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Yirgu R, Middleton J, Fekadu A, Cassell JA, Tesfaye A, Jones CI, Bremner S, Enbiale W, Davey G. Scabies in the Amhara region of northern Ethiopia: a cross-sectional study of prevalence, determinants, clinical presentation and community knowledge. BMJ Open 2023; 13:e075038. [PMID: 37880172 PMCID: PMC10603513 DOI: 10.1136/bmjopen-2023-075038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/11/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND The WHO aims to prevent, eliminate or control neglected tropical diseases, including scabies, by 2030. However, limited epidemiological data presented a challenge to control efforts, especially in high burden countries. There was a major scabies outbreak in northern Ethiopia starting in 2015 and prevalence has since increased across much of the country. OBJECTIVE To estimate scabies prevalence, identify its predictors, and assess community perception of, and knowledge about, the infestation. DESIGN Population-based cross-sectional study. STUDY SETTING Ayu Guagusa district, Amhara region, northern Ethiopia. PARTICIPANTS 1437 people who were members of 381 randomly selected households participated in the study. Five trained mid-level health workers clinically diagnosed people with scabies. OUTCOME MEASURES Clinically diagnosed scabies infestation. DATA ANALYSIS Multi-level logistic regression models were fitted to adjust for individual and household-level confounding variables, and identify predictors of scabies infestation. RESULTS Scabies prevalence was 13.4% (95% CI 11.8 to 15.5). Households of more than five people (adjusted OR (aOR)=3.5, 95% CI 1.2 to 10.2) were associated with increased odds of developing scabies, however, females had lower odds (aOR=0.5 95% CI 0.3 to 0.8). Scabietic lesions most frequently involved the trunk (62.0%), and vesicles were the most common types of lesions (67.7%). Two-thirds of adult study participants had heard about scabies and most obtained scabies related information from informal sources. Only 32% of cases sought care for scabies from any source. CONCLUSION Scabies prevalence was high, signifying the need for community-based control interventions. Host density and sex were important predictors of scabies. Despite the favourable attitude toward the effectiveness of scabies treatment, healthcare seeking was low.
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Affiliation(s)
- Robel Yirgu
- School of Public Health, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
- NIHR Global Health Research Unit on Neglected Tropical Diseases, Brighton and Sussex Medical School, Falmer, UK
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | - Jo Middleton
- NIHR Global Health Research Unit on Neglected Tropical Diseases, Brighton and Sussex Medical School, Falmer, UK
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, UK
| | - Abebaw Fekadu
- NIHR Global Health Research Unit on Neglected Tropical Diseases, Brighton and Sussex Medical School, Falmer, UK
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | - Jackie A Cassell
- NIHR Global Health Research Unit on Neglected Tropical Diseases, Brighton and Sussex Medical School, Falmer, UK
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, UK
| | - Abraham Tesfaye
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | - Christopher Iain Jones
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, UK
| | - Stephen Bremner
- NIHR Global Health Research Unit on Neglected Tropical Diseases, Brighton and Sussex Medical School, Falmer, UK
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, UK
| | - Wendemagegn Enbiale
- College of Medical and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gail Davey
- School of Public Health, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
- NIHR Global Health Research Unit on Neglected Tropical Diseases, Brighton and Sussex Medical School, Falmer, UK
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Horstick O, Runge-Ranzinger S. Multisectoral approaches for the control of vector-borne diseases, with particular emphasis on dengue and housing. Trans R Soc Trop Med Hyg 2019; 113:823-828. [PMID: 31034038 DOI: 10.1093/trstmh/trz020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/11/2018] [Accepted: 03/21/2019] [Indexed: 01/06/2023] Open
Abstract
The Sustainable Development Goals suggest an intersectoral approach for development and health, including for vector-borne diseases. Evidence-based policy recommendations exist for malaria and housing, but not for other, more underfunded, vector-borne diseases. This review aims to stimulate the process for developing policy recommendations for other vector-borne diseases and housing with the process as it was developed for dengue and Aedes control as an example and with suggestions for steps necessary for other vector-borne diseases. For dengue, some basic research on the efficacy of vector control in relation to housing exists, summary evidence highlights the lack of evidence and efficacy and policy recommendations remain difficult. For other vector-borne diseases, few studies have focused on protecting the house, combinations of effective interventions (e.g. intradomiciliary residual spraying, insecticide-treated materials and treatment of larval habitats with biological and chemical methods, which have proven to be effective) have not been studied and summary evidence is non-existent. In order to recommend vector control to protect the house against vector-borne diseases, basic research and summary evidence are needed, with an appropriate combination of the most efficacious interventions and linked to improvement of housing itself. Standards for such studies need to be developed.
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Horstick O, Runge-Ranzinger S. Protection of the house against Chagas disease, dengue, leishmaniasis, and lymphatic filariasis: a systematic review. THE LANCET. INFECTIOUS DISEASES 2017; 18:e147-e158. [PMID: 29074038 DOI: 10.1016/s1473-3099(17)30422-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 05/19/2017] [Accepted: 06/15/2017] [Indexed: 12/22/2022]
Abstract
In light of the recent Zika virus outbreak, vector control has received renewed interest. However, which interventions are efficacious and community effective and how to best deliver them remains unclear. Following PRISMA guidelines, we did a systematic review to assess evidence for applied vector control interventions providing protection against Chagas disease, dengue, leishmaniasis, and lymphatic filariasis at the household level. We searched for published literature and grey literature between Jan 1, 1980, and Nov 30, 2015, and updated our search on April 2, 2017, using databases including the Cochrane, Embase, LILACS, PubMed, Web of Science, and WHOLIS. The Cochrane Collaboration's tool for assessing risk of bias was used. Inclusion criteria included studies reporting vector control interventions in and around a house or dwelling; and use of insecticides as sprays on netting or screens, and any method to control larval breeding in water containers in and around the home. 1416 articles were assessed and 32 articles included. The most effective interventions affecting vector indices for multiple diseases were found to be intradomiciliary residual spraying, insecticide-treated materials (especially insecticide-treated nets or curtains), and treatment of larval habitats with biological and chemical methods. Waste management and clean-up campaigns reduce vector populations, although to a lesser extent than other interventions and not consistently. Modifications to the structure of homes (eg, wall plastering) had no impact on the control of vectors. Protection of the house and its surroundings might affect the transmission of several diseases. The most effective interventions should be prioritised when vector control programmes are designed; however, the quality of delivery (ie, coverage and reapplication) of interventions is a crucial factor to ensure their effectiveness. Additional randomised trials that assess the measures of human disease and eventually target several diseases with a combination of interventions that protect the household and its inhabitants against multiple vectors, are needed to inform global policy in this area.
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Affiliation(s)
- Olaf Horstick
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Silvia Runge-Ranzinger
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany; Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland.
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Koukounari A, Hollingsworth TD. A strengthening evidence-base for mass deworming, but questions remain. Lancet 2017; 389:231-233. [PMID: 27979384 DOI: 10.1016/s0140-6736(16)32452-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 11/07/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Artemis Koukounari
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
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Runge-Ranzinger S, Kroeger A, Olliaro P, McCall PJ, Sánchez Tejeda G, Lloyd LS, Hakim L, Bowman LR, Horstick O, Coelho G. Dengue Contingency Planning: From Research to Policy and Practice. PLoS Negl Trop Dis 2016; 10:e0004916. [PMID: 27653786 PMCID: PMC5031449 DOI: 10.1371/journal.pntd.0004916] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 07/21/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Dengue is an increasingly incident disease across many parts of the world. In response, an evidence-based handbook to translate research into policy and practice was developed. This handbook facilitates contingency planning as well as the development and use of early warning and response systems for dengue fever epidemics, by identifying decision-making processes that contribute to the success or failure of dengue surveillance, as well as triggers that initiate effective responses to incipient outbreaks. METHODOLOGY/PRINCIPAL FINDINGS Available evidence was evaluated using a step-wise process that included systematic literature reviews, policymaker and stakeholder interviews, a study to assess dengue contingency planning and outbreak management in 10 countries, and a retrospective logistic regression analysis to identify alarm signals for an outbreak warning system using datasets from five dengue endemic countries. Best practices for managing a dengue outbreak are provided for key elements of a dengue contingency plan including timely contingency planning, the importance of a detailed, context-specific dengue contingency plan that clearly distinguishes between routine and outbreak interventions, surveillance systems for outbreak preparedness, outbreak definitions, alert algorithms, managerial capacity, vector control capacity, and clinical management of large caseloads. Additionally, a computer-assisted early warning system, which enables countries to identify and respond to context-specific variables that predict forthcoming dengue outbreaks, has been developed. CONCLUSIONS/SIGNIFICANCE Most countries do not have comprehensive, detailed contingency plans for dengue outbreaks. Countries tend to rely on intensified vector control as their outbreak response, with minimal focus on integrated management of clinical care, epidemiological, laboratory and vector surveillance, and risk communication. The Technical Handbook for Surveillance, Dengue Outbreak Prediction/ Detection and Outbreak Response seeks to provide countries with evidence-based best practices to justify the declaration of an outbreak and the mobilization of the resources required to implement an effective dengue contingency plan.
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Affiliation(s)
- Silvia Runge-Ranzinger
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
- Special Programme for Research and Training WHO-TDR, Geneva, Switzerland
| | - Axel Kroeger
- Special Programme for Research and Training WHO-TDR, Geneva, Switzerland
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Piero Olliaro
- Special Programme for Research and Training WHO-TDR, Geneva, Switzerland
| | - Philip J. McCall
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Linda S. Lloyd
- Public Health Consultant, San Diego, California, United States of America
| | | | - Leigh R. Bowman
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Olaf Horstick
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
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Owusu-Addo E, Cross R, Sarfo-Mensah P. Evidence-based practice in local public health service in Ghana. CRITICAL PUBLIC HEALTH 2016. [DOI: 10.1080/09581596.2016.1182621] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Picado A, Ostyn B, Rijal S, Sundar S, Singh SP, Chappuis F, Das ML, Khanal B, Gidwani K, Hasker E, Dujardin JC, Vanlerberghe V, Menten J, Coosemans M, Boelaert M. Long-lasting insecticidal nets to prevent visceral leishmaniasis in the Indian subcontinent; methodological lessons learned from a cluster randomised controlled trial. PLoS Negl Trop Dis 2015; 9:e0003597. [PMID: 25856238 PMCID: PMC4391877 DOI: 10.1371/journal.pntd.0003597] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Albert Picado
- ISGlobal, Barcelona Center for International Health Research (CRESIB), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Bart Ostyn
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Suman Rijal
- Department of Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Shri Prakash Singh
- Department of Community Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Murari Lal Das
- Department of Microbiology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Basudha Khanal
- Department of Microbiology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Kamlesh Gidwani
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Epco Hasker
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jean Claude Dujardin
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Veerle Vanlerberghe
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Joris Menten
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marc Coosemans
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Marleen Boelaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- * E-mail:
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Abstract
Policy prescriptions for combating dengue fever tend to focus on addressing environmental and social conditions of poverty. However, while poverty has long been considered a determinant of dengue, the research evidence for such a relationship is not well established. Results of a systematic review of the research literature designed to identify and assess the current state of the empirical evidence for the dengue-poverty link reveal a mixed story. Of 260 peer-reviewed articles referencing dengue-poverty relationships, only 12 English-language studies empirically assessed these relationships. Our analysis covering various social and economic conditions of poverty showed no clear associations with dengue rates. While nine of the 12 studies demonstrated some positive associations between measures of dengue and poverty (measured inconsistently through income, education, structural housing condition, overcrowding, and socioeconomic status), nine also presented null results and five with negative results. Of the five studies relating to access to water and sanitation, four reported null associations. Income and physical housing conditions were more consistently correlated with dengue outcomes than other poverty indicators. The small size of this sample, and the heterogeneity of measures and scales used to capture conditions of poverty, make it difficult to assess the strength and consistency of associations between various poverty indicators and dengue outcomes. At present, the global body of eligible English-language peer-reviewed literature investigating dengue-poverty relationships is too small to support a definitive relationship. We conclude that more research, particularly using standardized measures of both outcomes and indicators, is needed to support evidence-informed policies and approaches.
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Bardosh K. Global aspirations, local realities: the role of social science research in controlling neglected tropical diseases. Infect Dis Poverty 2014; 3:35. [PMID: 25320672 PMCID: PMC4197218 DOI: 10.1186/2049-9957-3-35] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 09/16/2014] [Indexed: 11/23/2022] Open
Abstract
Neglected Tropical Diseases (NTDs) are both drivers and manifestations of poverty and social inequality. Increased advocacy efforts since the mid-2000s have led to ambitious new control and elimination targets set for 2020 by the World Health Organisation. While these global aspirations represent significant policy momentum, there are multifaceted challenges in controlling infectious diseases in resource-poor local contexts that need to be acknowledged, understood and engaged. However a number of recent publications have emphasised the “neglected” status of applied social science research on NTDs. In light of the 2020 targets, this paper explores the social science/NTD literature and unpacks some of the ways in which social inquiry can help support effective and sustainable interventions. Five priority areas are discussed, including on policy processes, health systems capacity, compliance and resistance to interventions, education and behaviour change, and community participation. The paper shows that despite the multifaceted value of having anthropological and sociological perspectives integrated into NTD programmes, contemporary efforts underutilise this potential. This is reflective of the dominance of top-down information flows and technocratic approaches in global health. To counter this tendency, social research needs to be more than an afterthought; integrating social inquiry into the planning, monitoring and evaluating process will help ensure that flexibility and adaptability to local realities are built into interventions. More emphasis on social science perspectives can also help link NTD control to broader social determinants of health, especially important given the major social and economic inequalities that continue to underpin transmission in endemic countries.
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Affiliation(s)
- Kevin Bardosh
- Centre of African Studies, School of Social and Political Science, College of Humanities and Social Science, The University of Edinburgh, 58 George Square, Edinburgh, EH8 9LD UK ; Division of Pathway Medicine and Centre for Infectious Diseases, School of Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB UK
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Yang GJ, Liu L, Zhu HR, Griffiths SM, Tanner M, Bergquist R, Utzinger J, Zhou XN. China's sustained drive to eliminate neglected tropical diseases. THE LANCET. INFECTIOUS DISEASES 2014; 14:881-92. [DOI: 10.1016/s1473-3099(14)70727-3] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Effect of deworming on physical fitness of school-aged children in Yunnan, China: a double-blind, randomized, placebo-controlled trial. PLoS Negl Trop Dis 2014; 8:e2983. [PMID: 25010608 PMCID: PMC4091871 DOI: 10.1371/journal.pntd.0002983] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 05/14/2014] [Indexed: 11/19/2022] Open
Abstract
Background There is considerable debate on the health impacts of soil-transmitted helminth infections. We assessed effects of deworming on physical fitness and strength of children in an area in Yunnan, People's Republic of China, where soil-transmitted helminthiasis is highly endemic. Methodology The double-blind, randomized, placebo-controlled trial was conducted between October 2011 and May 2012. Children, aged 9–12 years, were treated with either triple-dose albendazole or placebo, and monitored for 6 months post-treatment. The Kato-Katz and Baermann techniques were used for the diagnosis of soil-transmitted helminth infections. Physical fitness was assessed with a 20-m shuttle run test, where the maximum aerobic capacity within 1 min of exhaustive exercise (VO2 max estimate) and the number of 20-m laps completed were recorded. Physical strength was determined with grip strength and standing broad jump tests. Body height and weight, the sum of skinfolds, and hemoglobin levels were recorded as secondary outcomes. Principal Findings Children receiving triple-dose albendazole scored slightly higher in the primary and secondary outcomes than placebo recipients, but the difference lacked statistical significance. Trichuris trichiura-infected children had 1.6 ml kg−1 min−1 (P = 0.02) less increase in their VO2 max estimate and completed 4.6 (P = 0.04) fewer 20-m laps than at baseline compared to non-infected peers. Similar trends were detected in the VO2 max estimate and grip strength of children infected with hookworm and Ascaris lumbricoides, respectively. In addition, the increase in the VO2 max estimate from baseline was consistently higher in children with low-intensity T. trichiura and hookworm infections than in their peers with high-intensity infections of all soil-transmitted helminths (range: 1.9–2.1 ml kg−1 min−1; all P<0.05). Conclusions/Significance We found no strong evidence for significant improvements in physical fitness and anthropometric indicators due to deworming over a 6-month follow-up period. However, the negative effect of T. trichiura infections on physical fitness warrants further investigation. Children from the developing world are often burdened with intestinal worms due to poor water supply, sanitation, and hygiene. However, the assessment of the burden due to intestinal worms is difficult, and thus, the benefits of deworming are unclear. In this study, we determined the effect of deworming on the physical fitness and strength of 9- to 12-year-old children in Yunnan, China, where intestinal worms are common. Children were treated with triple-dose albendazole or placebo and monitored over a 6-month period. Stool samples were collected for the diagnosis of intestinal worm infections. Physical fitness was estimated with a 20-m shuttle run test and physical strength was assessed with grip strength and standing broad jump tests. Children receiving triple-dose albendazole scored slightly higher values in the primary and secondary outcomes than those children who were given placebo. However, the differences were not significant. We also found that children infected with intestinal worms performed significantly worse in the physical fitness and strength tests than their non-infected counterparts. In particular, the negative impact of whipworm infection on physical fitness warrants further investigation.
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Hawdon JM. Controlling Soil-Transmitted Helminths: Time to Think Inside the Box? J Parasitol 2014; 100:166-88. [DOI: 10.1645/13-412.1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Strunz EC, Addiss DG, Stocks ME, Ogden S, Utzinger J, Freeman MC. Water, sanitation, hygiene, and soil-transmitted helminth infection: a systematic review and meta-analysis. PLoS Med 2014; 11:e1001620. [PMID: 24667810 PMCID: PMC3965411 DOI: 10.1371/journal.pmed.1001620] [Citation(s) in RCA: 427] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 02/13/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Preventive chemotherapy represents a powerful but short-term control strategy for soil-transmitted helminthiasis. Since humans are often re-infected rapidly, long-term solutions require improvements in water, sanitation, and hygiene (WASH). The purpose of this study was to quantitatively summarize the relationship between WASH access or practices and soil-transmitted helminth (STH) infection. METHODS AND FINDINGS We conducted a systematic review and meta-analysis to examine the associations of improved WASH on infection with STH (Ascaris lumbricoides, Trichuris trichiura, hookworm [Ancylostoma duodenale and Necator americanus], and Strongyloides stercoralis). PubMed, Embase, Web of Science, and LILACS were searched from inception to October 28, 2013 with no language restrictions. Studies were eligible for inclusion if they provided an estimate for the effect of WASH access or practices on STH infection. We assessed the quality of published studies with the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. A total of 94 studies met our eligibility criteria; five were randomized controlled trials, whilst most others were cross-sectional studies. We used random-effects meta-analyses and analyzed only adjusted estimates to help account for heterogeneity and potential confounding respectively. Use of treated water was associated with lower odds of STH infection (odds ratio [OR] 0.46, 95% CI 0.36-0.60). Piped water access was associated with lower odds of A. lumbricoides (OR 0.40, 95% CI 0.39-0.41) and T. trichiura infection (OR 0.57, 95% CI 0.45-0.72), but not any STH infection (OR 0.93, 95% CI 0.28-3.11). Access to sanitation was associated with decreased likelihood of infection with any STH (OR 0.66, 95% CI 0.57-0.76), T. trichiura (OR 0.61, 95% CI 0.50-0.74), and A. lumbricoides (OR 0.62, 95% CI 0.44-0.88), but not with hookworm infection (OR 0.80, 95% CI 0.61-1.06). Wearing shoes was associated with reduced odds of hookworm infection (OR 0.29, 95% CI 0.18-0.47) and infection with any STH (OR 0.30, 95% CI 0.11-0.83). Handwashing, both before eating (OR 0.38, 95% CI 0.26-0.55) and after defecating (OR 0.45, 95% CI 0.35-0.58), was associated with lower odds of A. lumbricoides infection. Soap use or availability was significantly associated with lower infection with any STH (OR 0.53, 95% CI 0.29-0.98), as was handwashing after defecation (OR 0.47, 95% CI 0.24-0.90). Observational evidence constituted the majority of included literature, which limits any attempt to make causal inferences. Due to underlying heterogeneity across observational studies, the meta-analysis results reflect an average of many potentially distinct effects, not an average of one specific exposure-outcome relationship. CONCLUSIONS WASH access and practices are generally associated with reduced odds of STH infection. Pooled estimates from all meta-analyses, except for two, indicated at least a 33% reduction in odds of infection associated with individual WASH practices or access. Although most WASH interventions for STH have focused on sanitation, access to water and hygiene also appear to significantly reduce odds of infection. Overall quality of evidence was low due to the preponderance of observational studies, though recent randomized controlled trials have further underscored the benefit of handwashing interventions. Limited use of the Joint Monitoring Program's standardized water and sanitation definitions in the literature restricted efforts to generalize across studies. While further research is warranted to determine the magnitude of benefit from WASH interventions for STH control, these results call for multi-sectoral, integrated intervention packages that are tailored to social-ecological contexts.
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Affiliation(s)
- Eric C. Strunz
- Children Without Worms, The Task Force for Global Health, Decatur, Georgia, United States of America
| | - David G. Addiss
- Children Without Worms, The Task Force for Global Health, Decatur, Georgia, United States of America
| | - Meredith E. Stocks
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Stephanie Ogden
- Children Without Worms, The Task Force for Global Health, Decatur, Georgia, United States of America
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- International Trachoma Initiative, The Task Force for Global Health, Decatur, Georgia, United States of America
| | - Jürg Utzinger
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Matthew C. Freeman
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
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Montresor A, Gabrielli AF, Engels D, Daumerie D, Savioli L. Has the NTD community neglected evidence-based policy? PLOS NTDs 2013 expert commentary of the viewpoint by Nagpal S, Sinclair D, Garner P. PLoS Negl Trop Dis 2013; 7:e2299. [PMID: 23875037 PMCID: PMC3708845 DOI: 10.1371/journal.pntd.0002299] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Antonio Montresor
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland.
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