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Factors associated with soil-transmitted helminths infection in Benin : Findings from the deworm3 study

Factors associated with soil-transmitted helminths infection in Benin : Findings from the deworm3 study

Title: Factors associated with soil-transmitted helminths infection in Benin : Findings from the deworm3 study
Author: Avokpaho, Euripide F.G.A.
Houngbégnon, Parfait
Accrombessi, Manfred
Atindégla, Eloïc
Yard, Elodie
Means, Arianna Rubin
Kennedy, David S.
Littlewood, D. Timothy J.
Garcia, André
Massougbodji, Achille
... 6 more authors Show all authors
Date: 2021-08
Language: English
Department: Faculty of Medicine
Series: PLoS Neglected Tropical Diseases; 15(8)
ISSN: 1935-2727
DOI: https://doi.org/10.1371/journal.pntd.0009646
Subject: Sníklar; Jarðvegur; Benín; Benín; Lýðheilsa; Public Health, Environmental and Occupational Health; Infectious Diseases
URI: https://hdl.handle.net/20.500.11815/2830

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Avokpaho , E F G A , Houngbégnon , P , Accrombessi , M , Atindégla , E , Yard , E , Means , A R , Kennedy , D S , Littlewood , D T J , Garcia , A , Massougbodji , A , Galagan , S R , Walson , J L , Cottrell , G , Ibikounlé , M , Ásbjörnsdóttir , K H & Luty , A J F 2021 , ' Factors associated with soil-transmitted helminths infection in Benin : Findings from the deworm3 study ' , PLoS Neglected Tropical Diseases , vol. 15 , no. 8 , e0009646 . https://doi.org/10.1371/journal.pntd.0009646


Background Despite several years of school-based MDA implementation, STH infections remain an important public health problem in Benin, with a country-wide prevalence of 20% in 2015. The DeWorm3 study is designed to assess the feasibility of using community-based MDA with albendazole to interrupt the transmission of STH, through a series of cluster-random-ized trials in Benin, India and Malawi. We used the pre-treatment baseline survey data to describe and analyze the factors associated with STH infection in Comé, the study site of the DeWorm3 project in Benin. These data will improve understanding of the challenges that need to be addressed in order to eliminate STH as a public health problem in Benin. Methods Between March and April 2018, the prevalence of STH (hookworm spp., Ascaris and Tri-churis trichiura) was assessed by Kato-Katz in stool samples collected from 6,153 residents in the community of Comé, Benin using a stratified random sampling procedure. A standard-ized survey questionnaire was used to collect information from individual households con-cerning factors potentially associated with the presence and intensity of STH infections in pre-school (PSAC, aged 1–4), school-aged children (SAC, aged 5–14) and adults (aged 15 and above). Multilevel mixed-effects models were used to assess associations between these factors and STH infection. The overall prevalence of STH infection was 5.3%; 3.2% hookworm spp., 2.1% Ascaris lum-bricoides and 0.1% Trichuris. Hookworm spp. were more prevalent in adults than in SAC (4.4% versus 2.0%, respectively; p = 0.0001) and PSAC (4.4% versus 1.0%, respectively; p<0.0001), whilst Ascaris lumbricoides was more prevalent in SAC than in adults (3.0% versus 1.7%, respectively; p = 0.004). Being PSAC (adjusted Odds Ratio (aOR) = 0.2, p< 0.001; adjusted Infection Intensity Ratio (aIIR) = 0.1, p<0.001) or SAC (aOR = 0.5, p = 0.008; aIIR = 0.3, p = 0.01), being a female (aOR = 0.6, p = 0.004; aIIR = 0.3, p = 0.001), and having received deworming treatment the previous year (aOR = 0.4, p< 0.002; aIIR = 0.2, p<0.001) were associated with a lower prevalence and intensity of hookworm infection. Lower income (lowest quintile: aOR = 5.0, p<0.001, 2nd quintile aOR = 3.6, p = 0.001 and 3rd quintile aOR = 2.5, p = 0.02), being a farmer (aOR = 1.8, p = 0.02), medium population den-sity (aOR = 2.6, p = 0.01), and open defecation (aOR = 0.5, p = 0.04) were associated with a higher prevalence of hookworm infection. Lower education—no education, primary or sec-ondary school-(aIIR = 40.1, p = 0.01; aIIR = 30.9, p = 0.02; aIIR = 19.3, p = 0.04, respec-tively), farming (aIIR = 3.9, p = 0.002), natural flooring (aIIR = 0.2, p = 0.06), peri-urban settings (aIIR = 6.2, 95%CI 1.82–20.90, p = 0.003), and unimproved water source more than 30 minutes from the household (aIIR = 13.5, p = 0.02) were associated with a higher intensity of hookworm infection. Improved and unshared toilet was associated with lower intensity of hookworm infections (aIIR = 0.2, p = 0.01). SAC had a higher odds of Ascaris lumbricoides infection than adults (aOR = 2.0, p = 0.01) and females had a lower odds of infection (aOR = 0.5, p = 0.02). Conclusion Hookworm spp. are the most prevalent STH in Comé, with a persistent reservoir in adults that is not addressed by current control measures based on school MDA. Expanding MDA to target adults and PSAC is necessary to substantially impact population prevalence, particularly for hookworm.


Funding Information: JLW and DTL received the DeWorm3 study funding from The Bill and Melinda Gates foundation (OPP1129535). https://www. gatesfoundation.org/. EFGAA is a PhD candidate at the University of Paris. His research is funded by DeWorm3 as a staff member of the Benin coordinating team, and by the French Research Institute for Sustainable Development (IRD) through the International Mixed Laboratory LMI CONS_HELM (helminth infections: treatments and consequences on health and development in the South). https://www.ird.fr/benin/partenariat. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: © 2021, Public Library of Science. All rights reserved.

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