Search

Additional file 1: Additional Tables S1–S58. Figure S1. Geographical locations of schools included in the precision mapping in five districts of Simiyu region, north-western Tanzania. Figure S2. Geographical locations of schools included in the precision mapping in three districts of Mwanza region, north-western Tanzania. Figure S3. Geographical locations of schools included in the precision mapping in four districts of Kigoma region, western Tanzania. Figure S4. Geographical locations of schools included in the precision mapping in five districts of Shinyanga region, north-western Tanzania. Figure S5. Geographical locations of schools included in the precision mapping in five districts of Mara region, north-western Tanzania. Figure S6. Geographical locations of schools included in the precision mapping in five districts of Kagera region, north-western Tanzania.

Introduction. The ‘Enhanced School Health Initiative’ (ESHI) targeted 30 primary schools in southern Ethiopia and aimed to improve the health and educational outcomes of school children through an integrated package of school feeding, deworming and the provision of improved water sanitation and hygiene (WASH). This study investigated parental perceptions of this integrated school health and nutrition programme. Methods. The data was collected through group interviews with parents of children at schools targeted by the programme. Ten schools were purposively selected to represent geographical diversity. A team of two trained facilitators led the group interview in each school. All interviews were conducted in local dialects and then directly translated into English and transcribed. The transcripts were analysed using thematic analysis. Findings are structured around key themes identified from the discussions.Results and Discussion. Three main themes are identified from the interviews. The first relates to the perceptions of equity and opportunity generated for the children and the parents as a result of the programme. The second theme identifies the dissemination of learning throughout the community reported by parents. This includes the use of children as messengers, particularly for good hygiene practices and importance of deworming. The final theme explores concerns about ownership and sustainability of the programme within the communities. When probed on the topic of sustainability, parents raised conflicts surrounding ownership, and their ability to sustain the programme without further external input. Conclusions. The findings highlight the parent’s perceptions of this integrated school health and nutrition programme, and the multiple mechanisms through which it has an impact on the wider community. They also highlight what aspects of the programme are felt to be sustainable without further input, particularly behaviour change.

Hybrid trials that include both clinical and implementation science outcomes are increasingly relevant for public health researchers that aim to rapidly translate study findings into evidence- based practice. The DeWorm3 Project is a series of hybrid trials testing the feasibility of interrupting the transmission of soil transmitted helminths (STH), while conducting implementation science research that contextualizes clinical research findings and provides guidance on opportunities to optimize delivery of STH interventions. The purpose of DeWorm3 implementation science studies is to ensure rapid and efficient translation of evidence into practice. DeWorm3 will use stakeholder mapping to identify individuals who influence or are influenced by school-based or community-wide mass drug administration (MDA) for STH and to evaluate network dynamics that may affect study outcomes and future policy development. Individual interviews and focus groups will generate the qualitative data needed to identify factors that shape, contextualize, and explain DeWorm3 trial outputs and outcomes. Structural readiness surveys will be used to evaluate the factors that drive health system readiness to implement novel interventions, such as community-wide MDA for STH, in order to target change management activities and identify opportunities for sustaining or scaling the intervention. Process mapping will be used to understand what aspects of the intervention are adaptable across heterogeneous implementation settings and to identify contextually- relevant modifiable bottlenecks that may be addressed to improve the intervention delivery process and to achieve intervention outputs. Lastly, intervention costs and incremental cost-effectiveness will be evaluated to compare the efficiency of community-wide MDA to standard-of-care targeted MDA both over the duration of the trial and over a longer elimination time horizon.

Hybrid trials that include both clinical and implementation science outcomes are increasingly relevant for public health researchers that aim to rapidly translate study findings into evidence-based practice. The DeWorm3 Project is a series of hybrid trials testing the feasibility of interrupting the transmission of soil transmitted helminths (STH), while conducting implementation science research that contextualizes clinical research findings and provides guidance on opportunities to optimize delivery of STH interventions. The purpose of DeWorm3 implementation science studies is to ensure rapid and efficient translation of evidence into practice. DeWorm3 will use stakeholder mapping to identify individuals who influence or are influenced by school-based or community-wide mass drug administration (MDA) for STH and to evaluate network dynamics that may affect study outcomes and future policy development. Individual interviews and focus groups will generate the qualitative data needed to identify factors that shape, contextualize, and explain DeWorm3 trial outputs and outcomes. Structural readiness surveys will be used to evaluate the factors that drive health system readiness to implement novel interventions, such as community-wide MDA for STH, in order to target change management activities and identify opportunities for sustaining or scaling the intervention. Process mapping will be used to understand what aspects of the intervention are adaptable across heterogeneous implementation settings and to identify contextually-relevant modifiable bottlenecks that may be addressed to improve the intervention delivery process and to achieve intervention outputs. Lastly, intervention costs and incremental cost-effectiveness will be evaluated to compare the efficiency of community-wide MDA to standard-of-care targeted MDA both over the duration of the trial and over a longer elimination time horizon., Author summary The DeWorm3 Project is a series of randomized clinical trials testing the feasibility of interrupting the transmission of soil-transmitted helminths. We have integrated implementation science research questions into the trials in order to optimize delivery of trial interventions as well as to speed the translation of study evidence into relevant policy and practice. DeWorm3 implementation science research will take place at baseline (formative research), midline (process research), and endline (summative research). DeWorm3 will use stakeholder mapping and network analysis, qualitative data collection via individual interviews and focus groups, structural readiness surveys, process mapping, and economic evaluation methods to assess opportunities to maximize intervention effectiveness, evaluate the efficiency of the intervention relative to the standard-of-care, and identify strategies for sustaining, scaling, and replicating effective components of trial interventions. The implementation science research described in this protocol will be helpful to policy makers and program implementers who aim to use DeWorm3 findings to inform guidelines and routine programmatic activities. The DeWorm3 implementation science protocol is also relevant to researchers interested in incorporating implementation hypotheses into their own clinical research studies.