Abstract
BackgroundStudies have shown that households using sludge from human excreta for agriculture are at an increased risk of soil transmitted helminths. However, while use of ecological sanitation (EcoSan) latrines is increasing in most African countries including Malawi, few studies have been done to check whether use of such sludge could potentially increase the prevalence of helminthic infections among household members as a results of exposure to faecal sludge/compared to use of traditional latrines.MethodsA cross sectional study was done targeting households using EcoSan and traditional pit latrines. Samples were collected from both types of latrines in Chikwawa (rural) and Blantyre (urban) districts. These two districts have a high number of EcoSan latrines in southern region of Malawi. 156 latrines were sampled (n = 95 traditional; n = 61 EcoSan), and processed following standard guidelines using modified triple floatation method. Identification of helminth ova (Ascaris lumbricoides, hookworms, Trichuris trichiura, Taenia spp. and Diphyllobothrium latum) was done using standard microscopy methods. The difference between the prevalence and mean concentration of helminths between the two types of latrines was tested using Chi Square and t test respectively.ResultsOf the total latrines tested, 85.9% (n = 134) had at least one species of helminth while 84.6% (n = 132) had at least a STH, with 82.0% (n = 50) in EcoSan and 86.3% (n = 82) in traditional pit latrines. There was no significant difference between the prevalence of helminths in EcoSan and traditional pit latrines [χ2 = 0.43 (1), P = 0.5]. The prevalence of Ascaris lumbricoides was significantly higher in EcoSan than in traditional pit latrines [χ2 = 5.44 (1) p = 0.02] while prevalence of hookworms was significantly higher in traditional pit latrines than in EcoSan latrines [χ2 = 13.98 (1) p < 0.001]. The highest concentration of helminths per gram of faecal sludge was in traditional pit latrines [31.2 (95% CI 19.1–43.2)] than in EcoSan latrines [26.4 (95% CI 16.5–36.3)].ConclusionThere was no significant difference between overall prevalence of helminths between households using EcoSan and those using traditional pit latrines. However, Ascaris lumbricoides was significantly higher in households using EcoSan latrines. EcoSan users need awareness on safe ways of handling faecal sludge in order to reduce chances of reinfection from Ascaris lumbricoides. Further research should be undertaken on household members to identify those infected and potential routes of infection to enable preventive targeting.
Highlights
Studies have shown that households using sludge from human excreta for agriculture are at an increased risk of soil transmitted helminths
We found that 85.9% (n = 134) of the total latrines tested had at least one species of helminth while 84.6% (n = 132) had at least a Soil transmitted helminths (STH) with 82.0% (n = 50) in ecological sanitation (EcoSan) and 86.3% (n = 82) in traditional pit latrines
The prevalence of Ascaris lumbricoides was significantly higher in EcoSan than in traditional pit latrines [χ2 = 5.44 (1) p = 0.02] while that of hookworms was significantly higher in traditional pit latrines than in EcoSan latrines [χ2 = 13.98 (1) p < 0.001]
Summary
Studies have shown that households using sludge from human excreta for agriculture are at an increased risk of soil transmitted helminths. In 2013, Ascaris affected an estimated 807–1221 million people in the world mostly in developing countries [5,6,7], with an average prevalence of 21.2, 12.2 and 33.1% for hookworms, Ascaris lumbricoides and Trichuris trichiura respectively reported in southern sub Saharan Africa [8]. In Malawi, few studies have been done to estimate the household prevalence of STHs, a prevalence of 0.4, 1.3 and 0.5% for Schistosoma mansoni, hookworms and Ascaris lumbricoides respectively was reported in primary school children, with a higher prevalence in urban (16.5%) than rural children (3.6%) [9]. With specific reference to pregnancy, infection with Ascaris lumbricoides was reported to make women more susceptible to earlier first births and shortened interbirth intervals, while hookworm was associated with delayed first pregnancy [12, 13]
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