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BMC Infectious Diseases Jul 2020Tuberculosis and intestinal parasites are mostly affecting poor people. They are in a vicious since one is the risk factor for the other. However, the comprehensive... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Tuberculosis and intestinal parasites are mostly affecting poor people. They are in a vicious since one is the risk factor for the other. However, the comprehensive report on the burden and co-incidence of intestinal parasites and tuberculosis in Ethiopia is scant. This systematic review and meta-analysis aimed to provide abridge conclusive evidence on the intestinal parasite-tuberculosis co-infection in Ethiopia.
METHODS
A total of 414 articles published in English were searched from both electronic databases (CINAHL, DOAJ, Embase, Emcare, Medline, ProQuest, and PubMed, Science Direct, and Web of Science) and other sources. The qualities of the included studies were assessed using the Joanna Briggs Institute Critical Appraisal tools and the publication bias was measured using the funnel plot and Eggers regression test. Comprehensive meta-analysis (CMA) Version 3.3.07 and Review Manager software were used to estimate pooled prevalence and associations of intestinal parasites and tuberculosis infection.
RESULTS
Eleven articles with a total of 3158 tuberculosis patients included in the analysis based on the eligibility criteria. The estimated pooled prevalence of intestinal parasites co-infection was 33% (95% CI: 23.3, 44.3) using the random-effects model. The most common intestinal parasites were Ascaris lumbricoides 10.5% (95% CI: 6.0, 17.5), Hookworm 9.5% (95% CI: 6.10, 14.4), Giardia lamblia 5.7% (95% CI: 2.90, 10.9) and Strongyloides sterocoralis 5.6% (95% CI: 3.3, 9.5). The odds of intestinal parasites infection was higher among tuberculosis patients compared to tuberculosis free individuals (OR = 1.76; 95% CI: 1.17, 2.63). A significant difference was observed among TB patients for infection with intestinal helminths (OR = 2.01; 95% CI: 1.07, 3.80) but not for intestinal protozoans when compared with their counterparts. The odds of multiple parasitic infections was higher among tuberculosis patients (OR = 2.59, 95% CI: 1.90, 3.55) compared to tuberculosis free individuals. However, intestinal parasites co-infection was not associated with HIV status among tuberculosis patients (OR = 0.97; 95% CI: 0.71, 1.32).
CONCLUSION
One-third of tuberculosis patients are co-infected with one or more intestinal parasites, and they are more likely to be infected with intestinal helminths and multiple intestinal parasitic infections compared to TB free individuals. We recommend routine screening of tuberculosis patients for intestinal parasites. The effect of mass deworming on tuberculosis incidence would be important to be considered in future researches.
TRIAL REGISTRATION
Registered on PROSPERO with reference number ID: CRD42019135350 .
Topics: Ancylostomatoidea; Animals; Ascaris lumbricoides; Coinfection; Ethiopia; Feces; Female; Giardia lamblia; Humans; Intestinal Diseases, Parasitic; Male; Prevalence; Risk Factors; Tuberculosis
PubMed: 32664873
DOI: 10.1186/s12879-020-05237-7 -
Infectious Diseases 2022A Soil-transmitted helminthic infection (STHIs) remains a notable health problem in resource-limited countries.
BACKGROUND
A Soil-transmitted helminthic infection (STHIs) remains a notable health problem in resource-limited countries.
OBJECTIVE
This systematic review and meta-analysis aimed to determine the overall prevalence of STH infections in Ethiopia.
METHODS
Articles written in English were searched from online public databases. Searching terms taken separately and jointly were "prevalence," "soil-transmitted helminths" "nematode," "Geo-helminths," "roundworm," "Necator," "Ancylostoma," "Ascaris," "Trichuris," "hookworm," "whipworm," "," "associated factors," and "Ethiopia." We used STATA version 14 for meta-analysis and Cochran's Q test statistics and the test for heterogeneity.
RESULT
From 297 reviewed articles 41 fulfilled the inclusion criteria. The pooled prevalence of STH infections in Ethiopia was 36.78% Ascaris lumbricoides had the highest pooled prevalence 17.63%, followed by hook worm12.35%. Trichuris trichiura 7.24% when the prevalence of was 2.16% (95% CI: 0.97-3.35). Age, sex, residence, family education level, lack of shoe wearing habits and open defecation were identified as risk factors for STH infection. Eating unwashed and uncooked fruit and vegetables increased the risk of STH infection by 1.88 times while untrimmed finger nail and lack of hand washing habits increase the risk of STH infection by 1.28 and 3.16 times respectively with 95% CI.
LIMITATION
Lack of published studies from Afar, Gambela, Somali, and Benshangul gumuz regions may affect the true picture. The other limitation is that the search strategy will be restricted articles published only in the English language but there might be articles that published using another language.
CONCLUSION
Ascaris lumbricoides, hookworms and Trichuris trichiura, are the most prevalent soil-transmitted helminthes infections in Ethiopia. Age, sex, residence, family education level, lack of shoe wearing habits Open defecation untrimmed finger nail and lack of hand washing habits significantly associated with STH infection. When eating unwashed, uncooked fruit and vegetables were not significantly associated with STH infection. Strategic use of anti-helminthic, health education, and adequate sanitation, taking into account this epidemiologic information is helpful in the control of STH infections in Ethiopia.
PubMed: 35356097
DOI: 10.1177/11786337211055437 -
TheScientificWorldJournal 2022Food-borne disease due to intestinal parasites (IPs) and enteric bacterial infections (EBIs) remain a major public health problem. Food handlers, individuals involved in... (Meta-Analysis)
Meta-Analysis Review
Prevalence and Associated Risk Factors of Intestinal Parasites and Enteric Bacterial Infections among Selected Region Food Handlers of Ethiopia during 2014-2022: A Systematic Review and Meta-Analysis.
Food-borne disease due to intestinal parasites (IPs) and enteric bacterial infections (EBIs) remain a major public health problem. Food handlers, individuals involved in preparing and serving food, working with poor personal hygiene could pose a potential threat of spreading IPs and EBIs to the public. The aim of this study was to examine the overall prevalence and risk factors of IPs and EBIs among food handlers in four selected regions of Ethiopia. Scientific articles written in English were recovered from PubMed, ScienceDirect, Web of Science, Google Scholar, Cochrane Library, and other sources from Google Engine and University Library Databases. "Prevalence," "Intestinal Parasites," "Enteric Bacterial Infections," "Associated Factors," "Food Handlers," and "Ethiopia" were the search terms used for this study. For critical appraisal, PRISMA 2009 was applied. Stata software version 16 was used to perform the meta-analysis. Heterogeneity and publication bias were evaluated using Cochran's , inverse variance ( ), and funnel plot asymmetry tests. A random-effects model was used to calculate the pooled burden of IPs and EBIs and its associated factors among food handlers, along with the parallel odds ratio (OR) and 95% confidence interval (CI). For this meta-analysis, a total of 5844 food handlers were included in the 20 eligible studies. The overall pooled prevalence of IPs and EBIs among food handlers in four selected regions of Ethiopia was 29.16% (95% CI: 22.61, 35.71), with covering (25.77%) and (3.39%) by IPs and EBIs, respectively. , /, , and hookworm were the most prevalent IPs among food handlers with a pooled prevalence of 7.58%, 6.78%, 3.67%, and 2.70%, respectively. and spp. were the most prevalent EBIs among food handlers with a pooled prevalence of 2.78% and 0.61%, respectively. A high prevalence of IPs and EBIs among food handlers was observed in Oromia (38.56%; 95% CI: 29.98, 47.14), while a low prevalence was observed in the Tigray region (19.45%; 95% CI: 6.08, 32.82). Food handlers who had not taken food hygiene training (OR: 0.68, 95% CI: -0.34, 1.69), untrimmed finger nail (OR: 2.23, 95% CI: 1.47, 2.99), lack of periodic medical checkup (OR: 1.52, 95% CI: 0.41, 2.64), lack of handwashing habits (OR: 1.97, 95% CI: 0.53, 3.41), and eating raw vegetables and meat (OR: 2.63, 95% CI: 0.92, 4.34) were factors significantly associated with the prevalence of IPs and EBIs. The prevalence of IPs and EBIs was high in the selected Ethiopian region (Amhara, Oromia, SNNPR, and Tigray) food handlers along an increasing prevalence trend from 2014 to 2022. Therefore, this study recommends the provision of proper health education and training regarding personal hygiene, hand washing, food handling, medical checks, as well as raw vegetable and meat safety.
Topics: Animals; Humans; Bacterial Infections; Cross-Sectional Studies; Ethiopia; Food Services; Intestinal Diseases, Parasitic; Parasites; Prevalence; Risk Factors
PubMed: 36277127
DOI: 10.1155/2022/7786036 -
TheScientificWorldJournal 2022Intestinal helminth infections are still public health problems in tropical and subtropical countries including Ethiopia. This review and meta-analysis aimed to produce... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Intestinal helminth infections are still public health problems in tropical and subtropical countries including Ethiopia. This review and meta-analysis aimed to produce the pooled prevalence and associated risk factors of human intestinal helminth parasitic infections (HIHPIs) in Ethiopia.
METHODS
Articles written in English were searched from online databases. Sixty-seven studies were included. Meta-analysis was computed using STATA version 14.
RESULT
The pooled prevalence of HIHPIs was (33.35%, 95% CI: 28.85%, 37.86%). (10.84%, 95% CI: 9.34, 12.34), hookworm spp. (8.89%, 95% CI: 7.75, 10.04), (4.22%, 95% CI: 3.64, 4.81), (2.51%, 95% CI: 2.17, 2.86), (2.29%, 95% CI: 1.96, 2.63), species (1.01%, 95% CI: 0.80, 1.22), (1.17%, 95% CI: 0.92, 1.41), and (0.71%, 95% CI: 0.52, 0.90) were recorded. Handwashing before food (OR: 5.22,95% CI: 3.49, 6.94), handwashing after toilet (OR: 3.03, 95%; CI: 1.01, 5.05), age (OR: 1.66, 95% CL. 1.09, 2.23), open defecation (OR: 2.42, 95% CI: 1.60, 3.24), eating raw and unwashed vegetables/fruits (OR: 1.98, 95%; CI: 1.30, 2.66), maternal education (OR: 1.81, 95% CI: 0.91, 2.72), family income (OR: 2.00, 95% CI: 0.87, 3.31), source of drinking water (OR: 3.12, 95% CI: 1.96, 4.27), swimming/contact with river water (OR: 1.90, 95% CI: 1.11, 2.69), barefoot (OR: 3.28, 95% CI: 1.67, 4.88), playing with soil (OR: 2.64, 95% CI: 1.40, 3.88), and family size (OR: 3.75, 95% CI: 2.03, 5.46) were factors associated with HIHPIs in Ethiopia. High heterogeneity of the prevalence of HIHPIs was observed among the studies within and among regions (I > 99.6% and ≤ 0.001).
CONCLUSION
HIHPIs in Ethiopia were significantly high. Therefore, special attention should be given by all stakeholders to minimize HIHPIs in Ethiopia.
Topics: Animals; Cross-Sectional Studies; Ethiopia; Helminthiasis; Helminths; Humans; Intestinal Diseases, Parasitic; Prevalence; Risk Factors
PubMed: 36093316
DOI: 10.1155/2022/3905963 -
PLoS Neglected Tropical Diseases Apr 2021Intestinal parasitic infection are a major public health concern affecting both children and adolescents in Ethiopia. The aim of this systematic review and meta-analysis... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Intestinal parasitic infection are a major public health concern affecting both children and adolescents in Ethiopia. The aim of this systematic review and meta-analysis was to determine pooled prevalence and associated factors of intestinal parasitic infection in this target group.
METHOD
We systematically retrieved available articles on the prevalence of intestinal parasitic infection following database searches using PubMed, Scopus, Cochrane Library, and Science Direct between March 1 and May 27, 2020. Two authors independently extracted all relevant data using a standardized Microsoft Excel data extraction form. Heterogeneity among included studies was assessed with the Higgins I2 tests. The pooled estimates and associated factors were assessed with a random-effects model using Stata/se Version 14.
RESULT
We retrieved 30 eligible articles with a pooled sample size of 14,445 primary school children with response rate of 97.8%. Entamoeba spp (16.11%), Ascaris lumbricoides (13.98%), hookworm (12.51%) and Giardia lamblia (9.98%) are the top causes of intestinal parasitic infection among primary school children in Ethiopia. The pooled prevalence for at least one intestinal parasitic infection was 46.09 (95% CI: 38.50, 53.68). Heterogeneity was assessed by doing subgroup analysis by study province/region. Thus, the highest prevalence of 66.6% (95% CI: 55.5, 77.7) occurred in Tigray region, which was followed by Southern Nations, Nationalities, and Peoples' Region at 50.8% (95% CI: 33.1, 68.5). No latrine availability (OR = 4.39: 2.50,7.73), no fingernail hygiene (OR = 2.37: 1.67, 3.35), open defecation (OR = 1.67:1.64,4.36), no formal maternal education (OR = 2.02: 1.18,3.47), rural residence (OR = 1.88: 1.46, 2.41), no habit of wearing shoes (OR = 2.66: 1.79, 3.96), non-pipe source of drinking water (OR = 1.99: 1.42,2.76), no regular hand washing practices (OR = 3.45:1.85,6.47), and no habit of washing fruits and vegetables (OR = 1.59:1.01,2.49) were associated with parasitic infection.
CONCLUSIONS
The prevalence of intestinal parasitic infection was high (46%). Attention should be given to promoting personal hygiene, latrine utilization, wearing shoes, avoiding eating raw food, creating awareness for those mothers who lack formal education. Moreover, future research ideally will expand on the topic by conducting research in regions which have no prior research.
Topics: Adolescent; Child; Ethiopia; Humans; Intestinal Diseases, Parasitic; Prevalence; Risk Factors; Schools; Students
PubMed: 33905414
DOI: 10.1371/journal.pntd.0009379 -
PLoS Neglected Tropical Diseases Nov 2021Soil transmitted helminth (STH) infections cause one of the most prevalent diseases in man. STHs disproportionately impact socio-economically disadvantaged communities... (Meta-Analysis)
Meta-Analysis
The prevalence of soil transmitted helminth infections in minority indigenous populations of South-East Asia and the Western Pacific Region: A systematic review and meta-analysis.
INTRODUCTION
Soil transmitted helminth (STH) infections cause one of the most prevalent diseases in man. STHs disproportionately impact socio-economically disadvantaged communities including minority indigenous populations. This systematic review aimed to quantify the prevalence of STH infection within minority indigenous populations of the South-East Asia and Western Pacific Regions.
METHODS
The systematic review was conducted in accordance with The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines following a published protocol. A random effects meta-analysis was used to estimate the pooled prevalence of STH infection, and meta-regression analysis was used to quantify associations with study characteristics. Where comparative data were available, sub-group analysis was conducted to evaluate the risk of STH infection in minority indigenous people relative to other population groups. The heterogeneity between studies was evaluated visually using Forest plots and was assessed quantitatively by the index of heterogeneity (I2) and Cochran Q-statistics.
RESULTS
From 1,366 unique studies that were identified, 81 were included in the final analysis. The pooled prevalence of infection within minority indigenous populations was 61.4% (95% CI 50.8, 71.4) for overall STH infection; 32.3% (95% CI 25.7, 39.3) for Ascaris.lumbricoides; 43.6% (95% CI 32.6, 54.8) for Trichuris.trichiura; 19.9% (95% CI 15.7, 24.5) for hookworm and 6.3% (95% CI 3.2, 10.2) for Strongyloides.stercoralis. A significant increase in T. trichiura prevalence was observed over time. The stratified analysis showed that the prevalence of infection for STH overall and for each STH species were not significantly different in minority indigenous participants compared to other populations groups.
CONCLUSION
The prevalence of STH infection is high within minority indigenous populations across countries at very different levels of socio-economic development. The increasing prevalence of T. trichiura calls for the implementation of more effective therapies and control strategies.
Topics: Adolescent; Adult; Asia, Southeastern; Child; Child, Preschool; Feces; Female; Helminthiasis; Humans; Indigenous Peoples; Male; Middle Aged; Pacific Islands; Prevalence; Soil; Young Adult
PubMed: 34758024
DOI: 10.1371/journal.pntd.0009890 -
Journal of Laboratory Physicians Mar 2023Soil-transmitted helminths (STH) is a major healthcare challenge in the pediatric age group affecting poor and deprived parts of our community. The main species that... (Review)
Review
Soil-transmitted helminths (STH) is a major healthcare challenge in the pediatric age group affecting poor and deprived parts of our community. The main species that infect people are roundworm (AL, ), whipworm (TT, ), and hookworms (HW, and ). We aimed to estimate the pooled prevalence of STH infections in India in the pediatric age group (< 18 years) and assess the risk factors associated with STH in this age group. Three databases were searched (PubMed, Scopus, and Embase) up to February 16, 2021 with deliberate and inclusive search terms for original research articles estimating the prevalence of either of the three STH in India. Data extracted included individual prevalence of the three STH, prevalence of double or triple infections, and associated risk factors. We identified systematically 1,408 publications, of which 44 were included for the final analysis, including studies from 20 states covering 34,590 children. In our study, the prevalence of AL ranged from 0.8 to 91% with a pooled prevalence of 25%, prevalence of TT ranged from 0.3 to 72% with a pooled prevalence of 13%, and for HW prevalence ranged from 0.2 to 80% with pooled prevalence of 10%. Two most important risk factors with higher odds ratio were open defecation practices or open latrine (odds ratio: 5.2) and washing hands without soap using water only (odds ratio: 2.49). Knowledge of areas with high prevalence of STH and associated risk factors would help in designing effective control strategies in the high-risk groups to prevent infection and aid in a drastic reduction of morbidity in children.
PubMed: 37064993
DOI: 10.1055/s-0042-1751319 -
International Journal of Environmental... Jan 2021Coinfection of malaria and intestinal helminths affects one third of the global population, largely among communities with severe poverty. The spread of these parasitic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Coinfection of malaria and intestinal helminths affects one third of the global population, largely among communities with severe poverty. The spread of these parasitic infections overlays in several epidemiological locations and the host shows different outcomes. This systematic review and meta-analysis determine the pooled prevalence of malaria and intestinal helminthiases coinfections among malaria suspected patients in Ethiopia.
METHODS
Primary studies published in English language were retrieved using appropriate search terms on Google Scholar, PubMed/MEDLINE, CINHAL, Scopus, and Embase. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for critical appraisal of studies. A pooled statistical meta-analysis was conducted using STATA Version 14.0 software. The heterogeneity and publication bias were assessed using the I2 statistics and Egger's test, respectively. Duval and Tweedie's nonparametric trim and fill analysis using the random-effect analysis. The Random effects model was used to estimate the summary prevalence of comorbidity of malaria and soil transmitted helminthiases and the corresponding 95% confidence intervals (CI). The review protocol has registered in PROSPERO number CRD42019144803.
RESULTS
We identified ten studies ( = 6633 participants) in this study. The overall pooled result showed 13% of the ambulatory patients infected by malaria and intestinal helminths concurrently in Ethiopia. The pooled prevalence of and , and mixed infections were 12, 30, and 6%, respectively. The most common intestinal helminth parasites detected were , , and .
CONCLUSIONS
The comorbidity of malaria and intestinal helminths causes lower hemoglobin level leading to maternal anemia, preterm delivery, and still birth in pregnant women and lactating mother. School-aged children and neonates coinfected by plasmodium species and soil transmitted helminths develop cognitive impairment, protein energy malnutrition, low birth weight, small for gestational age, and gross motor delay. The Ministry of Health of Ethiopia and its international partners working on malaria elimination programs should give more emphasis to the effect of the interface of malaria and soil transmitted helminths, which calls for an integrated disease control and prevention.
Topics: Animals; Child; Comorbidity; Ethiopia; Female; Health Facilities; Helminths; Humans; Infant, Newborn; Lactation; Malaria; Outpatients; Pregnancy; Prevalence
PubMed: 33498343
DOI: 10.3390/ijerph18030862 -
Parasites & Vectors Feb 2021Ethiopia has set the ambitious national targets of eliminating soil-transmitted helminths (STH) and schistosomiasis (SCH) as public health problems by 2020, and breaking...
BACKGROUND
Ethiopia has set the ambitious national targets of eliminating soil-transmitted helminths (STH) and schistosomiasis (SCH) as public health problems by 2020, and breaking their transmission by 2025. This systematic review was performed to provide insight into the progress made by the national STH and SCH control programme purposed with reaching these targets.
METHODS
Studies published on STH and SCH in Ethiopia were searched for using Web of Science, PubMed, Scopus, and the resulting references of selected studies. Prevalence and intensity were analysed, stratified by region, age, and diagnostics.
RESULTS
A total of 231 papers published between 2000 and 2020 were included. Over the past two decades, Trichuris trichiura (TT) infection has shown the most statistically significant decrease (93%, p < 0.0001), followed by Schistosoma mansoni (SM) (69%, p < 0.0001), Ascaris lumbricoides (AL) (67%, p < 0.0001) and Schistosoma haematobium (83%, p = 0.038) infections. Geographically, parasite burden has only consistently shown a significant reduction in the Southern Nations, Nationalities and Peoples' Region of Ethiopia, where AL, TT, hookworm and SM significantly decreased by 80% (p = 0.006), 95% (p = 0.005), 98% (p = 0.009) and 87% (p = 0.031), respectively. Prevalence of STH was highest among adults across all species, contrary to typical age-infection profiles for TT and AL that peak among school-aged children. Expanding treatment to the whole community would target reservoirs of adult and preschool-aged infection within the community, assisting Ethiopia in reaching their national transmission break targets. There was substantial heterogeneity in diagnostic methods used across studies, the majority of which predominantly used single-slide Kato-Katz. This low slide frequency provides poor diagnostic sensitivity, particularly in low endemic settings.
CONCLUSION
The prevalence of STH and SCH in Ethiopia has decreased over time due to the strategic use of anthelmintics. Both standardising and increasing the sensitivity of the diagnostics used, alongside the ubiquitous use of parasite intensity with prevalence, would enable a more accurate and comparable understanding of Ethiopia's epidemiological progress. Further work is needed on community-wide surveillance in order to understand the burden and subsequent need for treatment among those outside of the standard school-based control program.
Topics: Cross-Sectional Studies; Ethiopia; Feces; Helminthiasis; Humans; Prevalence; Schistosomiasis; Soil; World Health Organization
PubMed: 33546757
DOI: 10.1186/s13071-021-04600-0 -
The Cochrane Database of Systematic... Jun 2022It is estimated that 1.5 billion people are infected with soil-transmitted helminths (STHs) worldwide. Re-infection occurs rapidly following deworming, and interruption... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
It is estimated that 1.5 billion people are infected with soil-transmitted helminths (STHs) worldwide. Re-infection occurs rapidly following deworming, and interruption of transmission is unlikely without complementary control efforts such as improvements in water, sanitation, and hygiene (WASH) access and behaviours.
OBJECTIVES
To assess the effectiveness of WASH interventions to prevent STH infection.
SEARCH METHODS
We used standard, extensive Cochrane search methods. The latest search date was 19 October 2021.
SELECTION CRITERIA
We included interventions to improve WASH access or practices in communities where STHs are endemic. We included randomized controlled trials (RCTs), as well as trials with an external control group where participants (or clusters) were allocated to different interventions using a non-random method (non-RCTs). We did not include observational study designs. Our primary outcome was prevalence of any STH infection. Prevalence of individual worms was a secondary outcome, including for Ascaris lumbricoides, Trichuris trichiura, hookworm (Ancylostoma duodenale or Necator americanus), or Strongyloides stercoralis. Intensity of infection, measured as a count of eggs per gram of faeces for each species, was another secondary outcome.
DATA COLLECTION AND ANALYSIS
Two review authors independently reviewed titles and abstracts and full-text records for eligibility, performed data extraction, and assessed risk of bias using the Cochrane risk of bias assessment tool for RCTs and the EPOC tool for non-RCTs. We used a random-effects meta-analysis to pool study estimates. We used Moran's I² statistic to assess heterogeneity and conducted subgroup analyses to explore sources of heterogeneity. We assessed the certainty of the evidence using the GRADE approach.
MAIN RESULTS
We included 32 studies (16 RCTs and 16 non-RCTs) involving a total of 52,944 participants in the review. Twenty-two studies (14 RCTs (16 estimates) and eight non-RCTs (11 estimates)) reported on our primary outcome, prevalence of infection with at least one STH species. Twenty-one studies reported on the prevalence of A lumbricoides (12 RCTs and 9 non-RCTs); 17 on the prevalence of T trichiura (9 RCTs and 8 non-RCTs); 18 on the prevalence of hookworm (10 RCTs and 8 non-RCTs); and one on the prevalence of S stercoralis (1 non-RCT). Sixteen studies measured the intensity of infection for an individual STH type. Ten RCTs and five non-RCTs reported on the intensity of infection of A lumbricoides; eight RCTs and five non-RCTs measured the intensity of infection of T trichiura; and eight RCTs and five non-RCTs measured the intensity of hookworm infection. No studies reported on the intensity of infection of S stercoralis. The overall pooled effect estimates showed that the WASH interventions under study may result in a slight reduction of any STH infection, with an odds ratio (OR) of 0.86 amongst RCTs (95% confidence interval (CI) 0.74 to 1.01; moderate-certainty evidence) and an OR of 0.71 amongst non-RCTs (95% CI 0.54 to 0.94; low-certainty evidence). All six of the meta-analyses assessing individual worm infection amongst both RCTs and non-RCTs had pooled estimates in the preventive direction, although all CIs encapsulated the null, leaving the possibility of the null or even harmful effects; the certainty of the evidence ranged from very low to moderate. Individual studies assessing intensity of infection showed mixed evidence supporting WASH. Subgroup analyses focusing on narrow specific subsets of water, sanitation, and hygiene interventions did very little to elucidate which interventions might be better than others. Data on intensity of infection (e.g. faecal egg count) were reported in a variety of ways across studies, precluding the pooling of results for this outcome. We did not find any studies reporting adverse events resulting from the WASH interventions under study or from mass drug administration (MDA).
AUTHORS' CONCLUSIONS
Whilst the available evidence suggests that the WASH interventions under study may slightly protect against STH infection, WASH also serves as a broad preventive measure for many other diseases that have a faecal oral transmission route of transmission. As many of the studies were done in addition to MDA/deworming (i.e. MDA was ongoing in both the intervention and control arm), our data support WHO recommendations for implementation of improvements to basic sanitation and adequate access to safe water alongside MDA. The biological plausibility for improved access to WASH to interrupt transmission of STHs is clear, but WASH interventions as currently delivered have shown impacts that were lower than expected. There is a need for more rigorous and targeted implementation research and process evaluations in order that future WASH interventions can better provide benefit to users. Inconsistent reporting of the intensity of infection underscores the need to define the minimal, standard data that should be collected globally on STHs to enable pooled analyses and comparisons.
Topics: Animals; Ascaris lumbricoides; Humans; Hygiene; Observational Studies as Topic; Sanitation; Soil; Water
PubMed: 35726112
DOI: 10.1002/14651858.CD012199.pub2