Discussion

Effective soil-transmitted helminth (STH) control programmes require accurate infection estimates to target communities, optimise resources, and evaluate interventions. Little is known about STH prevalence, risk factors, or morbidity associations in Timor-Leste. As part of a cluster randomised controlled trial, 24 villages in Manufahi, Timor-Leste, were surveyed. Water, sanitation and hygiene (WASH) and socioeconomic risk factors associated with STH infections in different age groups (preschool, school-aged children, adults) were assessed, as well as associations between STH and anaemia, child stunting and wasting. STH prevalence was 69% (95% Confidence Interval (CI) 67%-71%), with Necator americanus predominant (60%; 95%CI 58%-62%). Risk factors for N. americanus infection were age, male sex, and socioeconomic quintile. Risk factors for Ascaris spp. included increasing age in years (preschool children), and using shared piped water (adults). Few associations between WASH and STH infections were found, likely reflecting uniformly poor WASH infrastructure and behaviours. Very high stunting (60%; 95%CI 57%-63%), and wasting (19%; 95%CI 17%-22%), but low anaemia prevalence (15%; 95%CI 14%-17%), was identified. Male sex and poorest socioeconomic quintile, but not STH, were significantly associated with moderate and severe stunting. Child stunting and wasting in this population are critically high. Policy and practical implications will be discussed.