Effect of primary schools sanitation and hygiene on soil-transmitted helminth infection: An approach for research in a rural district of KwaZulu-Natal, South Africa

Abstract

Soil-transmitted helminths (STHs) cause some of the most prevalent infections worldwide, and are fundamentally associated with poor sanitation and hygiene conditions. The worm eggs require soil to develop into infectious stages, and soil contamination is thus the link between sanitation and infection. Children are particularly susceptible to STHs. In theory, it is likely that the sanitation, hygiene and soil contamination of STH in schools would be associated with the level of infection among the learners. This is however a severely neglected area of research, where the few studies conducted only to a limited extent have succeeded in providing evidence for an association. The Ugu District of KwaZulu-Natal (KZN), South Africa, is highly burdened with helminthiasis. It is a suggested study area as it already has data of the learners level of infection available. This project sought to develop an approach for research of the association between toilet and hand washing facilities in primary schools and infection with A. lumbricoides and T. trichiura among the learners. A method for evaluating the toilet and washing facilities is presented along with a method for the quantification of STH eggs in soil. The paper presents a relatively quick and inexpensive way to investigate the association between sanitation, hygiene, soil contamination and infection, in the setting of primary schools. The overwhelming extent of disease burden, the theoretical likelihood of an existing association and the considerable lack of research, is likely to make the study worthwhile, despite its several limitations.