{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T07:18:08Z","timestamp":1790925488449,"version":"4.1.0"},"reference-count":28,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2020,8,20]],"date-time":"2020-08-20T00:00:00Z","timestamp":1597881600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"EMORY RSPH GLOBAL FIELD EXPERIENCE AWARD","award":["NO NUMBER"],"award-info":[{"award-number":["NO NUMBER"]}]},{"name":"ORDER OF ST LAZARUS, US","award":["NO NUMBER"],"award-info":[{"award-number":["NO NUMBER"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Access to safe water, sanitation, and hygiene (WASH) is critical for preventing the spread of neglected tropical diseases (NTDs) including leprosy. WASH-related transmission factors remain largely unexplored in the leprosy transmission cycle. The aim of this project is to better understand WASH exposures among leprosy cases through a case-control study in North Gondar, Ethiopia. We hypothesized that leprosy cases were more likely to have inadequate WASH access and were more likely to have concurrent schistosomiasis, as schistosomiasis immune consequences may facilitate leprosy infection. Forty leprosy cases (forty-one controls) were enrolled, tested for Schistosomamansoni, administered a demographic and WASH survey, and assigned a WASH index score. WASH factors significantly associated with leprosy on adjusted analyses included open defecation (aOR = 19.9, 95% CI 2.2, 176.3) and lack of access to soap (aOR = 7.3, 95% CI 1.1, 49.9). S. mansoni was detected in 26% of participants and in stratified analysis those with leprosy had a 3.6 (95% CI (0.8, 15.9)) greater odds of schistosomiasis in districts bordering the lake, compared to 0.33 lower odds of schistosomiasis in districts not bordering the lake (95% CI (0.09, 1.2)). Overall, results suggest that leprosy transmission may be related to WASH adequacy and access as well as to schistosomiasis co-infection.<\/jats:p>","DOI":"10.3390\/ijerph17176061","type":"journal-article","created":{"date-parts":[[2020,8,20]],"date-time":"2020-08-20T09:35:31Z","timestamp":1597916131000},"page":"6061","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Poor WASH (Water, Sanitation, and Hygiene) Conditions Are Associated with Leprosy in North Gondar, Ethiopia"],"prefix":"10.3390","volume":"17","author":[{"given":"Lisa E.","family":"Emerson","sequence":"first","affiliation":[{"name":"Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Puneet","family":"Anantharam","sequence":"additional","affiliation":[{"name":"Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feleke M.","family":"Yehuala","sequence":"additional","affiliation":[{"name":"College of Medicine and Health Sciences, University of Gondar, P.O. Box 196 Gondar, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kassahun D.","family":"Bilcha","sequence":"additional","affiliation":[{"name":"School of Medicine, Emory University, Atlanta, GA 30322, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annisa B.","family":"Tesfaye","sequence":"additional","affiliation":[{"name":"College of Medicine and Health Sciences, University of Gondar, P.O. Box 196 Gondar, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica K.","family":"Fairley","sequence":"additional","affiliation":[{"name":"Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA"},{"name":"School of Medicine, Emory University, Atlanta, GA 30322, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,8,20]]},"reference":[{"key":"ref_1","unstructured":"(2019, January 31). Goal 3 Sustainable Development Knowledge Platform. Available online: https:\/\/sustainabledevelopment.un.org\/sdg3."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1128\/CMR.00079-13","article-title":"Leprosy in the 21st Century","volume":"28","author":"White","year":"2015","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_3","unstructured":"WHO (2020, May 14). Global Leprosy Update, 2016: Accelerating Reduction of Disease Burden. Available online: http:\/\/www.who.int\/lep\/resources\/who_wer9235\/en\/."},{"key":"ref_4","unstructured":"WHO (2019, January 17). Elimination of Leprosy FAQ. Available online: http:\/\/www.who.int\/lep\/strategy\/faqs\/en\/."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1097\/QCO.0b013e3283638b04","article-title":"New findings in the pathogenesis of leprosy and implications for the management of leprosy","volume":"26","author":"Polycarpou","year":"2013","journal-title":"Curr. Opin. Infect. Dis."},{"key":"ref_6","unstructured":"(2019, January 31). CDC\u2014Schistosomiasis, Available online: https:\/\/www.cdc.gov\/parasites\/schistosomiasis\/index.html."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"852","DOI":"10.4269\/ajtmh.2001.65.852","article-title":"Short report: Do intestinal nematodes increase the risk for multibacillary leprosy?","volume":"65","author":"Diniz","year":"2001","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1590\/0074-02760160395","article-title":"A tale of two neglected tropical infections: Using GIS to assess the spatial and temporal overlap of schistosomiasis and leprosy in a region of Minas Gerais, Brazil","volume":"112","author":"Phillips","year":"2017","journal-title":"Mem\u00f3rias Inst. Oswaldo Cruz"},{"key":"ref_9","unstructured":"(2019, January 18). GHO|By Country|Ethiopia\u2014Statistics Summary (2002\u2013present). Available online: http:\/\/apps.who.int\/gho\/data\/node.country.country-ETH."},{"key":"ref_10","unstructured":"(2019, March 18). WHO|Water Sanitation and Hygiene for Accelerating and Sustaining Progress on Neglected Tropical Diseases. Available online: http:\/\/www.who.int\/water_sanitation_health\/publications\/wash-and-ntd-strategy\/en\/."},{"key":"ref_11","first-page":"61","article-title":"Mycobacterium leprae DNA in daily using water as a possible source of leprosy infection","volume":"71","author":"Matsuoka","year":"1999","journal-title":"Indian J. Lepr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.meegid.2011.10.023","article-title":"Dynamics of Mycobacterium leprae transmission in environmental context: Deciphering the role of environment as a potential reservoir","volume":"12","author":"Turankar","year":"2012","journal-title":"Infect. Genet. Evol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"FAUTH (2015). Viability of Mycobacterium leprae in the environment and its role in leprosy dissemination. Indian J. Dermatol. Venereol. Lepr., 82, 23.","DOI":"10.4103\/0378-6323.168935"},{"key":"ref_14","unstructured":"(2019, January 28). Global Leprosy Strategy 2016\u20132020: Accelerating Towards a Leprosy-Free World. Available online: https:\/\/apps.who.int\/iris\/handle\/10665\/208824."},{"key":"ref_15","unstructured":"(2019, February 28). Census 2007, Available online: http:\/\/www.csa.gov.et\/census-report\/complete-report\/census-2007?start=5."},{"key":"ref_16","unstructured":"(2018, October 17). mjs76 Gone to Gondar: Union Officer visits Ethiopia\u2014University of Leicester. Available online: https:\/\/www2.le.ac.uk\/news\/blog\/2011-archive\/july\/gone-to-gondar-union-officer-visits-ethiopia."},{"key":"ref_17","unstructured":"(2019, April 17). Core questions|JMP. Available online: https:\/\/washdata.org\/monitoring\/methods\/core-questions."},{"key":"ref_18","unstructured":"(2020, May 14). Rapid Medical Diagnostics Schisto POC-CCA Rapid Test for Qualitative Detection of: Bilharzia (Schistosomiasis) Pretoria, South Africa. Available online: http:\/\/www.ictdiagnostics.co.za\/schistosomanew.html."},{"key":"ref_19","unstructured":"World Health Organization (2020, May 14). WHO\/UNICEF Joint Monitoring Programme for Water Supply and Sanitation; Unicef WASH in the 2030 Agenda: New Global Indicators for Drinking Water, and Sanitation New York, USA. Available online: https:\/\/washdata.org\/sites\/default\/files\/documents\/reports\/2017-07\/JMP-2017-WASH-in-the-2030-agenda.pdf."},{"key":"ref_20","unstructured":"(2020, July 26). OpenEpi Menu. Available online: https:\/\/www.openepi.com\/Menu\/OE_Menu.htm."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1093\/ije\/dyl072","article-title":"Socioeconomic, environmental, and behavioural risk factors for leprosy in North-east Brazil: Results of a case-control study","volume":"35","author":"Barreto","year":"2006","journal-title":"Int. J. Epidemiol."},{"key":"ref_22","unstructured":"(2020, July 26). TDR|The Effects of Leprosy on Men and Women: A Gender Study. Available online: https:\/\/www.who.int\/tdr\/publications\/tdr-research-publications\/leprosy-gender\/en\/."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"142","DOI":"10.47276\/lr.86.2.142","article-title":"Current knowledge on Mycobacterium leprae transmission: A systematic literature review","volume":"86","author":"Bratschi","year":"2015","journal-title":"Lepr. Rev."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Wheat, W.H., Casali, A.L., Thomas, V., Spencer, J.S., Lahiri, R., Williams, D.L., McDonnell, G.E., Gonzalez-Juarrero, M., Brennan, P.J., and Jackson, M. (2014). Long-term Survival and Virulence of Mycobacterium leprae in Amoebal Cysts. PLoS Negl. Trop. Dis., 8.","DOI":"10.1371\/journal.pntd.0003405"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"401","DOI":"10.47276\/lr.79.4.401","article-title":"The role of free-living pathogenic amoeba in the transmission of leprosy: A proof of principle","volume":"79","author":"Lahiri","year":"2008","journal-title":"Lepr. Rev."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Davis, G.L., Ray, N.A., Lahiri, R., Gillis, T.P., Krahenbuhl, J.L., Williams, D.L., and Adams, L.B. (2013). Molecular assays for determining mycobacterium leprae viability in tissues of experimentally infected mice. PLoS Negl. Trop. Dis., 7.","DOI":"10.1371\/journal.pntd.0002404"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1590\/0074-02760170117","article-title":"Natural environmental water sources in endemic regions of northeastern Brazil are potential reservoirs of viable Mycobacterium leprae","volume":"112","author":"Arraes","year":"2017","journal-title":"Mem\u00f3rias Inst. Oswaldo Cruz"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1111\/j.1365-2249.2010.04164.x","article-title":"Presence of intestinal helminths decreases T helper type 1 responses in tuberculoid leprosy patients and may increase the risk for multi-bacillary leprosy","volume":"161","author":"Diniz","year":"2010","journal-title":"Clin. Exp. Immunol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/17\/6061\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:04:04Z","timestamp":1760177044000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/17\/6061"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,20]]},"references-count":28,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2020,9]]}},"alternative-id":["ijerph17176061"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17176061","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8,20]]}}}