03303nas a2200325   4500000000100000008004100001653003900042653003800081653000900119653001600128653001400144100001500158700001100173700001400184700001400198700001100212700001500223700001200238700001500250700001600265700001500281700001500296700001800311245016200329856009800491300001300589490000700602520235400609022001402963       2017                            d10aNeglected tropical diseases (NTDs)10aSoil-Transmitted Helminths (STHs)10aWASH10aTimor Leste10aTreatment1 aCampbell S1 aNery S1 aWardell R1 aD'Este CA1 aGray D1 aMcCarthy J1 aTraub R1 aAndrews RM1 aLlewellyn S1 aVallely AJ1 aWilliams G1 aClements AC A00aWater, Sanitation and Hygiene (WASH) and environmental risk factors for soil-transmitted helminth intensity of infection in Timor-Leste, using real time PCR.  uhttp://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0005393&type=printable  ae00053930 v113 a<p><strong>BACKGROUND: </strong>No investigations have been undertaken of risk factors for intensity of soil-transmitted helminth (STH) infection in Timor-Leste. This study provides the first analysis of risk factors for intensity of STH infection, as determined by quantitative PCR (qPCR), examining a broad range of water, sanitation and hygiene (WASH) and environmental factors, among communities in Manufahi District, Timor-Leste.</p>

<p><strong>METHODS: </strong>A baseline cross-sectional survey of 18 communities was undertaken as part of a cluster randomised controlled trial, with additional identically-collected data from six other communities. qPCR was used to assess STH infection from stool samples, and questionnaires administered to collect WASH, demographic, and socioeconomic data. Environmental information was obtained from open-access sources and linked to infection outcomes. Mixed-effects multinomial logistic regression was undertaken to assess risk factors for intensity of Necator americanus and Ascaris infection.</p>

<p><strong>RESULTS: </strong>2152 participants provided stool and questionnaire information for this analysis. In adjusted models incorporating WASH, demographic and environmental variables, environmental variables were generally associated with infection intensity for both N. americanus and Ascaris spp. Precipitation (in centimetres) was associated with increased risk of moderate-intensity (adjusted relative risk [ARR] 6.1; 95% confidence interval [CI] 1.9-19.3) and heavy-intensity (ARR 6.6; 95% CI 3.1-14.1) N. americanus infection, as was sandy-loam soil around households (moderate-intensity ARR 2.1; 95% CI 1.0-4.3; heavy-intensity ARR 2.7; 95% CI 1.6-4.5; compared to no infection). For Ascaris, alkaline soil around the household was associated with reduced risk of moderate-intensity infection (ARR 0.21; 95% CI 0.09-0.51), and heavy-intensity infection (ARR 0.04; 95% CI 0.01-0.25). Few WASH risk factors were significant.</p>

<p><strong>CONCLUSION: </strong>In this high-prevalence setting, strong risk associations with environmental factors indicate that anthelmintic treatment alone will be insufficient to interrupt STH transmission, as conditions are favourable for ongoing environmental transmission. Integrated STH control strategies should be explored as a priority.</p>
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