Worrell Caitlin M, Wiegand Ryan E, Davis Stephanie M, Odero Kennedy O, Blackstock Anna, Cuéllar Victoria M, Njenga Sammy M, Montgomery Joel M, Roy Sharon L, Fox LeAnne M
Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya.
PLoS One. 2016 Mar 7;11(3):e0150744. doi: 10.1371/journal.pone.0150744. eCollection 2016.
Soil-transmitted helminth (STH) infections affect persons living in areas with poor water, sanitation, and hygiene (WASH). Preschool-aged children (PSAC) and school-aged children (SAC) are disproportionately affected by STH infections. We aimed to identify WASH factors associated with STH infection among PSAC and SAC in Kibera, Kenya. In 2012, households containing a PSAC or SAC were randomly selected from those enrolled in the International Emerging Infections Program, a population-based surveillance system. We administered a household questionnaire, conducted environmental assessments for WASH, and tested three stools from each child for STH eggs using the Kato-Katz method. WASH factors were evaluated for associations with STH infection using univariable and multivariable Poisson regression. Any-STH prevalence was 40.8% among 201 PSAC and 40.0% among 475 SAC enrolled. Using the Joint Monitoring Programme water and sanitation classifications, 1.5% of households reported piped water on premises versus 98.5% another improved water source; 1.3% reported improved sanitation facilities, while 81.7% used shared sanitation facilities, 13.9% had unimproved facilities, and 3.1% reported no facilities (open defecation). On univariable analysis, STH infection was significantly associated with a household toilet located off-premises (prevalence ratio (PR) = 1.33; p = 0.047), while always treating water (PR = 0.81; p = 0.04), covering drinking water containers (PR = 0.75; p = 0.02), using clean towels during hand drying (PR = 0.58; p<0.01), having finished household floor material (PR = 0.76; p<0.01), having electricity (PR = 0.70; p<0.01), and increasing household elevation in 10-meter increments (PR = 0.89; p<0.01) were protective against STH infection. On multivariable analysis, usually versus always treating water was associated with increased STH prevalence (adjusted prevalence ratio (aPR) = 1.52; p<0.01), while having finished household floor material (aPR = 0.76; p = 0.03), reported child deworming in the last year (aPR = 0.76; p<0.01), and 10-meter household elevation increases (aPR = 0.89; p<0.01) were protective against infection. The intersection between WASH and STH infection is complex; site-specific WASH interventions should be considered to sustain the gains made by deworming activities.
土壤传播的蠕虫（STH）感染影响生活在水、环境卫生和个人卫生（WASH）条件较差地区的人群。学龄前儿童（PSAC）和学龄儿童（SAC）受STH感染的影响尤为严重。我们旨在确定肯尼亚基贝拉PSAC和SAC中与STH感染相关的WASH因素。2012年，从参与国际新发感染项目（一个基于人群的监测系统）登记的家庭中随机抽取有PSAC或SAC的家庭。我们发放了家庭问卷，对WASH进行了环境评估，并使用加藤厚涂片法对每个儿童的三份粪便进行STH虫卵检测。使用单变量和多变量泊松回归评估WASH因素与STH感染的关联。在登记的201名PSAC中，任何STH感染率为40.8%，在475名SAC中为40.0%。根据联合监测计划的水和环境卫生分类，1.5%的家庭报告家中有自来水，而98.5%的家庭使用其他改善水源；1.3%的家庭报告有改善的卫生设施，而81.7%的家庭使用共享卫生设施，13.9%的家庭设施未改善，3.1%的家庭报告没有设施（露天排便）。在单变量分析中，STH感染与室外家庭厕所显著相关（患病率比（PR）=1.33；p = 0.047），而始终对水进行处理（PR = 0.81；p = 0.04）、覆盖饮用水容器（PR = 0.75；p = 0.02）、在擦干手时使用干净毛巾（PR = 0.58；p<0.01）、有完成的家庭地面材料（PR = 0.76；p<0.01）、有电（PR = 0.70；p<0.01）以及家庭海拔每增加10米（PR = 0.89；p<0.01）对STH感染有保护作用。在多变量分析中，通常对水进行处理与始终对水进行处理相比，STH患病率增加（调整患病率比（aPR）=1.52；p<0.01），而有完成的家庭地面材料（aPR = 0.76；p = 0.03）、报告去年对儿童进行过驱虫（aPR = 0.76；p<0.01）以及家庭海拔增加10米（aPR = 0.89；p<0.01）对感染有保护作用。WASH与STH感染之间的交叉情况很复杂；应考虑针对具体地点的WASH干预措施，以维持驱虫活动取得的成果。
