02853nas a2200253   4500000000100000008004100001653003600042653002000078653003300098653002300131100001200154700001400166700001000180700001200190700001800202700001500220700002300235245016200258856007900420300001300499490000700512520206600519022001402585       2019                            d10aSoil-transmitted helminth (STH)10aDisease control10aFunctional illitiracy burden10aEcological studies1 aOwada K1 aNielsen M1 aLau C1 aYakob L1 aClements AC A1 aLeonardo L1 aSoares Magalhaes R00aFunctional illiteracy burden in soil-transmitted helminth (STH) endemic regions of the Philippines: An ecological study and geographical prediction for 2017.  uhttps://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0007494  ae00074940 v133 a<p><strong>BACKGROUND: </strong>Soil-transmitted helminth (STH) infections remain highly endemic across the Philippines, and are believed to be important contributors to delayed cognitive development of school-aged children. Identification of communities where children are at risk of functional illiteracy is important for the attainment of Sustainable Development Goals target for literacy. We aimed to quantify the associations between the spatial variation of STH infections and functional literacy indicators adjusting for other important contributors, and identify priority areas in the Philippines in need of interventions.</p>

<p><strong>METHODOLOGY/PRINCIPAL FINDINGS: </strong>We used data from 11,313 school-aged children on functional literacy indicators collected in 2008. Nested fixed-effects multinomial regression models were built to determine associations between STH endemicity and geographical distribution of functional literacy, adjusting for demographics, household level variables, and the prevalence of malaria. Bayesian multinomial geostatistical models were built to geographically predict the prevalence of each level of functional literacy. The number of school-aged children belonging to each of the functional literacy indicator classes was forecast for 2017. We estimated 4.20% of functional illiteracy burden among school-aged children in Mindanao might be averted by preventing T. trichiura infections. Areas predicted with the highest prevalence of functional illiteracy were observed in localised areas of the eastern region of the Visayas, and the south-eastern portion of Mindanao.</p>

<p><strong>CONCLUSIONS/SIGNIFICANCE: </strong>The study demonstrates significant geographical variation in burden of functional illiteracy in school-aged children associated with STH infections suggesting that targeted helminth control could potentially promote the development of cognitive function of school-aged children in the Philippines. The benefits of a spatially targeted strategy should be tested by future studies.</p>
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