title: Associations between school- and household-level water, sanitation and hygiene conditions and soil-transmitted helminth infection among Kenyan school children.
abstract: BACKGROUND
  Soil-transmitted helminths, a class of parasitic intestinal worms, are pervasive in many low-income settings. Infection among children can lead to poor nutritional outcomes, anaemia, and reduced cognition. Mass treatment, typically administered through schools, with yearly or biannual drugs is inexpensive and can reduce worm burden, but reinfection can occur rapidly. Access to and use of sanitation facilities and proper hygiene can reduce infection, but rigorous data are scarce. Among school-age children, infection can occur at home or at school, but little is known about the relative importance of WASH in transmission in these two settings.
  
  
  METHODS
  We explored the relationships between school and household water, sanitation, and hygiene conditions and behaviours during the baseline of a large-scale mass drug administration programme in Kenya. We assessed several WASH measures to quantify the exposure of school children, and developed theory and empirically-based parsimonious models.
  
  
  RESULTS
  Results suggest mixed impacts of household and school WASH on prevalence and intensity of infection. WASH risk factors differed across individual worm species, which is expected given the different mechanisms of infection.
  
  
  CONCLUSIONS
  No trend of the relative importance of school versus household-level WASH emerged, though some factors, like water supply were more strongly related to lower infection, which suggests it is important in supporting other school practices, such as hand-washing and keeping school toilets clean.
authors.affiliation: Department of Environmental Health, Emory University, Atlanta, Georgia, USA. matthew.freeman@emory.edu.
authors.forename: M C
authors.initials: MC
authors.lastname: Freeman
authors.affiliation: Department of Environmental Health, Emory University, Atlanta, Georgia, USA. achard@emory.edu.
authors.forename: A N
authors.initials: AN
authors.lastname: Chard
authors.affiliation: Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK. birgit.nikolay@lshtm.ac.uk.
authors.forename: B
authors.initials: B
authors.lastname: Nikolay
authors.affiliation: Department of Environmental Health, Emory University, Atlanta, Georgia, USA. jgarn@emory.edu.
authors.forename: J V
authors.initials: JV
authors.lastname: Garn
authors.affiliation: Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya. collinsomondiokoyo@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Okoyo
authors.affiliation: Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya. jimmykihara09@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Kihara
authors.affiliation: Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya. SNjenga@kemri.org.
authors.forename: S M
authors.initials: SM
authors.lastname: Njenga
authors.affiliation: Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK. Rachel.Pullan@lshtm.ac.uk.
authors.forename: R L
authors.initials: RL
authors.lastname: Pullan
authors.affiliation: Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK. Simon.Brooker@lshtm.ac.uk.
authors.forename: S J
authors.initials: SJ
authors.lastname: Brooker
authors.affiliation: Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya. CMwandawiro@kemri.org.
authors.forename: C S
authors.initials: CS
authors.lastname: Mwandawiro
mesh_terms: D002648:Child; D005191:Family Characteristics; D006373:Helminthiasis / Q000453:epidemiology / Q000469:parasitology*; D006801:Humans; D006920:Hygiene; D007630:Kenya / Q000453:epidemiology; D016017:Odds Ratio; D012307:Risk Factors; D012499:Sanitation; D012574:Schools; D012987:Soil / Q000469:parasitology*; D060753:Water Quality
chemical_list: D012987:Soil