title: Gender-based differences in water, sanitation and hygiene-related diarrheal disease and helminthic infections: a systematic review and meta-analysis.
abstract: BACKGROUND
  Qualitative evidence suggests that inadequate water, sanitation and hygiene (WASH) may affect diarrheal and helminthic infection in women disproportionately. We systematically searched PubMed in June 2014 (updated 2016) and the WHO website, for relevant articles.
  
  
  METHODS
  Articles dealing with the public health relevance of helminthic and diarrheal diseases, and highlighting the role of gender in WASH were included. Where possible, we carried out a meta-analysis.
  
  
  RESULTS
  In studies of individuals 5 years or older, cholera showed lower prevalence in males (OR 0.56; 95% CI 0.34-0.94), while Schistosoma mansoni (1.38; 95% CI 1.14-1.67), Schistosoma japonicum (1.52; 95% CI 1.13-2.05), hookworm (1.43; 95% CI 1.07-1.89) and all forms of infectious diarrhea (1.21; 95% CI 1.06-1.38) showed a higher prevalence in males. When studies included all participants, S. mansoni and S. japonicum showed higher prevalence with males (OR 1.40; 95% CI 1.27-1.55 and 1.84; 95% CI 1.27-2.67, respectively). Prevalence of Trichiuris and hookworm infection showed effect modification with continent.
  
  
  CONCLUSIONS
  Evidence of gender differences in infection may reflect differences in gender norms, suggesting that policy changes at the regional level may help ameliorate gender related disparities in helminthic and diarrheal disease prevalence.
authors.affiliation: Department of Biostatistics, Jiann-Ping Hsu College of Public Health, Georgia Southern University, GA, USA.
authors.forename: Varadan
authors.initials: V
authors.lastname: Sevilimedu
authors.affiliation: Department of Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, GA, USA.
authors.forename: Keisha D
authors.initials: KD
authors.lastname: Pressley
authors.affiliation: Department of Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, GA, USA.
authors.forename: Kassandra R
authors.initials: KR
authors.lastname: Snook
authors.affiliation: Department of Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, GA, USA.
authors.forename: Jamesa V
authors.initials: JV
authors.lastname: Hogges
authors.affiliation: Department of Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, GA, USA.|Department of Epidemiology, College of Public Health, University of Kentucky, KY, USA.
authors.forename: Maria D
authors.initials: MD
authors.lastname: Politis
authors.affiliation: Department of Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, GA, USA.
authors.forename: Jessica K
authors.initials: JK
authors.lastname: Sexton
authors.affiliation: Department of Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, GA, USA.
authors.forename: Carmen H
authors.initials: CH
authors.lastname: Duke
authors.affiliation: Department of Community and Behavioral Health, College of Public Health, University of Iowa, IA, USA.
authors.forename: Blake A
authors.initials: BA
authors.lastname: Smith
authors.affiliation: Department of Epidemiology, College of Public Health, University of Iowa, IA, USA.
authors.forename: Lena C
authors.initials: LC
authors.lastname: Swander
authors.affiliation: Department of Occupational and Environmental Health, College of Public Health, University of Iowa, IA, USA.
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Baker
authors.affiliation: Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Vic, Australia.
authors.forename: Manoj
authors.initials: M
authors.lastname: Gambhir
authors.affiliation: Department of Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, GA, USA.
authors.forename: Isaac Chun-Hai
authors.initials: IC
authors.lastname: Fung
mesh_terms: D003967:Diarrhea / Q000469:parasitology; D005260:Female; D006373:Helminthiasis; D006801:Humans; D006920:Hygiene; D008297:Male; D012737:Sex Factors; D014881:Water Supply
keywords: Diarrhea; Gender; Helminths; Sanitation; Water