Pullan RL, Smith JL, Jasrasaria R, Brooker SJ, 2014. Global numbers of infection and disease burden of soil transmitted helminth infections in 2010. Parasit Vectors 7: 37.
GBD 2015 DALYs and HALE Collaborators, 2016. Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 388: 1603–1658.
Bethony J, Brooker S, Albonico M, Geiger SM, Loukas A, Diemert D, Hotez PJ, 2006. Soil-transmitted helminth infections: ascariasis, trichuriasis, and hookworm. Lancet 367: 1521–1532.
Campbell SJ, Nery SV, Doi SA, Gray DJ, Magalhaes RJS, McCarthy JS, Traub RJ, Andrews RM, Clements AC, 2016. Complexities and perplexities: a critical appraisal of the evidence for soil-transmitted helminth infection-related morbidity. PLoS Negl Trop Dis 10: e0004566.
Vercruysse J et al. 2011. Assessment of the anthelmintic efficacy of albendazole in school children in seven countries where soil-transmitted helminths are endemic. PLoS Negl Trop Dis 5: e948.
WHO, 2012. Eliminating Soil-Transmitted Helminthiasis as a Public Health Problem in Children: Progress Report 2001–2010 and Strategic Plan 2011–2020. Geneva, Switzerland: World Health Organization.
Anderson RM, Turner HC, Truscott JE, Hollingsworth TD, Brooker SJ, 2015. Should the goal for the treatment of soil transmitted helminth (STH) infections be changed from morbidity control in children to community-wide transmission elimination? PLoS Negl Trop Dis 9: e0003897.
Turner HC, Truscott JE, Bettis AA, Shuford KV, Dunn JC, Hollingsworth TD, Brooker SJ, Anderson RM, 2015. An economic evaluation of expanding hookworm control strategies to target the whole community. Parasit Vectors 8: 1–11.
Clarke NE, Clements AC, Doi SA, Wang D, Campbell SJ, Gray D, Nery SV, 2017. Differential effect of mass deworming and targeted deworming campaigns for soil-transmitted helminth control in children: a systematic review and meta-analysis. Lancet 389: 287–297.
Jia TW, Melville S, Utzinger J, King CH, Zhou XN, 2012. Soil-transmitted helminth reinfection after drug treatment: a systematic review and meta-analysis. PLoS Negl Trop Dis 6: e1621.
Campbell SJ et al. 2014. Water, sanitation, and hygiene (WASH): a critical component for sustainable soil-transmitted helminth and schistosomiasis control. PLoS Negl Trop Dis 8: e2651.
Strunz EC, Addiss DG, Stocks ME, Ogden S, Utzinger J, Freeman MC, 2014. Water, sanitation, hygiene, and soil-transmitted helminth infection: a systematic review and meta-analysis. PLoS Med 11: e1001620.
Freeman MC, Clasen T, Brooker SJ, Akoko DO, Rheingans R, 2013. The impact of a school-based hygiene, water quality and sanitation intervention on soil-transmitted helminth reinfection: a cluster-randomized trial. Am J Trop Med Hyg 89: 875–883.
Bieri FA et al. 2013. Health-education package to prevent worm infections in Chinese schoolchildren. N Engl J Med 368: 1603–1612.
Gyorkos TW, Maheu-Giroux M, Blouin B, Casapia M, 2013. Impact of health education on soil-transmitted helminth infections in schoolchildren of the Peruvian Amazon: a cluster-randomized controlled trial. PLoS Negl Trop Dis 7: e2397.
Mahmud MA, Spigt M, Bezabih AM, Pavon IL, Dinant G-J, Velasco RB, 2015. Efficacy of handwashing with soap and nail clipping on intestinal parasitic infections in school-aged children: a factorial cluster randomized controlled trial. PLoS Med 12: e1001837.
Clasen T et al. 2014. Effectiveness of a rural sanitation programme on diarrhoea, soil-transmitted helminth infection, and child malnutrition in Odisha, India: a cluster-randomised trial. Lancet Glob Health 2: e645–e653.
Patil SR, Arnold BF, Salvatore AL, Briceno B, Ganguly S, Colford JM Jr., Gertler PJ, 2014. The effect of India’s total sanitation campaign on defecation behaviors and child health in rural Madhya Pradesh: a cluster randomized controlled trial. PLoS Med 11: e1001709.
Nery SV et al. 2015. A cluster-randomised controlled trial integrating a community-based water, sanitation and hygiene programme, with mass distribution of albendazole to reduce intestinal parasites in Timor-Leste: the WASH for WORMS research protocol. BMJ Open 5: e009293.
Campbell SJ et al. 2016. Water, sanitation and hygiene related risk factors for soil-transmitted helminth and Giardia duodenalis infections in rural communities in Timor-Leste. Int J Parasitol 46: 771–779.
WaterAid, 2011. Training Manual—Water Resource Management: Integrated Planning and Management at Community Level .Kathmandu, Nepal: WaterAid.
Kar K, 2005. Practical Guide to Triggering Community-Led Total Sanitation (CLTS). Brighton, England: Institute of Development Studies.
Llewellyn S, Inpankaew T, Nery S, Gray D, Verweij J, Clements A, Gomes S, Traub R, McCarthy J, 2016. Application of a multiplex quantitative PCR to assess prevalence and intensity of intestinal parasite infections in a controlled clinical trial. PLoS Negl Trop Dis 10: e0004380.
WHO Multicentre Growth Reference Study Group, 2006. WHO Child Growth Standards: Length/Height-for-Age, Weight-for-Age, Weight-for-Length, Weight-for-Height and Body Mass Index-for-Age. Methods and Development. Geneva, Switzerland: World Health Organization.
WHO, 2007. WHO AnthroPlus Software. Geneva, Switzerland: World Health Organization.
WHO, 2011. WHO Anthro (Version 3.2.2, January 2011) and Macros. Geneva, Switzerland: World Health Organization.
WHO, 2011. Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity. Geneva, Switzerland: World Health Organization.
Leonardo L et al. 2012. A national baseline prevalence survey of schistosomiasis in the Philippines using stratified two-step systematic cluster sampling design. J Trop Med 2012: 936128.
Gray DJ, Forsyth SJ, Li RS, McManus DP, Li Y, Chen H, Zheng F, Williams GM, 2009. An innovative database for epidemiological field studies of neglected tropical diseases. PLoS Negl Trop Dis 3: e413.
Campbell SJ et al. 2017. Water, sanitation and hygiene (WASH) and environmental risk factors for soil-transmitted helminth intensity of infection in Timor-Leste, using real time PCR. PLoS Negl Trop Dis 11: e0005393.
Wardell R, Clements ACA, Lal A, Summers D, Llewellyn S, Campbell SJ, McCarthy J, Gray DJ, Nery SV, 2017. An environmental assessment and risk map of Ascaris lumbricoides and Necator americanus distributions in Manufahi District, Timor-Leste. PLoS Negl Trop Dis 11: e0005565.
Campbell SJ et al. 2017. Investigations into the association between soil-transmitted helminth infections, haemoglobin and child development indices in Manufahi District, Timor-Leste. Parasit Vectors 10: 192.
Udonsi J, Atata G, 1987. Necator americanus: temperature, pH, light, and larval development, longevity, and desiccation tolerance. Exp Parasitol 63: 136–142.
Muller R, 2002. Chapter 5: the nematodes. Muller R, ed. Worms and Human Disease. London, United Kingdom: CABI.
Manun’Ebo M, Cousens S, Haggerty P, Kalengaie M, Ashworth A, Kirkwood B, 1997. Measuring hygiene practices: a comparison of questionnaires with direct observations in rural Zaire. Trop Med Int Health 2: 1015–1021.
Ram PK et al. 2010. Is structured observation a valid technique to measure handwashing behavior? Use of acceleration sensors embedded in soap to assess reactivity to structured observation. Am J Trop Med Hyg 83: 1070–1076.
Arnold BF, Khush RS, Ramaswamy P, Rajkumar P, Durairaj N, Ramaprabha P, Balakrishnan K, Colford JM Jr., 2015. Reactivity in rapidly collected hygiene and toilet spot check measurements: a cautionary note for longitudinal studies. Am J Trop Med Hyg 92: 159–162.
Clasen T et al. 2012. Making sanitation count: developing and testing a device for assessing latrine use in low-income settings. Environ Sci Technol 46: 3295–3303.
Collender PA, Kirby AE, Addiss DG, Freeman MC, Remais JV, 2015. Methods for quantification of soil-transmitted helminths in environmental media: current techniques and recent advances. Trends Parasitol 31: 625–639.
Steinbaum L, Kwong LH, Ercumen A, Negash MS, Lovely AJ, Njenga SM, Boehm AB, Pickering AJ, Nelson KL, 2017. Detecting and enumerating soil-transmitted helminth eggs in soil: new method development and results from field testing in Kenya and Bangladesh. PLoS Negl Trop Dis 11: e0005522.
Gyawali P, Ahmed W, Sidhu JP, Nery SV, Clements AC, Traub R, McCarthy JS, Llewellyn S, Jagals P, Toze S, 2016. Quantitative detection of viable helminth ova from raw wastewater, human feces, and environmental soil samples using novel PMA-qPCR methods. Environ Sci Pollut Res Int 23: 18639–18648.
Sigler R, Mahmoudi L, Graham JP, 2015. Analysis of behavioral change techniques in community-led total sanitation programs. Health Promot Int 30: 16–28.
Garn JV, Sclar GD, Freeman MC, Penakalapati G, Alexander KT, Brooks P, Rehfuess EA, Boisson S, Medlicott KO, Clasen TF, 2017. The impact of sanitation interventions on latrine coverage and latrine use: a systematic review and meta-analysis. Int J Hyg Environ Health 220: 329–340.
Guiteras R, Levinsohn J, Mobarak AM, 2015. Encouraging sanitation investment in the developing world: a cluster-randomized trial. Science 348: 903–906.
Montgomery MA, Bartram J, Elimelech M, 2009. Increasing functional sustainability of water and sanitation supplies in rural sub-Saharan Africa. Environ Eng Sci 26: 1017–1023.
Partnership for Human Development Australia Timor-Leste, 2017. ODF Sustainability in Timor-Leste. Dili, Timor-Leste: PHD.
Perez E et al. 2012. Working Paper: What Does it Take to Scale up Rural Sanitation? Washington, DC: Water and Sanitation Program.
Arnold BF et al. 2013. Cluster-randomised controlled trials of individual and combined water, sanitation, hygiene and nutritional interventions in rural Bangladesh and Kenya: the WASH Benefits study design and rationale. BMJ Open 3: e003476.
WHO, 2017. Integrating Neglected Tropical Diseases in Global Health and Development: Fourth WHO Report on Neglected Tropical Diseases. Geneva, Switzerland: World Health Organization.
WHO, 2015. Water Sanitation & Hygiene for Accelerating and Sustaining Progress on Neglected Tropical Diseases: A Global Strategy 2015–2020. Geneva, Switzerland: World Health Organization.
|Past two years||Past Year||Past 30 Days|
|Full Text Views||3193||1378||32|
Water, sanitation, and hygiene (WASH) interventions have been proposed as an important complement to deworming programs for sustainable control of soil-transmitted helminth (STH) infections. We aimed to determine whether a community-based WASH program had additional benefits in reducing STH infections compared with community deworming alone. We conducted the WASH for WORMS cluster-randomized controlled trial in 18 rural communities in Timor-Leste. Intervention communities received a WASH intervention that provided access to an improved water source, promoted improved household sanitation, and encouraged handwashing with soap. All eligible community members in intervention and control arms received albendazole every 6 months for 2 years. The primary outcomes were infection with each STH, measured using multiplex real-time quantitative polymerase chain reaction. We compared outcomes between study arms using generalized linear mixed models, accounting for clustering at community, household, and individual levels. At study completion, the integrated WASH and deworming intervention did not have an effect on infection with Ascaris spp. (relative risk [RR] 2.87, 95% confidence interval [CI]: 0.66–12.48, P = 0.159) or Necator americanus (RR 0.99, 95% CI: 0.52–1.89, P = 0.987), compared with deworming alone. At the last follow-up, open defecation was practiced by 66.1% (95% CI: 54.2–80.2) of respondents in the control arm versus 40.2% (95% CI: 25.3–52.6) of respondents in the intervention arm (P = 0.005). We found no evidence that the WASH intervention resulted in additional reductions in STH infections beyond that achieved with deworming alone over the 2-year trial period. The role of WASH on STH infections over a longer period of time and in the absence of deworming remains to be determined.
Financial support: N. E. C. is supported by an Australian Government Research Training Program Scholarship, A. C. A. C. and A. J. V. are supported by a National Health and Medical Research Council (NHMRC) Senior Research Fellowship, J. S. M. is an Australian NHMRC Practitioner Fellow, and D. J. G. is an Australian NHMRC Career Development Fellow. This work is funded by an NHMRC Partnership project in collaboration with WaterAid Australia . The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Authors’ addresses: Susana Vaz Nery and Andrew J. Vallely, Kirby Institute for Infection and Immunity in Society, University of New South Wales, Kensington, Australia, E-mails: email@example.com and firstname.lastname@example.org. Rebecca J. Traub, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Australia, E-mail: email@example.com. James S. McCarthy and Stacey Llewellyn, Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia, E-mails: firstname.lastname@example.org and email@example.com. Naomi E. Clarke, Salvador Amaral, Alice Richardson, and Darren J. Gray, Research School of Population Health, Australian National University, Canberra, Australia, E-mails: firstname.lastname@example.org,email@example.com, firstname.lastname@example.org, and email@example.com. Edmund Weking, WaterAid Australia, Dili, Timor-Leste, E-mail: firstname.lastname@example.org. Suzy J. Campbell, Evidence Action, Washington, DC, E-mail: email@example.com. Gail M. Williams, School of Public Health, University of Queensland, Brisbane, Australia, E-mail: firstname.lastname@example.org. Ross M. Andrews, Menzies School of Health Research, Charles Darwin University, Darwin, Australia, E-mail: email@example.com. Archie C. A. Clements, Faculty of Health Sciences, Curtin University, Bentley, Australia, E-mail: firstname.lastname@example.org.