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(S)WASH-D for Worms: A pilot study investigating the differential impact of school- versus community-based integrated control programs for soil-transmitted helminths
- Source :
- PLoS Neglected Tropical Diseases, PLoS Neglected Tropical Diseases, Vol 12, Iss 5, p e0006389 (2018)
- Publication Year :
- 2018
- Publisher :
- Public Library of Science (PLoS), 2018.
-
Abstract
- Background Soil-transmitted helminths (STH) infect nearly 1.5 billion individuals globally, and contribute to poor physical and cognitive development in children. STH control programs typically consist of regular delivery of anthelminthic drugs, targeting school-aged children. Expanding STH control programs community-wide may improve STH control among school-aged children, and combining deworming with improvements to water, sanitation and hygiene (WASH) may further reduce transmission. The (S)WASH-D for Worms pilot study aims to compare the differential impact of integrated WASH and deworming programs when implemented at primary schools only versus when additionally implemented community-wide. Methodology/Principal findings A two-arm, non-randomized cluster intervention study was conducted. Six communities were identified by partner WASH agencies and enrolled in the study. All communities received a school-based WASH and deworming program, while three additionally received a community-based WASH and deworming program. STH infections were measured in school-aged children at baseline and six months after deworming. Over 90% of eligible children were recruited for the study, of whom 92.3% provided stool samples at baseline and 88.9% at follow-up. The school WASH intervention improved school sanitation, while the community WASH intervention reduced open defecation from 50.4% (95% CI 41.8–59.0) to 23.5% (95% CI 16.7–32.0). There was a trend towards reduced odds of N. americanus infection among children who received the community-wide intervention (OR 0.42, 95% CI 0.07–2.36, p = 0.32). Conclusions This pilot study provides proof of principle for testing the hypothesis that community-wide STH control programs have a greater impact on STH infections among children than school-based programs, and supports the rationale for conducting a full-scale cluster randomized controlled trial. High recruitment and participation rates and successful implementation of school WASH programs demonstrate study feasibility and acceptability. However, eliminating open defecation remains a challenge; ongoing work is required to develop community sanitation programs that achieve high and sustainable latrine coverage. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12615001012561<br />Author summary Soil-transmitted helminth (STH) infections are widespread globally, and their health impacts include poor growth and impaired cognitive development in children. STH control programs therefore usually focus on delivering deworming medications to school-aged children. However, expanding such programs to the whole community may result in larger benefits for children. Additionally, using water, sanitation and hygiene (WASH) interventions has been encouraged, to augment deworming programs by reducing environmental transmission. We conducted a pilot study to investigate the impact of an integrated WASH and deworming program implemented at primary schools only with a similar program implemented community-wide. Results confirm that the study procedures were feasible and acceptable to participants. Furthermore, results provide preliminary evidence that a community-wide control program will result in greater reductions in STH prevalence among school-aged children, compared to a school-based program.
- Subjects :
- Male
Nematoda
Sanitation
Physiology
Helminthiasis
Social Sciences
Pilot Projects
law.invention
Deworming
Families
Soil
0302 clinical medicine
Sociology
Randomized controlled trial
Residence Characteristics
law
Hygiene
Medicine and Health Sciences
Medicine
Public and Occupational Health
030212 general & internal medicine
Defecation
Child
Children
media_common
Anthelmintics
Schools
lcsh:Public aspects of medicine
Eukaryota
Necator
3. Good health
Infectious Diseases
Helminth Infections
Research Design
Child, Preschool
Female
Environmental Health
Research Article
Neglected Tropical Diseases
lcsh:Arctic medicine. Tropical medicine
Adolescent
lcsh:RC955-962
media_common.quotation_subject
030231 tropical medicine
Research and Analysis Methods
Disease cluster
Education
03 medical and health sciences
Helminths
Environmental health
Parasitic Diseases
Animals
Humans
Open defecation
business.industry
Organisms
Australia
Public Health, Environmental and Occupational Health
Biology and Life Sciences
Water
lcsh:RA1-1270
Pilot Studies
Tropical Diseases
Invertebrates
Health Care
Clinical trial
Soil-Transmitted Helminthiases
Hookworms
Age Groups
Necator Americanus
People and Places
Latrine
Population Groupings
Physiological Processes
business
Subjects
Details
- ISSN :
- 19352735
- Volume :
- 12
- Database :
- OpenAIRE
- Journal :
- PLOS Neglected Tropical Diseases
- Accession number :
- edsair.doi.dedup.....27004108d1c51c2a733bd7ed4f64ab84