The effectiveness and acceptability of the 'BALatrine': a culturally acceptable latrine intervention in resource limited environments.

The intervention is a household latrine (BALatrine) plus health education/promotion on hygiene and sanitation. The BALatrine is a simple squat latrine, usually constructed by the villagers themselves, at the side of a house. It comprises a 2 metre pit (with optional bamboo/concrete pipe strengthening); a base cover with raised footsteps (which can be used during dry periods); and a flushable U-bend porcelain bowl that may be removable. All can be made from local materials. All householders in the intervention village will construct one, with material support and advice from the researchers, if required. The intervention period is 12 months, after which the control villages will also receive the intervention. The Health education/health promotion intervention will be delivered via community meetings in each sub-village in the Intervention group of communities. Community meetings will be run by the local research team. A representative from all ‘dusun’ households will be invited to the meetings which will be held in the Village meeting hall.. The Health education/health promotion intervention will be implemented through 1 two-hour village wide mobilization meeting and 1 two-hour village wide meeting covering hygiene/sanitation educational inputs meeting after all latrines have been constructed. After the baseline survey all cohort members (intervention and control villages) will receive a singe dose of Albendazole (400mg) in the form of an oral tablet, as per WHO guidelines. This will be administered during the national de-worming program delivered by local health officials and recorded onto a treatment registry. According to Indonesian guidelines, pregnant women will not be treated Albendazole. The first meeting - to be implemented after the baseline questionnaire and prior to latrine construction-will be the project launch and mobilization of households (consciousness-raising and provision of general information about parasite infection and burden of STH). This will comprise description of the BALatrine intervention, its construction, maintenance and use. BALatrine construction workshops will assist village residents (particularly those with special needs) to plan, construct, use and maintain their latrines. Leaflets supporting the meeting and summarising the health education content discussed will be distributed to each household. The second meeting will present/discuss hygiene and sanitation educational inputs for each intervention household, plus information about cleaning, maintenance and use of the latrine. This meeting will cover behavioural change (hygiene and sanitation behaviour change) requirements. All aspects of the questionnaire relating to Knowledge, Attitudes and Behaviour associated with WASH will be covered in this meeting, either as revision of content presented in Meeting 1, or as new material. Health Education content will comprise both general hygiene/sanitation topics that provide the context and background of the need for introduction and appropriate use of improved latrines, and topics specifically related to STH: (a) Presentation and group discussion: 1. STH and other Gastro-intestinal diseases (types, definition, symptoms, treatment, complications, causes) 2. Prevention of STH and GI diseases (drinking water, defecation, sanitation, hand-washing, food safety, insects) 3. STH (definitions, lifecycle, types: Pinworms, Hookworms, Whipworms, Ascaris, Tapeworms, 4. Preventing STH infection (personal hygiene, sanitary environment) 5. Significance of the latrine (definition, types, characteristics of good latrine construction) 6. Water quality (characteristics of pure water, water purification – boil, solar, chlorine, storage) 7. Healthy wells (requirements,special layout, pollutants, structure, maintenance) 8. Animals in house (benefits, zoonotic diseases – toxoplasmosis, rabies, avian flu, worms, leptospirosis, prevention of animal-borne diseases) 9. Healthy food (definition, common food-borne diseases, digestion, infections in food) 10. Principles of food management (preparation, storage, processing, transporting) 11. Digestion and the normal gut (germs and pathogens). (b) Leaflets 1. Similar information as (a) above 2. How to construct a BALatrine. All community meeting attendees will be registered onto a meeting register.