None listed
Conditions
Brief summary
The current WHO strategy for control of soil-transmitted helminths (STH) is school-based targeted drug treatment focusing on school-age children. Deworming programmes with anthelminthic drugs are highly effective in reducing morbidity but rapid reinfection occurs if there is no reduction in environmental contamination with parasite infective stages. Therefore, provision of water, sanitation and hygiene (WASH) programs is of critical importance in the sustainable control of STHs. In fact, WASH programs have been shown to reduce worm infection, both when implemented at schools and in entire communities. On the other hand, recent modeling has raised questions about WHO guidelines, demonstrating limited impact from school-based delivery of interventions on community health and, importantly, STH transmission. This is contrary to the currently accepted idea that adults benefit from school-based deworming as a result of its impact on the overall intensity of transmission within the population. Therefore, when thinking of the long-term control of STH, it will be necessary to optimise strategies for deworming and WASH programs, with respect to school versus community-based delivery of interventions. This pilot study aims to establish the feasibility of conducting a large cluster-randomised trial investigating the differential impact of school- versus community-based integrated WASH and deworming programmes. The pilot study also aims to establish "proof of principle" that a community-based intervention will be more effective than a school-based intervention at reducing STH infections in school-aged children.
Interventions
The intervention to be evaluated in this proposal will involve provision of access to improved water and sanitation and improving related hygiene practices, implemented at both a community level and a primary school level. This intervention will be implemented by non-governmental organisation Plan International in Timor-Leste. The sanitation component will involve construction of school latrines by contractors working with Plan International, as well a Community Led Total Sanitation approach. Ac
The intervention to be evaluated in this proposal will involve provision of access to improved water and sanitation and improving related hygiene practices, implemented at both a community level and a primary school level. This intervention will be implemented by non-governmental organisation Plan International in Timor-Leste. The sanitation component will involve construction of school latrines by contractors working with Plan International, as well a Community Led Total Sanitation approach. Access to an improved water supply will also be provided, and local partner NGOs will provide house-by-house education on hygiene practices, in particular hand-washing with soap at critical times. Hygiene education including posters relating to handwashing with soap will be provided to schools, and handwashing stations with soap will be constructed as part of the school latrines. Furthermore, communities in the intervention arm of the pilot study will receive mass chemotherapy (distributed to all members of the community) with one oral tablet of albendazole 400mg, which will be administered once 80% of the households have sanitation (as defined by the presence of a household latrine) and the school latrines have been completed. Albendazole intake will be directly observed by the field workers delivering the tablets, who will be working under the supervision of a registered nurse. The intervention period will continue until the school latrine construction is finished, household latrine construction is complete, hygiene promotion has been conducted in all households and mass chemotherapy has been delivered. This is estimated to take between 2-4 months.
Sponsors
Susana Vaz Nery
Study design
Allocation
Non-randomised trial
Intervention model
Parallel
Primary purpose
Prevention
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
1 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Inclusion criteria for enrollment in the study: - Child enrolled in and attending the primary school - Informed consent obtained from parent/caregiver Selection of communities for inclusion in the study: - Communities were selected for inclusion in this pilot study in consultation with each partner NGO (Plan International and Cruz Vermelha Timor-Leste (CVTL)) - For the intervention clusters, Plan International identified three villages in which they were planning both a school- and community-based WASH programme. - For the control clusters, the research team and CVTL identified three schools suitable for a school-based WASH programme, located in a nearby district to the intervention communities.
Exclusion criteria
Exclusion criteria for enrollment in the study: - Not attending the primary school - Informed consent not obtained Exclusion criteria for receiving albendazole (including students enrolled in the study AND other members of communities in the intervention clusters): - Women in the first trimester of pregnancy - Children under the age of 1 year
Outcome results
None listed