{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T20:01:09Z","timestamp":1772740869382,"version":"3.50.1"},"reference-count":58,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,4]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    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, \u201calways use household latrine\u201d was associated with lower odds of undifferentiated STH infection (adjusted odds ratio [aOR]: 0.59; 95% CI: 0.37\u20130.96). \u201cAlways wash hands before eating\u201d was associated with lower odds of\n                    <jats:italic>Trichuris trichiura<\/jats:italic>\n                    (\n                    <jats:italic>T. trichiura<\/jats:italic>\n                    ) infection (aOR: 0.35; 95% CI: 0.13\u20130.97), whereas \u201calways have soap to wash hands at home\u201d was associated with higher odds of\n                    <jats:italic>T. trichiura<\/jats:italic>\n                    infection (aOR: 4.22; 95% CI: 1.56\u201311.43). In the WASH and socioeconomic factors analysis, \u201cusually defecate at household\/neighbor\u2019s latrine\u201d was associated with lower odds of undifferentiated STH (aOR: 0.13; 95% CI: 0.04\u20130.43) and\n                    <jats:italic>Ascaris lumbricoides<\/jats:italic>\n                    infections (aOR: 0.19; 95% CI: 0.06\u20130.64). Additionally, the availability of school handwashing stations was associated with lower odds of\n                    <jats:italic>T. trichiura<\/jats:italic>\n                    infection (aOR: 0.21; 95% CI: 0.05\u20130.86). 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.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.25-0372","type":"journal-article","created":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T16:49:24Z","timestamp":1768495764000},"page":"511-518","source":"Crossref","is-referenced-by-count":0,"title":["Water, Sanitation, Hygiene, and Socioeconomic Risk Factors for Soil-Transmitted Helminth Infections in Children: A Cross-Sectional Study in Timor-Leste"],"prefix":"10.4269","volume":"114","author":[{"given":"Maudita D.","family":"Anbarani","sequence":"first","affiliation":[{"name":"School of Population Health, University of New South Wales, Sydney, Australia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamad","family":"Assoum","sequence":"additional","affiliation":[{"name":"The Kirby Institute, University of New South Wales, Sydney, Australia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katrina","family":"Blazek","sequence":"additional","affiliation":[{"name":"School of Population Health, University of New South Wales, Sydney, Australia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brandon","family":"Le","sequence":"additional","affiliation":[{"name":"The Kirby Institute, University of New South Wales, Sydney, Australia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Merita Antonia","family":"Armindo Monteiro","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Sa\u00fade P\u00fablika de Timor-Leste, Dili, Timor-Leste;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salvador","family":"Amaral","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research, Charles Darwin University, Darwin, Australia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sze Fui","family":"Hii","sequence":"additional","affiliation":[{"name":"Faculty of Science, University of Melbourne, Melbourne, Australia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angus","family":"Hughes","sequence":"additional","affiliation":[{"name":"School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Arkel","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research, Charles Darwin University, Darwin, Australia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Yan","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research, Charles Darwin University, Darwin, Australia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josh","family":"Francis","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research, Charles Darwin University, Darwin, Australia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susana","family":"Vaz Nery","sequence":"additional","affiliation":[{"name":"The Kirby Institute, University of New South Wales, Sydney, Australia;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","article-title":"Soil-Transmitted Helminth Infections.","year":"2023"},{"key":"b2","series-title":"Lancet","first-page":"1789","article-title":"Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990\u20132017: A systematic analysis for the Global Burden of Disease Study 2017","volume":"392","year":"2018"},{"key":"b3","article-title":"Preventive Chemotherapy to Control Soil-Transmitted Helminth Infections in at-Risk Population Groups.","year":"2017"},{"key":"b4","series-title":"Parasit Vectors","first-page":"213","article-title":"Epidemiology of soil-transmitted helminths using quantitative PCR and risk factors for hookworm and Necator americanus infection in school children in Dak Lak province, Vietnam","volume":"16","author":"Hughes","year":"2023"},{"key":"b5","series-title":"Int J Parasitol","first-page":"389","article-title":"Risk factors for infection with soil-transmitted helminths during an integrated community level water, sanitation, and hygiene and deworming intervention in Timor-Leste","volume":"49","author":"Vaz Nery","year":"2019"},{"key":"b6","series-title":"PLoS One","first-page":"e0274702","article-title":"Prevalence and intensity of soil-transmitted helminth infections and associated risk factors among household heads living in the peri-urban areas of Jimma town, Oromia, Ethiopia: A community-based cross-sectional study","volume":"17","author":"Zeynudin","year":"2022"},{"key":"b7","article-title":"Timor-Leste Population and Housing Census 2022 Main Report.","year":"2023"},{"key":"b8","article-title":"Transmission Assessment Survey of Neglected Tropical Disease in Timor Leste, 2020\u20132022.","year":"2022"},{"key":"b9","article-title":"Master Plan for Implementation of Neglected Tropical Diseases (NTDs) Control in Timor Leste 2015\u20132020."},{"key":"b10","series-title":"Lancet Glob Health","first-page":"e924","article-title":"The impact of ivermectin, diethylcarbamazine citrate, and albendazole mass drug administration on the prevalence of scabies and soil-transmitted helminths in school-aged children in three municipalities in Timor-Leste: A before-after assessment","volume":"11","author":"Le","year":"2023"},{"key":"b11","article-title":"Eliminating Soil-Transmitted Helminthiases as a Public Health Problem in Children: Progress Report 2001\u20132010 and Strategic Plan 2011\u20132020.","year":"2012"},{"key":"b12","series-title":"Int J Parasitol","first-page":"729","article-title":"Novel statistical approaches to identify risk factors for soil-transmitted helminth infection in Timor-Leste","volume":"51","author":"Aw","year":"2021"},{"key":"b13","series-title":"Int J Parasitol","first-page":"771","article-title":"Water, sanitation and hygiene related risk factors for soil-transmitted helminth and Giardia duodenalis infections in rural communities in Timor-Leste","volume":"46","author":"Campbell","year":"2016"},{"key":"b14","series-title":"PLoS Negl Trop Dis","first-page":"e0005393","article-title":"Water, sanitation and hygiene (WASH) and environmental risk factors for soil-transmitted helminth intensity of infection in Timor-Leste, using real time PCR","volume":"11","author":"Campbell","year":"2017"},{"key":"b15","series-title":"PLoS Negl Trop Dis","first-page":"e0005565","article-title":"An environmental assessment and risk map of Ascaris lumbricoides and Necator americanus distributions in Manufahi District, Timor-Leste","volume":"11","author":"Wardell","year":"2017"},{"key":"b16","series-title":"Am J Trop Med Hyg","first-page":"1186","article-title":"Development and evaluation of a multiplex quantitative real-time PCR for hookworm species in human stool","volume":"99","author":"Hii","year":"2018"},{"key":"b17","series-title":"PLoS Negl Trop Dis","first-page":"e0009395","article-title":"Comparison of the egg recovery rates and limit of detection for soil-transmitted helminths using the Kato-Katz thick smear, faecal flotation and quantitative real-time PCR in human stool","volume":"15","author":"Zendejas Heredia","year":"2021"},{"key":"b18","article-title":"Improved Sanitation Facilities and Drinking-Water Sources.","year":"2025"},{"key":"b19","article-title":"STAT 462 Applied Regression Analysis: 10.7 \u2013 Detecting Multicollinearity Using Variance Inflation Factors.","year":"2018"},{"key":"b20","article-title":"Stata Statistical Software: Release 17.","year":"2021"},{"key":"b21","series-title":"BMC Public Health","first-page":"1882","article-title":"Prevalence of soil-transmitted helminth infections and associated risk factors among elderly individuals living in rural areas of southern Thailand","volume":"20","author":"Kache","year":"2020"},{"key":"b22","series-title":"BMC Infect Dis","first-page":"361","article-title":"Prevalence and associated risk factors of soil-transmitted helminth infections in Kandahar, Afghanistan","volume":"22","author":"Rahimi","year":"2022"},{"key":"b23","series-title":"BMC Public Health","first-page":"1066","article-title":"Prevalence and risk factors of soil-transmitted helminthiasis among school children living in an agricultural area of North Sumatera, Indonesia","volume":"19","author":"Pasaribu","year":"2019"},{"key":"b24","series-title":"Ann Glob Health","first-page":"120","article-title":"Risk of soil-transmitted helminthiasis among agrarian communities of Kogi State, Nigeria","volume":"85","author":"Toochukwu Joy","year":"2019"},{"key":"b25","series-title":"J Trop Med","first-page":"4561561","article-title":"Soil contamination and infection of school children by soil-transmitted helminths and associated factors at Kola Diba Primary School, Northwest Ethiopia: An institution-based cross-sectional study","volume":"2022","author":"Hussein","year":"2022"},{"key":"b26","series-title":"PLoS Med","first-page":"e1001837","article-title":"Efficacy of handwashing with soap and nail clipping on intestinal parasitic infections in school-aged children: A factorial cluster randomized controlled trial","volume":"12","author":"Mahmud","year":"2015"},{"key":"b27","series-title":"Prev Med","first-page":"63","article-title":"Integrating theory into community interventions to reduce liver cancer disparities: The Health Behavior Framework","volume":"50","author":"Bastani","year":"2010"},{"key":"b28","series-title":"Environ Health Insights","first-page":"1178630219896804","article-title":"Socioeconomic predictors of intestinal parasitic infections among under-five children in rural Dembiya, Northwest Ethiopia: A community-based cross-sectional study","volume":"13","author":"Gizaw","year":"2019"},{"key":"b29","series-title":"J Parasitol Res","first-page":"4603638","article-title":"Prevalence and associated risk factors of soil-transmitted helminth infections among schoolchildren around Lake Tana, Northwest Ethiopia","volume":"2022","author":"Getaneh","year":"2022"},{"key":"b1","article-title":"Soil-Transmitted Helminth Infections.","year":"2023"},{"key":"b2","series-title":"Lancet","first-page":"1789","article-title":"Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990\u20132017: A systematic analysis for the Global Burden of Disease Study 2017","volume":"392","year":"2018"},{"key":"b3","article-title":"Preventive Chemotherapy to Control Soil-Transmitted Helminth Infections in at-Risk Population Groups.","year":"2017"},{"key":"b4","series-title":"Parasit Vectors","first-page":"213","article-title":"Epidemiology of soil-transmitted helminths using quantitative PCR and risk factors for hookworm and Necator americanus infection in school children in Dak Lak province, Vietnam","volume":"16","author":"Hughes","year":"2023"},{"key":"b5","series-title":"Int J Parasitol","first-page":"389","article-title":"Risk factors for infection with soil-transmitted helminths during an integrated community level water, sanitation, and hygiene and deworming intervention in Timor-Leste","volume":"49","author":"Vaz Nery","year":"2019"},{"key":"b6","series-title":"PLoS One","first-page":"e0274702","article-title":"Prevalence and intensity of soil-transmitted helminth infections and associated risk factors among household heads living in the peri-urban areas of Jimma town, Oromia, Ethiopia: A community-based cross-sectional study","volume":"17","author":"Zeynudin","year":"2022"},{"key":"b7","article-title":"Timor-Leste Population and Housing Census 2022 Main Report.","year":"2023"},{"key":"b8","article-title":"Transmission Assessment Survey of Neglected Tropical Disease in Timor Leste, 2020\u20132022.","year":"2022"},{"key":"b9","article-title":"Master Plan for Implementation of Neglected Tropical Diseases (NTDs) Control in Timor Leste 2015\u20132020."},{"key":"b10","series-title":"Lancet Glob Health","first-page":"e924","article-title":"The impact of ivermectin, diethylcarbamazine citrate, and albendazole mass drug administration on the prevalence of scabies and soil-transmitted helminths in school-aged children in three municipalities in Timor-Leste: A before-after assessment","volume":"11","author":"Le","year":"2023"},{"key":"b11","article-title":"Eliminating Soil-Transmitted Helminthiases as a Public Health Problem in Children: Progress Report 2001\u20132010 and Strategic Plan 2011\u20132020.","year":"2012"},{"key":"b12","series-title":"Int J Parasitol","first-page":"729","article-title":"Novel statistical approaches to identify risk factors for soil-transmitted helminth infection in Timor-Leste","volume":"51","author":"Aw","year":"2021"},{"key":"b13","series-title":"Int J Parasitol","first-page":"771","article-title":"Water, sanitation and hygiene related risk factors for soil-transmitted helminth and Giardia duodenalis infections in rural communities in Timor-Leste","volume":"46","author":"Campbell","year":"2016"},{"key":"b14","series-title":"PLoS Negl Trop Dis","first-page":"e0005393","article-title":"Water, sanitation and hygiene (WASH) and environmental risk factors for soil-transmitted helminth intensity of infection in Timor-Leste, using real time PCR","volume":"11","author":"Campbell","year":"2017"},{"key":"b15","series-title":"PLoS Negl Trop Dis","first-page":"e0005565","article-title":"An environmental assessment and risk map of Ascaris lumbricoides and Necator americanus distributions in Manufahi District, Timor-Leste","volume":"11","author":"Wardell","year":"2017"},{"key":"b16","series-title":"Am J Trop Med Hyg","first-page":"1186","article-title":"Development and evaluation of a multiplex quantitative real-time PCR for hookworm species in human stool","volume":"99","author":"Hii","year":"2018"},{"key":"b17","series-title":"PLoS Negl Trop Dis","first-page":"e0009395","article-title":"Comparison of the egg recovery rates and limit of detection for soil-transmitted helminths using the Kato-Katz thick smear, faecal flotation and quantitative real-time PCR in human stool","volume":"15","author":"Zendejas Heredia","year":"2021"},{"key":"b18","article-title":"Improved Sanitation Facilities and Drinking-Water Sources.","year":"2025"},{"key":"b19","article-title":"STAT 462 Applied Regression Analysis: 10.7 \u2013 Detecting Multicollinearity Using Variance Inflation Factors.","year":"2018"},{"key":"b20","article-title":"Stata Statistical Software: Release 17.","year":"2021"},{"key":"b21","series-title":"BMC Public Health","first-page":"1882","article-title":"Prevalence of soil-transmitted helminth infections and associated risk factors among elderly individuals living in rural areas of southern Thailand","volume":"20","author":"Kache","year":"2020"},{"key":"b22","series-title":"BMC Infect Dis","first-page":"361","article-title":"Prevalence and associated risk factors of soil-transmitted helminth infections in Kandahar, Afghanistan","volume":"22","author":"Rahimi","year":"2022"},{"key":"b23","series-title":"BMC Public Health","first-page":"1066","article-title":"Prevalence and risk factors of soil-transmitted helminthiasis among school children living in an agricultural area of North Sumatera, Indonesia","volume":"19","author":"Pasaribu","year":"2019"},{"key":"b24","series-title":"Ann Glob Health","first-page":"120","article-title":"Risk of soil-transmitted helminthiasis among agrarian communities of Kogi State, Nigeria","volume":"85","author":"Toochukwu Joy","year":"2019"},{"key":"b25","series-title":"J Trop Med","first-page":"4561561","article-title":"Soil contamination and infection of school children by soil-transmitted helminths and associated factors at Kola Diba Primary School, Northwest Ethiopia: An institution-based cross-sectional study","volume":"2022","author":"Hussein","year":"2022"},{"key":"b26","series-title":"PLoS Med","first-page":"e1001837","article-title":"Efficacy of handwashing with soap and nail clipping on intestinal parasitic infections in school-aged children: A factorial cluster randomized controlled trial","volume":"12","author":"Mahmud","year":"2015"},{"key":"b27","series-title":"Prev Med","first-page":"63","article-title":"Integrating theory into community interventions to reduce liver cancer disparities: The Health Behavior Framework","volume":"50","author":"Bastani","year":"2010"},{"key":"b28","series-title":"Environ Health Insights","first-page":"1178630219896804","article-title":"Socioeconomic predictors of intestinal parasitic infections among under-five children in rural Dembiya, Northwest Ethiopia: A community-based cross-sectional study","volume":"13","author":"Gizaw","year":"2019"},{"key":"b29","series-title":"J Parasitol Res","first-page":"4603638","article-title":"Prevalence and associated risk factors of soil-transmitted helminth infections among schoolchildren around Lake Tana, Northwest Ethiopia","volume":"2022","author":"Getaneh","year":"2022"}],"container-title":["The American Journal of Tropical Medicine and 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