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

A Olsen

A Strina

A Toma

A Yajima

B Matthys

Benjamin Speich

BF Arnold

BH Singer

C Brocklehurst

CH King

CV Holland

CW Stiles

D Atkins

D Mara

D Stürchler

DA Grimes

DA Okun

Daniel Mäusezahl

DF Stroup

DJ Schliessmann

DT Trang

EA de Souza

EM Morales-Espinoza

F Arfaa

FF Carneiro

G Norman

GA Schad

GC Ilechukwu

GF Otto

GS Gunawardena

GT Jombo

H Nishiura

H Waddington

I Hagel

J Bartram

J Bethony

J Horton

J Keiser

J Utzinger

JA Basualdo

JA Scott

JA Sterne

Jennifer Keiser

JHJ Ensink

JM Spiegel

JR Stothard

Jürg Utzinger

Kathrin Ziegelbauer

L Fewtrell

LD Wang

LF Corrales

LK Kightlinger

LS Stephenson

M Boot

M Khalil

M Wördemann

MJ Burton

MS Al-Mekhlafi

MS Chan

N Katz

P Steinmann

P Torres

PH Nguyen

PJ Hotez

PR Hunter

R DerSimonian

RF Gloor

RG Hughes

RJ Traub

Robert Bos

S Belo

S Brooker

S Cairncross

S Knopp

SA Esrey

Simon Hales

SM Hartinger

SO Asaolu

TE Erlanger

TF Clasen

US Ugbomoiko

V Chongsuvivatwong

WW Cort

YA Raja'a

YD Sun

PLoS Medicine

English

PubMed

BACKGROUND: In countries of high endemicity of the soil-transmitted helminth parasites Ascaris lumbricoides, Trichuris trichiura, and hookworm, preventive chemotherapy (i.e., repeated administration of anthelmintic drugs to at-risk populations) is the main strategy to control morbidity. However, rapid reinfection of humans occurs after successful deworming, and therefore effective preventive measures are required to achieve public health goals with optimal efficiency and sustainability. METHODS AND FINDINGS: We conducted a systematic review and meta-analysis to assess the effect of sanitation (i.e., access and use of facilities for the safe disposal of human urine and feces) on infection with soil-transmitted helminths. PubMed, Embase, ISI Web of Science, and the World Health Organization Library Database were searched without language restrictions and year of publication (search performed until December 31, 2010). Bibliographies of identified articles were hand-searched. All types of studies reporting data on sanitation availability (i.e., having access at own household or living in close proximity to sanitation facility), or usage, and soil-transmitted helminth infections at the individual level were considered. Reported odds ratios (ORs) of the protective effect of sanitation on soil-transmitted helminth infections were extracted from the papers or calculated from reported numbers. The quality of published studies was assessed with a panel of criteria developed by the authors. Random effects meta-analyses were used to account for observed heterogeneity. Thirty-six publications, consisting of 39 datasets, met our inclusion criteria. Availability of sanitation facilities was associated with significant protection against infection with soil-transmitted helminths (OR = 0.46 to 0.58). Regarding the use of sanitation, ORs of 0.54 (95% confidence interval [CI] 0.28-1.02), 0.63 (95% CI 0.37-1.05), and 0.78 (95% CI 0.60-1.00) were determined for T. trichiura, hookworm, and A. lumbricoides, respectively. The overall ORs, combining sanitation availability and use, were 0.51 (95% CI 0.44-0.61) for the three soil-transmitted helminths combined, 0.54 (95% CI 0.43-0.69) for A. lumbricoides, 0.58 (95% CI 0.45-0.75) for T. trichiura, and 0.60 (95% CI 0.48-0.75) for hookworm. CONCLUSIONS: Despite a number of limitations (e.g., most studies used a cross-sectional design and were of low quality, with potential biases and considerable heterogeneity), our results reveal that sanitation is associated with a reduced risk of transmission of helminthiases to humans. Access to improved sanitation should be prioritized alongside preventive chemotherapy and health education to achieve a durable reduction of the burden of helminthiases. Please see later in the article for the Editors' Summar

Ziegelbauer, K.

Speich, B.

Mäusezahl, D.

Bos, R.

Keiser, J.

Utzinger, J.

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World Health Organization

Effect of sanitation on soil-transmitted helminth infection : systematic review and meta-analysis

BackgroundIn countries of high endemicity of the soil-transmitted helminth parasites Ascaris lumbricoides, Trichuris trichiura, and hookworm, preventive chemotherapy (i.e., repeated administration of anthelmintic drugs to at-risk populations) is the main strategy to control morbidity. However, rapid reinfection of humans occurs after successful deworming, and therefore effective preventive measures are required to achieve public health goals with optimal efficiency and sustainability.Methods and findingsWe conducted a systematic review and meta-analysis to assess the effect of sanitation (i.e., access and use of facilities for the safe disposal of human urine and feces) on infection with soil-transmitted helminths. PubMed, Embase, ISI Web of Science, and the World Health Organization Library Database were searched without language restrictions and year of publication (search performed until December 31, 2010). Bibliographies of identified articles were hand-searched. All types of studies reporting data on sanitation availability (i.e., having access at own household or living in close proximity to sanitation facility), or usage, and soil-transmitted helminth infections at the individual level were considered. Reported odds ratios (ORs) of the protective effect of sanitation on soil-transmitted helminth infections were extracted from the papers or calculated from reported numbers. The quality of published studies was assessed with a panel of criteria developed by the authors. Random effects meta-analyses were used to account for observed heterogeneity. Thirty-six publications, consisting of 39 datasets, met our inclusion criteria. Availability of sanitation facilities was associated with significant protection against infection with soil-transmitted helminths (OR  =  0.46 to 0.58). Regarding the use of sanitation, ORs of 0.54 (95% confidence interval [CI] 0.28-1.02), 0.63 (95% CI 0.37-1.05), and 0.78 (95% CI 0.60-1.00) were determined for T. trichiura, hookworm, and A. lumbricoides, respectively. The overall ORs, combining sanitation availability and use, were 0.51 (95% CI 0.44-0.61) for the three soil-transmitted helminths combined, 0.54 (95% CI 0.43-0.69) for A. lumbricoides, 0.58 (95% CI 0.45-0.75) for T. trichiura, and 0.60 (95% CI 0.48-0.75) for hookworm.ConclusionsDespite a number of limitations (e.g., most studies used a cross-sectional design and were of low quality, with potential biases and considerable heterogeneity), our results reveal that sanitation is associated with a reduced risk of transmission of helminthiases to humans. Access to improved sanitation should be prioritized alongside preventive chemotherapy and health education to achieve a durable reduction of the burden of helminthiases

Directory of Open Access Journals

Effect of sanitation on soil-transmitted helminth infection: systematic review and meta-analysis.

<div><h3>Background</h3><p>In countries of high endemicity of the soil-transmitted helminth parasites <em>Ascaris lumbricoides</em>, <em>Trichuris trichiura</em>, and hookworm, preventive chemotherapy (i.e., repeated administration of anthelmintic drugs to at-risk populations) is the main strategy to control morbidity. However, rapid reinfection of humans occurs after successful deworming, and therefore effective preventive measures are required to achieve public health goals with optimal efficiency and sustainability.</p> <h3>Methods and Findings</h3><p>We conducted a systematic review and meta-analysis to assess the effect of sanitation (i.e., access and use of facilities for the safe disposal of human urine and feces) on infection with soil-transmitted helminths. PubMed, Embase, ISI Web of Science, and the World Health Organization Library Database were searched without language restrictions and year of publication (search performed until December 31, 2010). Bibliographies of identified articles were hand-searched. All types of studies reporting data on sanitation availability (i.e., having access at own household or living in close proximity to sanitation facility), or usage, and soil-transmitted helminth infections at the individual level were considered. Reported odds ratios (ORs) of the protective effect of sanitation on soil-transmitted helminth infections were extracted from the papers or calculated from reported numbers. The quality of published studies was assessed with a panel of criteria developed by the authors. Random effects meta-analyses were used to account for observed heterogeneity. Thirty-six publications, consisting of 39 datasets, met our inclusion criteria. Availability of sanitation facilities was associated with significant protection against infection with soil-transmitted helminths (OR  =  0.46 to 0.58). Regarding the use of sanitation, ORs of 0.54 (95% confidence interval [CI] 0.28–1.02), 0.63 (95% CI 0.37–1.05), and 0.78 (95% CI 0.60–1.00) were determined for <em>T. trichiura</em>, hookworm, and <em>A. lumbricoides</em>, respectively. The overall ORs, combining sanitation availability and use, were 0.51 (95% CI 0.44–0.61) for the three soil-transmitted helminths combined, 0.54 (95% CI 0.43–0.69) for <em>A. lumbricoides</em>, 0.58 (95% CI 0.45–0.75) for <em>T. trichiura</em>, and 0.60 (95% CI 0.48–0.75) for hookworm.</p> <h3>Conclusions</h3><p>Despite a number of limitations (e.g., most studies used a cross-sectional design and were of low quality, with potential biases and considerable heterogeneity), our results reveal that sanitation is associated with a reduced risk of transmission of helminthiases to humans. Access to improved sanitation should be prioritized alongside preventive chemotherapy and health education to achieve a durable reduction of the burden of helminthiases.</p> <h3></h3><p> <em>Please see later in the article for the Editors' Summary</em></p> </div

Kathrin Ziegelbauer (188765)

Benjamin Speich (159922)

Daniel Mäusezahl (188769)

Robert Bos (188771)

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

http://edoc.unibas.ch/30026/1/20130711161331_51debd8b6eb08.pdf

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

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