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Randomized Controlled Trial
. 2020 Dec 9;15(12):e0242240.
doi: 10.1371/journal.pone.0242240. eCollection 2020.

Hand hygiene intervention to optimize helminth infection control: Design and baseline results of Mikono Safi-An ongoing school-based cluster-randomised controlled trial in NW Tanzania

Kenneth Makata  1 , Safari Kinung'hi  2 , Christian Hansen  3 , Philip Ayieko  1   3 , Simon Sichalwe  1 , Onike Mcharo  1 , Jeroen Ensink  4 , Robert Dreibelbis  4 , Sarah Rockowitz  5 , Elialilia Okello  1 , Heiner Grosskurth  1   2   3 , Saidi Kapiga  1   2   3
Affiliations
Randomized Controlled Trial

Hand hygiene intervention to optimize helminth infection control: Design and baseline results of Mikono Safi-An ongoing school-based cluster-randomised controlled trial in NW Tanzania

Kenneth Makata et al. PLoS One. .

Abstract

Introduction: Soil transmitted helminths (STH) can affect over 50% of children in some parts of Tanzania. Control measures involve annual deworming campaigns in schools, but re-infection is rapid. This paper presents the design and baseline survey results of an ongoing school-based cluster-randomised controlled trial in Kagera region, NW Tanzania. The trial aims to determine whether the effect of routine deworming on the prevalence of Ascaris lumbricoides and Trichuris trichiura infections among school aged children can be sustained when combined with a behaviour change intervention promoting handwashing with water and soap.

Methods: As part of the trial, a total of 16 schools were randomised to receive the intervention (N = 8) or as controls (N = 8). Randomisation was stratified per district and restricted to ensure pre-trial STH prevalence was balanced between study arms. The combination intervention to be tested comprises class-room based teacher-led health education, improvement of handwash stations, coloured nudges to facilitate handwashing and parental engagement sessions. The impact evaluation involves two cross-sectional surveys conducted at baseline and endline. The objectives of the baseline survey were: (i) to confirm whether the deworming campaign was successful, and identify and treat students still infected about 2 weeks after deworming, (ii) to document any baseline differences in STH prevalence between trial arms, and (iii) to assess handwashing behaviours, and access to water and sanitation at school and home. We randomly sampled 35 students per class in Grades 1-6 (an average of 200 children per school), stratified to ensure equal representation between genders. Assenting students were interviewed using a structured questionnaire and asked to provide a stool specimen.

Results: Results of the baseline survey conducted about 2 weeks after deworming shows balanced demographic and STH prevalence data across trial arms. We observed a low prevalence of ascariasis (< 5%) as expected; however, the prevalence of trichuriasis was still about 35% in both arms.

Conclusion: The randomisation procedure was successful in achieving a balanced distribution of demographic characteristics and helminth infections between trial arms. The intervention is being rolled out. The current deworming treatment regimen may need to be revised with regards to the treatment of trichuriasis.

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Conflict of interest statement

The authors have declared that no competing interests exists.

Figures

Fig 1
Fig 1. Map showing study sites in Kagera region, Tanzania.
Fig 2
Fig 2. A picture of a primary school from Kagera region.
Fig 3
Fig 3. Handwashing facility with painted nudges from one intervention school.
Fig 4
Fig 4. Relative timing of intervention events, surveys and deworming campaign.
See this image and copyright information in PMC

References

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