Controlling soil transmitted helminths: Time to think inside the box?

TLDR: Using China as an example, the use of biogas technology as a solution to rural sanitation and energy problems is described, and its advantages over current strategies of mass drug administration and vaccination for STH control are highlighted.

Abstract: Soil-transmitted helminths (STH) refer to several parasitic nematode species that infect over 1 billion people worldwide. Infections with Ascaris lumbricoides, Trichuris trichiura, and the hookworms Necator americanus and Ancylostoma duodenale cause significant morbidity in more than 450 million people, primarily children and pregnant women, resulting in over 39 million disability-adjusted life years lost. Considerable effort and resources have been, and continue to be, spent on top-down, medical-based programs to control STH infections, with little success. This review discusses the problems with these methods and proposes a new emphasis on sustainable, long-term investments in sanitation-based approaches using improved latrines (the “box”) to provide bottom-up, culturally appropriate, and economically desirable solutions to STH control in endemic areas. One such approach is the use of biogas technology. Waste undergoes fermentation in specially designed septic systems, generating a methane ga...