title: The epidemiology of soil-transmitted helminths in Bihar State, India.
abstract: BACKGROUND
  Soil-transmitted helminths (STHs) infect over a billion individuals worldwide. In India, 241 million children are estimated to need deworming to avert the negative consequences STH infections can have on child health and development. In February-April 2011, 17 million children in Bihar State were dewormed during a government-led school-based deworming campaign. Prior to programme implementation, a study was conducted to assess STH prevalence in the school-age population to direct the programme. The study also investigated risk factors for STH infections, including caste, literacy, and defecation and hygiene practices, in order to inform the development of complementary interventions.
  
  
  METHODS
  A cross-sectional survey was conducted among children in 20 schools in Bihar. In addition to providing stool samples for identification of STH infections, children completed a short questionnaire detailing their usual defecation and hand-hygiene practices. Risk factors for STH infections were explored.
  
  
  RESULTS
  In January-February 2011, 1279 school children aged four to seventeen provided stool samples and 1157 children also completed the questionnaire. Overall, 68% of children (10-86% across schools) were infected with one or more soil-transmitted helminth species. The prevalence of ascariasis, hookworm and trichuriasis was 52%, 42% and 5% respectively. The majority of children (95%) practiced open defecation and reported most frequently cleansing hands with soil (61%). Increasing age, lack of maternal literacy and certain castes were independently associated with hookworm infection. Absence of a hand-washing station at the schools was also independently associated with A. lumbricoides infection.
  
  
  CONCLUSIONS
  STH prevalence in Bihar is high, and justifies mass deworming in school-aged children. Open defecation is common-place and hands are often cleansed using soil. The findings reported here can be used to help direct messaging appropriate to mothers with low levels of literacy and emphasise the importance of water and sanitation in the control of helminths and other diseases.
authors.affiliation: Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Katie
authors.initials: K
authors.lastname: Greenland
authors.affiliation: Partnership for Child Development, Imperial College, London, United Kingdom; Deworm the World, Washington, D.C., United States of America.
authors.forename: Ruth
authors.initials: R
authors.lastname: Dixon
authors.affiliation: Patna University, Bihar, India.
authors.forename: Shabbir Ali
authors.initials: SA
authors.lastname: Khan
authors.affiliation: Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Parasitology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka.
authors.forename: Kithsiri
authors.initials: K
authors.lastname: Gunawardena
authors.affiliation: Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
authors.forename: Jimmy H
authors.initials: JH
authors.lastname: Kihara
authors.affiliation: Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Smith
authors.affiliation: Partnership for Child Development, Imperial College, London, United Kingdom; Deworm the World, Washington, D.C., United States of America; London Centre for Neglected Tropical Disease Research, Imperial College London, School of Public Health, Faculty of Medicine, Norfolk Place, London, United Kingdom.
authors.forename: Lesley
authors.initials: L
authors.lastname: Drake
authors.affiliation: Partnership for Child Development, Imperial College, London, United Kingdom; Deworm the World, Washington, D.C., United States of America.
authors.forename: Prerna
authors.initials: P
authors.lastname: Makkar
authors.affiliation: Deworm the World, Washington, D.C., United States of America.
authors.forename: Sri
authors.initials: S
authors.lastname: Raman
authors.affiliation: Division of Clinical Microbiology & Molecular Medicine, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sarman
authors.initials: S
authors.lastname: Singh
authors.affiliation: Secretary Health-cum- Executive Director State Health Society, Bihar, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006373:Helminthiasis / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D006920:Hygiene; D007194:India / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012987:Soil / Q000469:parasitology*
chemical_list: D012987:Soil