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Meta-Analysis
. 2022 Jun 21;6(6):CD012199.
doi: 10.1002/14651858.CD012199.pub2.

Interventions to improve water, sanitation, and hygiene for preventing soil-transmitted helminth infection

Joshua V Garn  1 , Jennifer L Wilkers  2 , Ashley A Meehan  2 , Lisa M Pfadenhauer  2   3   4 , Jacob Burns  3   4 , Rubina Imtiaz  5 , Matthew C Freeman  2
Affiliations
Meta-Analysis

Interventions to improve water, sanitation, and hygiene for preventing soil-transmitted helminth infection

Joshua V Garn et al. Cochrane Database Syst Rev. .

Abstract

Background: It is estimated that 1.5 billion people are infected with soil-transmitted helminths (STHs) worldwide. Re-infection occurs rapidly following deworming, and interruption of transmission is unlikely without complementary control efforts such as improvements in water, sanitation, and hygiene (WASH) access and behaviours.

Objectives: To assess the effectiveness of WASH interventions to prevent STH infection.

Search methods: We used standard, extensive Cochrane search methods. The latest search date was 19 October 2021.

Selection criteria: We included interventions to improve WASH access or practices in communities where STHs are endemic. We included randomized controlled trials (RCTs), as well as trials with an external control group where participants (or clusters) were allocated to different interventions using a non-random method (non-RCTs). We did not include observational study designs. Our primary outcome was prevalence of any STH infection. Prevalence of individual worms was a secondary outcome, including for Ascaris lumbricoides, Trichuris trichiura, hookworm (Ancylostoma duodenale or Necator americanus), or Strongyloides stercoralis. Intensity of infection, measured as a count of eggs per gram of faeces for each species, was another secondary outcome.

Data collection and analysis: Two review authors independently reviewed titles and abstracts and full-text records for eligibility, performed data extraction, and assessed risk of bias using the Cochrane risk of bias assessment tool for RCTs and the EPOC tool for non-RCTs. We used a random-effects meta-analysis to pool study estimates. We used Moran's I² statistic to assess heterogeneity and conducted subgroup analyses to explore sources of heterogeneity. We assessed the certainty of the evidence using the GRADE approach.

Main results: We included 32 studies (16 RCTs and 16 non-RCTs) involving a total of 52,944 participants in the review. Twenty-two studies (14 RCTs (16 estimates) and eight non-RCTs (11 estimates)) reported on our primary outcome, prevalence of infection with at least one STH species. Twenty-one studies reported on the prevalence of A lumbricoides (12 RCTs and 9 non-RCTs); 17 on the prevalence of T trichiura (9 RCTs and 8 non-RCTs); 18 on the prevalence of hookworm (10 RCTs and 8 non-RCTs); and one on the prevalence of S stercoralis (1 non-RCT). Sixteen studies measured the intensity of infection for an individual STH type. Ten RCTs and five non-RCTs reported on the intensity of infection of A lumbricoides; eight RCTs and five non-RCTs measured the intensity of infection of T trichiura; and eight RCTs and five non-RCTs measured the intensity of hookworm infection. No studies reported on the intensity of infection of S stercoralis. The overall pooled effect estimates showed that the WASH interventions under study may result in a slight reduction of any STH infection, with an odds ratio (OR) of 0.86 amongst RCTs (95% confidence interval (CI) 0.74 to 1.01; moderate-certainty evidence) and an OR of 0.71 amongst non-RCTs (95% CI 0.54 to 0.94; low-certainty evidence). All six of the meta-analyses assessing individual worm infection amongst both RCTs and non-RCTs had pooled estimates in the preventive direction, although all CIs encapsulated the null, leaving the possibility of the null or even harmful effects; the certainty of the evidence ranged from very low to moderate. Individual studies assessing intensity of infection showed mixed evidence supporting WASH. Subgroup analyses focusing on narrow specific subsets of water, sanitation, and hygiene interventions did very little to elucidate which interventions might be better than others. Data on intensity of infection (e.g. faecal egg count) were reported in a variety of ways across studies, precluding the pooling of results for this outcome. We did not find any studies reporting adverse events resulting from the WASH interventions under study or from mass drug administration (MDA).

Authors' conclusions: Whilst the available evidence suggests that the WASH interventions under study may slightly protect against STH infection, WASH also serves as a broad preventive measure for many other diseases that have a faecal oral transmission route of transmission. As many of the studies were done in addition to MDA/deworming (i.e. MDA was ongoing in both the intervention and control arm), our data support WHO recommendations for implementation of improvements to basic sanitation and adequate access to safe water alongside MDA. The biological plausibility for improved access to WASH to interrupt transmission of STHs is clear, but WASH interventions as currently delivered have shown impacts that were lower than expected. There is a need for more rigorous and targeted implementation research and process evaluations in order that future WASH interventions can better provide benefit to users. Inconsistent reporting of the intensity of infection underscores the need to define the minimal, standard data that should be collected globally on STHs to enable pooled analyses and comparisons.

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Conflict of interest statement

JVG was contracted by a nonprofit, The Task Force for Global Health, to perform the analyses and write this review. JVG declares no other conflicts of interest.

JW has no conflicts of interest to declare.

AM has no conflicts of interest to declare.

LMP has no conflicts of interest to declare.

JB has no conflicts of interest to declare.

RI has engaged in activities related to the topic of this review, including work as a co‐author on opinion pieces, in global health development, and as the previous director of Children Without Worms (a non‐governmental organization leading on soil‐transmitted helminth policy and a program of the Task Force for Global Health). RI declares no other conflicts of interest.

MCF serves on the Soil‐Transmitted Helminthiasis Advisory Committee (Children Without Worms), which receives funding from Johnson & Johnson and GlaxoSmithKline. MCF received a grant from Johnson & Johnson for work assessing the impact of school‐based water, sanitation, and hygiene on soil‐transmitted helminth infection, and has consulted as a member of the Global Scientific Expert Community (Reckitt Benckiser Health Limited). MCF declares no other conflicts of interest.

Children Without Worms’ relationship with Johnson & Johnson and GlaxoSmithKline was assessed by the Cochrane Funding Panel, who determined that Children Without Worms’ financial support did not represent a financial conflict of interest for this review.

Figures

1
1
PRISMA flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Forest plot of comparison: 1 WASH intervention versus control, outcome: 1.1 Any STH prevalence amongst RCTs.
4
4
Forest plot of comparison: 1 WASH intervention versus control, outcome: 1.6 Any STH prevalence amongst non‐RCTs.
5
5
Forest plot of comparison: 1 WASH intervention versus control, outcome: 1.14 Ascaris lumbricoides prevalence amongst RCTs.
6
6
Forest plot of comparison: 1 WASH intervention versus control, outcome: 1.15 Ascaris lumbricoides prevalence amongst non‐RCTs.
7
7
Forest plot of comparison: 1 WASH intervention versus control, outcome: 1.24 Trichuris trichiura prevalence amongst RCTs.
8
8
Forest plot of comparison: 1 WASH intervention versus control, outcome: 1.26 Trichuris trichiura prevalence amongst non‐RCTs.
9
9
Forest plot of comparison: 1 WASH intervention versus control, outcome: 1.35 Hookworm prevalence amongst RCTs.
10
10
Forest plot of comparison: 1 WASH intervention versus control, outcome: 1.37 Hookworm prevalence amongst non‐RCTs.
1.1
1.1. Analysis
Comparison 1: WASH intervention versus control, Outcome 1: Any STH prevalence amongst RCTs
1.2
1.2. Analysis
Comparison 1: WASH intervention versus control, Outcome 2: Any STH prevalence amongst RCTs ‐ low risk of bias
1.3
1.3. Analysis
Comparison 1: WASH intervention versus control, Outcome 3: Any STH prevalence ‐ ICC
1.4
1.4. Analysis
Comparison 1: WASH intervention versus control, Outcome 4: Any STH prevalence amongst non‐RCTs
1.5
1.5. Analysis
Comparison 1: WASH intervention versus control, Outcome 5: Any STH prevalence ‐ narrow WASH categories amongst non‐RCTs
1.6
1.6. Analysis
Comparison 1: WASH intervention versus control, Outcome 6: Any STH prevalence amongst RCTs (intervention type subgroup)
1.7
1.7. Analysis
Comparison 1: WASH intervention versus control, Outcome 7: Any STH prevalence amongst RCTs (age subgroup)
1.8
1.8. Analysis
Comparison 1: WASH intervention versus control, Outcome 8: Any STH prevalence amongst RCTs (school village subgroup)
1.9
1.9. Analysis
Comparison 1: WASH intervention versus control, Outcome 9: Any STH prevalence amongst RCTs (MDA subgroup)
1.10
1.10. Analysis
Comparison 1: WASH intervention versus control, Outcome 10: Any STH prevalence amongst RCTs (rural urban subgroup)
1.11
1.11. Analysis
Comparison 1: WASH intervention versus control, Outcome 11: Any STH prevalence amongst RCTs (world region subgroup)
1.12
1.12. Analysis
Comparison 1: WASH intervention versus control, Outcome 12: Any STH prevalence ‐ narrow WASH categories amongst RCTs
1.13
1.13. Analysis
Comparison 1: WASH intervention versus control, Outcome 13: Ascaris lumbricoides prevalence amongst RCTs
1.14
1.14. Analysis
Comparison 1: WASH intervention versus control, Outcome 14: Ascaris lumbricoides prevalence amongst RCTs ‐ low risk of bias studies only
1.15
1.15. Analysis
Comparison 1: WASH intervention versus control, Outcome 15: Ascaris lumbricoides prevalence amongst non‐RCTs
1.16
1.16. Analysis
Comparison 1: WASH intervention versus control, Outcome 16: Ascaris lumbricoides prevalence ‐ narrow WASH categories amongst non‐RCTs
1.17
1.17. Analysis
Comparison 1: WASH intervention versus control, Outcome 17: Ascaris lumbricoides prevalence amongst RCTs (intervention type subgroup)
1.18
1.18. Analysis
Comparison 1: WASH intervention versus control, Outcome 18: Ascaris lumbricoides prevalence amongst RCTs (age subgroup)
1.19
1.19. Analysis
Comparison 1: WASH intervention versus control, Outcome 19: Ascaris lumbricoides prevalence amongst RCTs (school village subgroup)
1.20
1.20. Analysis
Comparison 1: WASH intervention versus control, Outcome 20: Ascaris lumbricoides prevalence amongst RCTs (MDA subgroup)
1.21
1.21. Analysis
Comparison 1: WASH intervention versus control, Outcome 21: Ascaris lumbricoides prevalence amongst RCTs (rural urban subgroup)
1.22
1.22. Analysis
Comparison 1: WASH intervention versus control, Outcome 22: Ascaris lumbricoides prevalence amongst RCTs (world region subgroup)
1.23
1.23. Analysis
Comparison 1: WASH intervention versus control, Outcome 23: Ascaris lumbricoides prevalence ‐ narrow WASH categories amongst RCTs
1.24
1.24. Analysis
Comparison 1: WASH intervention versus control, Outcome 24: Trichuris trichiura prevalence amongst RCTs
1.25
1.25. Analysis
Comparison 1: WASH intervention versus control, Outcome 25: Trichuris trichiura prevalence amongst RCTs ‐ low risk of bias studies only
1.26
1.26. Analysis
Comparison 1: WASH intervention versus control, Outcome 26: Trichuris trichiura prevalence amongst non‐RCTs
1.27
1.27. Analysis
Comparison 1: WASH intervention versus control, Outcome 27: Trichuris trichiura prevalence ‐ narrow WASH categories amongst non‐RCTs
1.28
1.28. Analysis
Comparison 1: WASH intervention versus control, Outcome 28: Trichuris trichiura prevalence amongst RCTs (intervention type subgroup)
1.29
1.29. Analysis
Comparison 1: WASH intervention versus control, Outcome 29: Trichuris trichiura prevalence amongst RCTs (age subgroup)
1.30
1.30. Analysis
Comparison 1: WASH intervention versus control, Outcome 30: Trichuris trichiura prevalence amongst RCTs (school village subgroup)
1.31
1.31. Analysis
Comparison 1: WASH intervention versus control, Outcome 31: Trichuris trichiura prevalence amongst RCTs (MDA subgroup)
1.32
1.32. Analysis
Comparison 1: WASH intervention versus control, Outcome 32: Trichuris trichiura prevalence amongst RCTs (rural urban subgroup)
1.33
1.33. Analysis
Comparison 1: WASH intervention versus control, Outcome 33: Trichuris trichiura prevalence amongst RCTs (world region subgroup)
1.34
1.34. Analysis
Comparison 1: WASH intervention versus control, Outcome 34: Trichuris trichiura prevalence ‐ narrow WASH categories amongst RCTs
1.35
1.35. Analysis
Comparison 1: WASH intervention versus control, Outcome 35: Hookworm prevalence amongst RCTs
1.36
1.36. Analysis
Comparison 1: WASH intervention versus control, Outcome 36: Hookworm prevalence amongst RCTs ‐ low risk of bias studies only
1.37
1.37. Analysis
Comparison 1: WASH intervention versus control, Outcome 37: Hookworm prevalence amongst non‐RCTs
1.38
1.38. Analysis
Comparison 1: WASH intervention versus control, Outcome 38: Hookworm prevalence ‐ narrow WASH categories amongst non‐RCTs
1.39
1.39. Analysis
Comparison 1: WASH intervention versus control, Outcome 39: Hookworm prevalence amongst RCTs (intervention type subgroup)
1.40
1.40. Analysis
Comparison 1: WASH intervention versus control, Outcome 40: Hookworm prevalence amongst RCTs (age subgroup)
1.41
1.41. Analysis
Comparison 1: WASH intervention versus control, Outcome 41: Hookworm prevalence amongst RCTs (school village subgroup)
1.42
1.42. Analysis
Comparison 1: WASH intervention versus control, Outcome 42: Hookworm prevalence amongst RCTs (MDA subgroup)
1.43
1.43. Analysis
Comparison 1: WASH intervention versus control, Outcome 43: Hookworm prevalence amongst RCTs (rural urban subgroup)
1.44
1.44. Analysis
Comparison 1: WASH intervention versus control, Outcome 44: Hookworm prevalence amongst RCTs (world region subgroup)
1.45
1.45. Analysis
Comparison 1: WASH intervention versus control, Outcome 45: Hookworm prevalence ‐ narrow WASH categories amongst RCTs
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    1. Pickering AJ, Njenga SM, Steinbaum L, Swarthout J, Lin A, Arnold BF, et al. Effects of single and integrated water, sanitation, handwashing, and nutrition interventions on child soil-transmitted helminth and giardia infections: a cluster-randomized controlled trial in rural Kenya. PLOS Medicine 2019;16(6):e1002841. [DOI: 10.1371/journal.pmed.1002841] - DOI - PMC - PubMed
    1. Pickering AJ, Njenga SM, Steinbaum L, Swarthout J, Lin A, Arnold BF, et al. Effects of single and integrated water, sanitation, handwashing, and nutrition interventions on child soil-transmitted helminth and Giardia infections: a cluster-randomized controlled trial in rural Kenya. PLOS Medicine 2019;16(6):e1002841. - PMC - PubMed
Reese 2019 {published data only}
    1. Reese H, Routray P, Torondel B, Sinharoy SS, Mishra S, Freeman MC, et al. Assessing longer-term effectiveness of a combined household-level piped water and sanitation intervention on child diarrhoea, acute respiratory infection, soil-transmitted helminth infection and nutritional status: a matched cohort study in rural Odisha, India. International Journal of Epidemiology 2019;48(6):1757-67. [DOI: 10.1093/ije/dyz157] - DOI - PMC - PubMed
Steinmann 2014 {published data only}
    1. Steinmann P, Yap P, Utzinger J, Du ZW, Jiang JY, Chen R, et al. Control of soil-transmitted helminthiasis in Yunnan province, People's Republic of China: experiences and lessons from a 5-year multi-intervention trial. Acta Tropica 2014;141(Pt B):271-80. [DOI: 10.1016/j.actatropica.2014.10.001] - DOI - PubMed

References to studies excluded from this review

Abdoli 2017 {published data only}
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Abraham 2018 {published data only}
    1. Abraham D, Kaliappan SP, Walson JL, Rao Ajjampur SS. Intervention strategies to reduce the burden of soil-transmitted helminths in India. Indian Journal of Medical Research 2018;147(6):533-44. [DOI: 10.4103/ijmr.IJMR_881_18] - DOI - PMC - PubMed
ACTRN12613000523707 {published data only}
    1. ACTRN12613000523707. The effectiveness and acceptability of the 'BALatrine': a culturally acceptable latrine intervention in resource limited environments [Indonesian villagers' use of a new household latrine to reduce soil transmitted helminth infection and environmental contamination]. anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12613000523707 (first received 6 May 2013).
ACTRN12617001048370 (a) {published data only}
    1. ACTRN12617001048370. A randomized controlled trial to evaluate the impact of combining hygiene education with deworming [A randomized controlled trial to evaluate if combining school-based hygiene education with mass drug administration (MDA) of deworming medication decreases the reinfection rate of soil-transmitted helminths (STH) in school-age children]. anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373102 (first received 8 June 2017).
ACTRN12617001048370 (b) {published data only}
    1. ACTRN12617001048370. A randomized controlled trial to evaluate the impact of combining hygiene education with deworming. who.int/trialsearch/trial2.aspx? Trialid=actrn12617001048370 (first received 8 June 2017).
Addiss 2015 {published data only}
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Alegria 2015 {published data only}
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Altinoz Aytar 2015 {published data only}
    1. Altinoz Aytar A, Ozturk EC, Gocmen S, Caliskan E, Ozaras F, Avcioglu F, et al. Investigation of intestinal parasites and level of hygiene knowledge of school students. Turkiye Parazitol Derg 2015;39(4):277-85. [DOI: 10.5152/tpd.2015.3717] - DOI - PubMed
Anantaphruti 2008 {published data only}
    1. Anantaphruti MT, Waikagul J, Maipanich W, Nuamtanong S, Watthanakulpanich D, Pubampen S, et al. School-based health education for the control of soil-transmitted helminthiases in Kanchanaburi province, Thailand. Annals of Tropical Medicine & Parasitology 2008;102(6):521-8. [DOI: 10.1179/136485908x311768] - DOI - PubMed
Appleby 2019 {published data only}
    1. Appleby LJ, Tadesse G, Wuletawu Y, Dejene NG, Grimes JET, French MD, et al. Integrated delivery of school health interventions through the school platform: investing for the future. PLOS Neglected Tropical Diseases 2019;13(1):e0006449. [DOI: 10.1371/journal.pntd.0006449] - DOI - PMC - PubMed
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Basualdo 2009 {published data only}
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    1. Pezzan BC, Minvielle MC, Ciarmela ML, Apezteguía MC, Basualdo JA. Community participation in the control of intestinal parasitoses at a rural site in Argentina. Revista Panamericana de Salud Pública 2009;26(6):471-7. - PubMed
Benjamin Chung 2018 {published data only}
    1. Benjamin-Chung J, Amin N, Ercumen A, Arnold BF, Hubbard AE, Unicomb L, et al. A randomized controlled trial to measure spillover effects of a combined water, sanitation, and handwashing intervention in Rural Bangladesh. American Journal of Epidemiology 2018;187(8):1733-44. [DOI: 10.1093/aje/kwy046] - DOI - PMC - PubMed
Bentwich 2019a {published data only}
    1. Bentwich Z, Team N. An innovative integrative approach for neglected tropical diseases (NTD) control in Ethiopia: sustained reduction in prevalence of schistosoma and soil-transmitted helminthiasis (STH) infections in rural and urban populations. American Journal of Tropical Medicine and Hygiene 2019;101(5 Suppl):168-9. [DOI: 10.4269/ajtmh.abstract2019] - DOI
Bentwich 2019b {published data only}
    1. Bentwich Z, Rennert L. Health education and behavior change of children are essential for controlling NTDS: lessons from a successful pilot trial in Ethiopia. American Journal of Tropical Medicine and Hygiene 2019;101(5 Suppl):169. [DOI: 10.4269/ajtmh.abstract2019] - DOI
Bieri 2014 {published data only}
    1. Bieri FA, Li YS, Yuan LP, He YK, Gray DJ, Williams GM, et al. School-based health education targeting intestinal worms - further support for integrated control. PLOS Neglected Tropical Diseases 2014;8(3):e2621. [DOI: 10.1371/journal.pntd.0002621] - DOI - PMC - PubMed
Bird 2014 {published data only}
    1. Bird C, Ame S, Albonico M, Bickle Q. Do shoes reduce hookworm infection in school-aged children on Pemba Island, Zanzibar? a pragmatic trial. Transactions of the Royal Society of Tropical Medicine and Hygiene 2014;108(5):297-304. [DOI: 10.1093/trstmh/tru037] - DOI - PubMed
Brito 2013 {published data only}
    1. Brito M, Lemos M, Mirante C, Moura S. Preliminary results from an intervention study in children aged 2-16 years in controlling Schistosomiasis in a village from Bengo Province (Angola). Tropical Medicine and International Health 2013;18(Suppl 1):123. [DOI: 10.1111/tmi.12163] - DOI
Brocklehurst 2014 {published data only}
    1. Brocklehurst C. Scaling up rural sanitation in India. PLOS Medicine 2014;11(8):e1001710. [DOI: 10.1371/journal.pmed.1001710] - DOI - PMC - PubMed
Brown 2015 {published data only}
    1. Brown J, Cumming O, Bartram J, Cairncross S, Ensink J, Holcomb D, et al. A controlled, before-and-after trial of an urban sanitation intervention to reduce enteric infections in children: research protocol for the Maputo Sanitation (MapSan) study, Mozambique. BMJ Open 2015;5(6):e008215. [DOI: 10.1136/bmjopen-2015-008215] - DOI - PMC - PubMed
Cairncross 1987 {published data only}
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    1. Chandler AC. A comparison of helminthic and protozoan infections in two Egyptian villages two years after the installation of sanitary improvements in one of them. American Journal of Tropical Medicine and Hygiene 1954;3(1):59-73. - PubMed
Campbell 2014 {published data only}
    1. Campbell SJ, Savage GM, Gray DJ, Atkinson JA, Soares Magalhaes RJ, Nery SV. Water, Sanitation, and Hygiene (WASH): a critical component for sustainable soil-transmitted helminth and schistosomiasis control. PLOS Neglected Tropical Diseases 2014;8(4):e2651. [DOI: 10.1371/journal.pntd.0002651] - DOI - PMC - PubMed
Chandler 1954 {published data only}
    1. Chandler AC. An evaluation of the effects, after two years, of sanitary improvements in an Egyptian village. Journal of the Egyptian Medical Association 1953;36(5-6):357-67. - PubMed
Chen 1969 {published data only}
    1. Chen ER, Hsieh HC. Study of ascariasis control in Taiwan. Taiwan Yi Xue Hui Za Zhi 1969;68(8):411-27. - PubMed
Chen 2021 {published data only}
    1. Chen YD, Li HZ, Xu LQ, Qian MB, Tian HC, Fang YY, et al. Effectiveness of a community-based integrated strategy to control soil-transmitted helminthiasis and clonorchiasis in the People's Republic of China. Acta Tropica 2021;214:105650. - PubMed
Clarke 2018 {published data only}
    1. ACTRN12615001012561. Should integrated deworming and water, sanitation and hygiene (WASH) programs for soil-transmitted helminth (STH) control be delivered in schools or the community? A pilot study [A pilot study comparing the impact of school- and community-based integrated water, sanitation and hygiene (WASH) and deworming programmes on soil-transmitted helminth infections in school-aged children in Timor-Leste]. anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369077 (first received 9 April 2015).
    1. Clarke NE, Clements AC, McCarthy J, Traub R, Gray D, Nery SV. Investigating the differential impact of school and community-based integrated control programs for soil-transmitted helminths in Timor-Leste: the (S)WASH-D for Worms pilot study. American Journal of Tropical Medicine and Hygiene 2017;97(5 Suppl 1):374.
    1. Clarke NE, Clements ACA, Amaral S, Richardson A, McCarthy JS, McGown J, et al. (S)WASH-D for Worms: A pilot study investigating the differential impact of school- versus community-based integrated control programs for soil-transmitted helminths. PLOS Neglected Tropical Diseases 2018;12(5):e0006389. [DOI: 10.1371/journal.pntd.0006389] - DOI - PMC - PubMed
Coffeng 2018 {published data only}
    1. Coffeng LE, Vaz Nery S, Gray DJ, Bakker R, Vlas SJ, Clements ACA. Predicted short and long-term impact of deworming and water, hygiene, and sanitation on transmission of soil-transmitted helminths. PLOS Neglected Tropical Diseases 2018;12(12):e0006758. [DOI: 10.1371/journal.pntd.0006758] - DOI - PMC - PubMed
Curtale 2003 {published data only}
    1. Curtale F, Abd-el Wahab Hassanein Y, El Wakeel A, Barduagni P, Savioli L. The School Health Programme in Behera: an integrated helminth control programme at governorate level in Egypt. Acta Tropica 2003;86(2-3):295-307. - PubMed
De Carneri 1992 {published data only}
    1. De Carneri I, Di Matteo L, Tedla S. A comparison of helminth infections in urban and rural areas of Addis Ababa. Transactions of the Royal Society of Tropical Medicine and Hygiene 1992;86(5):540-1. [DOI: 10.1016/0035-9203%2892%2990099-X] - DOI - PubMed
Dias 1981 {published data only}
    1. Dias LC. Soil-transmitted helminths in Brazil. Boletín Chileno de parasitología 1981;36(1-2):27-8. - PubMed
Falavigna Guilherme 2004 {published data only}
    1. Falavigna Guilherme AL, De Araujo SM, Teles Pupulim AR, De Lima JE Jr, Morais Falavigna DL. Intestinal parasites and commensals of settled populations in three land settlements (Vilas Rurais) of Parana state, Brazil. Acta Scientiarum - Health Sciences 2004;26(2):331-6.
Fan 2012 {published data only}
    1. Fan CK, Liao CW, Lyu SY, Sukati H, Ji DD, Cho CM, et al. Prevalence of intestinal parasitic infections among primary school children in areas devoid of sanitation in northwestern Kingdom of Swaziland, Southern Africa. Pathogens and Global Health 2012;106(1):60-2. [DOI: 10.1179/2047773211Y.0000000017] - DOI - PMC - PubMed
Figueroa 1985 {published data only}
    1. Figueroa L, Puga S, Schweikart A, Franjola R. Enteroparasitoses in school children from the locality of Chonchi and its relationship with some basic sanitation factors. Insular Chiloe, X region, Chile. Boletin Chileno de Parasitologia 1985;40(3-4):94-6. - PubMed
Fort 1915 {published data only}
    1. Fort AG. Rural sanitation and hookworm disease. American Journal of Public Health 1915;5(10):1038-43. - PMC - PubMed
Freeman 2012 {published data only}
    1. Freeman MC, Clasen T, Brooker S, Akoko D, Rheingans R. The impact of a school-based hygiene, water quality and sanitation intervention on soiltransmitted helminth reinfection: a cluster randomized trial. American Journal of Tropical Medicine and Hygiene 2012;87(5 Suppl 1):341. - PMC - PubMed
Freeman 2019 {published data only}
    1. Freeman MC, Akogun O, Belizario V Jr, Brooker SJ, Gyorkos TW, Imtiaz R, et al. Challenges and opportunities for control and elimination of soil-transmitted helminth infection beyond 2020. PLOS Neglected Tropical Diseases 2019;13(4):e0007201. [DOI: 10.1371/journal.pntd.0007201] - DOI - PMC - PubMed
Garn 2016 {published data only}
    1. Garn JV, Brumback BA, Drews-Botsch CD, Lash TL, Kramer MR, Freeman MC. Estimating the effect of school water, sanitation, and hygiene improvements on pupil health outcomes. Epidemiology 2016;27(5):752-60. [DOI: 10.1097/ede.0000000000000522] - DOI - PMC - PubMed
Gelaye 2014 {published data only}
    1. Gelaye B, Kumie A, Aboset N, Berhane Y, Williams MA. School-based intervention: evaluating the role of water, latrines and hygiene education on trachoma and intestinal parasitic infections in Ethiopia. Journal of Water Sanitation and Hygiene for Development 2014;4(1):120-30. [DOI: 10.2166/washdev.2013.060] - DOI - PMC - PubMed
Greene 2012 {published data only}
    1. Greene LE, Freeman MC, Akoko D, Saboori S, Moe C, Rheingans R. Impact of a school-based hygiene promotion and sanitation intervention on pupil hand contamination in Western Kenya: a cluster randomized trial. American Journal of Tropical Medicine and Hygiene 2012;87(3):385-93. [DOI: 10.4269/ajtmh.2012.11-0633] - DOI - PMC - PubMed
Grimes 2016 {published data only}
    1. Grimes JET, Templeton MR. School water, sanitation, and hygiene to reduce the transmission of schistosomes and soil-transmitted helminths. Trends in Parasitology 2016;32(9):661-4. [DOI: 10.1016/j.pt.2016.06.004] - DOI - PubMed
Hastings 2014 {published data only}
    1. Hastings AN, Chadee ANN, Driscoll MM, Henderson CE. Helminth infections: a new global women's health agenda. Obstetrics and Gynecology 2014;123(6):1354. [DOI: 10.1097/AOG.0000000000000308] - DOI - PubMed
Hayashi 1981 {published data only}
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Homeida 1994 {published data only}
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Hong Chun 2011 {published data only}
    1. Hong-Chun T, Meng T, Hong X, Han-Gang L, Xiao-Ke Z, Chang-Hua L, et al. Evaluation on effectiveness of comprehensive control model for soil-transmitted nematodiasis. Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi 2011;23(5):518-23. - PubMed
Hosain 2003 {published data only}
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ISRCTN16961836 {published data only}
    1. ISRCTN16961836. Efficacy of a behavioural intervention based on food consumption, nutritional state and micronutrient deficiency in under five children, Angola. who.int/trialsearch/trial2.aspx? Trialid=isrctn16961836 (first received 2 June 2016).
ISRCTN17030361 {published data only}
    1. ISRCTN17030361. Combining treatment, sanitation and health education to control neglected tropical diseases. An integrated approach to control neglected tropical diseases. doi.org/10.1186/ISRCTN17030361 (first received 19 July 2017).
ISRCTN45013173 {published data only}
    1. ISRCTN45013173. Mikono Safi Study - Hand hygiene intervention to optimise helminthic infections control: a cluster-randomised controlled trial in NW Tanzania. doi.org/10.1186/ISRCTN45013173 (first received 9 June 2017).
Jiang 2015 {published data only}
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Kobayashi 1984 {published data only}
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Krushinskaia 1976 {published data only}
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Li 2011 {published data only}
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Liu 2017 {published data only}
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Minamoto 2012 {published data only}
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Mogaji 2015 {published data only}
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Mogaji 2016 {published data only}
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Mohapatra 2015 {published data only}
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NCT02441699 {published data only}
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Nery 2014 {published data only}
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References to ongoing studies

Mationg 2020 {published data only}
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References to other published versions of this review

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Publication types