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The transmission soil transmitted helminths (STH) occurs via ingestion of or contact with infective stages present in soil contaminated with human faeces. It follows therefore that efforts to reduce faecal contamination of the environment should help to reduce risk of parasite exposure and improvements in water, sanitation and hygiene (WASH) are seen as essential for the long-term, sustainable control of STH. However, the link between WASH and STH is not always supported by the available evidence from randomised controlled trials, which report mixed effects of WASH intervention on infection risk. This review critically summarises the available trial evidence and offers an interpretation of the observed heterogeneity in findings. The review also discusses the implications of findings for control programmes and highlights three main issues which merit further consideration: intervention design, exposure assessment, and intervention fidelity assessment.

Background: Scabies is a common but neglected skin disease caused by the parasitic mite Sarcoptes scabiei var. hominis. Globally, the disease affects more than 400 million people. Although Ethiopia is a high-burden country for scabies, its epidemiology has not been well assessed. Therefore, this study aimed to determine the prevalence of scabies, clinical features, and associated risk factors in the communities of the Hawassa Zuria District of the Sidama Region, southern Ethiopia. Methods: A community-based cross-sectional study was conducted from September through November 2023 in the Hawassa Zuria District. A multistage random sampling technique was applied to enrol 511 participants. The International Alliance for Control of Scabies Diagnostic Criteria was used for examination. The data were collected electronically using the Open Data Kit application through a pretested interviewer-administered questionnaire. Analysis was performed using STATA software. The binary logistic regression analyses model was used to assess the association between each independent variable and scabies prevalence. During the bivariate logistic regression analyses a variable with a p-value of < 0.25 was a candidate for multivariable logistic regression analyses. In multivariable logistic regression analyses the odds ratios with a 95% confidence interval and a p-value less than 0.05 were used to describe the strength of the association and statistical significance. Results: The median age of the study participants was 19 years (interquartile range: 11–32 years), and 52.6% of the participants were females. The overall prevalence of scabies was 6.3% (95% CI 4.3–8.7%). The majority of individuals with scabies had a moderate degree of severity. The most frequent lesions were intensely itchy papules, vesicles, and pustules that appeared in the interdigital space, flexor wrist surfaces, and elbow. Males were more likely to have scabies [adjusted odds ratio (AOR) = 2.57; 95% CI: 1.10–6.00] than females were and it was not influenced by age. The risk of scabies was higher for households with low (AOR = 3.88; 95% CI: 1.01–14.91) and middle-class wealth index (AOR = 4.43; 95% CI: 1.13–17.33), as well as for individuals residing in households with an overcrowding index >1.5 (AOR = 2.64; 95% CI: 1.13–6.18), in those individuals who washed their hands with water only (AOR = 2.98; 95% CI: 1.23–7.24), in those who used an unimproved water source (AOR = 2.98; 95% CI: 1.25–7.06) and in those who slept on the floor (AOR = 2.70; 95% CI: 1.17–6.18). Conclusion: The observed moderate presence of scabies in the study area stresses the need to strengthen disease management efforts, improve wealth, reduce overcrowding, ensure clean water access, and promote better hygiene practices to reduce the spread of scabies. [ABSTRACT FROM AUTHOR]

Background: Following the COVID-19 pandemic declaration, the World Health Organization recommended suspending neglected tropical diseases (NTD) control activities as part of sweeping strategies to minimise COVID-19 transmission. Understanding how NTD programs were impacted and resumed operations will inform contingency planning for future emergencies. This is the first study that documents how South-East Asian and Pacific NTD programs addressed challenges experienced during the COVID-19 pandemic. Methodology/Principal findings: Data was collected through semi-structured interviews with 11 NTD Program Coordinators and related personnel from Fiji, Papua New Guinea, The Philippines, Timor-Leste, and Vanuatu. Constructivist grounded theory methods were drawn on to generate an explanation of factors that enabled or hindered NTD program operations during the COVID-19 pandemic. The COVID-19 pandemic disrupted NTD programs in all countries. Some programs implemented novel strategies by partnering with services deemed essential or used new communications technology to continue (albeit scaled-back) NTD activities. Strong relationships to initiate cross-program integration, sufficient resources to implement adapted activities, and dedicated administrative systems were key enabling factors for recommencement. As the COVID-19 pandemic continued, exacerbating health resources scarcity, programs faced funding shortages and participants needed to find efficiencies through greater integration and activity prioritisation within their NTD units. Emphasising community-led approaches to restore trust and engagement was critical after widespread social anxiety and disconnection. Conclusions/Significance: Sustaining effective NTD programs during a global emergency goes beyond managing immediate activity disruptions and requires attention to how NTD programs can be better ensconced within wider health programs, administrative, and social systems. This study underscores the importance of pre-emergency planning that reinforces NTD control programs as a critical service at all health systems levels, accompanied by governance arrangements that increase NTD staff control over their operations and strategies to maintain strong community relationships. Ensuring NTD units are supported via appropriate funding, personnel, and bureaucratic resources is also required. Author summary: Disruptions to health services during the COVID-19 pandemic may delay progress in neglected tropical diseases (NTDs) control by several years. Current studies of how NTD programs responded to the challenges arising from the COVID-19 pandemic are largely from African settings and focus on earlier periods during the pandemic when policy advice was most stringent. In contrast, this study documents how NTD staff and other related personnel in five South-East Asian and Pacific countries adapted to changing situations throughout the pandemic. We found a difference in the strategies NTD programs initially used to manage the immediate challenges of strict new public health measures compared to those used later in the pandemic's evolution when seeking to recommence usual programs. Initially, some NTD programs devised new ways of offering modified services, primarily though cross-program integration with other health services that were allowed to continue operating. When operations re-commenced, NTD programs faced financial challenges that meant human and resource efficiencies in these units needed to be found. The cumulative impact of pandemic-related restrictions and misinformation eroded community trust in health programs more broadly and required NTD staff to rebuild local relationships. The lessons learned in these settings may help NTD programs in these and other regions prepare for prolonged future emergencies. [ABSTRACT FROM AUTHOR]

Following a national population-based trachoma survey in Malawi one round of azithromycin mass drug administration (MDA) was carried out, with a post-MDA impact survey showing TF prevalence below 5% and considered eliminated as a public health problem. However, active trachoma was still present in over 200 children. We assessed whether water, sanitation, and hygiene (WASH) factors were associated with ongoing presence of TF in children aged 1–9 years following MDA. A secondary analysis was performed on a sub-set of the post-MDA impact survey data for children aged 1–9 years. We used a logistic regression analysis, adjusted for clustering at the household and village level. Among 16,142 children aged 1–9 years, 209 (1.3%) had TF after MDA. Factors associated with a significantly lower odds of TF after MDA were living in a household with a handwashing facility (aOR: 0.37) and living in a household where water for washing is located further away from the home (30 min away aOR: 0.39, p =.034, or more than 1 h away aOR: 0.31, p =.018) compared with water in the yard. The inverse association between a domestic handwashing facility and TF is consistent with previous findings, but the association of increasing distance to collect water for washing with a reduced risk of TF was unexpected and may reflect the impact of drought and unmeasured behavioural factors related to water usage. A more comprehensive collection of sociodemographic and WASH factor information in population-based trachoma surveys will provide insight into achieving and maintaining low levels of trachoma. [ABSTRACT FROM AUTHOR]

Background: Strongyloides stercoralis is a neglected soil-transmitted helminth (STH) that leads to significant morbidity in endemic populations. Infection with this helminth has recently been recognised by the World Health Organization (WHO) as a major global health problem to be addressed with ivermectin preventive chemotherapy, and therefore, there is now, the need to develop guidelines for strongyloidiasis control that can be implemented by endemic countries. This study aimed to evaluate the impact of ivermectin preventive chemotherapy (PC) on S. stercoralis prevalence in endemic areas to generate evidence that can inform global health policy. Methodology/Principal findings: This study was a systematic review and meta-analysis. We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and LILACS for literature published between 1990 and 2022 and reporting prevalence of S. stercoralis before and after PC with ivermectin, administered either at school or at community level. The search strategy identified 933 records, eight of which were included in the meta-analysis. Data extraction and quality assessment were carried out by two authors. Meta-analysis of studies based on fecal testing demonstrated a significant reduction of S. stercoralis prevalence after PC: prevalence Risk Ratio (RR) 0.18 (95% CI 0.14–0.23), I2 = 0. A similar trend was observed in studies that used serology for diagnosis: RR 0.35 (95% CI 0.26–0.48), I2 = 4.25%. A sensitivity analysis was carried out for fecal tests where low quality studies were removed, confirming a post-intervention reduction in prevalence. The impact of PC could not be evaluated at different time points or comparing annual vs biannual administration due to insufficient data. Conclusions/Significance: Our findings demonstrate a significant decrease of S. stercoralis prevalence in areas where ivermectin PC has taken place, supporting the use of ivermectin PC in endemic areas. Author summary: Ivermectin is a broad-spectrum, anti-parasitic drug that has been administered for decades in the context of preventive chemotherapy programs for onchocerciasis and lymphatic filariasis elimination. Ivermectin is also effective against Strongyloides stercoralis, an intestinal worm causing significant morbidity in low-income countries in tropical and subtropical regions. The World Health Organization recently identified the need to develop guidelines to assist S. stercoralis control in endemic countries. We aimed to study the impact of ivermectin preventive chemotherapy on S. stercoralis prevalence to generate evidence that can inform global health policy. Therefore, we conducted a systematic review of the available literature, collecting data from studies where ivermectin was administered for control of S. stercoralis or other parasitic infections. The analysis demonstrated a reduction in the prevalence of S. stercoralis in areas where ivermectin was administered. These data may be useful for informing future public health policies. [ABSTRACT FROM AUTHOR]