title: School Water, Sanitation, and Hygiene, Soil-Transmitted Helminths, and Schistosomes: National Mapping in Ethiopia.
abstract: BACKGROUND
  It is thought that improving water, sanitation, and hygiene (WASH) might reduce the transmission of schistosomes and soil-transmitted helminths, owing to their life cycles. However, few large-scale studies have yet assessed the real extent of associations between WASH and these parasites.
  
  
  RESULTS
  In the 2013-2014 Ethiopian national mapping of infections with these parasites, school WASH was assessed alongside infection intensity in children, mostly between 10 and 15 years of age. Scores were constructed reflecting exposure to schistosomes arising from water collection for schools, from freshwater sources, and the adequacy of school sanitation and hygiene facilities. Kendall's τb was used to test the WASH scores against the school-level arithmetic mean intensity of infection with each parasite, in schools with at least one child positive for the parasite in question. WASH and parasitology data were available for 1,645 schools. More frequent collection of water for schools, from open freshwater sources was associated with statistically significantly higher Schistosoma mansoni infection intensity (Kendall's τb = 0.097, 95% confidence interval, CI: 0.011 to 0.18), better sanitation was associated with significantly lower Ascaris lumbricoides intensity (Kendall's τb = -0.067, 95% CI: -0.11 to -0.023) and borderline significant lower hookworm intensity (Kendall's τb = -0.039, 95% CI: -0.090 to 0.012, P = 0.067), and better hygiene was associated with significantly lower hookworm intensity (Kendall's τb = -0.076, 95% CI: -0.13 to -0.020). However, no significant differences were observed when comparing sanitation and infection with S. mansoni or Trichuris trichiura, or hygiene and infection with A. lumbricoides or T. trichiura.
  
  
  CONCLUSIONS
  Improving school WASH may reduce transmission of these parasites. However, different forms of WASH appear to have different effects on infection with the various parasites, with our analysis finding the strongest associations between water and S. mansoni, sanitation and A. lumbricoides, and hygiene and hookworm.
authors.affiliation: Department of Civil and Environmental Engineering, South Kensington Campus, Imperial College London, London, United Kingdom.
authors.forename: Jack E T
authors.initials: JE
authors.lastname: Grimes
authors.affiliation: Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
authors.forename: Gemechu
authors.initials: G
authors.lastname: Tadesse
authors.affiliation: Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
authors.forename: Kalkidan
authors.initials: K
authors.lastname: Mekete
authors.affiliation: Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
authors.forename: Yonas
authors.initials: Y
authors.lastname: Wuletaw
authors.affiliation: Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
authors.forename: Abeba
authors.initials: A
authors.lastname: Gebretsadik
authors.affiliation: Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College London, London, United Kingdom.
authors.forename: Michael D
authors.initials: MD
authors.lastname: French
authors.affiliation: Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College London, London, United Kingdom.
authors.forename: Wendy E
authors.initials: WE
authors.lastname: Harrison
authors.affiliation: Partnership for Child Development, Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College London, London, United Kingdom.
authors.forename: Lesley J
authors.initials: LJ
authors.lastname: Drake
authors.affiliation: Partnership for Child Development, Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College London, London, United Kingdom.
authors.forename: Iain A
authors.initials: IA
authors.lastname: Gardiner
authors.affiliation: Partnership for Child Development, Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College London, London, United Kingdom.
authors.forename: Elodie
authors.initials: E
authors.lastname: Yard
authors.affiliation: Department of Civil and Environmental Engineering, South Kensington Campus, Imperial College London, London, United Kingdom.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Templeton
mesh_terms: D000293:Adolescent; D000818:Animals; D002648:Child; D003140:Communicable Disease Control / Q000379:methods*; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D006302:Health Services Research; D006373:Helminthiasis / Q000453:epidemiology* / Q000517:prevention & control; D006376:Helminths / Q000145:classification / Q000302:isolation & purification*; D006801:Humans; D006920:Hygiene; D007411:Intestinal Diseases, Parasitic / Q000453:epidemiology* / Q000517:prevention & control; D008297:Male; D012499:Sanitation / Q000379:methods*; D012574:Schools; D014867:Water / Q000469:parasitology*
chemical_list: D014867:Water