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The Impact of a School-Based Hygiene, Water Quality and Sanitation Intervention on Soil-Transmitted Helminth Reinfection: A Cluster-Randomized Trial
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.
Author Notes
Financial support: The project was funded by the Bill & Melinda Gates Foundation and led by CARE – USA.
Authors' addresses: Matthew C. Freeman, Emory University, Environmental Health, Atlanta, GA, E-mail: mcfreem@emory.edu. Thomas Clasen, London School of Hygiene and Tropical Medicine, Infectious and Tropical Diseases, London, UK, E-mail: thomas.clasen@lshtm.ac.uk. Simon J. Brooker, London School of Hygiene and Tropical Medicine, Infectious and Tropical Diseases, London, UK, and KEMRI Wellcome Trust, Nairobi, Kenya, E-mail: simon.brooker@lshtm.ac.uk. Daniel O. Akoko, Great Lakes University of Kisumu, Tropical Institute of Community Health and Development, Kisumu, Kenya, E-mail: obotedaniel@yahoo.com. Richard Rheingans, University of Florida, Environmental and Global Health, Gainesville, FL, and Emory University, Global Health, Atlanta, GA, E-mail: rrheing@ufl.edu.