Effect of a sanitation intervention on soil-transmitted helminth prevalence and concentration in household soil: A cluster-randomized controlled trial and risk factor analysis

PLoS Negl Trop Dis. 2019 Feb 11;13(2):e0007180. doi: 10.1371/journal.pntd.0007180. eCollection 2019 Feb.

Abstract

Improved sanitation has been associated with a reduced prevalence of soil-transmitted helminth (STH) infection and has been hypothesized to prevent fecal contamination from spreading throughout the household environment. We evaluated the effect of providing households with a pit latrine with a plastic slab and drophole cover, child feces management tools, and associated behavioral messaging on reducing STH eggs in household soil. We collected soil samples from 2107 households (898 control and 1209 improved sanitation intervention households) that were enrolled in the WASH Benefits cluster randomized controlled trial in rural Kenya and performed a post-intervention analysis after two years of intervention exposure. Following a pre-specified analysis plan, we combined all households that received the sanitation intervention into one group for comparison to control households. The prevalence of STH eggs in soil was 18.9% in control households and 17.0% in intervention households. The unadjusted prevalence ratio of total STH eggs in the intervention groups compared to the control group was 0.94 (95% CI: 0.78-1.13). The geometric mean concentration was 0.05 eggs/g dry soil in control households and intervention households. Unadjusted and adjusted models gave similar results. We found use of a shared latrine, presence of a roof over the sampling area, and the number of dogs owned at baseline was associated with an increased prevalence of STH eggs in soil; the presence of a latrine that was at least 2 years old and a latrine with a covered drophole was associated with a reduction in the prevalence of STH eggs in soil. Soil moisture content was also associated with an increased prevalence of STH eggs in soil. Our results indicate that an intervention designed to increase access to improved latrines and child feces management tools may not be enough to impact environmental occurrence of STH in endemic areas where latrine coverage is already high.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Animals
  • Family Characteristics*
  • Helminthiasis / epidemiology
  • Helminthiasis / prevention & control*
  • Helminthiasis / transmission
  • Helminths / isolation & purification
  • Humans
  • Kenya / epidemiology
  • Ovum
  • Prevalence
  • Risk Factors
  • Sanitation / methods*
  • Soil / parasitology*

Substances

  • Soil

Grants and funding

Funding was provided in the form of student fellowships to Lauren Steinbaum by the National Science Foundation Graduate Research Fellowship Program (1000160864), the U.S. Agency for International Development Research and Innovation Fellowships Program (2000004603), and the Stanford Center for African Studies Summer Graduate Student Research Grant and Language Study Grant. This study was made possible by utilizing the data collection infrastructure established by the WASH Benefits Kenya study. The WASH Benefits Kenya study was funded by a grant from the Bill and Melinda Gates Foundation to UC Berkeley (OPPGD759). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors declare no competing financial interest.