Water, Sanitation, Hygiene, and Socioeconomic Risk Factors for Soil-Transmitted Helminth Infections in Children: A Cross-Sectional Study in Timor-Leste

Soil-transmitted helminths (STHs) predominantly affect resource-poor communities with poor access to water, sanitation, and hygiene (WASH) infrastructure. Understanding the risk factors for STH infections can help inform public health control strategies, including WASH interventions and preventive chemotherapy. In this school-based cross-sectional study, mixed-effects logistic regression was used to examine the associations between WASH and socioeconomic factors and STH infections in Timor-Leste. Two statistical analyses were conducted: the first included individual-level sanitation and hygiene factors, whereas the second also included household-level WASH and socioeconomic factors. In the sanitation and hygiene analysis, "always use household latrine" was associated with lower odds of undifferentiated STH infection (adjusted odds ratio [aOR]: 0.59; 95% CI: 0.37-0.96). "Always wash hands before eating" was associated with lower odds of Trichuris trichiura (T. trichiura) infection (aOR: 0.35; 95% CI: 0.13-0.97), whereas "always have soap to wash hands at home" was associated with higher odds of T. trichiura infection (aOR: 4.22; 95% CI: 1.56-11.43). In the WASH and socioeconomic factors analysis, "usually defecate at household/neighbor's latrine" was associated with lower odds of undifferentiated STH (aOR: 0.13; 95% CI: 0.04-0.43) and Ascaris lumbricoides infections (aOR: 0.19; 95% CI: 0.06-0.64). Additionally, the availability of school handwashing stations was associated with lower odds of T. trichiura infection (aOR: 0.21; 95% CI: 0.05-0.86). The present study indicates that sanitation and hygiene are important risk factors for STH infections, and therefore, efforts to reduce STH infections should also promote sanitation and hygiene infrastructure and practices.