The Impact of a School-Based Hygiene, Water Quality and Sanitation Intervention on Soil-Transmitted Helminth Reinfection: A Cluster-Randomized Trial

• Type of Material: Article
• Authors: Matthew Freeman, Emory University; Thomas Clasen, Emory University; Simon J. Brooker, London School of Hygiene and Tropical Medicine; Daniel O. Akoko, Great Lakes University of Kisumu; Richard Rheingans, Emory University
• Language: English
• Date: 2013-11-01
• Publisher: American Society of Tropical Medicine and Hygiene
• Publication Version: Final Published Version
• Copyright Statement: Copyright © 2013 by The American Society of Tropical Medicine and Hygiene.
• Final Published Version (URL): http://dx.doi.org/10.4269/ajtmh.13-0237
• Title of Journal or Parent Work: American Journal of Tropical Medicine and Hygiene
• ISSN: 0002-9637
• Volume: 89
• Issue: 5
• Start Page: 875
• End Page: 883
• Grant/Funding Information: SJB is supported by a Wellcome Trust Senior Fellowship in Basic Biomedical Science (098045).; The project was funded by the Bill & Melinda Gates Foundation and led by CARE – USA.
• Keywords: POOR URBAN AREAS; ALBENDAZOLE TREATMENT; Public, Environmental & Occupational Health; RISK-FACTORS; Science & Technology; Tropical Medicine; ASCARIS-LUMBRICOIDES; CHILDREN; Life Sciences & Biomedicine; CHEMOTHERAPY; PATTERNS; EPIDEMIOLOGY; EFFICACY; HOOKWORM INFECTION
• Research Categories: Health Sciences, Public Health; Environmental Sciences

Abstract

We conducted a cluster-randomized trial to assess the impact of a school-based water treatment, hygiene, and sanitation program on reducing infection with soil-transmitted helminths (STHs) after school-based deworming. We assessed infection with STHs at baseline and then at two follow-up rounds 8 and 10 months after deworming. Forty government primary schools in Nyanza Province, Kenya were randomly selected and assigned to intervention or control arms. The intervention reduced reinfection prevalence (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.31-1.00) and egg count (rate ratio [RR] 0.34, CI 0.15-0.75) of Ascaris lumbricoides. We found no evidence of significant intervention effects on the overall prevalence and intensity of Trichuris trichiura, hookworm, or Schistosoma mansoni reinfection. Provision of school-based sanitation, water quality, and hygiene improvements may reduce reinfection of STHs after school-based deworming, but the magnitude of the effects may be sex- and helminth species-specific.