Poor WASH (Water, Sanitation, and Hygiene) Conditions Are Associated with Leprosy in North Gondar, Ethiopia
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. WASH Survey
2.3. Schistosomiasis Testing
2.4. WASH Index
2.5. Statistical Analysis
2.6. Human Subject and Ethical Considerations
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
- Goal 3 Sustainable Development Knowledge Platform. Available online: https://sustainabledevelopment.un.org/sdg3 (accessed on 31 January 2019).
- White, C.; Franco-Paredes, C. Leprosy in the 21st Century. Clin. Microbiol. Rev. 2015, 28, 80–94. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- WHO. Global Leprosy Update, 2016: Accelerating Reduction of Disease Burden. Available online: http://www.who.int/lep/resources/who_wer9235/en/ (accessed on 14 May 2020).
- WHO. Elimination of Leprosy FAQ. Available online: http://www.who.int/lep/strategy/faqs/en/ (accessed on 17 January 2019).
- Polycarpou, A.; Walker, S.L.; Lockwood, D.N. New findings in the pathogenesis of leprosy and implications for the management of leprosy. Curr. Opin. Infect. Dis. 2013, 26, 413–419. [Google Scholar] [CrossRef] [PubMed]
- CDC—Schistosomiasis. Available online: https://www.cdc.gov/parasites/schistosomiasis/index.html (accessed on 31 January 2019).
- Diniz, L.M.; Zandonade, E.; Dietze, R.; Pereira, F.E.; Ribeiro-Rodrigues, R. Short report: Do intestinal nematodes increase the risk for multibacillary leprosy? Am. J. Trop. Med. Hyg. 2001, 65, 852–854. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Phillips, D.A.; Ferreira, J.A.; Ansah, D.; Teixeira, H.S.; Kitron, U.; de Filippis, T.; de Alcântara, M.H.; Fairley, J.K. A tale of two neglected tropical infections: Using GIS to assess the spatial and temporal overlap of schistosomiasis and leprosy in a region of Minas Gerais, Brazil. Memórias Inst. Oswaldo Cruz 2017, 112, 275–280. [Google Scholar] [CrossRef] [PubMed]
- GHO|By Country|Ethiopia—Statistics Summary (2002–present). Available online: http://apps.who.int/gho/data/node.country.country-ETH (accessed on 18 January 2019).
- WHO|Water Sanitation and Hygiene for Accelerating and Sustaining Progress on Neglected Tropical Diseases. Available online: http://www.who.int/water_sanitation_health/publications/wash-and-ntd-strategy/en/ (accessed on 18 March 2019).
- Matsuoka, M.; Izumi, S.; Budiawan, T.; Nakata, N.; Saeki, K. Mycobacterium leprae DNA in daily using water as a possible source of leprosy infection. Indian J. Lepr. 1999, 71, 61–67. [Google Scholar] [PubMed]
- Turankar, R.P.; Lavania, M.; Singh, M.; Siva Sai, K.S.R.; Jadhav, R.S. Dynamics of Mycobacterium leprae transmission in environmental context: Deciphering the role of environment as a potential reservoir. Infect. Genet. Evol. 2012, 12, 121–126. [Google Scholar] [CrossRef] [PubMed]
- FAUTH. Viability of Mycobacterium leprae in the environment and its role in leprosy dissemination. Indian J. Dermatol. Venereol. Lepr. 2015, 82, 23. [Google Scholar] [CrossRef]
- Global Leprosy Strategy 2016–2020: Accelerating Towards a Leprosy-Free World. Available online: https://apps.who.int/iris/handle/10665/208824 (accessed on 28 January 2019).
- Census 2007. Available online: http://www.csa.gov.et/census-report/complete-report/census-2007?start=5 (accessed on 28 February 2019).
- mjs76 Gone to Gondar: Union Officer visits Ethiopia—University of Leicester. Available online: https://www2.le.ac.uk/news/blog/2011-archive/july/gone-to-gondar-union-officer-visits-ethiopia (accessed on 17 October 2018).
- Core questions|JMP. Available online: https://washdata.org/monitoring/methods/core-questions (accessed on 17 April 2019).
- Rapid Medical Diagnostics Schisto POC-CCA Rapid Test for Qualitative Detection of: Bilharzia (Schistosomiasis) Pretoria, South Africa. Available online: http://www.ictdiagnostics.co.za/schistosomanew.html (accessed on 14 May 2020).
- World Health Organization. WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation; Unicef WASH in the 2030 Agenda: New Global Indicators for Drinking Water, and Sanitation New York, USA. Available online: https://washdata.org/sites/default/files/documents/reports/2017-07/JMP-2017-WASH-in-the-2030-agenda.pdf (accessed on 14 May 2020).
- OpenEpi Menu. Available online: https://www.openepi.com/Menu/OE_Menu.htm (accessed on 26 July 2020).
- Kerr-Pontes, L.R.S.; Barreto, M.L.; Evangelista, C.M.N.; Rodrigues, L.C.; Heukelbach, J.; Feldmeier, H. Socioeconomic, environmental, and behavioural risk factors for leprosy in North-east Brazil: Results of a case-control study. Int. J. Epidemiol. 2006, 35, 994–1000. [Google Scholar] [CrossRef] [PubMed]
- TDR|The Effects of Leprosy on Men and Women: A Gender Study. Available online: https://www.who.int/tdr/publications/tdr-research-publications/leprosy-gender/en/ (accessed on 26 July 2020).
- Bratschi, M.W.; Steinmann, P.; Wickenden, A.; Gillis, T.P. Current knowledge on Mycobacterium leprae transmission: A systematic literature review. Lepr. Rev. 2015, 86, 142–155. [Google Scholar] [PubMed]
- Wheat, W.H.; Casali, A.L.; Thomas, V.; Spencer, J.S.; Lahiri, R.; Williams, D.L.; McDonnell, G.E.; Gonzalez-Juarrero, M.; Brennan, P.J.; Jackson, M. Long-term Survival and Virulence of Mycobacterium leprae in Amoebal Cysts. PLoS Negl. Trop. Dis. 2014, 8. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Lahiri, R.; Krahenbuhl, J.L. The role of free-living pathogenic amoeba in the transmission of leprosy: A proof of principle. Lepr. Rev. 2008, 79, 401–409. [Google Scholar] [PubMed]
- Davis, G.L.; Ray, N.A.; Lahiri, R.; Gillis, T.P.; Krahenbuhl, J.L.; Williams, D.L.; Adams, L.B. Molecular assays for determining mycobacterium leprae viability in tissues of experimentally infected mice. PLoS Negl. Trop. Dis. 2013, 7, e2404. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Arraes, M.L.B.d.M.; de Holanda, M.V.; Lima, L.N.G.C.; Sabadia, J.A.B.; Duarte, C.R.; Almeida, R.L.F.; Kendall, C.; Kerr, L.R.S.; Frota, C.C. Natural environmental water sources in endemic regions of northeastern Brazil are potential reservoirs of viable Mycobacterium leprae. Memórias Inst. Oswaldo Cruz 2017, 112, 805–811. [Google Scholar] [CrossRef] [PubMed]
- Diniz, L.M.; Magalhães, E.F.L.; Pereira, F.E.L.; Dietze, R.; Ribeiro-Rodrigues, R. Presence of intestinal helminths decreases T helper type 1 responses in tuberculoid leprosy patients and may increase the risk for multi-bacillary leprosy. Clin. Exp. Immunol. 2010, 161, 142–150. [Google Scholar] [CrossRef] [PubMed]
Variable | Total (n = 81) |
---|---|
Age, years (median, SD) | 33 (18.4) |
Sex, n (%) | |
Male | 61 (75.3) |
Leprosy Type, n (%) | |
Total Leprosy Cases | 40 |
MB | 33 (82.5) |
PB | 4 (10) |
Unknown | 3 (7.5) |
Disability Grade at Diagnosis | |
Total Leprosy Cases | 40 |
Grade0 | 20 (50) |
Grade1 | 12 (30) |
Grade2 | 8 (5) |
Positive Schistosomiasis, n (%) | 21 (25.9) |
Drinking Water Source, n (%) | |
Piped Water to House/Yard | 25 (30.9) |
Public Tap/Standpipe | 29 (35.8) |
Other Protected Source | 14 (17.3) |
Unprotected Spring | 10 (12.4) |
Surface Water | 3 (3.7) |
Water fetching time in minutes (median, SD) | 10 (15.4) |
Toilet Facility, n (%) | |
Flush Toilet | 5 (6.2) |
Improved Pit Latrine | 23 (28.8) |
Pit Latrine | 32 (39.5) |
No Toilet Facility | 20 (24.7) |
Household Water Treatment, n (%) | |
Yes | 21 (25.9) |
No | 60 (74) |
Soap Available for Handwashing, n (%) | |
Yes | 44 (54.3) |
No | 36 (44.4) |
Handwashing at home, n (%) | |
No handwashing | 29 (35.8) |
In kitchen | 14 (17.3) |
By latrine/toilet | 6 (7.4) |
Drinking Water | Total n (%) | Leprosy Cases, n (%) | Sanitation | Total n, (%) | Leprosy Cases, n (%) | Hygiene b | Total n, (%) | Leprosy Cases, n (%) |
---|---|---|---|---|---|---|---|---|
Tier 5. Drinking water from an improved water source, which is located on premises, available when needed and free from fecal and priority chemical contamination. | 24 (30) | 8 (20) | Tier 5. Use of improved facilities which are not shared with other households and where excreta are safely disposed in situ or transported and treated off-site. | 1 (1) | 0 (0) | |||
Tier 4. Drinking water from an improved source, provided collection time is not more than 30 min for a roundtrip including queuing. | 40 (49) | 22 (55) | Tier 4. Use of improved facilities, which are not shared with other households. | 14 (17) | 11 (28) | Tier 3. Availability of a handwashing facility on premises with soap and water. | 36 (44) | 11 (28) |
Tier 3. Drinking water from an improved source for which collection time exceeds 30 min for a roundtrip including queuing. | 3 (4) | 0 (0) | Tier 3. Use of improved facilities shared between two or more households. | 13 (16) | 3 (8) | Tier 2. Availability of a handwashing facility on premises without soap and water. | 16 (20) | 8 (20) |
Tier 2. Drinking water from an unprotected dug well or unprotected spring. | 10 (12) | 9 (23) | Tier 2. Use of pit latrines without a slab or platform, hanging latrines or bucket latrines. | 33 (41) | 11 (28) | Tier 1. No handwashing facility on premises. | 29 (36) | 20 (50) |
Tier 1. Drinking water directly from a river, dam, lake pond, stream, canal or irrigation canal. | 4 (5) | 1 (3) | Tier 1. Disposal of human feces in fields, forests, bushes, open bodies of water, beaches, and other open spaces or with solid waste. | 20 (25) | 15 (38) |
Covariate | OR | Lower Limit a | Upper Limit | aOR f | Lower Limit a | Upper Limit |
---|---|---|---|---|---|---|
Water Source b | 4.22 | 1.07 | 16.72 | 3.47 | 0.31 | 38.76 |
Lack of Premise Water Access c,d | 2.83 | 1.05 | 7.65 | - | - | - |
Lack of Water Treatment | 1.62 | 0.59 | 4.40 | 0.28 | 0.04 | 1.79 |
Time to get water | 1.01 | 0.98 | 1.04 | 0.99 | 0.93 | 1.05 |
Lack of Soap | 2.61 | 1.06 | 6.42 | 7.31 | 1.07 | 49.94 |
Lack of Handwashing | 4.56 | 1.69 | 12.28 | 2.46 | 0.47 | 12.82 |
Open Defecation | 4.32 | 1.67 | 11.18 | 19.86 | 2.24 | 176.25 |
Schistosomiasis d | 0.54 | 0.20 | 1.49 | - | - | - |
Lake Region d,e | 0.60 | 0.22 | 1.69 | - | - | - |
Strata | n (%) | OR | Lower Limit a | Upper Limit a |
---|---|---|---|---|
Near Lake Tana | 20 | 3.56 | 0.80 | 15.85 |
Distant from Lake Tana | 61 | 0.33 | 0.09 | 1.19 |
© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Emerson, L.E.; Anantharam, P.; Yehuala, F.M.; Bilcha, K.D.; Tesfaye, A.B.; Fairley, J.K. Poor WASH (Water, Sanitation, and Hygiene) Conditions Are Associated with Leprosy in North Gondar, Ethiopia. Int. J. Environ. Res. Public Health 2020, 17, 6061. https://doi.org/10.3390/ijerph17176061
Emerson LE, Anantharam P, Yehuala FM, Bilcha KD, Tesfaye AB, Fairley JK. Poor WASH (Water, Sanitation, and Hygiene) Conditions Are Associated with Leprosy in North Gondar, Ethiopia. International Journal of Environmental Research and Public Health. 2020; 17(17):6061. https://doi.org/10.3390/ijerph17176061
Chicago/Turabian StyleEmerson, Lisa E., Puneet Anantharam, Feleke M. Yehuala, Kassahun D. Bilcha, Annisa B. Tesfaye, and Jessica K. Fairley. 2020. "Poor WASH (Water, Sanitation, and Hygiene) Conditions Are Associated with Leprosy in North Gondar, Ethiopia" International Journal of Environmental Research and Public Health 17, no. 17: 6061. https://doi.org/10.3390/ijerph17176061