Giardia duodenalis infection in the context of a community-based deworming and water, sanitation and hygiene trial in Timor-Leste

Jessica Y.H. Aw, Naomi E. Clarke, James S. McCarthy, Rebecca J. Traub, Salvador Amaral, Md Hamidul Huque, Ross M. Andrews, Darren J. Gray, Archie C.A. Clements, Susana Vaz Nery

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Background: Giardiasis is a common diarrhoeal disease caused by the protozoan Giardia duodenalis. It is prevalent in low-income countries in the context of inadequate access to water, sanitation and hygiene (WASH), and is frequently co-endemic with neglected tropical diseases such as soil-transmitted helminth (STH) infections. Large-scale periodic deworming programmes are often implemented in these settings; however, there is limited evidence for the impact of regular anthelminthic treatment on G. duodenalis infection. Additionally, few studies have examined the impact of WASH interventions on G. duodenalis.

    Methods: The WASH for WORMS cluster randomised controlled trial was conducted in remote communities in Manufahi municipality, Timor-Leste, between 2012 and 2016. All study communities received four rounds of deworming with albendazole at six-monthly intervals. Half were randomised to additionally receive a community-level WASH intervention following study baseline. We measured G. duodenalis infection in study participants every six months for two years, immediately prior to deworming, as a pre-specified secondary outcome of the trial. WASH access and behaviours were measured using questionnaires.

    Results: There was no significant change in G. duodenalis prevalence in either study arm between baseline and the final study follow-up. We found no additional benefit of the community-level WASH intervention on G. duodenalis infection (relative risk: 1.05, 95% CI: 0.72-1.54). Risk factors for G. duodenalis infection included living in a household with a child under five years of age (adjusted odds ratio, aOR: 1.35, 95% CI: 1.04-1.75), living in a household with more than six people (aOR: 1.32, 95% CI: 1.02-1.72), and sampling during the rainy season (aOR: 1.23, 95% CI: 1.04-1.45). Individuals infected with the hookworm Necator americanus were less likely to have G. duodenalis infection (aOR: 0.71, 95% CI: 0.57-0.88).

    Conclusions: Prevalence of G. duodenalis was not affected by a community WASH intervention or by two years of regular deworming with albendazole. Direct household contacts appear to play a dominant role in driving transmission. We found evidence of antagonistic effects between G. duodenalis and hookworm infection, which warrants further investigation in the context of global deworming efforts.

    Original languageEnglish
    Article number491
    Pages (from-to)1-10
    Number of pages10
    JournalParasites and Vectors
    Volume12
    Issue number1
    DOIs
    Publication statusPublished - 18 Oct 2019

    Fingerprint

    Giardia lamblia
    Sanitation
    Hygiene
    Water
    Infection
    Albendazole
    Necator americanus
    Hookworm Infections
    Timor-Leste
    Neglected Diseases
    Giardiasis
    Ancylostomatoidea
    Helminths
    Soil
    Randomized Controlled Trials
    Odds Ratio

    Cite this

    Aw, J. Y. H., Clarke, N. E., McCarthy, J. S., Traub, R. J., Amaral, S., Huque, M. H., ... Vaz Nery, S. (2019). Giardia duodenalis infection in the context of a community-based deworming and water, sanitation and hygiene trial in Timor-Leste. Parasites and Vectors, 12(1), 1-10. [491]. https://doi.org/10.1186/s13071-019-3752-9
    Aw, Jessica Y.H. ; Clarke, Naomi E. ; McCarthy, James S. ; Traub, Rebecca J. ; Amaral, Salvador ; Huque, Md Hamidul ; Andrews, Ross M. ; Gray, Darren J. ; Clements, Archie C.A. ; Vaz Nery, Susana. / Giardia duodenalis infection in the context of a community-based deworming and water, sanitation and hygiene trial in Timor-Leste. In: Parasites and Vectors. 2019 ; Vol. 12, No. 1. pp. 1-10.
    @article{93675531fbf6490599ff65e181de4259,
    title = "Giardia duodenalis infection in the context of a community-based deworming and water, sanitation and hygiene trial in Timor-Leste",
    abstract = "Background: Giardiasis is a common diarrhoeal disease caused by the protozoan Giardia duodenalis. It is prevalent in low-income countries in the context of inadequate access to water, sanitation and hygiene (WASH), and is frequently co-endemic with neglected tropical diseases such as soil-transmitted helminth (STH) infections. Large-scale periodic deworming programmes are often implemented in these settings; however, there is limited evidence for the impact of regular anthelminthic treatment on G. duodenalis infection. Additionally, few studies have examined the impact of WASH interventions on G. duodenalis. Methods: The WASH for WORMS cluster randomised controlled trial was conducted in remote communities in Manufahi municipality, Timor-Leste, between 2012 and 2016. All study communities received four rounds of deworming with albendazole at six-monthly intervals. Half were randomised to additionally receive a community-level WASH intervention following study baseline. We measured G. duodenalis infection in study participants every six months for two years, immediately prior to deworming, as a pre-specified secondary outcome of the trial. WASH access and behaviours were measured using questionnaires. Results: There was no significant change in G. duodenalis prevalence in either study arm between baseline and the final study follow-up. We found no additional benefit of the community-level WASH intervention on G. duodenalis infection (relative risk: 1.05, 95{\%} CI: 0.72-1.54). Risk factors for G. duodenalis infection included living in a household with a child under five years of age (adjusted odds ratio, aOR: 1.35, 95{\%} CI: 1.04-1.75), living in a household with more than six people (aOR: 1.32, 95{\%} CI: 1.02-1.72), and sampling during the rainy season (aOR: 1.23, 95{\%} CI: 1.04-1.45). Individuals infected with the hookworm Necator americanus were less likely to have G. duodenalis infection (aOR: 0.71, 95{\%} CI: 0.57-0.88). Conclusions: Prevalence of G. duodenalis was not affected by a community WASH intervention or by two years of regular deworming with albendazole. Direct household contacts appear to play a dominant role in driving transmission. We found evidence of antagonistic effects between G. duodenalis and hookworm infection, which warrants further investigation in the context of global deworming efforts.",
    keywords = "Albendazole, Deworming, Giardia duodenalis, Giardiasis, Hygiene, Sanitation, Water",
    author = "Aw, {Jessica Y.H.} and Clarke, {Naomi E.} and McCarthy, {James S.} and Traub, {Rebecca J.} and Salvador Amaral and Huque, {Md Hamidul} and Andrews, {Ross M.} and Gray, {Darren J.} and Clements, {Archie C.A.} and {Vaz Nery}, Susana",
    year = "2019",
    month = "10",
    day = "18",
    doi = "10.1186/s13071-019-3752-9",
    language = "English",
    volume = "12",
    pages = "1--10",
    journal = "Parasites and Vectors",
    issn = "1756-3305",
    publisher = "BioMed Central",
    number = "1",

    }

    Aw, JYH, Clarke, NE, McCarthy, JS, Traub, RJ, Amaral, S, Huque, MH, Andrews, RM, Gray, DJ, Clements, ACA & Vaz Nery, S 2019, 'Giardia duodenalis infection in the context of a community-based deworming and water, sanitation and hygiene trial in Timor-Leste', Parasites and Vectors, vol. 12, no. 1, 491, pp. 1-10. https://doi.org/10.1186/s13071-019-3752-9

    Giardia duodenalis infection in the context of a community-based deworming and water, sanitation and hygiene trial in Timor-Leste. / Aw, Jessica Y.H.; Clarke, Naomi E.; McCarthy, James S.; Traub, Rebecca J.; Amaral, Salvador; Huque, Md Hamidul; Andrews, Ross M.; Gray, Darren J.; Clements, Archie C.A.; Vaz Nery, Susana.

    In: Parasites and Vectors, Vol. 12, No. 1, 491, 18.10.2019, p. 1-10.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Giardia duodenalis infection in the context of a community-based deworming and water, sanitation and hygiene trial in Timor-Leste

    AU - Aw, Jessica Y.H.

    AU - Clarke, Naomi E.

    AU - McCarthy, James S.

    AU - Traub, Rebecca J.

    AU - Amaral, Salvador

    AU - Huque, Md Hamidul

    AU - Andrews, Ross M.

    AU - Gray, Darren J.

    AU - Clements, Archie C.A.

    AU - Vaz Nery, Susana

    PY - 2019/10/18

    Y1 - 2019/10/18

    N2 - Background: Giardiasis is a common diarrhoeal disease caused by the protozoan Giardia duodenalis. It is prevalent in low-income countries in the context of inadequate access to water, sanitation and hygiene (WASH), and is frequently co-endemic with neglected tropical diseases such as soil-transmitted helminth (STH) infections. Large-scale periodic deworming programmes are often implemented in these settings; however, there is limited evidence for the impact of regular anthelminthic treatment on G. duodenalis infection. Additionally, few studies have examined the impact of WASH interventions on G. duodenalis. Methods: The WASH for WORMS cluster randomised controlled trial was conducted in remote communities in Manufahi municipality, Timor-Leste, between 2012 and 2016. All study communities received four rounds of deworming with albendazole at six-monthly intervals. Half were randomised to additionally receive a community-level WASH intervention following study baseline. We measured G. duodenalis infection in study participants every six months for two years, immediately prior to deworming, as a pre-specified secondary outcome of the trial. WASH access and behaviours were measured using questionnaires. Results: There was no significant change in G. duodenalis prevalence in either study arm between baseline and the final study follow-up. We found no additional benefit of the community-level WASH intervention on G. duodenalis infection (relative risk: 1.05, 95% CI: 0.72-1.54). Risk factors for G. duodenalis infection included living in a household with a child under five years of age (adjusted odds ratio, aOR: 1.35, 95% CI: 1.04-1.75), living in a household with more than six people (aOR: 1.32, 95% CI: 1.02-1.72), and sampling during the rainy season (aOR: 1.23, 95% CI: 1.04-1.45). Individuals infected with the hookworm Necator americanus were less likely to have G. duodenalis infection (aOR: 0.71, 95% CI: 0.57-0.88). Conclusions: Prevalence of G. duodenalis was not affected by a community WASH intervention or by two years of regular deworming with albendazole. Direct household contacts appear to play a dominant role in driving transmission. We found evidence of antagonistic effects between G. duodenalis and hookworm infection, which warrants further investigation in the context of global deworming efforts.

    AB - Background: Giardiasis is a common diarrhoeal disease caused by the protozoan Giardia duodenalis. It is prevalent in low-income countries in the context of inadequate access to water, sanitation and hygiene (WASH), and is frequently co-endemic with neglected tropical diseases such as soil-transmitted helminth (STH) infections. Large-scale periodic deworming programmes are often implemented in these settings; however, there is limited evidence for the impact of regular anthelminthic treatment on G. duodenalis infection. Additionally, few studies have examined the impact of WASH interventions on G. duodenalis. Methods: The WASH for WORMS cluster randomised controlled trial was conducted in remote communities in Manufahi municipality, Timor-Leste, between 2012 and 2016. All study communities received four rounds of deworming with albendazole at six-monthly intervals. Half were randomised to additionally receive a community-level WASH intervention following study baseline. We measured G. duodenalis infection in study participants every six months for two years, immediately prior to deworming, as a pre-specified secondary outcome of the trial. WASH access and behaviours were measured using questionnaires. Results: There was no significant change in G. duodenalis prevalence in either study arm between baseline and the final study follow-up. We found no additional benefit of the community-level WASH intervention on G. duodenalis infection (relative risk: 1.05, 95% CI: 0.72-1.54). Risk factors for G. duodenalis infection included living in a household with a child under five years of age (adjusted odds ratio, aOR: 1.35, 95% CI: 1.04-1.75), living in a household with more than six people (aOR: 1.32, 95% CI: 1.02-1.72), and sampling during the rainy season (aOR: 1.23, 95% CI: 1.04-1.45). Individuals infected with the hookworm Necator americanus were less likely to have G. duodenalis infection (aOR: 0.71, 95% CI: 0.57-0.88). Conclusions: Prevalence of G. duodenalis was not affected by a community WASH intervention or by two years of regular deworming with albendazole. Direct household contacts appear to play a dominant role in driving transmission. We found evidence of antagonistic effects between G. duodenalis and hookworm infection, which warrants further investigation in the context of global deworming efforts.

    KW - Albendazole

    KW - Deworming

    KW - Giardia duodenalis

    KW - Giardiasis

    KW - Hygiene

    KW - Sanitation

    KW - Water

    UR - http://www.scopus.com/inward/record.url?scp=85073590022&partnerID=8YFLogxK

    U2 - 10.1186/s13071-019-3752-9

    DO - 10.1186/s13071-019-3752-9

    M3 - Article

    VL - 12

    SP - 1

    EP - 10

    JO - Parasites and Vectors

    JF - Parasites and Vectors

    SN - 1756-3305

    IS - 1

    M1 - 491

    ER -