Household Finished Flooring and Soil-Transmitted Helminth and Giardia Infections among Children in Rural Bangladesh and Kenya: A Prospective Cohort Study

Background

Soil-transmitted helminths and Giardia duodenalis are responsible for a large burden of disease globally. In low-resource settings, household finished floors (eg, concrete floors) might reduce transmission of soil-transmitted helminths and G duodenalis.

Methods

In a prospective cohort of children nested within two randomised trials in rural Bangladesh and Kenya, we estimated associations between household finished flooring and soil-transmitted helminths and G duodenalis prevalence. In 2015–16, we collected stool samples from children aged 2–16 years in rural Bangladesh and Kenya. We detected soil-transmitted helminth infection using quantitative PCR (qPCR; Bangladesh n=2800; Kenya n=3094), and G duodenalis using qPCR in Bangladesh (n=6894) and ELISA in Kenya (n=8899). We estimated adjusted prevalence ratios (aPRs) using log-linear models adjusted for potential confounders.

Findings

7187 (92·2%) of 7795 children in Bangladesh and 9077 (93·7%) of 9686 children in Kenya provided stool specimens that were analysed by qPCR. At enrolment, 691 (10%) households in Bangladesh and 471 (5%) households in Kenya had finished floors. In both countries, household finished flooring was associated with lower Ascaris lumbricoides prevalence (Bangladesh aPR 0·33, 95% CI 0·14–0·78; Kenya 0·62, 0·39–0·98) and any soil-transmitted helminths (Bangladesh 0·73, 0·52–1·01; Kenya 0·57, 0·37–0·88). Household finished floors were also associated with lower Necator americanus prevalence in Bangladesh (0·52, 0·29–0·94) and G duodenalis prevalence in both countries (Bangladesh 0·78, 0·64–0·95; Kenya 0·82, 0·70–0·97).

Interpretation

In low-resource settings, living in households with finished floors over a 2-year period was associated with lower prevalence of G duodenalis and some soil-transmitted helminths in children.