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

<h4>Background</h4>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 morb...

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Autores principales:	Kathrin Ziegelbauer, Benjamin Speich, Daniel Mäusezahl, Robert Bos, Jennifer Keiser, Jürg Utzinger
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/71387d5179124c15bb3f4054b34ea5a6
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spelling	oai:doaj.org-article:71387d5179124c15bb3f4054b34ea5a62021-11-18T05:42:23ZEffect of sanitation on soil-transmitted helminth infection: systematic review and meta-analysis.1549-12771549-167610.1371/journal.pmed.1001162https://doaj.org/article/71387d5179124c15bb3f4054b34ea5a62012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22291577/pdf/?tool=EBIhttps://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4>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.<h4>Methods and findings</h4>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.<h4>Conclusions</h4>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.Kathrin ZiegelbauerBenjamin SpeichDaniel MäusezahlRobert BosJennifer KeiserJürg UtzingerPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 9, Iss 1, p e1001162 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Kathrin Ziegelbauer Benjamin Speich Daniel Mäusezahl Robert Bos Jennifer Keiser Jürg Utzinger Effect of sanitation on soil-transmitted helminth infection: systematic review and meta-analysis.
description	<h4>Background</h4>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.<h4>Methods and findings</h4>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.<h4>Conclusions</h4>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.
format	article
author	Kathrin Ziegelbauer Benjamin Speich Daniel Mäusezahl Robert Bos Jennifer Keiser Jürg Utzinger
author_facet	Kathrin Ziegelbauer Benjamin Speich Daniel Mäusezahl Robert Bos Jennifer Keiser Jürg Utzinger
author_sort	Kathrin Ziegelbauer
title	Effect of sanitation on soil-transmitted helminth infection: systematic review and meta-analysis.
title_short	Effect of sanitation on soil-transmitted helminth infection: systematic review and meta-analysis.
title_full	Effect of sanitation on soil-transmitted helminth infection: systematic review and meta-analysis.
title_fullStr	Effect of sanitation on soil-transmitted helminth infection: systematic review and meta-analysis.
title_full_unstemmed	Effect of sanitation on soil-transmitted helminth infection: systematic review and meta-analysis.
title_sort	effect of sanitation on soil-transmitted helminth infection: systematic review and meta-analysis.
publisher	Public Library of Science (PLoS)
publishDate	2012
url	https://doaj.org/article/71387d5179124c15bb3f4054b34ea5a6
work_keys_str_mv	AT kathrinziegelbauer effectofsanitationonsoiltransmittedhelminthinfectionsystematicreviewandmetaanalysis AT benjaminspeich effectofsanitationonsoiltransmittedhelminthinfectionsystematicreviewandmetaanalysis AT danielmausezahl effectofsanitationonsoiltransmittedhelminthinfectionsystematicreviewandmetaanalysis AT robertbos effectofsanitationonsoiltransmittedhelminthinfectionsystematicreviewandmetaanalysis AT jenniferkeiser effectofsanitationonsoiltransmittedhelminthinfectionsystematicreviewandmetaanalysis AT jurgutzinger effectofsanitationonsoiltransmittedhelminthinfectionsystematicreviewandmetaanalysis
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Effect of sanitation on soil-transmitted helminth infection: systematic review and meta-analysis.

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