Soil-transmitted helminth (STH) infections cause significant physical and cognitive morbidity. Water, sanitation and hygiene (WASH) likely play roles in STH infection. We conducted a cross-sectional survey of a county in Guatemala to evaluate WASH risk factors for STH infection. We randomly selected households from roofs identified in aerial photos, then surveyed household members and performed environmental WASH evaluations using standardized questionnaires. We used WHO/UNICEF drinking water and sanitation ladders to classify household WASH infrastructure quality as improved or not improved. We tested stool from participants ≥ 1 year of age for STHs using the Mini Parasep® fecal parasite concentrator method and drinking water for Escherichia coli using the Colilert® most probable number (MPN) method. We performed unadjusted and multivariable analyses, the latter using the Lasso penalized regression shrinkage method to select variables. We used mixed models to account for household clustering. Models were weighted by the inverse number of roofs per household and adjusted for age category, socioeconomic status, and STH treatment in the past year. We tested 701 persons in 184 households for STH: 76 (11%) 1-4 year olds, 202 (29%) 5-14 year olds, 167 (24%) women of childbearing age 15-44 years old and 256 (37%) other adults ≥ lk15 years old. Most were female (56%), 215 (31%) reported deworming in the past year, and 88 (13%) were positive for Ascaris, Trichuris or hookworm. Drinking water available for <6 hours/day (prevalence ratio [PR] 4.06, P=0.002), crowding calculated as household members per bedroom (PR 1.24, P=0.049), finished floors (PR 0.25, P<0.001), improved drinking water (PR 0.28, P=0.050) and ever cleaning the sanitation facility (PR 0.33, P=0.026) were significant in multivariable modeling. Our findings support previous studies indicating STH infection is associated with WASH. Basic household interventions to improve safe drinking water availability and behavior changes concerning environmental cleanliness may be helpful in preventing future STH infections.
