A comparative analysis of baseline and post-intervention surveillance in a hookworm control pilot: Evidence from Tiantai County, Zhejiang Province, 2022–2024
8 affiliations
- 1Infectious Disease Prevention and Control Center, Taizhou City Center for Disease Control and Prevention, Taizhou, Zhejiang, China.
- 2Department of Inspection and Testing, Tiantai County Center for Disease Control and Prevention, Taizhou, Zhejiang, China.
- 3Tiantai County Center for Disease Control and Prevention, Taizhou, Zhejiang, China.
- 4Department of Infectious Diseases, People's Hospital of Tiantai County, Taizhou, Zhejiang, China.
- 5Department of Microbiological Laboratory, Taizhou City Center for Disease Control and Prevention, Taizhou, Zhejiang, China.
- 6Infectious Disease Prevention and Control Center, Zhejiang Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
- 7Taizhou City Center for Disease Control and Prevention, Taizhou, Zhejiang, China.
- 8Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China.
Abstract
Hookworm infection remains a neglected tropical disease in rural areas where low-level transmission may persist despite long-term control efforts. This repeated cross-sectional study evaluated changes in hookworm infection in six rural villages of Tiantai County, Zhejiang Province, China, before and after implementation of an integrated control program. In 2022, approximately 200 permanent residents aged ≥3 years were sampled from each village for the baseline survey. After one year of integrated interventions, including sanitation improvement, health education, deworming, and strengthened village-level management, another cross-sectional survey was conducted in the same villages in 2024. Hookworm infection was detected using stool examination. Prevalence was compared between survey years, and Firth penalized logistic regression was used to estimate adjusted associations with infection while addressing sparse data and complete separation. A total of 1,218 individuals were examined in 2022, of whom 58 were positive for hookworm infection, corresponding to a prevalence of 4.76%. In 2024, 1,222 individuals were examined and 13 infections were detected, corresponding to a prevalence of 1.06%. The overall prevalence decreased by 77.73%. In the Firth penalized logistic regression model adjusted for sex, age group, educational level, occupation, and village, the odds of infection in the 2024 post-intervention survey were significantly lower than those in the 2022 baseline survey (adjusted OR = 0.223, 95% CI: 0.125–0.399, P < 0.001). Male sex, primary education or below, and residence in Qianyang, Xiatang, or Xiaqiao villages were associated with higher infection odds. Hookworm prevalence declined substantially in the same villages after implementation of integrated control measures. However, the absence of non-intervention control villages limits causal attribution. Sustained surveillance and targeted interventions remain needed for high-risk populations and villages. Author summary: Hookworm infection is a parasitic disease that can cause anemia, fatigue, and poor nutrition, especially in rural communities where people often work in close contact with soil. Although national control programs have reduced infection in many places, some villages and population groups can remain at risk, and it is not always clear which measures work best in real-world settings. In this study, we compared community surveys conducted in Tiantai County, Zhejiang Province, in 2022 and again in 2024 after implementation of an integrated hookworm control pilot that included sanitation improvement, health education, and deworming treatment. The overall proportion of people with hookworm infection fell from 4.76% to 1.06%, and most baseline-positive individuals who were successfully followed became infection-free. However, infection did not disappear completely. However, this was not a randomized or controlled study, and not all baseline-positive individuals were followed; therefore, the reduction cannot be attributed solely to the intervention package. Older adults, people with lower levels of schooling, and residents in certain villages continued to have higher risk. These findings suggest that integrated approaches may help reduce hookworm transmission, but long-term success requires better monitoring of intervention coverage, behavioral practices, environmental conditions, and residual high-risk groups.
Related
- Baseline growth rate shapes pollutant impacts in aquatic environments: Evidence from antibiotic responses in the harmful cyanobacterium Microcystis
- N-glycoproteomic profiling of the hookworm Ancylostoma ceylanicum reveals heterogeneity and phosphorylcholine-modified glycans in larval and adult parasites.
- Where are rabies cases lost along the surveillance pathway? A comparative evaluation of participatory and passive rabies surveillance in urban Lilongwe, Malawi
- Beyond abundance: an evidence-aware framework for environmental conditioning, surveillance and infection potential in Vibrio vulnificus
- PanVasc Research for AI assisted evidence analysis in panvascular intervention
BibTeX
@article{gao2026comparative,
title = {{A comparative analysis of baseline and post-intervention surveillance in a hookworm control pilot: Evidence from Tiantai County, Zhejiang Province, 2022–2024}},
author = {Qing Gao and Haiyan Hu and Junhua Ge and Weilong Pang and Yingjun Chen and Bingzhi Chen and Xiang Zheng and Weiwei Shen and Jimin Sun and Haijiang Lin},
journal = {PLOS Neglected Tropical Diseases},
year = {2026},
month = oct,
doi = {10.1371/journal.pntd.0014835},
url = {https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014835},
note = {CC BY},
}
RIS
TY - JOUR
TI - A comparative analysis of baseline and post-intervention surveillance in a hookworm control pilot: Evidence from Tiantai County, Zhejiang Province, 2022–2024
AU - Qing Gao
AU - Haiyan Hu
AU - Junhua Ge
AU - Weilong Pang
AU - Yingjun Chen
AU - Bingzhi Chen
AU - Xiang Zheng
AU - Weiwei Shen
AU - Jimin Sun
AU - Haijiang Lin
PY - 2026
DA - 2026/10/01
JO - PLOS Neglected Tropical Diseases
DO - 10.1371/journal.pntd.0014835
UR - https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014835
AB - Hookworm infection remains a neglected tropical disease in rural areas where low-level transmission may persist despite long-term control efforts. This repeated cross-sectional study evaluated changes in hookworm infection in six rural villages of Tiantai County, Zhejiang Province, China, before and after implementation of an integrated control program. In 2022, approximately 200 permanent residents aged ≥3 years were sampled from each village for the baseline survey. After one year of integrated interventions, including sanitation improvement, health education, deworming, and strengthened village-level management, another cross-sectional survey was conducted in the same villages in 2024. Hookworm infection was detected using stool examination. Prevalence was compared between survey years, and Firth penalized logistic regression was used to estimate adjusted associations with infection while addressing sparse data and complete separation. A total of 1,218 individuals were examined in 2022, of whom 58 were positive for hookworm infection, corresponding to a prevalence of 4.76%. In 2024, 1,222 individuals were examined and 13 infections were detected, corresponding to a prevalence of 1.06%. The overall prevalence decreased by 77.73%. In the Firth penalized logistic regression model adjusted for sex, age group, educational level, occupation, and village, the odds of infection in the 2024 post-intervention survey were significantly lower than those in the 2022 baseline survey (adjusted OR = 0.223, 95% CI: 0.125–0.399, P < 0.001). Male sex, primary education or below, and residence in Qianyang, Xiatang, or Xiaqiao villages were associated with higher infection odds. Hookworm prevalence declined substantially in the same villages after implementation of integrated control measures. However, the absence of non-intervention control villages limits causal attribution. Sustained surveillance and targeted interventions remain needed for high-risk populations and villages. Author summary: Hookworm infection is a parasitic disease that can cause anemia, fatigue, and poor nutrition, especially in rural communities where people often work in close contact with soil. Although national control programs have reduced infection in many places, some villages and population groups can remain at risk, and it is not always clear which measures work best in real-world settings. In this study, we compared community surveys conducted in Tiantai County, Zhejiang Province, in 2022 and again in 2024 after implementation of an integrated hookworm control pilot that included sanitation improvement, health education, and deworming treatment. The overall proportion of people with hookworm infection fell from 4.76% to 1.06%, and most baseline-positive individuals who were successfully followed became infection-free. However, infection did not disappear completely. However, this was not a randomized or controlled study, and not all baseline-positive individuals were followed; therefore, the reduction cannot be attributed solely to the intervention package. Older adults, people with lower levels of schooling, and residents in certain villages continued to have higher risk. These findings suggest that integrated approaches may help reduce hookworm transmission, but long-term success requires better monitoring of intervention coverage, behavioral practices, environmental conditions, and residual high-risk groups.
SN - 1935-2735
SN - 1935-2727
ER -