Oral Presentation Lancefield International Symposium for Streptococci and Streptococcal Diseases 2025

Water access, sanitation and hygiene-related risk factors for Streptococcus pyogenes carriage and infection within households in The Gambia (118345)

Edwin P Armitage 1 2 , Gabrielle Elina De Crombrugghe 3 , Alexander J Keeley 1 , Elina Senghore 1 , Fatoumata E Camara 1 , Musukoi Jammeh 1 , Thushan de Silva 4 , Michael Marks 5
  1. MRCG @ LSHTM, Fajara, The Gambia, N/A, Gambia
  2. Population Heatlh Sciences, University of Bristol, Bristol, United Kingdom
  3. Molecular Bacteriology Laboratory, European Plotkin Institute for Vaccinology, Brussels, Belgium
  4. Department of Infection, The University of Sheffield, Sheffield, UK
  5. Clinical Research Department, London School of Hygiene and Tropical Medicione, London, UK

Background:

Pyoderma caused by Streptococcus pyogenes (Strep A), causes a major burden of disease in Africa, and may contributed to rheumatic heart disease. This study investigates the impact of hygiene behaviours, and access to water, sanitation, and hygiene (WASH) on Strep A pyoderma and skin carriage within the SpyCATS study in The Gambia.

Methods:

A nested cross-sectional survey within the SpyCATS cohort, a longitudinal study of 44 households in The Gambia, captured WASH characteristics and reported personal hygiene behaviours. Participants underwent monthly normal skin swabbing, and incident pyoderma cases were swabbed for culture-based detection of Strep A. Risk of Strep A pyoderma and carriage for various hygiene and WASH-related risk factors were investigated using multivariable Cox regression models.

Results:

Among 231 respondents, more frequent handwashing (>5 times/day) was associated with a reduced risk of culture-positive Strep A pyoderma (HR 0.56, 95% CI 0.32-0.99, p=0.047). Daily changing of clothes reduced the risk of both Strep A pyoderma (HR 0.22, 95% CI 0.05-0.96, p=0.044) and skin carriage (HR 0.11, 95% CI 0.04-0.27, p<0.001). Improved wound care practices, including antiseptic use, were strongly protective against pyoderma (HR 0.27, 95% CI 0.13-0.55, p<0.001). WASH characteristics such as shared toilets, pit latrines, and presence of livestock were associated with increased pyoderma risk, though socioeconomic status may be confounding.

Conclusions:

Personal hygiene practices, particularly handwashing, laundry and wound care, appear protective against Strep A pyoderma and carriage. These findings suggest that targeted hygiene interventions could prevent Strep A carriage and disease, and should be further investigated.