, Canberra; QIMR Berghofer Medical Research Institute, Brisbane
| | | | | | | | | | - Donald E Stewart
- School of Medicine and Dentistry, Griffith Health, Griffith University
| | - Darren J Gray
- QIMR Berghofer Medical Research Institute, Brisbane.
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Adlakha A, Pathak P, Kumar A, Pandey P. Antecedents and consequences of adopting CLTS among tribal communities to become open defecation free: case study on Indian Swachh Bharat Abhiyan. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:45698-45715. [PMID: 35147880 PMCID: PMC8853393 DOI: 10.1007/s11356-022-18854-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/20/2022] [Indexed: 06/14/2023]
Abstract
The Swachh Bharat Mission undertaken by the Government of India (GoI) has been successful in accomplishing this objective within a short period thereby catalyzing governance following Sustainable Development Goals (SDGs). It is the responsibility of any democratic nation to ensure that its citizens have universal access to adequate and equitable sanitation. The key approach adapted to igniting a change in sanitation behavior rather than constructing toilets. An effort has been made in the study to affirm that even the marginalized sections of the society residing in tribal communities of West Bengal and Chhattisgarh have benefitted from this Government of India Mission and derived the required benefits. There is enough literature available to support the justification that civil participation holds the key for successful implementation of CLTS thereby making the communities open defecation free (ODF). It is therefore imperative to understand the behavioral transformation that takes place during the CLTS implementation. A hybrid model has been proposed in the study making use of the theory of reasoned action (TRA) and theory of planned behavior (TPB) to understand the pre-adoption and post-adoption behavior of residents. In present study, used model was empirically tested for several hypotheses. The finding reflects towards subjective norms and facilitating conditions as major determinants that ensure the continuation of intention for CLTS. They play a pivotal role in improving the health and hygiene conditions in the region and thus decrease the risk of spread of epidemic diseases.
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Affiliation(s)
- Amit Adlakha
- School of Management, IMS Unison University, Makkawala Greens, Dehradun, Uttarakhand, 248009, India.
| | - Paritosh Pathak
- School of Management, IMS Unison University, Makkawala Greens, Dehradun, Uttarakhand, 248009, India
| | - Anup Kumar
- IMT Nagpur, Katol Road, SH 248, Dorli, Nagpur, Maharashtra, 441502, India
| | - Prashant Pandey
- School of Management, IMS Unison University, Makkawala Greens, Dehradun, Uttarakhand, 248009, India
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Mationg MLS, Williams GM, Tallo VL, Olveda RM, Aung E, Alday P, Reñosa MD, Daga CM, Landicho J, Demonteverde MP, Santos ED, Bravo TA, Bieri FA, Li Y, Clements ACA, Steinmann P, Halton K, Stewart DE, McManus DP, Gray DJ. Soil-transmitted helminth infections and nutritional indices among Filipino schoolchildren. PLoS Negl Trop Dis 2021; 15:e0010008. [PMID: 34936644 PMCID: PMC8694453 DOI: 10.1371/journal.pntd.0010008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/19/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Soil-transmitted helminth (STH) infections are still prevalent among schoolchildren in the Philippines. We evaluated the risk factors associated with STH and the relationship between STH and nutritional indices among schoolchildren aged 9-10 years in Laguna province, the Philippines. METHODS We used the baseline data from 40 schools enrolled in a randomised controlled trial of the Magic Glasses Philippines health education package. Data on demographic and socio-economic variables, and STH related knowledge, attitudes and practices, were obtained through a questionnaire. Stool samples were collected and assessed for STH egg presence using the Kato-Katz technique. Haemoglobin levels and height and weight of study participants were also determined. The generalized estimating equations approach was used to construct logistic regression models to assess STH-associated risk factors, and the association between any STH infection and anaemia, child stunting, wasting and being underweight. The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12616000508471). FINDINGS Among 1,689 schoolchildren, the prevalence of any STH was 23%. The prevalence of anaemia, stunting, being underweight and wasting was 13%, 20.2%, 19% and 9.5%, respectively. Age, socio-economic status, rural/urban classification of schools and knowledge of STH were significant risk factors for acquiring a STH infection. Moreover, infections with any STH were significantly associated with stunting (P = <0.001) and being underweight (P = <0.003), but not wasting (P = 0.375) or anaemia (P = 0.462) after controlling for confounding covariates. CONCLUSION The study findings emphasise the need for sustainable deworming in tandem with other measures such as the provision of health education, improvements in sanitation and hygiene, and nutritional programs in order to control STH infections and improve morbidity outcomes in schoolchildren. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN12616000508471).
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Affiliation(s)
- Mary Lorraine S. Mationg
- Research School of Population Heath, The Australian National University, Canberra, Australia
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Gail M. Williams
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Veronica L. Tallo
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Remigio M. Olveda
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Eindra Aung
- Research School of Population Heath, The Australian National University, Canberra, Australia
- St Vincent’s Clinical School, University of New South Wales, Sydney, Australia
| | - Portia Alday
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Mark Donald Reñosa
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Chona Mae Daga
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Jhoys Landicho
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Maria Paz Demonteverde
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Eunice Diane Santos
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Thea Andrea Bravo
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Franziska Angly Bieri
- Research School of Population Heath, The Australian National University, Canberra, Australia
| | - Yuesheng Li
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, Australia
- Hunan Institute of Parasitic Diseases, World Health Organization Collaborating Centre for Research and Control on Schistosomiasis in Lake Region, Yueyang, China
| | | | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Kate Halton
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Donald E. Stewart
- Research School of Population Heath, The Australian National University, Canberra, Australia
- School of Medicine, Griffith University, Brisbane, Australia
| | - Donald P. McManus
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Darren J. Gray
- Research School of Population Heath, The Australian National University, Canberra, Australia
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Belizario V, Delos Trinos JPCR, Sison O, Miranda E, Molina V, Cuayzon A, Isiderio ME, Delgado R. High burden of soil-transmitted helminth infections, schistosomiasis, undernutrition, and poor sanitation in two Typhoon Haiyan-stricken provinces in Eastern Philippines. Pathog Glob Health 2021; 115:412-422. [PMID: 33956588 PMCID: PMC8592586 DOI: 10.1080/20477724.2021.1920777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
This study aimed to describe: 1) soil-transmitted helminthiasis (STH) and schistosomiasis prevalence and intensity in preschool-age children (PSAC) and school-age children (SAC), 2) schistosomiasis seroprevalence in SAC, 3) undernutrition prevalence in SAC, 4) sanitary toilet coverage in households, and 5) association between STH, Schistosoma japonicum exposure, nutritional status, and sanitation. PSAC and SAC in two Haiyan-stricken provinces were examined using Kato-Katz technique and ELISA Antibody test. Anthropometric and hemoglobin measurements were also obtained. The reported sanitary toilet coverage was validated in a survey. The prevalence of any STH in PSAC and SAC was 50.2% and 41.3%, respectively. Moderate-heavy intensity (MHI) STH prevalence in PSAC and SAC was 20.8% and 5.9%, respectively. The prevalence of any STH, MHI STH, ascariasis, MHI ascariasis, and MHI trichuriasis was significantly higher in PSAC. Stunting, underweight, wasting, overweight/obesity, and anemia prevalence was 38.4%, 24.5%, 4.8%, 2.7%, and 34.7% in PSAC, while the prevalence was 34.3%, 21.6%, 8.7%, 3.0%, and 19.2% in SAC, respectively. Anemia and wasting prevalence were significantly higher in PSAC and SAC, respectively. There were five schistosomiasis cases found (0.8% prevalence), while schistosomiasis seroprevalence was 60.1%. Validated and reported sanitary toilet coverage was significantly different in eight out of 13 barangays. Stunting and anemia were associated with STH. STH and anemia prevalence were significantly higher in non-ZOD barangays. High STH burden in PSAC and SAC persists. A more coordinated response addressing STH, undernutrition, and WASH in disaster-stricken areas will require strengthening local health systems and promoting intersectoral collaboration.
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Affiliation(s)
- Vicente Belizario
- Department of Parasitology, College of Public Health, University of the Philippines (UP) Manila, Manila, The Philippines
- Neglected Tropical Diseases Study Group, National Institutes of Health (NIH) UP Manila, Manila, The Philippines
| | - John Paul Caesar Robles Delos Trinos
- Neglected Tropical Diseases Study Group, National Institutes of Health (NIH) UP Manila, Manila, The Philippines
- Public Health Interventions Research Program, Kirby Institute, University of New South Wales-Sydney, Australia
| | - Olivia Sison
- Institute of Clinical Epidemiology NIH, UP Manila, Manila, The Philippines
| | | | - Victorio Molina
- Department of Parasitology, College of Public Health, University of the Philippines (UP) Manila, Manila, The Philippines
| | - Agnes Cuayzon
- Department of Health Eastern Visayas Center for Health Development, Leyte, The Philippines
| | | | - Rodel Delgado
- Eastern Samar Provincial Health Office Eastern Samar, The Philippines
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Mationg MLS, Tallo VL, Williams GM, Gordon CA, Clements ACA, McManus DP, Gray DJ. The control of soil-transmitted helminthiases in the Philippines: the story continues. Infect Dis Poverty 2021; 10:85. [PMID: 34118990 PMCID: PMC8196932 DOI: 10.1186/s40249-021-00870-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/27/2021] [Indexed: 03/30/2023] Open
Abstract
Background Soil-transmitted helminth (STH) infections have long been an important public health concern in the Philippines. In this review, we describe the current status of STH infections there and highlight the control efforts undertaken to reduce STH burden. Main text A nationwide STH mass drug administration (MDA) programme was started in 2006 but the overall STH prevalence remains stubbornly high across the Philippines, ranging from 24.9% to 97.4%. The continued increase in the prevalence may have been due to the challenges related to MDA implementation which include the lack of people’s awareness about the importance of regular treatment, misconceptions about the MDA strategy, lack of confidence on the drugs used, fear of adverse events and general distrust of government programs. There are existing water, sanitation and hygiene (WASH) programmes implemented in communities [e.g., Community-Led Total Sanitation (CLTS) program and providing toilet bowls and provision of subsidy for latrine construction] and schools [e.g., WASH in School (WINS) program], but sustained implementation is required to achieve expected outcomes. Although WASH in general is being taught in schools, integration of STH as a disease and community problem in the current public elementary school curriculum is still inadequate. The Integrated Helminth Control Program (IHCP) currently implemented in the country, which is focused on improved sanitation and personal hygiene, health education and preventive chemotherapy, will require continuous appraisal. The sustainability of this programme still continues to be a challenge. Conclusions Despite the major efforts to control STH infections for almost two decades in the Philippines, persistently high STH prevalence has been reported across the country, which is likely due to suboptimal MDA coverage and limitations in WASH and health education programs. Sustainable delivery of integrated control approaches will continue to play a pivotal role in the control and elimination of STH in the Philippines. Graphic abstract ![]()
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Affiliation(s)
- Mary Lorraine S Mationg
- Department of Global Health, Research School of Population Health, The Australian National University, Building 62 Mills Rd, Acton ACT, Canberra, 2601, Australia. .,Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines.
| | - Veronica L Tallo
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Gail M Williams
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Catherine A Gordon
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | - Donald P McManus
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Darren J Gray
- Department of Global Health, Research School of Population Health, The Australian National University, Building 62 Mills Rd, Acton ACT, Canberra, 2601, Australia
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Bekele T, Rawstorne P, Rahman B. Effect of water, sanitation and hygiene interventions alone and combined with nutrition on child growth in low and middle income countries: a systematic review and meta-analysis. BMJ Open 2020; 10:e034812. [PMID: 32660947 PMCID: PMC7359184 DOI: 10.1136/bmjopen-2019-034812] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/27/2020] [Accepted: 05/20/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE This study aimed to provide clarification on the benefits of water, sanitation and hygiene (WASH) alone separately and combined with nutrition in improving child growth outcomes. DESIGN Systematic review and meta-analysis. METHODS We conducted a systematic review using the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. PubMed, MEDLINE, EMBASE, Scopus, Cochrane Library, Web of Science and Science Direct were searched in May 2018 and last updated in April 2019. We included studies that reported WASH interventions alone separately or combined with nutrition. Fixed and random-effects models were used to estimate pooled effect in mean difference (MD). Heterogeneity and publication bias statistics were performed. RESULTS A total of 18 studies were included: 13 cluster randomised controlled trials (RCTs) and 5 non-randomised controlled trials (non-RCTs). Non-RCTs showed effect of WASH interventions alone on height-for-age z-score (HAZ) (MD=0.14; 95% CI 0.08 to 0.21) but RCTs did not. WASH alone of non-RCTs and RCTs that were delivered over 18-60 months indicated an effect on HAZ (MD=0.04; 95% CI 0.01 to 0.08). RCTs showed an effect for children <2 years (MD=0.07; 95% CI 0.01 to 0.13). Non-RCTs of WASH alone and those that included at least two components, improved HAZ (MD=0.15; 95% CI 0.07 to 0.23) but RCTs did not. WASH alone of non-RCTs and RCTs separately or together showed no effect on weight-for-age z-score (WAZ) and weight-for-height z-score (WHZ). Combined WASH with nutrition showed an effect on HAZ (MD=0.13; 95% CI 0.08 to 0.17) and on WAZ (MD=0.09; 95% CI 0.05 to 0.13) and was borderline on WHZ. CONCLUSIONS WASH interventions alone improved HAZ when delivered over 18-60 months and for children <2 years. Combined WASH with nutrition showed a strong effect on HAZ and WAZ and a borderline effect on WHZ. Integrated WASH with nutrition interventions may be effective inimproving child growth outcomes.
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Affiliation(s)
- Tolesa Bekele
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Public Health, College of Medicine and Health Sciences, Ambo University, Ambo, Oromia, Ethiopia
| | - Patrick Rawstorne
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Bayzidur Rahman
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Majorin F, Torondel B, Ka Seen Chan G, Clasen T. Interventions to improve disposal of child faeces for preventing diarrhoea and soil-transmitted helminth infection. Cochrane Database Syst Rev 2019; 9:CD011055. [PMID: 31549742 PMCID: PMC6757260 DOI: 10.1002/14651858.cd011055.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Diarrhoea and soil-transmitted helminth (STH) infections represent a large disease burden worldwide, particularly in low-income countries. As the aetiological agents associated with diarrhoea and STHs are transmitted through faeces, the safe containment and management of human excreta has the potential to reduce exposure and disease. Child faeces may be an important source of exposure even among households with improved sanitation. OBJECTIVES To assess the effectiveness of interventions to improve the disposal of child faeces for preventing diarrhoea and STH infections. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, Embase, and 10 other databases. We also searched relevant conference proceedings, contacted researchers, searched websites for organizations, and checked references from identified studies. The date of last search was 27 September 2018. SELECTION CRITERIA We included randomized controlled trials (RCTs) and non-randomized controlled studies (NRS) that compared interventions aiming to improve the disposal of faeces of children aged below five years in order to decrease direct or indirect human contact with such faeces with no intervention or a different intervention in children and adults. DATA COLLECTION AND ANALYSIS Two review authors selected eligible studies, extracted data, and assessed the risk of bias. We used meta-analyses to estimate pooled measures of effect where appropriate, or described the study results narratively. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS Sixty-three studies covering more than 222,800 participants met the inclusion criteria. Twenty-two studies were cluster RCTs, four were controlled before-and-after studies (CBA), and 37 were NRS (27 case-control studies (one that included seven study sites), three controlled cohort studies, and seven controlled cross-sectional studies). Most study sites (56/69) were in low- or lower middle-income settings. Among studies using experimental study designs, most interventions included child faeces disposal messages along with other health education messages or other water, sanitation, and hygiene (WASH) hardware and software components. Among observational studies, the main risk factors relevant to this review were safe disposal of faeces in the latrine or defecation of children under five years of age in a latrine.Education and hygiene promotion interventions, including child faeces disposal messages (no hardware provision)Four RCTs found that diarrhoea incidence was lower, reducing the risk by an estimated 30% in children under six years old (rate ratio 0.71, 95% confidence interval (CI) 0.59 to 0.86; 2 trials, low-certainty evidence). Diarrhoea prevalence measured in two other RCTs in children under five years of age was lower, but evidence was low-certainty (risk ratio (RR) 0.93, 95% CI 0.84 to 1.04; low-certainty evidence).Two controlled cohort studies that evaluated such an intervention in Bangladesh did not detect a difference on diarrhoea prevalence (RR 0.91, 95% CI 0.64 to 1.28; very low-certainty evidence). Two controlled cross-sectional studies that evaluated the Health Extension Package in Ethiopia were associated with a lower two-week diarrhoea prevalence in 'model' households than in 'non-model households' (odds ratio (OR) 0.26, 95% CI 0.16 to 0.42; very low-certainty evidence).Programmes to end open defecation by all (termed community-led total sanitation (CLTS) interventions plus adaptations)Four RCTs measured diarrhoea prevalence and did not detect an effect in children under five years of age (RR 0.92, 95% CI 0.79 to 1.07; moderate-certainty evidence). The analysis of two trials did not demonstrate an effect of the interventions on STH infection prevalence in children (pooled RR 1.03, 95% CI 0.64 to 1.65; low-certainty evidence).One controlled cross-sectional study compared the prevalence of STH infection in open defecation-free (ODF) villages that had received a CLTS intervention with control villages and reported a higher level of STH infection in the intervention villages (RR 2.51, 95% CI 1.74 to 3.62; very low-certainty evidence).Sanitation hardware and behaviour change interventions, that included child faeces disposal hardware and messagingTwo RCTs had mixed results, with no overall effect on diarrhoea prevalence demonstrated in the pooled analysis (RR 0.79, 95% CI 0.49 to 1.26; very low-certainty evidence).WASH hardware and education/behaviour change interventionsOne RCT did not demonstrate an effect on diarrhoea prevalence (RR 1.15, 95% CI 0.93 to 1.41; very low-certainty evidence).Two CBAs reported that the intervention reduced diarrhoea incidence by about a quarter in children under five years of age, but evidence was very low-certainty (rate ratio 0.77, 95% CI 0.71 to 0.84). Another CBA reported that the intervention reduced the prevalence of STH in an intervention village compared to a control village, again with GRADE assessed at very low-certainty (OR 0.17, 95% CI 0.02 to 0.73).Case-control studiesPooled results from case-control studies that presented data for child faeces disposal indicated that disposal of faeces in the latrine was associated with lower odds of diarrhoea among all ages (OR 0.73, 95% CI: 0.62 to 0.85; 23 comparisons; very low-certainty evidence). Pooled results from case-control studies that presented data for children defecating in the latrine indicated that children using the latrine was associated with lower odds of diarrhoea in all ages (OR 0.54, 95% CI 0.33 to 0.90; 7 studies; very low-certainty evidence). AUTHORS' CONCLUSIONS Evidence suggests that the safe disposal of child faeces may be effective in preventing diarrhoea. However, the evidence is limited and of low certainty. The limited research on STH infections provides only low and very-low certainty evidence around effects, which means there is currently no reliable evidence that interventions to improve safe disposal of child faeces are effective in preventing such STH infections.While child faeces may represent a source of exposure to young children, interventions generally only address it as part of a broader sanitation initiative. There is a need for RCTs and other rigorous studies to assess the effectiveness and sustainability of different hardware and software interventions to improve the safe disposal of faeces of children of different age groups.
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Affiliation(s)
- Fiona Majorin
- London School of Hygiene & Tropical MedicineFaculty of Infectious and Tropical DiseasesKeppel StreetLondonUKWC1E 7HT
| | - Belen Torondel
- London School of Hygiene & Tropical MedicineFaculty of Infectious and Tropical DiseasesKeppel StreetLondonUKWC1E 7HT
| | - Gabrielle Ka Seen Chan
- London School of Hygiene & Tropical MedicineFaculty of Infectious and Tropical DiseasesKeppel StreetLondonUKWC1E 7HT
| | - Thomas Clasen
- Rollins School of Public Health, Emory UniversityDepartment of Environmental Health1518 Clifton Road NEAtlantaGAUSA30322
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Owada K, Nielsen M, Lau CL, Yakob L, Clements ACA, Leonardo L, Soares Magalhães RJ. Functional illiteracy burden in soil-transmitted helminth (STH) endemic regions of the Philippines: An ecological study and geographical prediction for 2017. PLoS Negl Trop Dis 2019; 13:e0007494. [PMID: 31226111 PMCID: PMC6588226 DOI: 10.1371/journal.pntd.0007494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 05/26/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Soil-transmitted helminth (STH) infections remain highly endemic across the Philippines, and are believed to be important contributors to delayed cognitive development of school-aged children. Identification of communities where children are at risk of functional illiteracy is important for the attainment of Sustainable Development Goals target for literacy. We aimed to quantify the associations between the spatial variation of STH infections and functional literacy indicators adjusting for other important contributors, and identify priority areas in the Philippines in need of interventions. METHODOLOGY/PRINCIPAL FINDINGS We used data from 11,313 school-aged children on functional literacy indicators collected in 2008. Nested fixed-effects multinomial regression models were built to determine associations between STH endemicity and geographical distribution of functional literacy, adjusting for demographics, household level variables, and the prevalence of malaria. Bayesian multinomial geostatistical models were built to geographically predict the prevalence of each level of functional literacy. The number of school-aged children belonging to each of the functional literacy indicator classes was forecast for 2017. We estimated 4.20% of functional illiteracy burden among school-aged children in Mindanao might be averted by preventing T. trichiura infections. Areas predicted with the highest prevalence of functional illiteracy were observed in localised areas of the eastern region of the Visayas, and the south-eastern portion of Mindanao. CONCLUSIONS/SIGNIFICANCE The study demonstrates significant geographical variation in burden of functional illiteracy in school-aged children associated with STH infections suggesting that targeted helminth control could potentially promote the development of cognitive function of school-aged children in the Philippines. The benefits of a spatially targeted strategy should be tested by future studies.
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Affiliation(s)
- Kei Owada
- School of Medicine, The University of Queensland, South Brisbane, Queensland, Australia
- Children’s Health and Environment Program, Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
- Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - Mark Nielsen
- School of Psychology, The University of Queensland, St Lucia, Queensland, Australia
- Faculty of Humanities, University of Johannesburg, Auckland Park, South Africa
| | - Colleen L. Lau
- Children’s Health and Environment Program, Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Laith Yakob
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Archie C. A. Clements
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Lydia Leonardo
- Department of Parasitology, College of Public Health, University of the Philippines Manila, Manila, Philippines
| | - Ricardo J. Soares Magalhães
- Children’s Health and Environment Program, Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
- Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
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Owada K, Nielsen M, Lau CL, Yakob L, Clements ACA, Leonardo L, Soares Magalhães RJ. Determinants of Spatial Heterogeneity of Functional Illiteracy among School-Aged Children in the Philippines: An Ecological Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16010137. [PMID: 30621052 PMCID: PMC6339103 DOI: 10.3390/ijerph16010137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 12/23/2018] [Accepted: 01/02/2019] [Indexed: 01/02/2023]
Abstract
Functional literacy is one of the targets of the Sustainable Development Goals (SDGs) of the United Nations. Functional literacy indicators are likely to vary between locations given the geographical variability of its major determinants. This property poses a challenge to decisions around efficient allocation of population services and resources to mitigate the impact of functional literacy in populations most in need. Using functional literacy indicators of 11,313 school-aged children collected in 2008 during the nationwide survey, the current study examined the association between functional literacy and geographical disparities in socioeconomic status (SES), water supply, sanitation and hygiene, household education stimuli, and environmental variables in all three regions of the Philippines (Luzon, the Visayas, and Mindanao). Three nested fixed-effects multinomial regression models were built to determine associations between functional literacy and a wide array of variables. Our results showed the general prevalence rate of functional illiteracy as being 4.7%, with the highest prevalence rate in the Visayas, followed by Mindanao and Luzon (7.5%, 6.9%, and 3.0%, respectively. Our results indicated that in Luzon prevalence of functional illiteracy was explained by variation in household education stimuli scores, sources of drinking water, and type of toilet facility. In Mindanao and the Visayas prevalence of functional illiteracy was primarily explained by geographical variation in SES, and natural environmental conditions. Our study highlights region-specific determinants of functional literacy and the need for geographically targeted, integrated interventions.
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Affiliation(s)
- Kei Owada
- School of Medicine, The University of Queensland, South Brisbane, QLD 4101, Australia.
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, South Brisbane, QLD 4101, Australia.
- Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Gatton, QLD 4343, Australia.
| | - Mark Nielsen
- School of Psychology, The University of Queensland, St Lucia, QLD 4072, Australia.
- Faculty of Humanities, University of Johannesburg, Auckland Park 2006, South Africa.
| | - Colleen L Lau
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, South Brisbane, QLD 4101, Australia.
- Research School of Population Health, Australian National University, Canberra, ACT 0200, Australia.
| | - Laith Yakob
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
| | - Archie C A Clements
- Research School of Population Health, Australian National University, Canberra, ACT 0200, Australia.
| | - Lydia Leonardo
- Department of Parasitology, College of Public Health, University of the Philippines Manila, Manila 1000, Philippines.
| | - Ricardo J Soares Magalhães
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, South Brisbane, QLD 4101, Australia.
- Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Gatton, QLD 4343, Australia.
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Owada K, Lau CL, Leonardo L, Clements ACA, Yakob L, Nielsen M, Carabin H, Soares Magalhães RJ. Spatial distribution and populations at risk of A. lumbricoides and T. trichiura co-infections and infection intensity classes: an ecological study. Parasit Vectors 2018; 11:535. [PMID: 30285906 PMCID: PMC6171148 DOI: 10.1186/s13071-018-3107-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 09/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Soil-transmitted helminth (STH) infections are highly prevalent in the Philippines. Mapping the prevalence and high-intensity of STH co-infections can help guide targeted intervention programmes to reduce morbidity, especially among vulnerable school-aged children. In this study, we aimed to predict the spatial distribution of the prevalence of Ascaris lumbricoides and Trichuris trichiura co-infection and infection intensity classes in the Philippines to identify populations most in need of interventions. METHODS Data on STH infections from 29,919 individuals during the nationwide parasitological survey in 2005 to 2007 were included in the analysis. To geographically predict the prevalence of A. lumbricoides and T. trichiura co-infections and infection intensity classes, Bayesian multinomial geostatistical models were built including age, sex, environmental variables and a geostatistical random effect. The number of individuals co-infected and belonging to each of the infection intensity classes in 2017 was forecast by combining our predictive prevalence maps with population density maps. RESULTS Our models showed that school-aged children (5-19 years) are most at risk of A. lumbricoides and T. trichiura co-infections and of moderate/high infection intensity compared to other age groups. We identified target provinces where the likelihood of STH-associated morbidity was highest: Luzon (Bulacan, Benguet, Cavite, Sorsogon, Metropolitan Manila, Pampanga and Rizal), the Visayas (Cebu, Iloilo, Leyte and Negros Occidental), and in Mindanao (Agusan Del Norte, Davao Del Sur, Davao Oriental, Lanao Del Sur, Maguindanao, Misamis Oriental, Sulu and Zamboanga Del Sur). Luzon had the highest estimated number of school-aged children with A. lumbricoides and T. trichiura co-infections (estimated total 89,400), followed by the Visayas (38,300) and Mindanao (20,200). CONCLUSIONS Our study provided epidemiological evidence to highlight national priority areas for controlling co-infections and high intensity infections in the Philippines. Our maps could assist more geographically targeted interventions to reduce the risk of STH-associated morbidity in the Philippines.
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Affiliation(s)
- Kei Owada
- School of Medicine, The University of Queensland, QLD, South Brisbane, Australia. .,Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, QLD, South Brisbane, Australia.
| | - Colleen L Lau
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, QLD, South Brisbane, Australia.,Research School of Population Health, Australian National University, ACT, Canberra, Australia
| | - Lydia Leonardo
- Department of Parasitology, College of Public Health, University of the Philippines Manila, Manila, Philippines
| | - Archie C A Clements
- Research School of Population Health, Australian National University, ACT, Canberra, Australia
| | - Laith Yakob
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Mark Nielsen
- School of Psychology, The University of Queensland, QLD, St Lucia, Australia.,Faculty of Humanities, University of Johannesburg, Auckland Park, South Africa
| | - Hélène Carabin
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma, USA
| | - Ricardo J Soares Magalhães
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, QLD, South Brisbane, Australia.,Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, QLD, Gatton, Australia
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Effect of an integrated intervention package of preventive chemotherapy, community-led total sanitation and health education on the prevalence of helminth and intestinal protozoa infections in Côte d'Ivoire. Parasit Vectors 2018; 11:115. [PMID: 29486790 PMCID: PMC6389068 DOI: 10.1186/s13071-018-2642-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 01/12/2018] [Indexed: 12/21/2022] Open
Abstract
Background Preventive chemotherapy with donated anthelminthic drugs is the cornerstone for the control of helminthiases. However, reinfection can occur rapidly in the absence of clean water and sanitation coupled with unhygienic behaviour. The purpose of this study was to assess the effect of an integrated package of interventions, consisting of preventive chemotherapy, community-led total sanitation (CLTS) and health education, on the prevalence of helminth and intestinal protozoa infections and on participants’ knowledge, attitude, practice and beliefs (KAPB) towards these diseases including water, sanitation and hygiene (WASH). Methods A cross-sectional survey was carried out in nine communities of south-central Côte d’Ivoire to assess people’s infection with helminths and intestinal protozoa and KAPB. Subsequently, interventions were targeted to five communities, while the remaining communities served as control. The intervention encouraged latrine construction and an evaluation was done 6–7 months later to determine open defecation status of the respective communities. Anthelminthic treatment was provided to all community members. A follow-up cross-sectional survey was conducted approximately one year later, using the same procedures. Results Overall, 810 people had complete baseline and follow-up data and were given anthelminthic treatment. The baseline prevalence of hookworm, Schistosoma haematobium, Trichuris trichiura, Schistosoma mansoni and Ascaris lumbricoides was 31.1%, 7.0%, 2.0%, 1.0% and 0.3%, respectively. Four of the five intervention communities were classified open-defecation free. For hookworm infection, we observed higher negative changes in terms of proportion of decrease (-0.10; 95% confidence interval (CI): - 0.16, -0.04) and higher egg reduction rate (64.9 vs 15.2%) when comparing intervention with control communities. For intestinal protozoa, prevalence reduction was higher in intervention compared to control communities (8.2 vs 2.6%) and WASH indicators and intervention outcomes associated with lower odds for infection at follow-up. The intervention significantly impacted on reported latrine use (before: 15.5%, after: 94.6%), open defecation in the community surroundings (before: 75.0%, after: 16.7%) and awareness for environmental contamination through open defecation (before: 20.4%, after: 52.2%). Conclusions An integrated package of interventions consisting of preventive chemotherapy, health education and CLTS reduces the prevalence of helminth and intestinal protozoa infection. Additional studies in other social-ecological settings are warranted to confirm our findings. Electronic supplementary material The online version of this article (10.1186/s13071-018-2642-x) contains supplementary material, which is available to authorized users.
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12
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Impact of Water, Sanitation and Hygiene Interventions on Growth, Non-diarrheal Morbidity and Mortality in Children Residing in Low- and Middle-income Countries: A Systematic Review. Indian Pediatr 2018. [DOI: 10.1007/s13312-018-1279-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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13
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Venkataramanan V, Crocker J, Karon A, Bartram J. Community-Led Total Sanitation: A Mixed-Methods Systematic Review of Evidence and Its Quality. ENVIRONMENTAL HEALTH PERSPECTIVES 2018; 126:026001. [PMID: 29398655 PMCID: PMC6066338 DOI: 10.1289/ehp1965] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 11/21/2017] [Accepted: 11/24/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND Community-led total sanitation (CLTS) is a widely applied rural behavior change approach for ending open defecation. However, evidence of its impact is unclear. OBJECTIVES We conducted a systematic review of journal-published and gray literature to a) assess evidence quality, b) summarize CLTS impacts, and c) identify factors affecting implementation and effectiveness. METHODS Eligible studies were systematically screened and selected for analysis from searches of seven databases and 16 websites. We developed a framework to appraise literature quality. We qualitatively analyzed factors enabling or constraining CLTS, and summarized results from quantitative evaluations. DISCUSSION We included 200 studies (14 quantitative evaluations, 29 qualitative studies, and 157 case studies). Journal-published literature was generally of higher quality than gray literature. Fourteen quantitative evaluations reported decreases in open defecation, but did not corroborate the widespread claims of open defecation-free (ODF) villages found in case studies. Over one-fourth of the literature overstated conclusions, attributing outcomes and impacts to interventions without an appropriate study design. We identified 43 implementation- and community-related factors reportedly affecting CLTS. This analysis revealed the importance of adaptability, structured posttriggering activities, appropriate community selection, and further research on combining and sequencing CLTS with other interventions. CONCLUSIONS The evidence base on CLTS effectiveness available to practitioners, policy makers, and program managers to inform their actions is weak. Our results highlight the need for more rigorous research on CLTS impacts as well as applied research initiatives that bring researchers and practitioners together to address implementation challenges to improve rural sanitation efforts. https://doi.org/10.1289/EHP1965.
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Affiliation(s)
- Vidya Venkataramanan
- The Water Institute at University of North Carolina, Department of Environmental Sciences and Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jonny Crocker
- The Water Institute at University of North Carolina, Department of Environmental Sciences and Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Andrew Karon
- The Water Institute at University of North Carolina, Department of Environmental Sciences and Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jamie Bartram
- The Water Institute at University of North Carolina, Department of Environmental Sciences and Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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14
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Yacob NA, Mohd Noor NA, Mohd Yunus NY, Lob Yussof R, Zakaria SAKY. Advancements in Parasite Diagnosis and Challenges in the Management of Parasitic Infections: A Mini Review. REGIONAL CONFERENCE ON SCIENCE, TECHNOLOGY AND SOCIAL SCIENCES (RCSTSS 2016) 2018. [PMCID: PMC7121306 DOI: 10.1007/978-981-13-0074-5_64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Intestinal parasitic infections (IPIs) remain a widespread public health concern causing severe implications in both developed and developing countries. Globally, numerous studies have been carried out ranging from various communities to schoolchildren as well as indigenous communities. The infections are commonly caused by helminths (e.g. Ascaris lumbricoides, Trichuris trichiura and hookworm) and protozoa (e.g. Blastocystis hominis, Cryptosporidium sp., Entamoeba histolytica and Giardia duodenalis). Poor sanitation and poverty are some of the factors associated with IPIs. With the ever-increasing impact of IPIs, newer detection approaches have been developed and studied. The efficacy of diagnostic method is crucial to give an accurate identification of these parasites. Recent developments of diagnostic tools such as serology- and molecular-based assays are assisting the conventional method of microscopy in detecting and further confirming current or past infections and the specific species of parasites. Ongoing investigations in parasitic infections using these advanced tools will provide useful information that will enable the evaluation of the effectiveness of the current control program and thus, assist future planning for improved strategies in eradicating these parasitic infections.
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15
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Liwanag HJ, Uy J, Bataller R, Gatchalian JR, De La Calzada B, Uy JA, Dayrit M. Soil-Transmitted Helminthiasis and Schistosomiasis in Children of Poor Families in Leyte, Philippines: Lessons for Disease Prevention and Control. J Trop Pediatr 2017; 63:335-345. [PMID: 28115576 DOI: 10.1093/tropej/fmw078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Neglected tropical diseases (NTDs) continue to be a public health problem in the Philippines. We assessed the association of soil-transmitted helminthiasis (STH) and schistosomiasis with selected health-related and socioeconomic variables in four villages in Leyte, Philippines. METHODS Stool specimens from 418 adults and 533 of their children from 209 families were examined through the Kato-Katz technique. RESULTS STH and schistosomiasis were present in 64.6% and 12.5%, respectively, of study participants. Analysis through the generalized linear mixed model revealed a number of associations between infection in parents and their children. Findings indicate that years of disease prevention and control efforts in these areas have been unable to bring down prevalence in children and their parents. Eliminating NTDs as public health problems will require a systems thinking approach beyond implementation of vertical control programs alone.
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Affiliation(s)
- Harvy Joy Liwanag
- Ateneo Center for Health Evidence, Action, and Leadership (A-HEALS), Ateneo de Manila University, Ortigas Campus, 1605 Pasig City, Metro Manila, Philippines.,Ateneo School of Medicine and Public Health, Ateneo de Manila University, Ortigas Campus, 1605 Pasig City, Metro Manila, Philippines
| | - Jhanna Uy
- Ateneo Center for Health Evidence, Action, and Leadership (A-HEALS), Ateneo de Manila University, Ortigas Campus, 1605 Pasig City, Metro Manila, Philippines
| | - Ramil Bataller
- Department of Mathematics, School of Science and Engineering, Ateneo de Manila University, Loyola Heights Campus, 1108 Quezon City, Metro Manila, Philippines
| | - Janis Ruth Gatchalian
- Ateneo Center for Health Evidence, Action, and Leadership (A-HEALS), Ateneo de Manila University, Ortigas Campus, 1605 Pasig City, Metro Manila, Philippines
| | - Betty De La Calzada
- Schistosomiasis Research and Training Center, Department of Health Regional Office 8, 6501 Palo, Leyte, Philippines
| | - Justine Alessandra Uy
- Department of Pathology and Laboratory Medicine, The Medical City, Ortigas Avenue, 1605 Pasig City, Metro Manila, Philippines
| | - Manuel Dayrit
- Ateneo Center for Health Evidence, Action, and Leadership (A-HEALS), Ateneo de Manila University, Ortigas Campus, 1605 Pasig City, Metro Manila, Philippines.,Ateneo School of Medicine and Public Health, Ateneo de Manila University, Ortigas Campus, 1605 Pasig City, Metro Manila, Philippines
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16
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Freeman MC, Garn JV, Sclar GD, Boisson S, Medlicott K, Alexander KT, Penakalapati G, Anderson D, Mahtani AG, Grimes JET, Rehfuess EA, Clasen TF. The impact of sanitation on infectious disease and nutritional status: A systematic review and meta-analysis. Int J Hyg Environ Health 2017; 220:928-949. [PMID: 28602619 DOI: 10.1016/j.ijheh.2017.05.007] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/16/2017] [Accepted: 05/18/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Sanitation aims to sequester human feces and prevent exposure to fecal pathogens. More than 2.4 billion people worldwide lack access to improved sanitation facilities and almost one billion practice open defecation. We undertook systematic reviews and meta-analyses to compile the most recent evidence on the impact of sanitation on diarrhea, soil-transmitted helminth (STH) infections, trachoma, schistosomiasis, and nutritional status assessed using anthropometry. METHODS AND FINDINGS We updated previously published reviews by following their search strategy and eligibility criteria. We searched from the previous review's end date to December 31, 2015. We conducted meta-analyses to estimate pooled measures of effect using random-effects models and conducted subgroup analyses to assess impact of different levels of sanitation services and to explore sources of heterogeneity. We assessed risk of bias and quality of the evidence from intervention studies using the Liverpool Quality Appraisal Tool (LQAT) and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach, respectively. A total of 171 studies met the review's inclusion criteria, including 64 studies not included in the previous reviews. Overall, the evidence suggests that sanitation is protective against diarrhea, active trachoma, some STH infections, schistosomiasis, and height-for-age, with no protective effect for other anthropometric outcomes. The evidence was generally of poor quality, heterogeneity was high, and GRADE scores ranged from very low to high. CONCLUSIONS This review confirms positive impacts of sanitation on aspects of health. Evidence gaps remain and point to the need for research that rigorously describes sanitation implementation and type of sanitation interventions.
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Affiliation(s)
- Matthew C Freeman
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Joshua V Garn
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Gloria D Sclar
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sophie Boisson
- Department of Public Health, Environmental and Social Determinants of Health (PHE), World Health Organization, Geneva, Switzerland
| | - Kate Medlicott
- Department of Public Health, Environmental and Social Determinants of Health (PHE), World Health Organization, Geneva, Switzerland
| | - Kelly T Alexander
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Gauthami Penakalapati
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Darcy Anderson
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Amrita G Mahtani
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jack E T Grimes
- Department of Civil and Environmental Engineering, South Kensington Campus, Imperial College London, London, UK
| | - Eva A Rehfuess
- Institute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Germany
| | - Thomas F Clasen
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
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17
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Erismann S, Knoblauch AM, Diagbouga S, Odermatt P, Gerold J, Shrestha A, Tarnagda G, Savadogo B, Schindler C, Utzinger J, Cissé G. Prevalence and risk factors of undernutrition among schoolchildren in the Plateau Central and Centre-Ouest regions of Burkina Faso. Infect Dis Poverty 2017; 6:17. [PMID: 28100278 PMCID: PMC5244543 DOI: 10.1186/s40249-016-0230-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 12/23/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Multiple factors determine children's nutritional status, including energy and nutrient intake, recurrent infectious diseases, access (or lack thereof) to clean water and improved sanitation, and hygiene practices, among others. The "Vegetables go to School: improving nutrition through agricultural diversification" (VgtS) project implements an integrated school garden programme in five countries, including Burkina Faso. The aim of this study was to determine the prevalence of undernutrition and its risk factors among schoolchildren in Burkina Faso before the start of the project. METHODS In February 2015, a cross-sectional survey was carried out among 455 randomly selected children, aged 8-14 years, in eight schools in the Plateau Central and Centre-Ouest regions of Burkina Faso. Nutritional status was determined by anthropometric assessment. Helminth and intestinal protozoa infections were assessed using the Kato-Katz and a formalin-ether concentration method. A urine filtration technique was used to identify Schistosoma haematobium eggs. Prevalence of anaemia was determined by measuring haemoglobin levels in finger-prick blood samples. Questionnaires were administered to children to determine their knowledge of nutrition and health and their related attitudes and practices (KAP). Questionnaires were also administered to the children's caregivers to identify basic household socio-demographic and economic characteristics, and water, sanitation and hygiene (WASH) conditions. To determine the factors associated with schoolchildren's nutritional status, mixed logistic regression models were used. Differences and associations were considered statistically significant if P-values were below 0.05. RESULTS Complete datasets were available for 385 children. The prevalence of undernutrition, stunting and thinness were 35.1%, 29.4% and 11.2%, respectively. The multivariable analysis revealed that undernutrition was associated with older age (i.e. 12-14 years compared to <12 years; adjusted odds ratio (aOR) = 3.45, 95% confidence interval (CI) 2.12-5.62, P < 0.001), multiple pathogenic parasitic infections (aOR = 1.87, 95% CI 1.02-3.43, P = 0.044) and with moderate and severe anaemia in children (aOR = 2.52, 95% CI 1.25-5.08, P = 0.010). CONCLUSIONS We found high prevalence of undernutrition among the children surveyed in the two study regions of Burkina Faso. We further observed that undernutrition, anaemia and parasitic infections were strongly associated. In view of these findings, concerted efforts are needed to address undernutrition and associated risk factors among school-aged children. As part of the VgtS project, WASH, health education and nutritional interventions will be implemented with the goal to improve children's health. TRIAL REGISTRATION ISRCTN17968589 (date assigned: 17 July 2015).
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Affiliation(s)
- Séverine Erismann
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland
- University of Basel, P.O. Box, CH-4003, Basel, Switzerland
| | - Astrid M Knoblauch
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland
- University of Basel, P.O. Box, CH-4003, Basel, Switzerland
| | - Serge Diagbouga
- Institut de Recherches en Sciences de la Santé, P.O. Box 7192, Ouagadougou 03, Burkina Faso
| | - Peter Odermatt
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland
- University of Basel, P.O. Box, CH-4003, Basel, Switzerland
| | - Jana Gerold
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland
- University of Basel, P.O. Box, CH-4003, Basel, Switzerland
| | - Akina Shrestha
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland
- University of Basel, P.O. Box, CH-4003, Basel, Switzerland
- Kathmandu University, P.O. Box 6250, 45200, Dhulikhel, Nepal
| | - Grissoum Tarnagda
- Institut de Recherches en Sciences de la Santé, P.O. Box 7192, Ouagadougou 03, Burkina Faso
| | - Boubacar Savadogo
- Institut de Recherches en Sciences de la Santé, P.O. Box 7192, Ouagadougou 03, Burkina Faso
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland
- University of Basel, P.O. Box, CH-4003, Basel, Switzerland
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland
- University of Basel, P.O. Box, CH-4003, Basel, Switzerland
| | - Guéladio Cissé
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland.
- University of Basel, P.O. Box, CH-4003, Basel, Switzerland.
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18
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Njuguna J. Effect of eliminating open defecation on diarrhoeal morbidity: an ecological study of Nyando and Nambale sub-counties, Kenya. BMC Public Health 2016; 15:712. [PMID: 27488385 PMCID: PMC4973028 DOI: 10.1186/s12889-016-3421-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 07/30/2016] [Indexed: 11/16/2022] Open
Abstract
Background Defecating in the open predisposes people to soil transmitted helminthes and diarrhoeal diseases. An estimated 5.6 million Kenyans defecate in the open. Kenya launched a program to eradicate open defecation by 2013 in the rural areas. By end of 2013, only two sub-counties had eliminated open defecation. These are Nambale and Nyando. The study looked at the impact of eradicating open defecation on diarrhea prevalence among children in these two sub-counties. Methods Data on diarrhoea morbidity among children under 5 years was extracted from the Kenya Health Information System for all the sub-counties in Busia and Kisumu counties for 2012, 2013 and 2014 respectively. Prevalence was calculated for each sub-county in Kisumu for comparison with Nyando’s. Prevalence was also calculated for each sub-county in Busia County and compared to that of Nambale sub-county. A Mann–Whitney U Test was done to test the null hypothesis that diarrhoea prevalence was similar in both open defecation and open defecation free sub-counties. Results A Mann–Whitney U Test revealed significant difference in diarrhoeal prevalence of open defecation sub-counties (Md = 18.4, n = 34) and open defecation free sub-counties (Md = 9.8, n = 5), U = 9, z = −3.2, p = .001. Among the two Counties, Nambale had the lowest prevalence. It recorded a decline from 9.8 to 5.7 % across the three years. Prevalence for diarrhoea cases in Nyando declined from 19.1 to 15.2 % across the three years. Nyando initially had the second highest prevalence in Kisumu County and by 2014 it had the lowest prevalence. Conclusions The two sub-counties with open defecation free status had lower prevalence of diarrhoea cases compared to sub-counties which were yet to attain open defecation free status. This suggests that elimination of open defecation may reduce the number of diarrhoea cases.
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Affiliation(s)
- John Njuguna
- Mukurwe-ini sub-County Public Health Office, P.O. Box 112-10103, Mukurwe-ini, Kenya.
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Periago MV, Diniz RC, Pinto SA, Yakovleva A, Correa-Oliveira R, Diemert DJ, Bethony JM. The Right Tool for the Job: Detection of Soil-Transmitted Helminths in Areas Co-endemic for Other Helminths. PLoS Negl Trop Dis 2015; 9:e0003967. [PMID: 26241329 PMCID: PMC4524677 DOI: 10.1371/journal.pntd.0003967] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 07/08/2015] [Indexed: 11/19/2022] Open
Abstract
Background Due to the recent increased use of the McMaster (MM) fecal egg counting method for assessing benzimidazole drug efficacy for treating soil-transmitted helminth (STH) infections, the aim of the current study was to determine the operational value of including the MM method alongside the Kato-Katz (KK) fecal thick smear to increase the diagnostic sensitivity when STHs are co-endemic with trematode helminths (e.g., Schistosoma mansoni). Methods A cross-sectional study was conducted in school-aged children aged 4-18 years in the northeastern region of the State of Minas Gerais (Brazil), where Necator americanus, Ascaris lumbricoides, Trichuris trichiura, and S. mansoni are co-endemic. One fecal sample from each participant was collected and transported to the field laboratory for analysis. Coprological diagnosis was performed on each fecal sample by three different methods: Formalin-Ether Sedimentation (FES), KK and the MM technique. The diagnostic sensitivity and negative predictive value (NPV) of each technique was calculated using the combination of all three techniques as the composite standard. In order to determine the agreement between the three techniques Fleiss´ kappa was used. Both the Cure Rate (CR) and the Fecal Egg Count Reduction (FECR) were calculated using the two quantification techniques (i.e., the MM and KK). Results Fecal samples from 1260 children were analyzed. The KK had higher diagnostic sensitivity than the MM for the detection of both A. lumbricoides (KK 97.3%, MM 69.5%) and hookworm (KK 95.1%, MM 80.8%). The CR of a single dose of mebendazole varied significantly between the KK and MM for both A. lumbricoides (p = 0.016) and hookworm (p = 0.000), with lower rates obtained with the KK. On the other hand, the FECR was very similar between both techniques for both A. lumbricoides and hookworm. Conclusion The MM did not add any diagnostic value over the KK in areas where both STHs and trematodes were co-endemic. The lower sensitivity of the MM would have an important impact on the administration of selective school-based treatment in this area since if only the MM were used, 36 (13.9%) children diagnosed with A. lumbricoides would have gone untreated. Diagnosis of intestinal helminths and Schistosoma mansoni infections is based on the detection of eggs in feces. There are many techniques available for both detection and quantification of infection. For the quantification of helminth infections, the methods traditionally used are the Kato-Katz (KK) fecal think smear in humans, and the McMaster (MM) counting method in animals. Recently, the MM has been used for assessing the efficacy of benzimidazole drugs for treating soil-transmitted helminth (STH) infections in humans. In most parts of the world, however, STHs occur simultaneously with other helminth species, and the MM does not detect other helminth eggs. Therefore, in this study we sought to determine if the use of the MM in an area of Brazil were both STHs and S. mansoni are co-endemic, added any value to the current standard of diagnosis using the KK.
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Affiliation(s)
- Maria V Periago
- Laboratório de Imunologia Celular e Molecular, Centro de Pesquisa René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Renata C Diniz
- Laboratório de Imunologia Celular e Molecular, Centro de Pesquisa René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Simone A Pinto
- Laboratório de Imunologia Celular e Molecular, Centro de Pesquisa René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Anna Yakovleva
- Research Center for the Neglected Diseases of Poverty, School of Medicine and Health Science, George Washington University, Washington, DC, United States of America; Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Science, George Washington University, Washington, DC, United States of America
| | - Rodrigo Correa-Oliveira
- Laboratório de Imunologia Celular e Molecular, Centro de Pesquisa René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - David J Diemert
- Research Center for the Neglected Diseases of Poverty, School of Medicine and Health Science, George Washington University, Washington, DC, United States of America; Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Science, George Washington University, Washington, DC, United States of America
| | - Jeffrey M Bethony
- Research Center for the Neglected Diseases of Poverty, School of Medicine and Health Science, George Washington University, Washington, DC, United States of America; Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Science, George Washington University, Washington, DC, United States of America
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Sangaré I, Bamba S, Cissé M, Zida A, Bamogo R, Sirima C, Yaméogo BK, Sanou R, Drabo F, Dabiré RK, Guiguemdé RT. Prevalence of intestinal opportunistic parasites infections in the University hospital of Bobo-Dioulasso, Burkina Faso. Infect Dis Poverty 2015. [PMID: 26217488 PMCID: PMC4515886 DOI: 10.1186/s40249-015-0065-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background Gastrointestinal parasites infections are widespread in Africa and their prevalence infections vary from country to country. This study aimed at assessing the prevalence of opportunistic intestinal parasites infection and other gastrointestinal parasites infection among patients attending the laboratory of Parasitology and Mycology of the University Hospital Souro Sanou of Bobo-Dioulasso. Methods A hospital cross-sectional based study was conducted from April to August, 2012. Participants were persons whom parasitological examination of stools has been prescribed by a clinician. The stools examination methods included direct wet saline examination, lugol’s iodine staining technique, formol-ether concentration and modified Ziehl-Neelsen staining. We recorded age and sex information for each patient. Results The overall prevalence of intestinal parasite infections was 65.3 % (190/291). Majority of the parasitic infections was waterborne (64.3 %) consisting of high prevalence of Cryptosporidium sp. (26.5 %) and Entamoeba histolytica/dispar (23.4 %). The prevalence of opportunistic parasites was 28.9 % and Cryptosporidium sp. was the most prevalent species followed by Blastocystis sp. (1.0 %), Cyclospora sp. (0.7 %) and Isospora belli (0.7 %). The prevalence of intestinal helminthes was 1.7 %. Conclusions The prevalence of intestinal parasitism in general remains high in Bobo-Dioulasso requiring the establishment of adequate diagnostic techniques, treatment and prevention.
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Affiliation(s)
- Ibrahim Sangaré
- Institut Supérieur des Sciences de la Santé, Université Polytechnique de Bobo-Dioulasso, 01 BP 1091 Bobo-Dioulasso, Burkina Faso ; Centre MURAZ, Unité de Recherche en Paludisme et Maladies Tropicales Négligées, Bobo-Dioulasso, Burkina Faso ; Centre Hospitalier Universitaire Souro Sanou, Bobo-Dioulasso, Burkina Faso
| | - Sanata Bamba
- Institut Supérieur des Sciences de la Santé, Université Polytechnique de Bobo-Dioulasso, 01 BP 1091 Bobo-Dioulasso, Burkina Faso ; Centre MURAZ, Unité de Recherche en Paludisme et Maladies Tropicales Négligées, Bobo-Dioulasso, Burkina Faso ; Centre Hospitalier Universitaire Souro Sanou, Bobo-Dioulasso, Burkina Faso
| | - Mamoudou Cissé
- Institut Supérieur des Sciences de la Santé, Université Polytechnique de Bobo-Dioulasso, 01 BP 1091 Bobo-Dioulasso, Burkina Faso ; Centre MURAZ, Unité de Recherche en Paludisme et Maladies Tropicales Négligées, Bobo-Dioulasso, Burkina Faso
| | - Adama Zida
- Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Rabila Bamogo
- Institut Supérieur des Sciences de la Santé, Université Polytechnique de Bobo-Dioulasso, 01 BP 1091 Bobo-Dioulasso, Burkina Faso ; Centre MURAZ, Unité de Recherche en Paludisme et Maladies Tropicales Négligées, Bobo-Dioulasso, Burkina Faso
| | - Constant Sirima
- Institut Supérieur des Sciences de la Santé, Université Polytechnique de Bobo-Dioulasso, 01 BP 1091 Bobo-Dioulasso, Burkina Faso ; Centre MURAZ, Unité de Recherche en Paludisme et Maladies Tropicales Négligées, Bobo-Dioulasso, Burkina Faso
| | - Bienvenue K Yaméogo
- Institut de Recherche en Sciences de la Santé, Direction Régionale de l'ouest, Ouagadougou, Burkina Faso
| | - Roger Sanou
- Institut Supérieur des Sciences de la Santé, Université Polytechnique de Bobo-Dioulasso, 01 BP 1091 Bobo-Dioulasso, Burkina Faso ; Centre MURAZ, Unité de Recherche en Paludisme et Maladies Tropicales Négligées, Bobo-Dioulasso, Burkina Faso
| | - François Drabo
- Ministère de la Santé, Direction de la Lutte contre la Maladie, Coordination de la lutte contre les Maladies tropicales Négligées, Ouagadougou, Burkina Faso
| | - Roch K Dabiré
- Centre MURAZ, Unité de Recherche en Paludisme et Maladies Tropicales Négligées, Bobo-Dioulasso, Burkina Faso ; Institut de Recherche en Sciences de la Santé, Direction Régionale de l'ouest, Ouagadougou, Burkina Faso
| | - Robert T Guiguemdé
- Institut Supérieur des Sciences de la Santé, Université Polytechnique de Bobo-Dioulasso, 01 BP 1091 Bobo-Dioulasso, Burkina Faso ; Centre MURAZ, Unité de Recherche en Paludisme et Maladies Tropicales Négligées, Bobo-Dioulasso, Burkina Faso
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