Abstract
SummaryBackgroundSoil-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.MethodsIn 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.Findings7187 (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).InterpretationIn 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.FundingBill & Melinda Gates Foundation and Task Force for Global Health.
Highlights
Soil-transmitted helminths and Giardia duodenalis are estimated to infect over 1 billion people globally.[1,2] Infections can result in anaemia, malnutrition, and deficits in physical and cognitive development in children.[3]
Added value of this study We investigated the association between household finished flooring and soil-transmitted helminth and G duodenalis infection in rural Bangladesh and Kenya
We investigated whether young children living in homes with finished floors had lower prevalence and intensity of soil-transmitted helminths and G duodenalis infection 2 years after enrolment compared with children living in homes with unfinished floors
Summary
Soil-transmitted helminths (eg, Ascaris lumbricoides, hookworm, and Trichuris trichiura) and Giardia duodenalis are estimated to infect over 1 billion people globally.[1,2] Infections can result in anaemia, malnutrition, and deficits in physical and cognitive development in children.[3]. Finished flooring might decrease transmission of soiltransmitted helminths and G duodenalis by reducing faecal contamination of hands, food, and water. Because soiltransmitted helminth ova survive best under moist conditions, impermeable finished flooring might reduce environmental survival and interrupt the lifecycle of soiltransmitted helminths, which requires a soil stage for soiltransmitted helminth ova to become infective.[3] Studies in rural Kenya and urban Brazil detected soil-transmitted helminth ova at similar concentrations inside households and near latrines.[9,10] In low-resource settings, young children frequently ingest soil in households with dirt floors[11] and detection of soil-transmitted helminths larvae in soil near children’s play areas is associated with higher
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