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

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Grimes, Jack E. T., Tadesse, Gemechu, Gardiner, Iain A., Yard, Elodie, Wuletaw, Yonas, Templeton, Michael R., Harrison, Wendy E., Drake, Lesley J.·2017·PLOS Neglected Tropical Diseases
DOI 10.1371/journal.pntd.0005948PMC PMC5633169
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Abstract

BACKGROUND: Inadequate 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. METHODS: In 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. FINDINGS: Blood, 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). CONCLUSIONS: In 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.

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  • Four of the 18 publications reported no evidence of reduced risk for the primary disease-related outcome measures, including soil-transmitted helminths and E. coli on pupils' hands.

    “Four of the 18 publications reported no evidence of reduced risk for the primary disease-related outcome measures, including soil-transmitted helminths and E. coli on pupils’ hands [17,20,25,26].”

    From Water, Sanitation and Hygiene (WASH) in Schools in Low-Income Countries: A Review of Evidence of Impact (2019) · cites this paper as [26]

    The Abstract’s Findings and Conclusions report no statistically significant association between household sanitation and hookworm infection, a soil-transmitted helminth. But this is a baseline association study, not an assessment of reduced risk following an intervention; it does not report E. coli on pupils’ hands. The four-of-18 count is the citing review’s framing, not a finding attributed to this individual paper. (LLM, conf=0.85)

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Authors
Grimes, J. E. T., Tadesse, G., Gardiner, I. A., Yard, E., Wuletaw, Y., Templeton, M. R., Harrison, W. E., & Drake, L. J.
Affiliations
  • Imperial College London (GB)
  • Ethiopian Public Health Institute (ET)
Corresponding author
Grimes, Jack E. T.
ORCID
Venue
PLOS Neglected Tropical Diseases
Publisher
Public Library of Science (PLoS)
Published
2017-10-09
Volume
11
Issue
10
Pages
e0005948
ISSN
  • 1935-2727 (ISSN-L)
  • 1935-2735
DOI
10.1371/journal.pntd.0005948
PMC
PMC5633169
OpenAlex
W2761495024
Cited by
60
References
0
Citations by year
2026: 4 · 2025: 2 · 2024: 4 · 2023: 7 · 2022: 7 · 2021: 14 · 2020: 8 · 2019: 12 · 2018: 2
FWCI
5.00
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS neglected tropical diseases (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Spiral (Imperial College London) (submittedVersion, other-oa)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
  • Life Sciences › Immunology and Microbiology › Parasitology › Parasites and Host Interactions
  • Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
Keywords
hookworm infection, sanitation, anemia, stunting, wasting, elementary school students, water, sanitation and hygiene, soil-transmitted helminths, Schistosoma mansoni, Ascaris lumbricoides, Trichuris trichiura, open defecation, latrines, household sanitation, child nutrition, southern Ethiopia
MeSH terms
Adolescent, Anemia, Child, Child, Preschool, Ethiopia, Female, Growth Disorders, Hookworm Infections, Humans, Male, Surveys and Questionnaires, Risk Factors, Sanitation, Wasting Syndrome

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