Effect of an integrated intervention package of preventive chemotherapy, community-led total sanitation and health education on the prevalence of helminth and intestinal protozoa infections in Côte d'Ivoire

Preventive chemotherapy with donated anthelminthic drugs is the cornerstone for the control of helminthiases. However, reinfection can occur rapidly in the absence of clean water and sanitation coupled with unhygienic behaviour. The purpose of this study was to assess the effect of an integrated package of interventions, consisting of preventive chemotherapy, community-led total sanitation (CLTS) and health education, on the prevalence of helminth and intestinal protozoa infections and on participants' knowledge, attitude, practice and beliefs (KAPB) towards these diseases including water, sanitation and hygiene (WASH).; A cross-sectional survey was carried out in nine communities of south-central Côte d'Ivoire to assess people's infection with helminths and intestinal protozoa and KAPB. Subsequently, interventions were targeted to five communities, while the remaining communities served as control. The intervention encouraged latrine construction and an evaluation was done 6-7 months later to determine open defecation status of the respective communities. Anthelminthic treatment was provided to all community members. A follow-up cross-sectional survey was conducted approximately one year later, using the same procedures.; Overall, 810 people had complete baseline and follow-up data and were given anthelminthic treatment. The baseline prevalence of hookworm, Schistosoma haematobium, Trichuris trichiura, Schistosoma mansoni and Ascaris lumbricoides was 31.1%, 7.0%, 2.0%, 1.0% and 0.3%, respectively. Four of the five intervention communities were classified open-defecation free. For hookworm infection, we observed higher negative changes in terms of proportion of decrease (-0.10; 95% confidence interval (CI): - 0.16, -0.04) and higher egg reduction rate (64.9 vs 15.2%) when comparing intervention with control communities. For intestinal protozoa, prevalence reduction was higher in intervention compared to control communities (8.2 vs 2.6%) and WASH indicators and intervention outcomes associated with lower odds for infection at follow-up. The intervention significantly impacted on reported latrine use (before: 15.5%, after: 94.6%), open defecation in the community surroundings (before: 75.0%, after: 16.7%) and awareness for environmental contamination through open defecation (before: 20.4%, after: 52.2%).; An integrated package of interventions consisting of preventive chemotherapy, health education and CLTS reduces the prevalence of helminth and intestinal protozoa infection. Additional studies in other social-ecological settings are warranted to confirm our findings

Effects of hygiene and defecation behavior on helminths and intestinal protozoa infections in Taabo, Côte d'Ivoire

Effect of community-led total sanitation and hygiene education to reduce the transmission of helminthiases and intestinal protozoa infections

Significant associations between parasitic infections and household assets, hygiene, and defecation behavior.

<p>The study was carried out among 431 households in the Taabo health demographic surveillance system in south-central Côte d’Ivoire in July 2011. Logistic regression analysis was used with village level exchangeable random effects. Variables included as potential confounders were age groups (<5, 5–14, 15–24, 25–40, and >40 years), wealth quintiles and sex whenever age, sex, and socioeconomic status were significantly associated with a given parasitic infection.</p><p>No significant associations for <i>E. histolytica/E. dispar</i> and <i>G. intestinalis</i> with household assets, hygiene, and defecation behavior have been found after correction for potential confounders (sex, age group, or wealth quintile).</p>a<p><i>P</i>-value based on Wald test.</p

Helminth infection prevalence and intensity among 1,992 participants in Taabo, south-central Côte d’Ivoire, in July 2011.

<p>Infection intensities (mean egg count) were split into light, moderate, and heavy infections using WHO guidelines <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0065722#pone.0065722-WHO1" target="_blank">[10]</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0065722#pone.0065722-WHO2" target="_blank">[11]</a>.</p>a<p>Number of infected participants stratified by infection intensities (values in brackets as percentage, %).</p><p>n.d., not defined.</p

Age-prevalence curves of investigated parasites.

<p>The results of the intestinal protozoa and helminth infections arise from the baseline cross-sectional survey carried out in July 2011 among community members of two villages and seven hamlets in the Taabo health demographic and surveillance system, south-central Côte d’Ivoire. <i>Trichuris trichiura</i>, <i>Schistosoma mansoni</i> and <i>Ascaris lumbricoides</i> are not displayed due to very low prevalence.</p

Map of the study area in Taabo, situated in south-central Côte d’Ivoire.

<p>The study was carried out in two villages (Sahoua, Katchénou) and seven hamlets (1 = Beh N’Guessankro, 2 = Allah Thérèsekro, 3 = Yobouékro, 4 = Ouattafouékro, 5 = Kouadio Kouamékro, 6 = Boussoukro, 7 = Amani Kouadiokro) that are part of the Taabo health demographic surveillance system. Results presented here pertain to the baseline cross-sectional parasitological and questionnaire surveys conducted in July 2011.</p

Knowledge, attitude, practice, and beliefs related to hygiene behavior, latrine possession, and open defecation mentioned by the respondents.

<p>The study was carried out in the Taabo health demographic surveillance system in south-central Côte d’Ivoire in July 2011.</p>a<p>Proportion of categories reported spontaneously.</p>b<p>Mean prominence based on values assigned to each category (0 = not mentioned, 1 = probed, 2 = spontaneous).</p

Characteristics of the 431 households, participating in the knowledge, attitude, practice, and beliefs survey, stratified by wealth quintiles.

<p>The study was carried out in the Taabo health demographic surveillance system in south-central Côte d’Ivoire in July 2011. Questionnaires were conducted with the household chief if present; otherwise the next higher household member was interviewed.</p><p>Q1–Q3 stands for first quartile to third quartile, defining the interquartile range.</p

Defecation behavior assessed with the parameters place and frequency, stratified by the abundance of household-owned latrines.

<p>The study was carried out among 431 households in the Taabo health demographic surveillance system in south-central Côte d’Ivoire in July 2011.</p>a<p>Frequency of defecation (defecation frequency index) assessed on a semi-quantitative scale (0 = never, 1 = irregular, 2 = regular, 3 = often, 4 = always) for each place of defecation. Frequency is indicated as means (standard error in brackets).</p>b<p>P-value assessed with Wilcoxon rank-sum test.</p

Flow chart showing the study cohort and compliance with emphasis on the three different samples considered in the analysis.

<p>The study was carried out in the Taabo health demographic surveillance system in south-central Côte d’Ivoire in July 2011. The three sub-samples pertain to participants with complete parasitological data, households with complete questionnaire data, and participants with complete parasitological data from a household with complete questionnaire data.</p