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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

Clarke, Naomi; Clements, Archie; Amaral, Salvador; Richardson, Alice; McCarthy, James; McGown, John; Bryan, Stuart; Gray, Darren; Vaz Nery, Susana

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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...[Show more]

dc.contributor.authorClarke, Naomi
dc.contributor.authorClements, Archie
dc.contributor.authorAmaral, Salvador
dc.contributor.authorRichardson, Alice
dc.contributor.authorMcCarthy, James
dc.contributor.authorMcGown, John
dc.contributor.authorBryan, Stuart
dc.contributor.authorGray, Darren
dc.contributor.authorVaz Nery, Susana
dc.date.accessioned2019-05-09T04:45:31Z
dc.date.available2019-05-09T04:45:31Z
dc.identifier.issn1935-2727
dc.identifier.urihttp://hdl.handle.net/1885/161147
dc.description.abstractBackground 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.
dc.format.mimetypeapplication/pdf
dc.language.isoen_AU
dc.publisherPublic Library of Science
dc.rights© 2018 Clarke et al.
dc.sourcePLoS Neglected Tropical Diseases
dc.title(S)WASH-D for Worms: A pilot study investigating the differential impact of school- versus community-based integrated control programs for soil-transmitted helminths
dc.typeJournal article
local.description.notesImported from ARIES
local.identifier.citationvolume12
dc.date.issued2018
local.identifier.absfor111706 - Epidemiology
local.identifier.absfor111700 - PUBLIC HEALTH AND HEALTH SERVICES
local.identifier.ariespublicationu5684624xPUB258
local.publisher.urlhttps://www.plos.org/
local.type.statusPublished Version
local.contributor.affiliationClarke, Naomi, College of Health and Medicine, ANU
local.contributor.affiliationClements, Archie, College of Health and Medicine, ANU
local.contributor.affiliationAmaral, Salvador, College of Health and Medicine, ANU
local.contributor.affiliationRichardson, Alice, College of Health and Medicine, ANU
local.contributor.affiliationMcCarthy, James , QIMR Berghofer Medical Research Institute
local.contributor.affiliationMcGown, John, Plan International Timor-Leste
local.contributor.affiliationBryan, Stuart, Cruz Vermelha Timor-Leste
local.contributor.affiliationGray, Darren, College of Health and Medicine, ANU
local.contributor.affiliationVaz da Silva de Castro Nery, Susana, College of Health and Medicine, ANU
local.bibliographicCitation.issue5
local.bibliographicCitation.startpagee0006389
local.identifier.doi10.1371/journal.pntd.0006389
local.identifier.absseo920404 - Disease Distribution and Transmission (incl. Surveillance and Response)
dc.date.updated2019-03-12T07:38:18Z
dcterms.accessRightsOpen Access
dc.provenanceThis is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
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