Date of Award

January 2020

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Debbie Humphries


Soil-transmitted helminths are a major cause of disability and morbidity in resource-poor settings: over 1.5 billion are estimated to be at risk of infection. Human behaviors and household socioeconomic conditions that facilitate contact with contaminated soil may increase exposure to parasites. The primary objective of the study was to investigate the community-level variation in hookworm prevalence in the Kpandai district of Ghana.

We used a mixed-methods approach to investigate behavioral, societal and environmental risk factors to hookworm exposure. 264 individuals from three neighboring villages (Jagbigbingdo [JG], Takumdo [TK], Wiae Chabor [WC]) were recruited using a convenience sampling strategy. Household questionnaires regarding WASH were administered, and a representative from each household answered a semi-structured interview. Soil samples were taken to assess environmental hospitability for parasites. JG had a 24.4% hookworm prevalence, compared to 1.5% for TK, and 6.9% in WC, noting a continued community-level variation. Household size was a significant risk factor (OR = 2.09, 95% CI [1.17, 3.74]), while severely food insecure status was a protective factor (OR = 0.32, 95% CI [0.12, 0.85]). Qualitative interviews revealed that there is potential for regional WASH interventions and educational campaigns have penetrated at the community level. Environmental conditions did not vary significantly between the three villages, and nor did behavioral patterns. Infrastructure improvements may be needed to actualize behavioral changes from latrine construction, to achieve a sustainable reduction in parasite transmission. Concentrated foci of hookworm infected households may continue transmission patterns in JG, retarding efforts to reduce transmission at the community-level.


This is an Open Access Thesis.

Open Access

This Article is Open Access