title: The Interaction of Deworming, Improved Sanitation, and Household Flooring with Soil-Transmitted Helminth Infection in Rural Bangladesh.
abstract: BACKGROUND
  The combination of deworming and improved sanitation or hygiene may result in greater reductions in soil-transmitted helminth (STH) infection than any single intervention on its own. We measured STH prevalence in rural Bangladesh and assessed potential interactions among deworming, hygienic latrines, and household finished floors.
  
  
  METHODS
  We conducted a cross-sectional survey (n = 1,630) in 100 villages in rural Bangladesh to measure three exposures: self-reported deworming consumption in the past 6 months, access to a hygienic latrine, and household flooring material. We collected stool samples from children 1-4 years, 5-12 years, and women 15-49 years. We performed mini-FLOTAC on preserved stool samples to detect Ascaris lumbricoides, Enterobius vermicularis, hookworm, and Trichuris trichiura ova. Approximately one-third (32%) of all individuals and 40% of school-aged children had an STH infection. Less than 2% of the sample had moderate/heavy intensity infections. Deworming was associated with lower Ascaris prevalence (adjusted prevalence ratio (PR) = 0.53; 95% CI 0.40, 0.71), but there was no significant association with hookworm (PR = 0.93, 95% CI 0.60, 1.44) or Trichuris (PR = 0.90, 95% CI 0.74, 1.08). PRs for hygienic latrine access were 0.91 (95% CI 0.67,1.24), 0.73 (95% CI 0.43,1.24), and 1.03 (95% CI 0.84,1.27) for Ascaris, hookworm, and Trichuris, respectively. Finished floors were associated with lower Ascaris prevalence (PR = 0.56, 95% CI 0.32, 0.97) but not associated with hookworm (PR = 0.48 95% CI 0.16,1.45) or Trichuris (PR = 0.98, 95% CI 0.72,1.33). Across helminths and combinations of exposures, adjusted prevalence ratios for joint exposures were consistently more protective than those for individual exposures.
  
  
  CONCLUSIONS
  We found moderate STH prevalence in rural Bangladesh among children and women of childbearing age. This study is one of the first to examine independent and combined associations with deworming, sanitation, and hygiene. Our results suggest that coupling deworming with sanitation and flooring interventions may yield more sustained reductions in STH prevalence.
authors.affiliation: School of Public Health, University of California, Berkeley, Berkeley, California, United States of America.
authors.forename: Jade
authors.initials: J
authors.lastname: Benjamin-Chung
authors.affiliation: Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
authors.forename: Arifa
authors.initials: A
authors.lastname: Nazneen
authors.affiliation: Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
authors.forename: Amal K
authors.initials: AK
authors.lastname: Halder
authors.affiliation: Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
authors.forename: Rashidul
authors.initials: R
authors.lastname: Haque
authors.affiliation: Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Siddique
authors.affiliation: Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
authors.forename: Muhammed Salah
authors.initials: MS
authors.lastname: Uddin
authors.affiliation: Children Without Worms, Task Force for Global Health, Atlanta, Georgia, United States of America.
authors.forename: Kim
authors.initials: K
authors.lastname: Koporc
authors.affiliation: School of Public Health, University of California, Berkeley, Berkeley, California, United States of America.
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Arnold
authors.affiliation: School of Public Health, University of California, Berkeley, Berkeley, California, United States of America.
authors.forename: Alan E
authors.initials: AE
authors.lastname: Hubbard
authors.affiliation: Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
authors.forename: Leanne
authors.initials: L
authors.lastname: Unicomb
authors.affiliation: Department of Medicine, Stanford University, Stanford, California, United States of America.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Luby
authors.affiliation: Children Without Worms, Task Force for Global Health, Atlanta, Georgia, United States of America.
authors.forename: David G
authors.initials: DG
authors.lastname: Addiss
authors.affiliation: School of Public Health, University of California, Berkeley, Berkeley, California, United States of America.
authors.forename: John M
authors.initials: JM
authors.lastname: Colford
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D000871:Anthelmintics / Q000627:therapeutic use*; D001459:Bangladesh / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005243:Feces / Q000469:parasitology; D005260:Female; D006373:Helminthiasis / Q000188:drug therapy* / Q000453:epidemiology* / Q000635:transmission; D006376:Helminths / Q000145:classification / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D007411:Intestinal Diseases, Parasitic / Q000188:drug therapy* / Q000453:epidemiology* / Q000635:transmission; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population; D012499:Sanitation / Q000379:methods*; D055815:Young Adult
chemical_list: D000871:Anthelmintics