title: Effect of Poor Access to Water and Sanitation As Risk Factors for Soil-Transmitted Helminth Infection: Selectiveness by the Infective Route.
abstract: BACKGROUND
  Soil-transmitted helminth (STH) infections are a public health problem in resource-limited settings worldwide. Chronic STH infection impairs optimum learning and productivity, contributing to the perpetuation of the poverty-disease cycle. Regular massive drug administration (MDA) is the cardinal recommendation for its control; along with water, sanitation and hygiene (WASH) interventions. The impact of joint WASH interventions on STH infections has been reported; studies on the independent effect of WASH components are needed to contribute with the improvement of current recommendations for the control of STH. The aim of this study is to assess the association of lacking access to water and sanitation with STH infections, taking into account the differences in route of infection among species and the availability of adequate water and sanitation at home.
  
  
  RESULTS
  Cross-sectional study, conducted in Salta province, Argentina. During a deworming program that enrolled 6957 individuals; 771 were randomly selected for stool/serum sampling for parasitological and serological diagnosis of STH. Bivariate stratified analysis was performed to explore significant correlations between risk factors and STH infections grouped by mechanism of entry as skin-penetrators (hookworms and Strongyloides stercoralis) vs. orally-ingested (Ascaris lumbricoides and Trichuris trichiura). After controlling for potential confounders, unimproved sanitation was significantly associated with increased odds of infection of skin-penetrators (adjusted odds ratio [aOR] = 3.9; 95% CI: 2.6-5.9). Unimproved drinking water was significantly associated with increased odds of infection of orally-ingested (aOR = 2.2; 95% CI: 1.3-3.7).
  
  
  CONCLUSIONS
  Lack of safe water and proper sanitation pose a risk of STH infections that is distinct according to the route of entry to the human host used by each of the STH species. Interventions aimed to improve water and sanitation access should be highlighted in the recommendations for the control of STH.
authors.affiliation: Instituto de Investigaciones en Enfermedades Tropicales (IIET), Universidad Nacional de Salta-Sede Regional Orán, San Ramón de la Nueva Orán, Salta, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.
authors.forename: Adriana
authors.initials: A
authors.lastname: Echazú
authors.affiliation: Dirección Nacional de Prevención de Enfermedades y Riesgos, Ministerio de Salud de la Nación, Buenos Aires, Argentina.
authors.forename: Daniela
authors.initials: D
authors.lastname: Bonanno
authors.affiliation: Instituto de Investigaciones en Enfermedades Tropicales (IIET), Universidad Nacional de Salta-Sede Regional Orán, San Ramón de la Nueva Orán, Salta, Argentina; Fundación Mundo Sano, Buenos Aires, Argentina.
authors.forename: Marisa
authors.initials: M
authors.lastname: Juarez
authors.affiliation: Instituto de Investigaciones en Enfermedades Tropicales (IIET), Universidad Nacional de Salta-Sede Regional Orán, San Ramón de la Nueva Orán, Salta, Argentina.
authors.forename: Silvana P
authors.initials: SP
authors.lastname: Cajal
authors.affiliation: Hospital Juan Domingo Perón, Tartagal, Salta, Argentina.
authors.forename: Viviana
authors.initials: V
authors.lastname: Heredia
authors.affiliation: Hospital Juan Domingo Perón, Tartagal, Salta, Argentina.
authors.forename: Silvia
authors.initials: S
authors.lastname: Caropresi
authors.affiliation: Instituto de Investigaciones en Enfermedades Tropicales (IIET), Universidad Nacional de Salta-Sede Regional Orán, San Ramón de la Nueva Orán, Salta, Argentina.
authors.forename: Ruben O
authors.initials: RO
authors.lastname: Cimino
authors.affiliation: Instituto de Investigaciones en Enfermedades Tropicales (IIET), Universidad Nacional de Salta-Sede Regional Orán, San Ramón de la Nueva Orán, Salta, Argentina.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Caro
authors.affiliation: Instituto de Investigaciones en Enfermedades Tropicales (IIET), Universidad Nacional de Salta-Sede Regional Orán, San Ramón de la Nueva Orán, Salta, Argentina.
authors.forename: Paola A
authors.initials: PA
authors.lastname: Vargas
authors.affiliation: Hospital Juan Domingo Perón, Tartagal, Salta, Argentina.
authors.forename: Gladys
authors.initials: G
authors.lastname: Paredes
authors.affiliation: Instituto de Investigaciones en Enfermedades Tropicales (IIET), Universidad Nacional de Salta-Sede Regional Orán, San Ramón de la Nueva Orán, Salta, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.
authors.forename: Alejandro J
authors.initials: AJ
authors.lastname: Krolewiecki
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D001118:Argentina / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005243:Feces / Q000469:parasitology; D006801:Humans; D006920:Hygiene; D008297:Male; D009349:Nematode Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission; D012307:Risk Factors; D012499:Sanitation; D014867:Water / Q000469:parasitology*; D014881:Water Supply; D055815:Young Adult
chemical_list: D014867:Water