Household finished flooring and soil-transmitted helminth and Giardia infections among children in rural Bangladesh and Kenya: a prospective cohort study

Jade Benjamin-Chung; Yoshika S Crider; Andrew Mertens; Ayse Ercumen; Amy J Pickering; Audrie Lin; Lauren Steinbaum; Jenna Swarthout; Mahbubur Rahman; Sarker M Parvez; Rashidul Haque; Sammy M Njenga; Jimmy Kihara; Clair Null; Stephen P Luby; John M Colford Jr; Benjamin F Arnold

doi:10.1016/S2214-109X(20)30523-4

Household finished flooring and soil-transmitted helminth and Giardia infections among children in rural Bangladesh and Kenya: a prospective cohort study

Lancet Glob Health. 2021 Mar;9(3):e301-e308. doi: 10.1016/S2214-109X(20)30523-4.

Authors

Jade Benjamin-Chung¹, Yoshika S Crider², Andrew Mertens³, Ayse Ercumen⁴, Amy J Pickering⁵, Audrie Lin³, Lauren Steinbaum⁶, Jenna Swarthout⁵, Mahbubur Rahman⁷, Sarker M Parvez⁷, Rashidul Haque⁷, Sammy M Njenga⁸, Jimmy Kihara⁸, Clair Null⁹, Stephen P Luby¹⁰, John M Colford Jr³, Benjamin F Arnold¹¹

Affiliations

¹ Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, CA, USA. Electronic address: jadebc@berkeley.edu.
² Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, CA, USA; Energy & Resources Group, University of California, Berkeley, Berkeley, CA, USA.
³ Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, CA, USA.
⁴ Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC, USA.
⁵ Civil and Environmental Engineering, Tufts University, Medford, MA, USA.
⁶ Exponent, Sacramento, CA, USA.
⁷ International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
⁸ Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya.
⁹ Center for International Policy Research and Evaluation, Mathematica Policy Research, Washington, DC, USA.
¹⁰ Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA.
¹¹ Francis I Proctor Foundation, University of California, San Francisco, CA, USA; Department of Ophthalmology, University of California, San Francisco, CA, USA.

Abstract

Background: Soil-transmitted helminths and Giardia duodenalis are responsible for a large burden of disease globally. In low-resource settings, household finished floors (eg, concrete floors) might reduce transmission of soil-transmitted helminths and G duodenalis.

Methods: In a prospective cohort of children nested within two randomised trials in rural Bangladesh and Kenya, we estimated associations between household finished flooring and soil-transmitted helminths and G duodenalis prevalence. In 2015-16, we collected stool samples from children aged 2-16 years in rural Bangladesh and Kenya. We detected soil-transmitted helminth infection using quantitative PCR (qPCR; Bangladesh n=2800; Kenya n=3094), and G duodenalis using qPCR in Bangladesh (n=6894) and ELISA in Kenya (n=8899). We estimated adjusted prevalence ratios (aPRs) using log-linear models adjusted for potential confounders.

Findings: 7187 (92·2%) of 7795 children in Bangladesh and 9077 (93·7%) of 9686 children in Kenya provided stool specimens that were analysed by qPCR. At enrolment, 691 (10%) households in Bangladesh and 471 (5%) households in Kenya had finished floors. In both countries, household finished flooring was associated with lower Ascaris lumbricoides prevalence (Bangladesh aPR 0·33, 95% CI 0·14-0·78; Kenya 0·62, 0·39-0·98) and any soil-transmitted helminths (Bangladesh 0·73, 0·52-1·01; Kenya 0·57, 0·37-0·88). Household finished floors were also associated with lower Necator americanus prevalence in Bangladesh (0·52, 0·29-0·94) and G duodenalis prevalence in both countries (Bangladesh 0·78, 0·64-0·95; Kenya 0·82, 0·70-0·97).

Interpretation: In low-resource settings, living in households with finished floors over a 2-year period was associated with lower prevalence of G duodenalis and some soil-transmitted helminths in children.

Funding: Bill & Melinda Gates Foundation and Task Force for Global Health.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Bangladesh / epidemiology
Child
Child, Preschool
Developing Countries
Enzyme-Linked Immunosorbent Assay
Feces / parasitology
Female
Floors and Floorcoverings / methods*
Giardiasis / epidemiology*
Giardiasis / transmission
Helminthiasis / epidemiology*
Helminthiasis / transmission
Housing
Humans
Kenya / epidemiology
Male
Prevalence
Prospective Studies
Real-Time Polymerase Chain Reaction
Rural Population*
Soil / parasitology

Substances

Soil