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      Is there a difference in prevalence of helminths between households using ecological sanitation and those using traditional pit latrines? A latrine based cross sectional comparative study in Malawi

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          Abstract

          Background

          Studies 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.

          Methods

          A 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.

          Results

          Of 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 [χ 2 = 0.43 (1), P = 0.5]. The prevalence of Ascaris lumbricoides was significantly higher in EcoSan than in traditional pit latrines [χ 2 = 5.44 (1) p = 0.02] while prevalence of hookworms was significantly higher in traditional pit latrines than in EcoSan latrines [χ 2 = 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)].

          Conclusion

          There 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.

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            Pit Latrines and Their Impacts on Groundwater Quality: A Systematic Review

            Background: Pit latrines are one of the most common human excreta disposal systems in low-income countries, and their use is on the rise as countries aim to meet the sanitation-related target of the Millennium Development Goals. There is concern, however, that discharges of chemical and microbial contaminants from pit latrines to groundwater may negatively affect human health. Objectives: Our goals were to a) calculate global pit latrine coverage, b) systematically review empirical studies of the impacts of pit latrines on groundwater quality, c) evaluate latrine siting standards, and d) identify knowledge gaps regarding the potential for and consequences of groundwater contamination by latrines. Methods: We used existing survey and population data to calculate global pit latrine coverage. We reviewed the scientific literature on the occurrence of contaminants originating from pit latrines and considered the factors affecting transport of these contaminants. Data were extracted from peer-reviewed articles, books, and reports identified using Web of ScienceSM, PubMed, Google, and document reference lists. Discussion: We estimated that approximately 1.77 billion people use pit latrines as their primary means of sanitation. Studies of pit latrines and groundwater are limited and have generally focused on only a few indicator contaminants. Although groundwater contamination is frequently observed downstream of latrines, contaminant transport distances, recommendations based on empirical studies, and siting guidelines are variable and not well aligned with one another. Conclusions: In order to improve environmental and human health, future research should examine a larger set of contextual variables, improve measurement approaches, and develop better criteria for siting pit latrines.
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              Prevalence and risk factors of helminths and intestinal protozoa infections among children from primary schools in western Tajikistan

              Background Intestinal parasitic infections represent a public health problem in Tajikistan, but epidemiological evidence is scarce. The present study aimed at assessing the extent of helminths and intestinal protozoa infections among children of 10 schools in four districts of Tajikistan, and to make recommendations for control. Methods A cross-sectional survey was carried out in early 2009. All children attending grades 2 and 3 (age: 7-11 years) from 10 randomly selected schools were invited to provide a stool sample and interviewed about sanitary situation and hygiene behaviour. A questionnaire pertaining to demographic and socioeconomic characteristics was addressed to the heads of households. On the spot, stool samples were subjected to duplicate Kato-Katz thick smear examination for helminth diagnosis. Additionally, 1-2 g of stool was fixed in sodium acetate-acetic acid-formalin, transferred to a specialised laboratory in Europe and examined for helminths and intestinal protozoa. The composite results from both methods served as diagnostic 'gold' standard. Results Out of 623 registered children, 602 participated in our survey. The overall prevalence of infection with helminths and pathogenic intestinal protozoa was 32.0% and 47.1%, respectively. There was pronounced spatial heterogeneity. The most common helminth species was Hymenolepis nana (25.8%), whereas the prevalences of Ascaris lumbricoides, hookworm and Enterobius vermicularis were below 5%. The prevalence of pathogenic intestinal protozoa, namely Giardia intestinalis and Entamoeba histolytica/E. dispar was 26.4% and 25.9%, respectively. Almost half of the households draw drinking water from unimproved sources, such as irrigation canals, rivers and unprotected wells. Sanitary facilities were pit latrines, mostly private, and a few shared with neighbours. The use of public tap/standpipe as a source of drinking water emerged as a protective factor for G. intestinalis infection. Protected spring water reduced the risk of infection with E. histolytica/E. dispar and H. nana. Conclusions Our data obtained from the ecological 'lowland' areas in Tajikistan call for school-based deworming (recommended drugs: albendazole and metronidazole), combined with hygiene promotion and improved sanitation. Further investigations are needed to determine whether H. nana represents a public health problem.
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                Author and article information

                Contributors
                skumwenda@poly.ac.mw
                cmsefula@medcol.mw
                kadewa@bunda.luanar.mw
                yohanediness@gmail.com
                ckato@cartafrica.org
                tracy.thomson@strath.ac.uk
                bngwira@medcol.mw
                Journal
                BMC Res Notes
                BMC Res Notes
                BMC Research Notes
                BioMed Central (London )
                1756-0500
                9 June 2017
                9 June 2017
                2017
                : 10
                Affiliations
                [1 ]ISNI 0000 0001 2113 2211, GRID grid.10595.38, College of Medicine, , University of Malawi, ; Chichiri, P/Bag 360, Blantyre 3, Malawi
                [2 ]ISNI 0000 0001 2113 2211, GRID grid.10595.38, The Polytechnic, , University of Malawi, ; Chichiri, P/Bag 303, Blantyre 3, Malawi
                [3 ]ISNI 0000 0001 2176 4980, GRID grid.459750.a, , Lilongwe University of Agriculture and Natural Resources, ; P. O. Box 219, Lilongwe, Malawi
                [4 ]ISNI 0000 0004 0620 0548, GRID grid.11194.3c, School of Bio-security, Biotechnical & Laboratory Sciences, College of Veterinary Medicine, Animal Resources & Bio-security, , Makerere University, ; Kampala, Uganda
                [5 ]ISNI 0000000121138138, GRID grid.11984.35, Department of Civil and Environmental Engineering, , University of Strathclyde, ; Glasgow, UK
                Article
                2519
                10.1186/s13104-017-2519-7
                5466731
                28599671
                © The Author(s) 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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                © The Author(s) 2017

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