WASH Factors and Leprosy Schistosomiasis Co-Infections in North Gondar, Ethiopia: Risk Factors for Leprosy Transmission Open Access

Abstract

Access to safe water, sanitation, and hygiene (WASH) is critical for preventing the spread of many neglected tropical diseases (NTDs). While leprosy is thought to be transmitted primarily through nasal secretions from infected individuals, WASH-related transmission factors remain largely unexplored as part of the leprosy transmission cycle. The aim of this project is to better understand WASH exposures among leprosy cases through a case-control study in the North Gondar district of Ethiopia, an area endemic to leprosy and other NTDs. We hypothesize that leprosy cases are more likely to have inadequate access to safe WASH and are more likely to have concurrent schistosomiasis, as schistosomiasis immune consequences may facilitate leprosy infection. Adult leprosy cases and controls without leprosy were recruited from health districts in the North Gondar region and tested for Schistosoma mansoni with a point-of-care test. All participants answered a demographic and WASH survey. Participants were assigned a WASH index score using WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP) core questions on WASH for household surveys. Eighty-one persons were enrolled with a median age of 33, of whom 75% were male. The majority of the 40 cases had multibacillary disease (83%) and S. mansoni infection was detected in 26% of participants. WASH factors associated with leprosy on adjusted analyses showed an association with open defecation (OR=19.9, 95% CI 2.2, 176.3) and lack of access to soap (OR=7.3, 95% CI (1.1, 49.9); but were inconclusive for improved water source (OR=3.5, 95% CI 0.31, 38.8), lack of water treatment (OR=0.28, 95% CI 0.04, 1.8), time to fetch water (OR=0.99, 95% CI 0.93, 1.1), and lack of handwashing (OR=2.5, 95% CI 0.47, 12.8). In the stratified analysis, those with leprosy had a 3.6, 95% CI (0.8, 15.9), greater odds of schistosomiasis in districts bordering the lake, while those with leprosy had 0.33 lower odds of schistosomiasis in districts not bordering the lake 95% CI (0.09, 1.2). Overall, these results suggest that leprosy transmission may be related to WASH adequacy and access as well as schistosomiasis co-infection. 

Table of Contents

Chapter I:

Literature Review………………………………………………………………………………...……1

Chapter II:

Manuscript

Title, Authors, Abstract………………………………………………………………….11          

Introduction…………………………………………………………………………………12

Methods………………………………………………………………………….……………15

Results…………………………………………………………………………………………19

Discussion…………………………………………………………………………………….21

References……………………………………………………………………………………26

Tables…………………………………………………………………………………………. 31

Chapter III:

Summary, Public Health Implications, and Possible Future Directions……….34

Appendices

Appendix A……………………………………………………………………………………………...36

Appendix B……………………………………………………………………………………………...44

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	M.S.P.H.
Submission	Master's Thesis
Language	English
Research Field	Environmental Health Health Sciences, Epidemiology Health Sciences, Public Health
Keyword	Leprosy Neglected Tropical Disease WASH NTD
Committee Chair / Thesis Advisor	Matthew Freeman, Emory University
Committee Members	Jessica Fairley, Emory University

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