{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T11:29:01Z","timestamp":1783942141953,"version":"3.55.0"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2021,9,17]],"date-time":"2021-09-17T00:00:00Z","timestamp":1631836800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Sub Award:University of Georgia Research Foundation","award":["RR374-092\/S001315"],"award-info":[{"award-number":["RR374-092\/S001315"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Evidence indicates that whereas repeated rounds of mass drug administration (MDA) programs have reduced schistosomiasis prevalence to appreciable levels in some communities referred to here as responding villages (R). However, prevalence has remained high or less than anticipated in other areas referred to here as persistent hotspot villages (PHS). Using a cross-sectional quantitative approach, this study investigated the factors associated with sustained high <jats:italic>Schistosoma mansoni<\/jats:italic> prevalence in some villages despite repeated high annual treatment coverage in western Kenya.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Method<\/jats:title>\n<jats:p>Water contact sites selected based on observation of points where people consistently go to collect water, wash clothes, bathe, swim or play (young children), wash cars and harvest sand were mapped using hand-held smart phones on the Commcare platform. Quantitative cross-sectional surveys on behavioral characteristics were conducted using interviewer-based semi-structured questionnaires administered to assess water usage\/contact patterns and open defecation. Questionnaires were administered to 15 households per village, 50 pupils per school and 1 head teacher per school. One stool and urine sample was collected from 50 school children aged 9\u201312 year old and 50 adults from both responding (R) and persistent hotspot (PHS) villages. Stool was analyzed by the Kato-Katz method for eggs of <jats:italic>S<\/jats:italic>. <jats:italic>mansoni<\/jats:italic> and soil-transmitted helminths. Urine samples were tested using the point-of-care circulating cathodic antigen (POC-CCA) test for detection of <jats:italic>S<\/jats:italic>. <jats:italic>mansoni<\/jats:italic> antigen.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>There was higher latrine coverage in R (n = 6) relative to PHS villages (n = 6) with only 33% of schools in the PHS villages meeting the WHO threshold for boy: latrine coverage ratio versus 83.3% in R, while no villages met the girl: latrine ratio requirement. A higher proportion of individuals accessed unprotected water sources for both bathing and drinking (68.5% for children and 89% for adults) in PHS relative to R villages. In addition, frequency of accessing water sources was higher in PHS villages, with swimming being the most frequent activity. As expected based upon selection criteria, both prevalence and intensity of <jats:italic>S<\/jats:italic>. <jats:italic>mansoni<\/jats:italic> were higher in the PHS relative to R villages (prevalence: 43.7% vs 20.2%; P &lt; 0.001; intensity: 73.8 \u00b1 200.6 vs 22.2 \u00b1 96.0, P &lt; 0.0001), respectively.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Unprotected water sources and low latrine coverage are contributing factors to PHS for schistosomiasis in western Kenya. Efforts to increase provision of potable water and improvement in latrine infrastructure is recommended to augment control efforts in the PHS areas.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0253115","type":"journal-article","created":{"date-parts":[[2021,9,17]],"date-time":"2021-09-17T17:34:06Z","timestamp":1631900046000},"page":"e0253115","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":16,"title":["Unprotected water sources and low latrine coverage are contributing factors to persistent hotspots for schistosomiasis in western Kenya"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9138-5844","authenticated-orcid":true,"given":"Rosemary M.","family":"Musuva","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurice R.","family":"Odiere","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pauline N. 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sanitation intervention on soil-transmitted helminth reinfection: a cluster-randomized trial","volume":"89","author":"MC Freeman","year":"2013","journal-title":"Am J Trop Med Hyg"},{"key":"pone.0253115.ref026","author":"WHO","year":"1994","journal-title":"Report of the WHO informal consultation on hookworm infection and anemia in girls and women"},{"key":"pone.0253115.ref027","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.actatropica.2017.03.033","article-title":"Risk factors for schistosomiasis transmission among school children in Gwanda district","volume":"175","author":"Z Nyati-Jokomo","year":"2017","journal-title":"Zimbabwe. 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Water-contact activities in the schistosomiasis study area","volume":"74","author":"MA Tayo","year":"1980","journal-title":"Ann Trop Med Parasitol"},{"key":"pone.0253115.ref031","doi-asserted-by":"crossref","first-page":"e637","DOI":"10.1371\/journal.pntd.0000637","article-title":"Influence of exposure history on the immunology and development of resistance to human schistosomiasis mansoni","volume":"4","author":"CL Black","year":"2010","journal-title":"PLoS Negl Trop Dis"},{"key":"pone.0253115.ref032","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1111\/j.1365-3156.2007.01842.x","article-title":"Microgeographical and tribal variations in water contact and Schistosoma mansoni exposure within a Ugandan fishing community","volume":"12","author":"A Pinot de Moira","year":"2007","journal-title":"Trop Med Int Health"},{"key":"pone.0253115.ref033","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1186\/s13071-015-0766-9","article-title":"The roles of water, sanitation and hygiene in reducing schistosomiasis: a review","volume":"8","author":"JET Grimes","year":"2015","journal-title":"Parasites & Vectors"},{"key":"pone.0253115.ref034","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1590\/S0036-46651991000100011","article-title":"A multivariate analysis of socio-demographic factors, water contact patterns and Schistosoma mansoni infection in an endemic area in Brazil","volume":"33","author":"MFF Lima e Costa","year":"1991","journal-title":"Revista Instituto de Medicina Tropical de S\u00e3o Paulo"},{"key":"pone.0253115.ref035","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/0001-706X(93)90053-E","article-title":"Factors contributing to reinfection with Schistosomiasis japonica after treatment in the lake region of China","volume":"54","author":"W Zhaowu","year":"1993","journal-title":"Acta Tropica"},{"key":"pone.0253115.ref036","first-page":"293","article-title":"The epidemiology of Schistosoma haematobium and S. mansoni infections in the Egypt-49 project area 2. Prevalence of bilharziasis in relation to personal attributes and habits","volume":"35","author":"M Farooq","year":"1966","journal-title":"Bull World Health Organ"},{"key":"pone.0253115.ref037","first-page":"587","article-title":"A socio-ecological approach to the control of Schistosoma mansoni in St Lucia","volume":"54","author":"P Dalton","year":"1976","journal-title":"Bulletin of the World Health Organization"},{"key":"pone.0253115.ref038","doi-asserted-by":"crossref","first-page":"1859","DOI":"10.1017\/S0031182009991600","article-title":"Schistosomiasis and neglected tropical diseases: towards integrated and sustainable control and a word of caution","volume":"136","author":"J Utzinger","year":"2009","journal-title":"Parasitology"},{"key":"pone.0253115.ref039","doi-asserted-by":"crossref","first-page":"e2439","DOI":"10.1371\/journal.pntd.0002439","article-title":"Integration of water, sanitation, and hygiene for the prevention and control of neglected tropical diseases: a rationale for inter-sectoral collaboration","volume":"7","author":"MC Freeman","year":"2013","journal-title":"PLoS Negl Trop Dis"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0253115","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,17]],"date-time":"2021-09-17T17:34:37Z","timestamp":1631900077000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0253115"}},"subtitle":[],"editor":[{"given":"Josu\u00e9 de","family":"Moraes","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,9,17]]},"references-count":39,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,9,17]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0253115","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,17]]}}}