title: Controlling soil-transmitted helminths: time to think inside the box?
abstract: Soil-transmitted helminths (STH) refer to several parasitic nematode species that infect over 1 billion people worldwide. Infections with Ascaris lumbricoides , Trichuris trichiura , and the hookworms Necator americanus and Ancylostoma duodenale cause significant morbidity in more than 450 million people, primarily children and pregnant women, resulting in over 39 million disability-adjusted life years lost. Considerable effort and resources have been, and continue to be, spent on top-down, medical-based programs to control STH infections, with little success. This review discusses the problems with these methods and proposes a new emphasis on sustainable, long-term investments in sanitation-based approaches using improved latrines (the "box") to provide bottom-up, culturally appropriate, and economically desirable solutions to STH control in endemic areas. One such approach is the use of biogas technology. Waste undergoes fermentation in specially designed septic systems, generating a methane gas mixture ("biogas") that can be burned to augment or replace household energy needs such as cooking and light generation. Also, the effluent from the fermentation chamber provides a high quality, nitrogen rich fertilizer. Using China as an example, the use of biogas technology as a solution to rural sanitation and energy problems is described, and its advantages over current strategies of mass drug administration and vaccination for STH control are highlighted.
authors.affiliation: The George Washington University Medical Center, 517 Ross Hall, 2300 I St. NW, Washington D.C. 20037.
authors.forename: John M
authors.initials: JM
authors.lastname: Hawdon
mesh_terms: D000818:Animals; D000871:Anthelmintics / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use; D056804:Biofuels; D004195:Disease Models, Animal; D004351:Drug Resistance; D006801:Humans; D009349:Nematode Infections / Q000188:drug therapy / Q000517:prevention & control* / Q000635:transmission; D012499:Sanitation / Q000379:methods* / Q000592:standards; D012987:Soil / Q000469:parasitology*; D014038:Toilet Facilities / Q000191:economics / Q000592:standards*; D014612:Vaccines / Q000191:economics / Q000592:standards
chemical_list: D000871:Anthelmintics; D056804:Biofuels; D012987:Soil; D014612:Vaccines