Household-based prevalence of helminths and parasitic protozoa in rural KwaZulu-Natal, South Africa, assessed from faecal vault sampling
Identifieur interne : 003989 ( Istex/Corpus ); précédent : 003988; suivant : 003990Household-based prevalence of helminths and parasitic protozoa in rural KwaZulu-Natal, South Africa, assessed from faecal vault sampling
Auteurs : Linda Trönnberg ; David Hawksworth ; Anette Hansen ; Colleen Archer ; Thor Axel StenströmSource :
- Transactions of The Royal Society of Tropical Medicine and Hygiene [ 0035-9203 ] ; 2010-10.
English descriptors
- KwdEn :
Abstract
This study was undertaken to examine the family-based prevalence of environmentally persistent parasites in two rural communities of KwaZulu-Natal, South Africa. Samples were collected from 120 urine-diversion family toilets and screened for selected protozoa and helminths with immunomagnetic separation and the ammonium bicarbonate (AMBIC) protocol respectively. The parasites found were Ascaris lumbricoides (59%), Giardia intestinalis (54%), Trichuris trichiura (48%), Cryptosporidium spp. (21%) and Taenia spp. (18%). Only 14% of the household toilets were negative for these pathogens. The occurrence of A. lumbricoides and T. trichiura was lower (P < 0.001) in the area with better hygiene behaviour, whereas G. intestinalis was more common (P < 0.05) in families with at least one child aged five years or less and in families with more than four persons. Quantification of the parasites per gram was done for each sample and this provided realistic risk assessment data for the reuse of material from urine-diversion toilets. The high occurrence of parasites found in the two communities, in spite of sanitation and hygiene interventions in the areas, suggests an endemicity that will not be reduced without de-worming campaigns. Finally, the study showed that sampling directly from the deposited faecal material may be useful for parasitic prevalence estimations.
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DOI: 10.1016/j.trstmh.2010.06.009
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ISTEX:B0FB73AFD89FFBF1BA961E33BAD7A7B6D7E0AB3BLe document en format XML
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E-mail address: linda.tronnberg@smi.se</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: linda.tronnberg@smi.se</mods:affiliation></affiliation></author><author><name sortKey="Hawksworth, David" sort="Hawksworth, David" uniqKey="Hawksworth D" first="David" last="Hawksworth">David Hawksworth</name><affiliation><mods:affiliation>Pollution Research Group, University of KwaZulu-Natal, Biological and Conservation Sciences, Westville Campus, Durban, 4001 South Africa</mods:affiliation></affiliation></author><author><name sortKey="Hansen, Anette" sort="Hansen, Anette" uniqKey="Hansen A" first="Anette" last="Hansen">Anette Hansen</name><affiliation><mods:affiliation>Swedish Institute for Infectious Disease Control, Department of Parasitology, Mycology, Water and Environmental Microbiology, Nobels Väg 18, 171 82 Solna, Sweden</mods:affiliation></affiliation></author><author><name sortKey="Archer, Colleen" sort="Archer, Colleen" uniqKey="Archer C" first="Colleen" last="Archer">Colleen Archer</name><affiliation><mods:affiliation>Pollution Research Group, University of KwaZulu-Natal, Biological and Conservation Sciences, Westville Campus, Durban, 4001 South Africa</mods:affiliation></affiliation></author><author><name sortKey="Stenstrom, Thor Axel" sort="Stenstrom, Thor Axel" uniqKey="Stenstrom T" first="Thor Axel" last="Stenström">Thor Axel Stenström</name><affiliation><mods:affiliation>Swedish Institute for Infectious Disease Control, Department of Parasitology, Mycology, Water and Environmental Microbiology, Nobels Väg 18, 171 82 Solna, Sweden</mods:affiliation></affiliation><affiliation><mods:affiliation>Stockholm Environment Institute, Kräftriket 2B, 106 91 Stockholm, Sweden</mods:affiliation></affiliation><affiliation><mods:affiliation>University of Life Sciences, 1432, Ås, Norway</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:B0FB73AFD89FFBF1BA961E33BAD7A7B6D7E0AB3B</idno><date when="2010" year="2010">2010</date><idno type="doi">10.1016/j.trstmh.2010.06.009</idno><idno type="url">https://api.istex.fr/document/B0FB73AFD89FFBF1BA961E33BAD7A7B6D7E0AB3B/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">003989</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">003989</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a">Household-based prevalence of helminths and parasitic protozoa in rural KwaZulu-Natal, South Africa, assessed from faecal vault sampling</title><author><name sortKey="Tronnberg, Linda" sort="Tronnberg, Linda" uniqKey="Tronnberg L" first="Linda" last="Trönnberg">Linda Trönnberg</name><affiliation><mods:affiliation>Swedish Institute for Infectious Disease Control, Department of Parasitology, Mycology, Water and Environmental Microbiology, Nobels Väg 18, 171 82 Solna, Sweden</mods:affiliation></affiliation><affiliation><mods:affiliation>Royal Institute of Technology, Division of Water Resources Engineering, Teknikringen 76, 100 44 Stockholm, Sweden</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: linda.tronnberg@smi.se</mods:affiliation></affiliation><affiliation><mods:affiliation>Corresponding author. Tel.: +46 8 457 24 49; fax: +46 8 31 84 50. E-mail address: linda.tronnberg@smi.se</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: linda.tronnberg@smi.se</mods:affiliation></affiliation></author><author><name sortKey="Hawksworth, David" sort="Hawksworth, David" uniqKey="Hawksworth D" first="David" last="Hawksworth">David Hawksworth</name><affiliation><mods:affiliation>Pollution Research Group, University of KwaZulu-Natal, Biological and Conservation Sciences, Westville Campus, Durban, 4001 South Africa</mods:affiliation></affiliation></author><author><name sortKey="Hansen, Anette" sort="Hansen, Anette" uniqKey="Hansen A" first="Anette" last="Hansen">Anette Hansen</name><affiliation><mods:affiliation>Swedish Institute for Infectious Disease Control, Department of Parasitology, Mycology, Water and Environmental Microbiology, Nobels Väg 18, 171 82 Solna, Sweden</mods:affiliation></affiliation></author><author><name sortKey="Archer, Colleen" sort="Archer, Colleen" uniqKey="Archer C" first="Colleen" last="Archer">Colleen Archer</name><affiliation><mods:affiliation>Pollution Research Group, University of KwaZulu-Natal, Biological and Conservation Sciences, Westville Campus, Durban, 4001 South Africa</mods:affiliation></affiliation></author><author><name sortKey="Stenstrom, Thor Axel" sort="Stenstrom, Thor Axel" uniqKey="Stenstrom T" first="Thor Axel" last="Stenström">Thor Axel Stenström</name><affiliation><mods:affiliation>Swedish Institute for Infectious Disease Control, Department of Parasitology, Mycology, Water and Environmental Microbiology, Nobels Väg 18, 171 82 Solna, Sweden</mods:affiliation></affiliation><affiliation><mods:affiliation>Stockholm Environment Institute, Kräftriket 2B, 106 91 Stockholm, Sweden</mods:affiliation></affiliation><affiliation><mods:affiliation>University of Life Sciences, 1432, Ås, Norway</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Transactions of The Royal Society of Tropical Medicine and Hygiene</title><title level="j" type="abbrev">Trans R Soc Trop Med Hyg</title><idno type="ISSN">0035-9203</idno><idno type="eISSN">1878-3503</idno><imprint><publisher>Royal Society of Tropical Medicine and Hygiene</publisher><date type="published" when="2010-10">2010-10</date><biblScope unit="volume">104</biblScope><biblScope unit="issue">10</biblScope><biblScope unit="page" from="646">646</biblScope><biblScope unit="page" to="652">652</biblScope></imprint><idno type="ISSN">0035-9203</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0035-9203</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Cryptosporidium spp.</term><term>Taenia spp.</term><term>on-site sanitation</term><term>public health</term><term>soil-transmitted helminths</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract">This study was undertaken to examine the family-based prevalence of environmentally persistent parasites in two rural communities of KwaZulu-Natal, South Africa. Samples were collected from 120 urine-diversion family toilets and screened for selected protozoa and helminths with immunomagnetic separation and the ammonium bicarbonate (AMBIC) protocol respectively. The parasites found were Ascaris lumbricoides (59%), Giardia intestinalis (54%), Trichuris trichiura (48%), Cryptosporidium spp. (21%) and Taenia spp. (18%). Only 14% of the household toilets were negative for these pathogens. The occurrence of A. lumbricoides and T. trichiura was lower (P < 0.001) in the area with better hygiene behaviour, whereas G. intestinalis was more common (P < 0.05) in families with at least one child aged five years or less and in families with more than four persons. Quantification of the parasites per gram was done for each sample and this provided realistic risk assessment data for the reuse of material from urine-diversion toilets. The high occurrence of parasites found in the two communities, in spite of sanitation and hygiene interventions in the areas, suggests an endemicity that will not be reduced without de-worming campaigns. Finally, the study showed that sampling directly from the deposited faecal material may be useful for parasitic prevalence estimations.</div></front></TEI><istex><corpusName>oup</corpusName><author><json:item><name>Linda Trönnberg</name><affiliations><json:string>Swedish Institute for Infectious Disease Control, Department of Parasitology, Mycology, Water and Environmental Microbiology, Nobels Väg 18, 171 82 Solna, Sweden</json:string><json:string>Royal Institute of Technology, Division of Water Resources Engineering, Teknikringen 76, 100 44 Stockholm, Sweden</json:string><json:string>E-mail: linda.tronnberg@smi.se</json:string></affiliations></json:item><json:item><name>David Hawksworth</name><affiliations><json:string>Pollution Research Group, University of KwaZulu-Natal, Biological and Conservation Sciences, Westville Campus, Durban, 4001 South Africa</json:string></affiliations></json:item><json:item><name>Anette Hansen</name><affiliations><json:string>Swedish Institute for Infectious Disease Control, Department of Parasitology, Mycology, Water and Environmental Microbiology, Nobels Väg 18, 171 82 Solna, Sweden</json:string></affiliations></json:item><json:item><name>Colleen Archer</name><affiliations><json:string>Pollution Research Group, University of KwaZulu-Natal, Biological and Conservation Sciences, Westville Campus, Durban, 4001 South Africa</json:string></affiliations></json:item><json:item><name>Thor Axel Stenström</name><affiliations><json:string>Swedish Institute for Infectious Disease Control, Department of Parasitology, Mycology, Water and Environmental Microbiology, Nobels Väg 18, 171 82 Solna, Sweden</json:string><json:string>Stockholm Environment Institute, Kräftriket 2B, 106 91 Stockholm, Sweden</json:string><json:string>University of Life Sciences, 1432, Ås, Norway</json:string></affiliations></json:item></author><subject><json:item><value>Cryptosporidium spp.</value></json:item><json:item><value>soil-transmitted helminths</value></json:item><json:item><value>Taenia spp.</value></json:item><json:item><value>on-site sanitation</value></json:item><json:item><value>public health</value></json:item></subject><language><json:string>unknown</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>This study was undertaken to examine the family-based prevalence of environmentally persistent parasites in two rural communities of KwaZulu-Natal, South Africa. Samples were collected from 120 urine-diversion family toilets and screened for selected protozoa and helminths with immunomagnetic separation and the ammonium bicarbonate (AMBIC) protocol respectively. The parasites found were Ascaris lumbricoides (59%), Giardia intestinalis (54%), Trichuris trichiura (48%), Cryptosporidium spp. (21%) and Taenia spp. (18%). Only 14% of the household toilets were negative for these pathogens. The occurrence of A. lumbricoides and T. trichiura was lower (P > 0.001) in the area with better hygiene behaviour, whereas G. intestinalis was more common (P > 0.05) in families with at least one child aged five years or less and in families with more than four persons. Quantification of the parasites per gram was done for each sample and this provided realistic risk assessment data for the reuse of material from urine-diversion toilets. The high occurrence of parasites found in the two communities, in spite of sanitation and hygiene interventions in the areas, suggests an endemicity that will not be reduced without de-worming campaigns. 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Tel.: +46 8 457 24 49; fax: +46 8 31 84 50. E-mail address: linda.tronnberg@smi.se</affiliation></author><author xml:id="author-0001"><persName><forename type="first">David</forename><surname>Hawksworth</surname></persName><affiliation>Pollution Research Group, University of KwaZulu-Natal, Biological and Conservation Sciences, Westville Campus, Durban, 4001 South Africa</affiliation></author><author xml:id="author-0002"><persName><forename type="first">Anette</forename><surname>Hansen</surname></persName><affiliation>Swedish Institute for Infectious Disease Control, Department of Parasitology, Mycology, Water and Environmental Microbiology, Nobels Väg 18, 171 82 Solna, Sweden</affiliation></author><author xml:id="author-0003"><persName><forename type="first">Colleen</forename><surname>Archer</surname></persName><affiliation>Pollution Research Group, University of KwaZulu-Natal, Biological and Conservation Sciences, Westville Campus, Durban, 4001 South Africa</affiliation></author><author xml:id="author-0004"><persName><forename type="first">Thor Axel</forename><surname>Stenström</surname></persName><affiliation>Swedish Institute for Infectious Disease Control, Department of Parasitology, Mycology, Water and Environmental Microbiology, Nobels Väg 18, 171 82 Solna, Sweden</affiliation><affiliation>Stockholm Environment Institute, Kräftriket 2B, 106 91 Stockholm, Sweden</affiliation><affiliation>University of Life Sciences, 1432, Ås, Norway</affiliation></author><idno type="istex">B0FB73AFD89FFBF1BA961E33BAD7A7B6D7E0AB3B</idno><idno type="ark">ark:/67375/HXZ-TBSH0WDC-3</idno><idno type="DOI">10.1016/j.trstmh.2010.06.009</idno></analytic><monogr><title level="j">Transactions of The Royal Society of Tropical Medicine and Hygiene</title><title level="j" type="abbrev">Trans R Soc Trop Med Hyg</title><idno type="pISSN">0035-9203</idno><idno type="eISSN">1878-3503</idno><idno type="publisher-id">trstmh</idno><idno type="PublisherID-hwp">trstmh</idno><imprint><publisher>Royal Society of Tropical Medicine and Hygiene</publisher><date type="published" when="2010-10"></date><biblScope unit="volume">104</biblScope><biblScope unit="issue">10</biblScope><biblScope unit="page" from="646">646</biblScope><biblScope unit="page" to="652">652</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2010</date></creation><abstract><p>This study was undertaken to examine the family-based prevalence of environmentally persistent parasites in two rural communities of KwaZulu-Natal, South Africa. Samples were collected from 120 urine-diversion family toilets and screened for selected protozoa and helminths with immunomagnetic separation and the ammonium bicarbonate (AMBIC) protocol respectively. The parasites found were Ascaris lumbricoides (59%), Giardia intestinalis (54%), Trichuris trichiura (48%), Cryptosporidium spp. (21%) and Taenia spp. (18%). Only 14% of the household toilets were negative for these pathogens. The occurrence of A. lumbricoides and T. trichiura was lower (P < 0.001) in the area with better hygiene behaviour, whereas G. intestinalis was more common (P < 0.05) in families with at least one child aged five years or less and in families with more than four persons. Quantification of the parasites per gram was done for each sample and this provided realistic risk assessment data for the reuse of material from urine-diversion toilets. The high occurrence of parasites found in the two communities, in spite of sanitation and hygiene interventions in the areas, suggests an endemicity that will not be reduced without de-worming campaigns. Finally, the study showed that sampling directly from the deposited faecal material may be useful for parasitic prevalence estimations.</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>Keywords</head><item><term>Cryptosporidium spp.</term></item><item><term>soil-transmitted helminths</term></item><item><term>Taenia spp.</term></item><item><term>on-site sanitation</term></item><item><term>public health</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2010-10">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/B0FB73AFD89FFBF1BA961E33BAD7A7B6D7E0AB3B/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus oup, element #text not found" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" URI="journalpublishing.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article">
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<article-title>Household-based prevalence of helminths and parasitic protozoa in rural KwaZulu-Natal, South Africa, assessed from faecal vault sampling</article-title>
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<contrib-group>
<contrib contrib-type="author" corresp="yes">
<name><surname>Trönnberg</surname><given-names>Linda</given-names></name><xref ref-type="aff" rid="aff1"><sup>a</sup></xref><xref ref-type="aff" rid="aff2"><sup>b</sup></xref><xref ref-type="corresp" rid="cor1"><sup>⁎</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Hawksworth</surname><given-names>David</given-names></name><xref ref-type="aff" rid="aff3"><sup>c</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Hansen</surname><given-names>Anette</given-names></name><xref ref-type="aff" rid="aff1"><sup>a</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Archer</surname><given-names>Colleen</given-names></name><xref ref-type="aff" rid="aff3"><sup>c</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Stenström</surname><given-names>Thor Axel</given-names></name><xref ref-type="aff" rid="aff1"><sup>a</sup></xref><xref ref-type="aff" rid="aff4"><sup>d</sup></xref><xref ref-type="aff" rid="aff5"><sup>e</sup></xref>
</contrib>
<aff id="aff1">
<label>a</label>Swedish Institute for Infectious Disease Control, Department of Parasitology, Mycology, Water and Environmental Microbiology, Nobels Väg 18, 171 82 Solna, Sweden</aff>
<aff id="aff2">
<label>b</label>Royal Institute of Technology, Division of Water Resources Engineering, Teknikringen 76, 100 44 Stockholm, Sweden</aff>
<aff id="aff3">
<label>c</label>Pollution Research Group, University of KwaZulu-Natal, Biological and Conservation Sciences, Westville Campus, Durban, 4001 South Africa</aff>
<aff id="aff4">
<label>d</label>Stockholm Environment Institute, Kräftriket 2B, 106 91 Stockholm, Sweden</aff>
<aff id="aff5">
<label>e</label>University of Life Sciences, 1432, Ås, Norway</aff>
</contrib-group>
<author-notes>
<corresp id="cor1">
<label>⁎</label>Corresponding author. Tel.: +46 8 457 24 49; fax: +46 8 31 84 50. <italic>E-mail address:</italic> <email>linda.tronnberg@smi.se</email> (L. Trönnberg).</corresp>
</author-notes>
<pub-date pub-type="ppub">
<month>10</month>
<year>2010</year>
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<volume>104</volume>
<issue>10</issue>
<fpage>646</fpage>
<lpage>652</lpage>
<history>
<date date-type="received">
<day>15</day>
<month>12</month>
<year>2009</year></date>
<date date-type="rev-recd">
<day>25</day>
<month>6</month>
<year>2010</year></date>
<date date-type="accepted">
<day>25</day>
<month>6</month>
<year>2010</year></date>
</history>
<permissions>
<copyright-year>2010</copyright-year>
<copyright-holder>Royal Society of Tropical Medicine and Hygiene</copyright-holder>
</permissions>
<abstract>
<title>Abstract</title>
<p>This study was undertaken to examine the family-based prevalence of environmentally persistent parasites in two rural communities of KwaZulu-Natal, South Africa. Samples were collected from 120 urine-diversion family toilets and screened for selected protozoa and helminths with immunomagnetic separation and the ammonium bicarbonate (AMBIC) protocol respectively. The parasites found were <italic>Ascaris lumbricoides</italic> (59%), <italic>Giardia intestinalis</italic> (54%), <italic>Trichuris trichiura</italic> (48%), <italic>Cryptosporidium</italic> spp. (21%) and <italic>Taenia</italic> spp. (18%). Only 14% of the household toilets were negative for these pathogens. The occurrence of <italic>A. lumbricoides</italic> and <italic>T. trichiura</italic> was lower (<italic>P</italic> < 0.001) in the area with better hygiene behaviour, whereas <italic>G. intestinalis</italic> was more common (<italic>P</italic> < 0.05) in families with at least one child aged five years or less and in families with more than four persons. Quantification of the parasites per gram was done for each sample and this provided realistic risk assessment data for the reuse of material from urine-diversion toilets. The high occurrence of parasites found in the two communities, in spite of sanitation and hygiene interventions in the areas, suggests an endemicity that will not be reduced without de-worming campaigns. Finally, the study showed that sampling directly from the deposited faecal material may be useful for parasitic prevalence estimations.</p>
</abstract>
<kwd-group xml:lang="en">
<title>Keywords</title>
<kwd><italic>Giardia intestinalis</italic></kwd>
<kwd><italic>Cryptosporidium</italic> spp.</kwd>
<kwd>soil-transmitted helminths</kwd>
<kwd><italic>Taenia</italic> spp<italic>.</italic></kwd>
<kwd>on-site sanitation</kwd>
<kwd>public health</kwd>
</kwd-group>
</article-meta>
</front>
<body>
<sec sec-type="intro">
<label>1</label>
<title>Introduction</title>
<p>The prevalence of soil-transmitted helminths (STHs) is often high in tropical regions where communities do not have access to improved sanitation.<xref ref-type="bibr" rid="bib1"><sup>1</sup></xref> Infection with parasitic protozoa, like <italic>Giardia intestinalis</italic> and <italic>Cryptosporidium</italic> spp<italic>.,</italic> is also closely related to unsafe water, sanitation and hygiene (WSH).<xref ref-type="bibr" rid="bib2"><sup>2</sup></xref></p>
<p>Diarrhoeal diseases annually kill approximately 1.8 million people, of which the majority are children aged 0-4 years.<xref ref-type="bibr" rid="bib3"><sup>3</sup></xref> In South Africa, diarrhoea is the cause of death in 7.9% of the children in this age group.<xref ref-type="bibr" rid="bib4"><sup>4</sup></xref> Poor WSH has been estimated to cause 4.0% of all deaths and accounts for 5.7% of the total disease burden, measured as disability-adjusted life years (DALYs), in the world.<xref ref-type="bibr" rid="bib5"><sup>5</sup></xref> The outcome of infections with intestinal parasites is seldom directly linked to mortality, but parasite load adds to malnutrition, growth retardation and increases human susceptibility to other diseases.<xref ref-type="bibr" rid="bib6 bib7"><sup>6,7</sup></xref> It may also impact on both the physical and intellectual development of children, without an evident contribution to the global health statistics.<sup><xref ref-type="bibr" rid="bib1">1</xref>,<xref ref-type="bibr" rid="bib8">8</xref></sup> Children and people with suppressed immune systems, e.g., HIV positive persons, are more vulnerable to infections. According to Welz et al. (2007), 27% of the women (51% of the women aged 25–29 years) and 13.5% of the men, in rural KwaZulu-Natal (KZN) are infected with HIV.<xref ref-type="bibr" rid="bib9"><sup>9</sup></xref> In particular <italic>Cryptosporidium</italic> spp<italic>.</italic> are known to cause severe diarrhoea in immunocompromised patients.<xref ref-type="bibr" rid="bib10"><sup>10</sup></xref> Additionally, Gonçalves et al. (2009) reported an association between giardiasis and diarrhoea in HIV positive patients.<xref ref-type="bibr" rid="bib11"><sup>11</sup></xref></p>
<p>The parasitic protozoa and most of the helminths infect through the faecal-oral route. Excreted <italic>A. lumbricoides</italic> ova need a maturation period in the environment in order to become infective, while <italic>Cryptosporidium</italic> spp. and <italic>G. intestinalis</italic> (oo)cysts are immediately infective after excretion. The transmission route for <italic>Taenia</italic> spp<italic>.</italic> differs from the previously mentioned parasites. Passage of <italic>Taenia</italic> spp. through cattle or pigs is needed in order for the cysticercoid larvae to induce the gastrointestinal adult worm infection (after ingestion of the contaminated flesh by humans). However, ingestion of the ova of <italic>Taenia solium</italic>, the pork tapeworm, by humans results in cysticercoid formation in various tissues, with a predilection for the brain, causing neurocysticercosis.<xref ref-type="bibr" rid="bib12"><sup>12</sup></xref></p>
<p>Thus, if the pathogens excreted through faeces are not properly treated or contained within a well-functioning sanitation system, they will enter the environment with a subsequent risk for transmission. Currently, 2.4 billion people are exposed to an elevated risk for infection with intestinal pathogens due to lack of proper sanitation and safe water supplies.<xref ref-type="bibr" rid="bib13"><sup>13</sup></xref> The impact of these pathogens is further implicated by their long survival time in the environment, e.g. the time for 90% inactivation of <italic>A. lumbricoides</italic> ova has been referred to as 125 ± 30 days in excreted faeces and 625 ± 150 days in soil.<xref ref-type="bibr" rid="bib2"><sup>2</sup></xref></p>
<p>Adequate WSH is crucial in order to prevent transmission of gastrointestinal pathogens and a sanitary intervention in the eThekwini Municipality (KZN, South Africa) was therefore initiated at the beginning of 2000. Due to factors such as water scarcity, the geographical hilly conditions and management, e.g. emptying, the sanitation option selected by the municipality was dry toilets with urine-diversion (UD). In these toilets the faecal material is collected and contained in vaults, while the urine bowl is connected to a pipe that drains into a soak-away. The collected faecal matter is contained for one year after the vault is full and an adjacent alternative vault is used during this time. When the second vault is full, the dry material in the first vault is removed and buried in the ground, with the option, if judged safe in the future, to be used as a fertilizer resource. Since 2003, more than 78 000 households in peri-urban and rural areas within the eThekwini Municipality have been provided with this type of on-site UD toilet, together with safe water and hygiene education. An observational study recently undertaken in order to evaluate the health impact of the sanitary intervention in KZN, showed 41% reduction of diarrhoea episodes among families receiving the intervention package, Knight et al. (unpublished). In that study the economic status and the health of the population was assessed by a questionnaire survey addressing socio-economic factors and episodes of sickness (e.g. diarrhoea, skin-sores and vomiting), but without microbiological analyses of stool samples.</p>
<p>This study was therefore undertaken to examine the occurrence of environmentally persistent parasites among families in rural KZN. The parasites selected: <italic>G. intestinalis, Cryptosporidium</italic> spp., <italic>A. lumbricoides, T. trichiura</italic> and <italic>Taenia</italic> spp., were chosen since they pose a risk for environmental contamination when human excreta is either used as soil conditioner or when buried. In order to assess the health of a large population during a limited time period, it was decided to collect the samples directly from the faecal waste in the UD toilets with the intention to reflect the household-based prevalence of these organisms. The approach was thus household-centred and not based on individual infections. Attention was focused on these organisms due to their relative resistance as ova and (oo)cysts to environmental factors and the risk of long term persistence in the faecal standing vaults. Based on an epidemiological database produced as part of the observational study by Knight et al. (unpublished) and Lutchminarayan (2007) in the areas, factors involving a higher probability of occurrence of parasites in the vault could be discussed.<xref ref-type="bibr" rid="bib14"><sup>14</sup></xref> The intention was to make an assessment of the occurrence and concentrations to form a baseline for future studies on parasitic persistence in the faecal vaults and the environment.</p>
</sec>
<sec sec-type="materials|methods">
<label>2</label>
<title>Materials and Methods</title>
<p>A total of 120 households were selected based on oral consent by the householder, the household having a UD toilet and inclusion in the qualitative epidemiological studies (in which a multistage random sampling process was used to select households in the intervention areas) made by Knight et al. (unpublished) and Lutchminarayan (2007).<xref ref-type="bibr" rid="bib14"><sup>14</sup></xref> Three subsamples from the fresh faeces in the top part of the UD vault were removed and pooled to form one family sample of approximately 400 g. The pooled material from each vault was put into a plastic jar with a screw-top lid. The consistency of the collected faeces varied from loose to dry and sometimes mixed with soil (due to the practice of adding soil after defecation). All jars were stored at 4<sup>o</sup>C until screening for helminths and parasitic protozoa was conducted.</p>
<sec>
<label>2.1</label>
<title>Study sites</title>
<p>The households were located in two peri-urban to rural areas, Mtamuntengayo (<italic>n</italic> = 64, 437 individuals) and Sawpitts (<italic>n</italic> = 56, 371 individuals) in the eThekwini municipality. The two study areas are only approximately 3.2 km apart, but slightly different. Some overall socio-economic and hygiene-related indicators of the two areas are summarized in <xref ref-type="fig" rid="tbl1">Table 1</xref>
<fig id="tbl1">
<label>Table 1</label>
<caption>
<p>General socio-economic and hygiene factors for the two investigated areas, proportions derived from Lutchminarayan (2007)<xref ref-type="bibr" rid="bib14"><sup>14</sup></xref></p>
</caption>
<graphic mimetype="image" xlink:href="104-10-646-tbl001.tif"></graphic>
</fig> as modified from Lutchminarayan (2007).<xref ref-type="bibr" rid="bib14"><sup>14</sup></xref></p>
</sec>
<sec>
<label>2.2</label>
<title>Screening for <italic>Giardia intestinalis</italic> and <italic>Cryptosporidium</italic> spp.</title>
<p>The faecal material in each jar was mixed with sterile water and filtrated through a single layer of wet gauze. From the filtrate, 1 ml was analysed with respect to the weight of the solids (by adding 1 ml of the filtrate to weighed 1.5 ml test tubes, centrifugation (900 x g, 10 minutes, Heraeus Pico 17 Centrifuge; Thermo Fisher Scientific, Waltham, MA, USA), removal of the supernatant and weighing of the samples) and 1 ml was analysed for <italic>G. intestinalis</italic> and <italic>Cryptosporidium</italic> spp<italic>.</italic> as follows: Immunomagnetic separation (IMS) (Dynabeads<sup>R</sup>, GC-combo kit; Invitrogen Dynal AS, Oslo, Norway) was conducted according to manufacturer’s instructions and the final suspension was put onto microscope slides and air-dried in 56<sup>o</sup>C. Subsequently, 50 μl methanol was added to each slide and the samples were left to air-dry at room temperature. The methanol-fixed samples were then stained, as instructed by the manufacturer, with fluorescein isothiocyanate (FITC)-labelled anti-<italic>Giardia</italic> cysts and anti-<italic>Cryptosporidium</italic> oocysts monoclonal antibodies (A100FLR-20X, Aqua-Glo<sup>TM</sup> G/C Direct; Waterborne Inc., New Orleans, LA, USA). In order to stain the nuclei in the (oo)cysts, 50 μl of DAPI solution (4’,6-diamidino-2-phenylinole) (Sigma Aldrich Corp., St. Louis, MO, USA) with a concentration of 0.4 μg/ml was added after the FITC-labelling step. The samples were treated with the DAPI solution for two minutes after which the solution was gently rinsed off with phosphate-buffered saline (pH 7.4). Finally, the slides were examined under a fluorescence microscope (Zeiss Axioskop with the filters 490/525 nm and 359/441 nm; Carl Zeiss, Inc., USA) and the parasite load was related to the weight of the solids in each sample. The mean recovery for this method, when tested on seeded samples, was 22 ± 4.4%.</p>
</sec>
<sec>
<label>2.3</label>
<title>Screening for helminths</title>
<p>The ammonium bicarbonate (AMBIC) protocol developed by Hawksworth (2009)<xref ref-type="bibr" rid="bib15"><sup>15</sup></xref> was used for screening for <italic>A. lumbricoides, T. trichiura</italic> and <italic>Taenia</italic> spp<italic>.</italic> as follows: (1) 1 g of faecal material was put into a 15 ml conical test tube (ct tube); (2) The sample was mixed with a saturated AMBIC solution (pH 8.6 at 22 °C), made up to the 14 ml mark on the ct tube and vortexed for 3 minutes. The ct tube was capped and left to stand for thirty minutes after which it was again vortexed for 3 minutes and manually shaken for 2 minutes. Thirty minutes later this process was repeated and then the ct tube was centrifuged (940 x g for 3 minutes) and the supernatant discarded. Deionised water (14 ml) was added, the contents mixed and vortexed for 2 minutes. The ct tube was then centrifuged (940 x g for 3 minutes) and the supernatant discarded; (3) ZnSO<sub>4</sub> with specific gravity adjusted to 1.3 was added to the pellet from the previous step (12 ml). The mixture was vortexed for 2 minutes and then centrifuged (600 x g) for 3 minutes. The entire supernatant was divided equally among four clean 15 ml ct tubes which were then topped up to 14 ml with deionised water and centrifuged (1850 x g) for a further 3 minutes. The supernatant was discarded, the pellet viewed under a light microscope and the ova counted. This method, when tested on samples seeded with known numbers of <italic>Ascaris suum</italic> eggs, was found to give a mean recovery rate of 76 ± 1.4%.<xref ref-type="bibr" rid="bib15"><sup>15</sup></xref></p>
</sec>
<sec>
<label>2.4</label>
<title>Statistical analysis</title>
<p>Statistical Package for Social Sciences (SPSS) version 15.0 (SPSS Inc., Chicago, IL, USA) was used for handling the database containing information from the study done by Lutchminarayan (2007)<xref ref-type="bibr" rid="bib14"><sup>14</sup></xref> and Knight et al. (unpublished). Information was extracted from the SPSS database, collated with the prevalence results obtained in this study and further statistically evaluated with SigmaPlot 11.0 (Systat Software, Inc., San Jose, CA, USA). Odds ratios (OR) and the chi-square test were used to test for differences between variables and <italic>P</italic>-values less than 0.05 were considered significant.</p>
</sec>
</sec>
<sec sec-type="results">
<label>3</label>
<title>Results</title>
<sec>
<label>3.1</label>
<title>Occurrence of parasites</title>
<p>The 120 samples of fresh faecal deposits gave the following overall occurrence of parasites in the family toilets: <italic>A. lumbricoides</italic> (59%), <italic>G. intestinalis</italic> (54%), <italic>T. trichiura</italic> (48%), <italic>Cryptosporidium</italic> spp. (21%) and <italic>Taenia</italic> spp. (18%).</p>
<p>In 73% of the 120 household toilets, one or several types of helminths were found. A single helminth infection occurred in 34% of the household toilets, while a further 27% showed two and 13% showed three different helminths per household. The remaining 27% of the household toilets were negative for helminth infections. Dual infection with <italic>G. intestinalis</italic> and <italic>Cryptosporidium</italic> spp<italic>.</italic> occurred in 15% of the samples, whereas 40% were completely negative with respect to these two pathogens. In 3% of the samples all five parasites (<italic>G. intestinalis</italic>, <italic>Cryptosporidium</italic> spp<italic>.</italic>, <italic>A. lumbricoides</italic>, <italic>Taenia</italic> spp<italic>.</italic> and <italic>T. trichiura</italic>) were present. Only 14% of the samples were completely negative (<xref ref-type="fig" rid="fig1">Figure 1</xref>
<fig id="fig1" position="float">
<label>Figure 1</label>
<caption>
<p>Households with zero, single, dual and multiple parasitic occurrences in the family toilet.</p>
</caption>
<graphic mimetype="image" xlink:href="104-10-646-fig001.jpg"></graphic>
</fig>).</p>
</sec>
<sec>
<label>3.2</label>
<title>Concentration of parasites</title>
<p>The mean concentration detected among the 65 <italic>G. intestinalis</italic> positive household toilets was 33 400 cysts/g (median value 3 000 cysts/g) biosolids (<xref ref-type="fig" rid="fig2">Figure 2</xref>
<fig id="fig2" position="float">
<label>Figure 2</label>
<caption>
<p>Distribution of the concentrations for samples positive for (A) <italic>G. intestinalis</italic> and <italic>Cryptosporidium</italic> spp<italic>.</italic> and (B) the helminths.</p>
</caption>
<graphic mimetype="image" xlink:href="104-10-646-fig002.jpg"></graphic>
</fig>) with a range of 200 – 1 000 000 cysts/g. The corresponding concentrations for the 25 <italic>Cryptosporidium</italic> spp. positive households were a mean of 10 100 oocysts/g (median value 900 oocysts/g) and a range between 300 and 117 100 oocysts/g (<xref ref-type="fig" rid="fig2">Figure 2</xref>). The mean concentrations of detected helminth ova in the positive toilets were as follows: <italic>A. lumbricoides</italic> 103 eggs per gram of stool (EPG) (median value 25, range 1 – 1425 EPG, <italic>n</italic> = 71), <italic>T. trichiura</italic> 27 EPG (median value 5, range 1 – 417, <italic>n</italic> = 57) and <italic>Taenia</italic> spp<italic>.</italic> 55 EPG (median 4, range 1 - 703 EPG, <italic>n</italic> = 22) (<xref ref-type="fig" rid="fig2">Figure 2</xref>). The reported concentrations have not been adjusted for recovery.</p>
</sec>
<sec>
<label>3.3</label>
<title>Risk factors</title>
<p>In <xref ref-type="fig" rid="tbl2">Table 2</xref>
<fig id="tbl2">
<label>Table 2</label>
<caption>
<p>Stratified occurrence of the parasitic protozoa and the helminths.</p>
</caption>
<graphic mimetype="image" xlink:href="104-10-646-tbl002.tif"></graphic>
</fig> the frequency of positive samples is summarized for the two sampled areas as well as in relation to the family size and the presence of infants and young children. The odds ratio for occurrence of one or several of the parasites investigated was 8.27 when comparing the households in Sawpitts with those in Mtamuntengayo (<italic>P</italic> = 0.002), i.e. only 4% of the family toilets in the former area were completely negative whereas the corresponding figure for the latter area was 23%. Sawpitts had a significantly higher occurrence of <italic>A. lumbricoides</italic> (75%, OR = 3.62, <italic>P</italic> < 0.001) and <italic>T. trichiura</italic> (60%, OR = 2.39, <italic>P</italic> = 0.019) in the sampled excreta deposits than Mtamuntengayo (45% and 38% respectively), (<xref ref-type="fig" rid="tbl2">Table 2</xref>). The occurrence of <italic>Taenia</italic> spp. was also higher in Sawpitts, however this difference was not significant. The protozoa showed a slightly, yet not significantly, higher occurrence in Mtamuntengayo than in Sawpitts (<xref ref-type="fig" rid="tbl2">Table 2</xref>).</p>
<p>The size of the visited families varied between one and 16 members in both Mtamuntengayo (mean 6.8, median 6.0) and Sawpitts (mean 6.6, median 6.0). The 120 households representing the sum of both areas were divided into three groups based on family size (<xref ref-type="fig" rid="tbl2">Table 2</xref>). A significant difference in <italic>G. intestinalis</italic> occurrence was found when comparing the smallest size group with the largest group (OR = 0.26, <italic>P</italic> = 0.005) and the medium size group (OR = 0.36, <italic>P</italic> = 0.032). The same trend (although no significant differences) is also evident for <italic>Cryptosporidium</italic> spp., <italic>Taenia</italic> spp. and <italic>T. trichiura</italic>, while no differences occurred for <italic>A. lumbricoides</italic>.</p>
<p>The presence of children aged five years or less in the families was found to positively correlate with a higher prevalence of all parasites except <italic>A. lumbricoides</italic>, which with borderline significance showed the opposite (<xref ref-type="fig" rid="tbl2">Table 2</xref>). A significant correlation was however only found with respect to <italic>G. intestinalis</italic> occurrence (OR = 2.17, <italic>P</italic> = 0.037).</p>
</sec>
</sec>
<sec sec-type="discussion">
<label>4</label>
<title>Discussion</title>
<p>The prevalence results in this study are household-based and are thus an assessment of the family health status of the 808 people living in the households visited. The occurrence of parasites in 86% of the families implies a risk for further transmission of the pathogens if the hygiene behaviour is insufficient and the toilets are not properly used. The families in these areas are currently not reusing the faecal material after storage, but there is the possibility of doing so if the material is judged safe. The WHO Guidelines recommend at least one year of storage of faecal material in tropical regions and further studies on the persistence of pathogens in the dry vaults are necessary in order to give more precise recommendations.<xref ref-type="bibr" rid="bib2"><sup>2</sup></xref></p>
<p>The number of households positive for the protozoan parasites in this study, is lower but consistent with what Redlinger et al. (2002) reported from another area with poor socio-economic conditions.<xref ref-type="bibr" rid="bib16"><sup>16</sup></xref> The high prevalence of the helminths and parasitic protozoa in the family toilets demonstrates an endemic state in the communities. Redlinger et al. (2002) reported hyper-endemic levels of <italic>Cryptosporidium</italic> spp. (70%) and <italic>G. intestinalis</italic> (82%) in communities lacking municipal sewers.<xref ref-type="bibr" rid="bib16"><sup>16</sup></xref> Additionally, Gualberto and Heller (2006) undertook a meta-analysis of endemic <italic>Cryptosporidium</italic> spp. and reported on an odds ratio of 1.4 for unsafe drinking water sources when compared to safe drinking water sources, which further supports the potential link between parasite endemicity and poor water and sanitation.<xref ref-type="bibr" rid="bib17"><sup>17</sup></xref> Thus, the findings of the present study, in the light of the other studies, highlight the need for proper containment of excreta to reduce the likelihood of further transmission when hygiene resources are limited and in conditions of low socio-economic standards.</p>
<p>The reason for the high occurrence of parasites in the two communities may be partly related to environmental latency, in particular for <italic>A. lumbricoides</italic>, which implies that an extended time period is required to clear out the parasites from the public domain. However, endemicity of these parasites will not be fully combated without a de-worming campaign and curbing open defecation, particularly by children. Thereafter the provision of toilets, water and hygiene education will reduce re-infection rates. A study conducted by Saathoff et al. (2004) showed both high helminth prevalence and re-infection rates in a rural community in KZN and the authors concluded that regular mass-treatment should be undertaken.<xref ref-type="bibr" rid="bib18"><sup>18</sup></xref> In addition, proper health education has been suggested as the key determinant for optimal health benefits from sanitation implementation and drug therapy.<xref ref-type="bibr" rid="bib19"><sup>19</sup></xref></p>
<p>A high occurrence of <italic>Taenia</italic> spp. (18%) was found in the two communities and this may have hazardous implications if the material in the standing vaults of the toilets is reused as fertilizer in agriculture; development of cysticercosis after ingestion of <italic>Taenia</italic> spp<italic>.</italic> ova has been identified as one of the major risks in that regard.<xref ref-type="bibr" rid="bib20"><sup>20</sup></xref> The <italic>Taenia</italic> spp. ova are quite resistant to environmental factors, but not as much as <italic>A. lumbricoides,</italic> thus an evaluation of the die-off of <italic>A. lumbricoides</italic> will also ensure a similar reduction of <italic>Taenia</italic> spp.<xref ref-type="bibr" rid="bib21"><sup>21</sup></xref></p>
<p>In this study, the quantities of ova and (oo)cysts found in the sampled excreta from the vaults show that an overestimation of the risk will be made if the excreted values, as reported in the literature, are used as input parameters in a risk assessment.<sup><xref ref-type="bibr" rid="bib1">1</xref>,<xref ref-type="bibr" rid="bib12">12</xref>,<xref ref-type="bibr" rid="bib22">22</xref></sup> In order to perform quantitative microbiological risk assessments of the stored material in dry sanitation systems, the actual starting concentration in the vault is of higher importance than the number of excreted ova and (oo)cysts from an infected individual. Besides providing input data for microbiological risk assessment, the concentrations may be used as an indication of the number of people infected and the intensity of these infections.<xref ref-type="bibr" rid="bib1"><sup>1</sup></xref></p>
<p>Households in the Sawpitts area showed a significantly higher prevalence of <italic>A. lumbricoides</italic> and <italic>T. trichiura</italic> in the toilet vaults compared with those in Mtamuntengayo. The opposite, although not significant, was found in relation to the protozoa. When comparing data gathered in the earlier questionnaire-based observational study by Lutchminarayan (2007), a significant difference between hand-washing practices in Mtamuntengayo and Sawpitts was found (<xref ref-type="fig" rid="tbl1">Table 1</xref>).<xref ref-type="bibr" rid="bib14"><sup>14</sup></xref> According to the data gathered in that study, people in Mtamuntengayo were more prone to wash their hands before eating and after toilet use. The Mtamuntengayo population also used soap more often than the people in Sawpitts. These findings highlight the importance of hand-washing, in particular soap-usage, for the prevention of <italic>A. lumbricoides</italic> infection, which has previously been reported.<xref ref-type="bibr" rid="bib23"><sup>23</sup></xref> It was also found that the proportion of people above the poverty line is higher in Sawpitts than in Mtamuntengayo. Thus, people in Mtamuntengayo demonstrate better hygiene behaviour, but have a lower economical status than the people in Sawpitts. Even so, the protozoa are equally common in both areas, which may be explained by other transmission routes compared with the helminths, e.g. person-to-person contact or direct contamination of water and food.<sup><xref ref-type="bibr" rid="bib24">24</xref>–<xref ref-type="bibr" rid="bib26">26</xref></sup></p>
<p>This study shows a relationship between the occurrence of <italic>G. intestinalis</italic> in the family toilet and family parameters, i.e. number of members and presence of children aged five years or less. It has earlier been reported that children in families with five or more members suffer from a higher risk of contracting <italic>G. intestinalis</italic> infection.<xref ref-type="bibr" rid="bib27"><sup>27</sup></xref> The other parasites, <italic>A. lumbricoides</italic> excepted, show a trend and relationship similar to <italic>G. intestinalis</italic>, although not significant. The differences may reflect hygiene and socio-economic relationships and also the transmission routes. It may also be related to the fact that faecal matter collected in the latrines of large families is produced by several individuals and there is thus a higher likelihood that some of them are infected. The high prevalence of <italic>A. lumbricoides</italic> in the faecal vaults, without differences in relation to the family size and children, indicates a general exposure, which may relate to its environmental latency period and to family hygiene. Since <italic>A. lumbricoides</italic> eggs may remain infective for extended time periods, the transmission loci may be of older origin. A relationship between the presence of young children in the family and <italic>G. intestinalis</italic> infection has been reported before and could be explained by interfamily transmission and the fact that young children are often found in the highest risk group for <italic>G. intestinalis</italic> infection.<sup><xref ref-type="bibr" rid="bib27">27</xref>,<xref ref-type="bibr" rid="bib28">28</xref></sup> As children tend to play outside, and thereby potentially get exposed to contaminated soil, a correlation between family parameters and STHs was expected. It is probable that these helminths are endemic in the investigated areas and therefore equally common within the public domain regardless of family parameters such as number of members and presence of children in the youngest age group.</p>
<p>In conclusion, this study shows a high occurrence of both protozoan and helminth infections in the two communities, which suggests endemicity. The provided toilets will prevent the parasites from entering the environment, but if hygiene behaviour is insufficient, re-infection and transmission will occur. As the parasite loads are high in these communities, the need for further health and hygiene education and possibly de-worming programmes should be investigated. The quantities and frequency distribution of the different parasites in the vaults give a realistic estimate of input values for assessment of risk and further treatment efficiency. It should be emphasized that sampling directly from deposited faecal material is useful for both immediate estimation of the health in populations, and as a further base for quantitative microbiological risk assessment of the material in on-site sanitation systems.</p>
</sec>
<sec>
<title>Authors’ contributions</title>
<p>LT, TAS, AH and DH participated in the conception and design of the study. LT and DH organized and conducted the field-work. LT, AH, DH and CA undertook the microbiological analyses. LT carried out the statistical analyses. LT, TAS and DH drafted the manuscript. All authors read and approved the final manuscript. LT is the guarantor of the paper.</p>
</sec>
<sec>
<title>Funding</title>
<p>This study was funded by the Water Research Commission, the National Research Foundation and by the Swedish Institute for Infectious Disease Control.</p>
</sec>
<sec>
<title>Conflicts of interest</title>
<p>None declared.</p>
</sec>
<sec>
<title>Ethical approval</title>
<p>Not required.</p>
</sec>
</body>
<back>
<ack>
<title>Acknowledgements</title>
<p>The authors would especially like to thank Dr. Nicola Rodda and Renuka Lutchminarayan for providing an excellent research environment for the investigations. The authors would also like to acknowledge the students and staff at the University of KwaZulu-Natal and the eThekwini Municipality for their willingness and support during sampling.</p>
</ack>
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</article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Household-based prevalence of helminths and parasitic protozoa in rural KwaZulu-Natal, South Africa, assessed from faecal vault sampling</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Household-based prevalence of helminths and parasitic protozoa in rural KwaZulu-Natal, South Africa, assessed from faecal vault sampling</title></titleInfo><name type="personal" displayLabel="corresp"><namePart type="given">Linda</namePart><namePart type="family">Trönnberg</namePart><affiliation>Swedish Institute for Infectious Disease Control, Department of Parasitology, Mycology, Water and Environmental Microbiology, Nobels Väg 18, 171 82 Solna, Sweden</affiliation><affiliation>Royal Institute of Technology, Division of Water Resources Engineering, Teknikringen 76, 100 44 Stockholm, Sweden</affiliation><affiliation>E-mail: linda.tronnberg@smi.se</affiliation><affiliation>Corresponding author. Tel.: +46 8 457 24 49; fax: +46 8 31 84 50. E-mail address: linda.tronnberg@smi.se</affiliation><affiliation>E-mail: linda.tronnberg@smi.se</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">David</namePart><namePart type="family">Hawksworth</namePart><affiliation>Pollution Research Group, University of KwaZulu-Natal, Biological and Conservation Sciences, Westville Campus, Durban, 4001 South Africa</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Anette</namePart><namePart type="family">Hansen</namePart><affiliation>Swedish Institute for Infectious Disease Control, Department of Parasitology, Mycology, Water and Environmental Microbiology, Nobels Väg 18, 171 82 Solna, Sweden</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Colleen</namePart><namePart type="family">Archer</namePart><affiliation>Pollution Research Group, University of KwaZulu-Natal, Biological and Conservation Sciences, Westville Campus, Durban, 4001 South Africa</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Thor Axel</namePart><namePart type="family">Stenström</namePart><affiliation>Swedish Institute for Infectious Disease Control, Department of Parasitology, Mycology, Water and Environmental Microbiology, Nobels Väg 18, 171 82 Solna, Sweden</affiliation><affiliation>Stockholm Environment Institute, Kräftriket 2B, 106 91 Stockholm, Sweden</affiliation><affiliation>University of Life Sciences, 1432, Ås, Norway</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre><originInfo><publisher>Royal Society of Tropical Medicine and Hygiene</publisher><dateIssued encoding="w3cdtf">2010-10</dateIssued><copyrightDate encoding="w3cdtf">2010</copyrightDate></originInfo><abstract>This study was undertaken to examine the family-based prevalence of environmentally persistent parasites in two rural communities of KwaZulu-Natal, South Africa. Samples were collected from 120 urine-diversion family toilets and screened for selected protozoa and helminths with immunomagnetic separation and the ammonium bicarbonate (AMBIC) protocol respectively. The parasites found were Ascaris lumbricoides (59%), Giardia intestinalis (54%), Trichuris trichiura (48%), Cryptosporidium spp. (21%) and Taenia spp. (18%). Only 14% of the household toilets were negative for these pathogens. The occurrence of A. lumbricoides and T. trichiura was lower (P < 0.001) in the area with better hygiene behaviour, whereas G. intestinalis was more common (P < 0.05) in families with at least one child aged five years or less and in families with more than four persons. Quantification of the parasites per gram was done for each sample and this provided realistic risk assessment data for the reuse of material from urine-diversion toilets. The high occurrence of parasites found in the two communities, in spite of sanitation and hygiene interventions in the areas, suggests an endemicity that will not be reduced without de-worming campaigns. Finally, the study showed that sampling directly from the deposited faecal material may be useful for parasitic prevalence estimations.</abstract><subject lang="en"><genre>Keywords</genre><topic>Cryptosporidium spp.</topic><topic>soil-transmitted helminths</topic><topic>Taenia spp.</topic><topic>on-site sanitation</topic><topic>public health</topic></subject><relatedItem type="host"><titleInfo><title>Transactions of The Royal Society of Tropical Medicine and Hygiene</title></titleInfo><titleInfo type="abbreviated"><title>Trans R Soc Trop Med Hyg</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><identifier type="ISSN">0035-9203</identifier><identifier type="eISSN">1878-3503</identifier><identifier type="PublisherID">trstmh</identifier><identifier type="PublisherID-hwp">trstmh</identifier><part><date>2010</date><detail type="volume"><caption>vol.</caption><number>104</number></detail><detail type="issue"><caption>no.</caption><number>10</number></detail><extent unit="pages"><start>646</start><end>652</end></extent></part></relatedItem><identifier type="istex">B0FB73AFD89FFBF1BA961E33BAD7A7B6D7E0AB3B</identifier><identifier type="DOI">10.1016/j.trstmh.2010.06.009</identifier><recordInfo><recordContentSource authority="ISTEX" authorityURI="https://loaded-corpus.data.istex.fr" valueURI="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-GTWS0RDP-M">oup</recordContentSource><recordOrigin>Royal Society of Tropical Medicine and Hygiene</recordOrigin></recordInfo></mods><json:item><extension>json</extension><original>false</original><mimetype>application/json</mimetype><uri>https://api.istex.fr/document/B0FB73AFD89FFBF1BA961E33BAD7A7B6D7E0AB3B/metadata/json</uri></json:item></metadata><covers><json:item><extension>tiff</extension><original>true</original><mimetype>image/tiff</mimetype><uri>https://api.istex.fr/document/B0FB73AFD89FFBF1BA961E33BAD7A7B6D7E0AB3B/covers/tiff</uri></json:item></covers><annexes><json:item><extension>jpeg</extension><original>true</original><mimetype>image/jpeg</mimetype><uri>https://api.istex.fr/document/B0FB73AFD89FFBF1BA961E33BAD7A7B6D7E0AB3B/annexes/jpeg</uri></json:item><json:item><extension>gif</extension><original>true</original><mimetype>image/gif</mimetype><uri>https://api.istex.fr/document/B0FB73AFD89FFBF1BA961E33BAD7A7B6D7E0AB3B/annexes/gif</uri></json:item></annexes><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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