Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2018 May 3;12(5):e0006389.
doi: 10.1371/journal.pntd.0006389. eCollection 2018 May.

(S)WASH-D for Worms: A pilot study investigating the differential impact of school- versus community-based integrated control programs for soil-transmitted helminths

Naomi E Clarke  1 , Archie C A Clements  1 , Salvador Amaral  1 , Alice Richardson  1 , James S McCarthy  2 , John McGown  3 , Stuart Bryan  4 , Darren J Gray  1 , Susana V Nery  1
Affiliations
Clinical Trial

(S)WASH-D for Worms: A pilot study investigating the differential impact of school- versus community-based integrated control programs for soil-transmitted helminths

Naomi E Clarke et al. PLoS Negl Trop Dis. .

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.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. CONSORT flow diagram of the pilot study.
Study participation is defined as providing a questionnaire and/or stool sample.
Fig 2
Fig 2
Prevalence of (A) infection and (B) higher-intensity infection with Ascaris spp., before and six months following the study intervention. P values are based on logistic regression models comparing intervention and control arms, accounting for school-level clustering. CI = confidence interval; DID = difference in differences between intervention and control arms.
Fig 3
Fig 3
Prevalence of (A) infection and (B) higher-intensity infection with N. americanus, before and six months following the study intervention. P values are based on logistic regression models comparing intervention and control arms, accounting for school-level clustering. CI = confidence interval; DID = difference in differences between intervention and control arms.
See this image and copyright information in PMC

References

    1. Pullan RL, Smith JL, Jasrasaria R, Brooker SJ. Global numbers of infection and disease burden of soil transmitted helminth infections in 2010. Parasit Vectors. 2014;7: 37 doi: 10.1186/1756-3305-7-37 - DOI - PMC - PubMed
    1. Bethony J, Brooker S, Albonico M, Geiger SM, Loukas A, Diemert D, et al. Soil-transmitted helminth infections: ascariasis, trichuriasis, and hookworm. Lancet. 2006;367: 1521–1532. doi: 10.1016/S0140-6736(06)68653-4 - DOI - PubMed
    1. Taylor-Robinson DC, Maayan N, Soares-Weiser K, Donegan S, Garner P. Deworming drugs for soil-transmitted intestinal worms in children: effects on nutritional indicators, haemoglobin and school performance. Cochrane Database Syst Rev. 2015;7: CD000371. - PMC - PubMed
    1. Brooker S, Bethony J, Hotez PJ. Human hookworm infection in the 21st century. Adv Parasitol. 2004;58: 197–288. doi: 10.1016/S0065-308X(04)58004-1 - DOI - PMC - PubMed
    1. World Health Organization. Preventive chemotherapy in human helminthiasis Geneva: World Health Organization, 2006.

Publication types

LinkOut - more resources