Integration of water, sanitation, and hygiene for the prevention and control of neglected tropical diseases: a rationale for inter-sectoral collaboration.

Improvements of water, sanitation, and hygiene (WASH) infrastructure and appropriate health-seeking behavior are necessary for achieving sustained control, elimination, or eradication of many neglected tropical diseases (NTDs). Indeed, the global strategies to fight NTDs include provision of WASH, but few programs have specific WASH targets and approaches. Collaboration between disease control programs and stakeholders in WASH is a critical next step. A group of stakeholders from the NTD control, child health, and WASH sectors convened in late 2012 to discuss opportunities for, and barriers to, collaboration. The group agreed on a common vision, namely "Disease-free communities that have adequate and equitable access to water and sanitation, and that practice good hygiene." Four key areas of collaboration were identified, including (i) advocacy, policy, and communication; (ii) capacity building and training; (iii) mapping, data collection, and monitoring; and (iv) research. We discuss strategic opportunities and ways forward for enhanced collaboration between the WASH and the NTD sectors

Major Surface Glycoproteins of Insect Forms of Trypanosoma brucei Are Not Essential for Cyclical Transmission by Tsetse

Procyclic forms of Trypanosoma brucei reside in the midgut of tsetse flies where they are covered by several million copies of glycosylphosphatidylinositol-anchored proteins known as procyclins. It has been proposed that procyclins protect parasites against proteases and/or participate in tropism, directing them from the midgut to the salivary glands. There are four different procyclin genes, each subject to elaborate levels of regulation. To determine if procyclins are essential for survival and transmission of T. brucei, all four genes were deleted and parasite fitness was compared in vitro and in vivo. When co-cultured in vitro, the null mutant and wild type trypanosomes (tagged with cyan fluorescent protein) maintained a near-constant equilibrium. In contrast, when flies were infected with the same mixture, the null mutant was rapidly overgrown in the midgut, reflecting a reduction in fitness in vivo. Although the null mutant is patently defective in competition with procyclin-positive parasites, on its own it can complete the life cycle and generate infectious metacyclic forms. The procyclic form of T. brucei thus differs strikingly from the bloodstream form, which does not tolerate any perturbation of its variant surface glycoprotein coat, and from other parasites such as Plasmodium berghei, which requires the circumsporozoite protein for successful transmission to a new host

Effect of Sanitation on Soil-Transmitted Helminth Infection: Systematic Review and Meta-Analysis

A systematic review and meta-analysis by Kathrin Ziegelbauer and colleagues finds that sanitation is associated with a reduced risk of transmission of helminthiases to humans

Characteristics of studies examining the association of sanitation availability or sanitation use with soil-transmitted helminth infections, including quality assessment.

a<p>Data provided by author.</p><p>A.l., <i>Ascaris lumbricoides</i>; BM, Baermann (technique); Cal., calculated; DS, direct smear; FEC, formalin-ether concentration (technique); FES, formalin-ether sedimentation (technique); HH, household; H-M, Harada-Mori (technique); Hw, hookworm; KAP, Koga agar plate (technique); K-K, Kato-Katz (technique); Mod., modified; MVA, multivariate analysis; PAFS, polyvinyl alcohol fixative solution; PSc, pre-school children; n.s., not stated; RFEC, Ritchie's formalin-ether concentration (technique); Sc, schoolchildren; SS, stool sedimentation (technique); STH, soil-transmitted helminths; T-L, Teleman-Lima (technique); T.t., <i>Trichuris trichiura</i>; UVA, univariate analysis; ZSF, zinc sulfate flotation (technique).</p

Meta-analysis examining the association of sanitation facilities with hookworm infection.

<p>Data are presented separately for availability and use of sanitation. Rectangles indicate ORs, and sizes of the rectangles represent the weight given to each study in the meta-analysis; open diamonds and vertical dashed lines indicate combined ORs; and horizontal lines indicate 95% CIs. Data are presented separately for ^aonly pit latrine, ^bonly solar urine-diverting desiccating latrine, ^conly adults, ^donly children. N.A., not assessed.</p

Meta-analysis examining the association of sanitation facilities with <i>A. lumbricoides</i> infection.

<p>Data are presented separately for availability and use of sanitation. Rectangles indicate ORs, and sizes of the rectangles represent the weight given to each study in the meta-analysis; open diamonds and vertical dashed lines indicate combined ORs; and horizontal lines indicate 95% CIs. Data are presented separately for ^aonly pit latrine, ^bonly solar urine-diverting desiccating latrine, ^conly adults, ^donly children. N.A., not assessed.</p