Sanitation, hookworm, anemia, stunting, and wasting in primary school children in southern Ethiopia: Baseline results from a study in 30 schools

Abstract

BackgroundInadequate nutrition; neglected topical diseases; and insufficient water, sanitation, and hygiene (WASH) are interrelated problems in schools in low-income countries, but are not routinely tackled together. A recent three-year longitudinal study investigated integrated school health and nutrition approaches in 30 government primary schools in southern Ethiopia. Here, we report on baseline associations between sanitation, hookworm infection, anemia, stunting, and wasting.MethodsIn each school, the Schistosoma mansoni, S. haematobium, and soil-transmitted helminth infection intensities; blood hemoglobin concentrations; heights; and weights of approximately 125 students were assessed. Of these 125 students, approximately 20 were randomly selected for student WASH surveys. Of these 20, approximately 15 were randomly selected for household sanitation observations. School WASH was also assessed through a combination of observations and questions to the headteacher. Mixed-effects logistic regression was used to compare household sanitation with hookworm infection (the other parasites being much less prevalent); and hookworm infection with anemia, stunting, and wasting.FindingsBlood, stool, and urine samples were provided by 3,729 children, and student WASH and household WASH surveys were conducted with 596 and 448 of these students, respectively.Hookworm, Ascaris lumbricoides, Trichuris trichiura, and S. mansoni infections had prevalences of 18%, 4.8%, 0.6%, and 0.3%, respectively, and no S. haematobium infections were found. Anemia, stunting, and wasting had prevalences of 23%, 28%, and 14%, respectively.No statistically significant associations were found between latrine absence or evidence of open defecation at home, and hookworm infection (adjusted odds ratio, OR = 1.28, 95% confidence interval, CI: 0.476–3.44; and adjusted OR = 1.21, 95% CI: 0.468–3.12; respectively); or between hookworm infection and anemia, stunting, or wasting (adjusted OR = 1.24, 95% CI: 0.988–1.57; adjusted OR = 0.992, 95% CI: 0.789–1.25; and adjusted OR = 0.969, 95% CI: 0.722–1.30; respectively).ConclusionsIn this setting, no statistically significant associations were found between sanitation and hookworm; or between hookworm and anemia, stunting, or wasting. More evidence on best practices for integrated school health interventions will be gathered from the follow-up surveys in this study.

Intestinal parasites among rural school children in southern Ethiopia: A cross-sectional multilevel and zero-inflated regression model

“…The prevalence of intestinal parasite infections that we found was higher than previously found in southern Ethiopia (12, 24) but lower than other places (17, 46). Compared with the 24.6% prevalence found in Ethiopia (16), 26.3% in the Democratic Republic of Congo, and 26.5% found in Kenya (47, 48), we found a higher prevalence of T. trichiura infection.…”

“…The rate for hookworm infection in this study aligned with the 7.4% rate found during national mapping (49). However, it is lower than the 56.8% (16), 46.9% (50), and 18% reported in other regions of Ethiopia (24). All detected infections in this study were of light intensity (32), which is comparable with other studies in Ethiopia (24, 45, 51).…”

“…However, it is lower than the 56.8% (16), 46.9% (50), and 18% reported in other regions of Ethiopia (24). All detected infections in this study were of light intensity (32), which is comparable with other studies in Ethiopia (24, 45, 51). Variations in intestinal parasite prevalence could be due to different diagnostic techniques and ecological settings.…”

“…School-based, cross-sectional studies have been used to study the prevalence and predictors of intestinal parasite infections (8, 11-17). Many of these studies have been conducted in urban settings in northern Ethiopia, and they focused on school feeding programs (24) and infection prevalence (25). Unfortunately, they did not assess potential household risk factors or adequately address the nested structure of school data (i.e., individuals nested within the same classes, which are nested within the same schools).…”

Local Perceptions of an Integrated School Health and Nutrition Programme involving WASH, school feeding and deworming in Southwest Ethiopia

“…Primary school enrolment is 62% and 56% for boys and girls respectively [ 11 ]. A baseline survey in the 30-targeted primary schools found 23% of children tested positive for at least one parasitic infection, with a prevalence of 4.8% for Ascaris lumbricoides, 18% for hookworm, 0.3% for Schistosoma mansoni and 0.6% for Trichuris trichiura [ 12 ]. Full detail of the baseline sanitation and hygiene is described elsewhere, as well as a map for location of each school [ 12 ].…”