title: Risk of Intestinal Parasitic Infections in People with Different Exposures to Wastewater and Fecal Sludge in Kampala, Uganda: A Cross-Sectional Study.
abstract: BACKGROUND
  There are health risks associated with wastewater and fecal sludge management and use, but little is known about the magnitude, particularly in rapidly growing urban settings of low- and middle-income countries. We assessed the point-prevalence and risk factors of intestinal parasite infections in people with different exposures to wastewater and fecal sludge in Kampala, Uganda.
  
  
  METHODS
  A cross-sectional survey was carried out in September and October 2013, enrolling 915 adults from five distinct population groups: workers maintaining wastewater facilities; workers managing fecal sludge; urban farmers; slum dwellers at risk of flooding; and slum dwellers without risk of flooding. Stool samples were subjected to the Kato-Katz method and a formalin-ether concentration technique for the diagnosis of helminth and intestinal protozoa infections. A questionnaire was administered to determine self-reported signs and symptoms, and risk factors for intestinal parasite infections. Univariate and multivariate analyses, adjusted for sex, age, education, socioeconomic status, water, sanitation, and hygiene behaviors, were conducted to estimate the risk of infection with intestinal parasites and self-reported health outcomes, stratified by population group.
  
  
  RESULTS
  The highest point-prevalence of intestinal parasite infections was found in urban farmers (75.9%), whereas lowest point-prevalence was found in workers managing fecal sludge (35.8%). Hookworm was the predominant helminth species (27.8%). In urban farmers, the prevalence of Trichuris trichiura, Schistosoma mansoni, Ascaris lumbricoides, and Entamoeba histolytica/E. dispar was 15% and above. For all investigated parasites, we found significantly higher odds of infection among urban farmers compared to the other groups (adjusted odds ratios ranging between 1.6 and 12.9). In general, female participants had significantly lower odds of infection with soil-transmitted helminths and S. mansoni compared to males. Higher educational attainment was negatively associated with the risk of intestinal protozoa infections, while socioeconomic status did not emerge as a significant risk factor for any tested health outcome.
  
  
  CONCLUSIONS
  Urban farmers are particularly vulnerable to infections with soil-transmitted helminths, S. mansoni, and intestinal protozoa. Hence, our findings call for public health protection measures for urban farmers and marginalized communities, going hand-in-hand with integrated sanitation safety planning at city level.
authors.affiliation: Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors.forename: Samuel
authors.initials: S
authors.lastname: Fuhrimann
authors.affiliation: Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors.forename: Mirko S
authors.initials: MS
authors.lastname: Winkler
authors.affiliation: Schistosomiasis Control Initiative, Imperial College London, London, United Kingdom.
authors.forename: Narcis B
authors.initials: NB
authors.lastname: Kabatereine
authors.affiliation: Vector Control Division, Ministry of Health, Kampala, Uganda.
authors.forename: Edridah M
authors.initials: EM
authors.lastname: Tukahebwa
authors.affiliation: School of Public Health, Makerere University, Kampala, Uganda.
authors.forename: Abdulla A
authors.initials: AA
authors.lastname: Halage
authors.affiliation: School of Public Health, Makerere University, Kampala, Uganda.
authors.forename: Elizeus
authors.initials: E
authors.lastname: Rutebemberwa
authors.affiliation: Department of Public Health and Environment, World Health Organization, Geneva, Switzerland.
authors.forename: Kate
authors.initials: K
authors.lastname: Medlicott
authors.affiliation: Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Schindler
authors.affiliation: Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors.forename: Jürg
authors.initials: J
authors.lastname: Utzinger
authors.affiliation: Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors.forename: Guéladio
authors.initials: G
authors.lastname: Cissé
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D019411:Clinical Laboratory Techniques; D003430:Cross-Sectional Studies; D004781:Environmental Exposure; D005243:Feces / Q000469:parasitology; D005260:Female; D006801:Humans; D007411:Intestinal Diseases, Parasitic / Q000453:epidemiology*; D008853:Microscopy; D008875:Middle Aged; D016273:Occupational Exposure; D015995:Prevalence; D018570:Risk Assessment; D012722:Sewage / Q000469:parasitology*; D011795:Surveys and Questionnaires; D014454:Uganda / Q000453:epidemiology; D062065:Wastewater / Q000469:parasitology*; D055815:Young Adult
chemical_list: D012722:Sewage; D062065:Wastewater