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Epidemiology of soil transmitted helminths and risk analysis of hookworm infections in the community : Results from the deworm3 trial in southern india

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dc.contributor.author Ajjampur, Sitara S.R.
dc.contributor.author Kaliappan, Saravanakumar Puthupalayam
dc.contributor.author Halliday, Katherine E.
dc.contributor.author Palanisamy, Gokila
dc.contributor.author Farzana, Jasmine
dc.contributor.author Manuel, Malathi
dc.contributor.author Abraham, Dilip
dc.contributor.author Laxmanan, Selvi
dc.contributor.author Aruldas, Kumudha
dc.contributor.author Rose, Anuradha
dc.contributor.author Kennedy, David S.
dc.contributor.author Oswald, William E.
dc.contributor.author Pullan, Rachel L.
dc.contributor.author Galagan, Sean R.
dc.contributor.author Ásbjörnsdóttir, Kristjana Hrönn
dc.contributor.author Anderson, Roy M.
dc.contributor.author Muliyil, Jayaprakash
dc.contributor.author Sarkar, Rajiv
dc.contributor.author Kang, Gagandeep
dc.contributor.author Walson, Judd L.
dc.date.accessioned 2022-01-15T01:02:21Z
dc.date.available 2022-01-15T01:02:21Z
dc.date.issued 2021-04-30
dc.identifier.citation Ajjampur , S S R , Kaliappan , S P , Halliday , K E , Palanisamy , G , Farzana , J , Manuel , M , Abraham , D , Laxmanan , S , Aruldas , K , Rose , A , Kennedy , D S , Oswald , W E , Pullan , R L , Galagan , S R , Ásbjörnsdóttir , K H , Anderson , R M , Muliyil , J , Sarkar , R , Kang , G & Walson , J L 2021 , ' Epidemiology of soil transmitted helminths and risk analysis of hookworm infections in the community : Results from the deworm3 trial in southern india ' , PLoS Neglected Tropical Diseases , vol. 15 , no. 4 , e0009338 , pp. e0009338 . https://doi.org/10.1371/journal.pntd.0009338
dc.identifier.issn 1935-2727
dc.identifier.other PURE: 42198598
dc.identifier.other PURE UUID: 8af2d006-253b-4334-a69b-547a73811253
dc.identifier.other Scopus: 85105700229
dc.identifier.other unpaywall: 10.1371/journal.pntd.0009338
dc.identifier.uri https://hdl.handle.net/20.500.11815/2831
dc.description Funding Information: The DeWorm3 study is funded through a grant to the Natural History Museum, London from the Bill and Melinda Gates Foundation (OPP1129535, PI JLW). SSRA is supported by an Emerging Global Leader Award (K43) from Fogarty International Center, NIH (1K43TW011415). The funders were not involved in the decision to publish the manuscript and had no role in data collection, analysis or publication of study results. Publisher Copyright: © 2021 Ajjampur et al.
dc.description.abstract Since 2015, India has coordinated the largest school-based deworming program globally, targeting soil-transmitted helminths (STH) in ~250 million children aged 1 to 19 years twice yearly. Despite substantial progress in reduction of morbidity associated with STH, reinfection rates in endemic communities remain high. We conducted a community based parasitological survey in Tamil Nadu as part of the DeWorm3 Project-a cluster-randomised trial evaluating the feasibility of interrupting STH transmission at three geographically distinct sites in Africa and Asia-allowing the estimation of STH prevalence and analysis of associated factors. In India, following a comprehensive census, enumerating 140,932 individuals in 36,536 households along with geospatial mapping of households, an age-stratified sample of individuals was recruited into a longitudinal monitoring cohort (December 2017-February 2018) to be followed for five years. At enrolment, a total of 6089 consenting individuals across 40 study clusters provided a single adequate stool sample for analysis using the Kato-Katz method, as well as answering a questionnaire covering individual and household level factors. The unweighted STH prevalence was 17.0% (95% confidence interval [95%CI]: 16.0-17.9%), increasing to 21.4% when weighted by age and cluster size. Hookworm was the predominant species, with a weighted infection prevalence of 21.0%, the majority of which (92.9%) were light intensity infections. Factors associated with hookworm infection were modelled using mixed-effects multilevel logistic regression for presence of infection and mixed-effects negative binomial regression for intensity. The prevalence of both Ascaris lumbricoides and Trichuris trichiura infections were rare (<1%) and risk factors were therefore not assessed. Increasing age (multivariable odds ratio [mOR] 21.4, 95%CI: 12.3-37.2, p<0.001 for adult age-groups versus pre-school children) and higher vegetation were associated with an increased odds of hookworm infection, whereas recent deworming (mOR 0.3, 95%CI: 0.2-0.5, p<0.001) and belonging to households with higher socioeconomic status (mOR 0.3, 95%CI: 0.2-0.5, p<0.001) and higher education level of the household head (mOR 0.4, 95%CI: 0.3-0.6, p<0.001) were associated with lower odds of hookworm infection in the multilevel model. The same factors were associated with intensity of infection, with the use of improved sanitation facilities also correlated to lower infection intensities (multivariable infection intensity ratio [mIIR] 0.6, 95%CI: 0.4-0.9, p<0.016). Our findings suggest that a community-based approach is required to address the high hookworm burden in adults in this setting. Socioeconomic, education and sanitation improvements alongside mass drug administration would likely accelerate the drive to elimination in these communities. Trial Registration: NCT03014167.
dc.format.extent e0009338
dc.language.iso en
dc.relation.ispartofseries PLoS Neglected Tropical Diseases; 15(4)
dc.rights info:eu-repo/semantics/openAccess
dc.subject Faraldsfræði
dc.subject Lýðheilsa
dc.subject Indland
dc.subject Indland
dc.subject Sníklar
dc.subject Smitsjúkdómar
dc.subject Hooksworm infections
dc.subject Public health
dc.subject India
dc.subject Parasitology
dc.subject Helminths/isolation & purification
dc.subject India/epidemiology
dc.subject Prevalence
dc.subject Humans
dc.subject Middle Aged
dc.subject Sanitation
dc.subject Child, Preschool
dc.subject Male
dc.subject Young Adult
dc.subject Ascariasis/epidemiology
dc.subject Toilet Facilities
dc.subject Adult
dc.subject Female
dc.subject Child
dc.subject Schools
dc.subject Trichuris/isolation & purification
dc.subject Soil/parasitology
dc.subject Risk Factors
dc.subject Feces/parasitology
dc.subject Logistic Models
dc.subject Hookworm Infections/epidemiology
dc.subject Family Characteristics
dc.subject Animals
dc.subject Trichuriasis/epidemiology
dc.subject Adolescent
dc.subject Ascaris lumbricoides/isolation & purification
dc.subject Public Health, Environmental and Occupational Health
dc.subject Infectious Diseases
dc.title Epidemiology of soil transmitted helminths and risk analysis of hookworm infections in the community : Results from the deworm3 trial in southern india
dc.type /dk/atira/pure/researchoutput/researchoutputtypes/contributiontojournal/article
dc.description.version Peer reviewed
dc.identifier.pmid 33930024
dc.identifier.doi https://doi.org/10.1371/journal.pntd.0009338
dc.relation.url http://www.scopus.com/inward/record.url?scp=85105700229&partnerID=8YFLogxK
dc.contributor.department Faculty of Medicine

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