Integration of deworming with a water, sanitation and hygiene program for the prevention of intestinal parasites in Timor-Leste

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Soil-transmitted helminths (STH) are most prevalent in communities lacking adequate clean water, sanitation and hygiene (WASH). Deworming programmes with anthelminthic drugs are highly effective in reducing morbidity but rapid reinfection occurs if there is no reduction in environmental contamination with infective stages, impeding the sustainability of STH control programmes based on deworming alone. WASH for WORMS is a cluster randomised controlled trial assessing the impact of a community-based WASH intervention, implemented by WaterAid Australia, on infection with intestinal parasites following mass albendazole chemotherapy in villages in Timor-Leste. This research will test the hypothesis that a community-based hygiene and sanitation programme will reduce infections of people in communities with gastro-intestinal parasites above that achieved through mass chemotherapy with the benzamidazole anthelminthic drug albendazole. The aims of this study are: 1. To determine the effectiveness of an established community-based hygiene and sanitation programme in reducing the prevalence of parasitic infection (with hookworm, roundworm, whipworm and gastro-intestinal protozoa) following mass albendazole chemotherapy in rural villages in Timor-Leste. 2. To determine the reduction in parasitic disease-related morbidity in children, including anaemia, and stunting and wasting, achieved by implementation of the community-based hygiene and sanitation programme. 3. To evaluate the acceptability and uptake of the community-based hygiene and sanitation programme.