WASH for WORMS

A Cluster-Randomized Controlled Trial of the Impact of a Community Integrated Water, Sanitation, and Hygiene and Deworming Intervention on Soil-Transmitted Helminth Infections

Susana Vaz Nery, Rebecca J. Traub, James S. McCarthy, Naomi E. Clarke, Salvador Amaral, Stacey Llewellyn, Edmund Weking, Alice Richardson, Suzy J. Campbell, Darren J. Gray, Andrew J. Vallely, Gail M. Williams, Ross M. Andrews, Archie C.A. Clements

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    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.

    Original languageEnglish
    Pages (from-to)750-761
    Number of pages12
    JournalThe American Journal of Tropical Medicine and Hygiene
    Volume100
    Issue number3
    DOIs
    Publication statusPublished - 1 Mar 2019

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    Sanitation
    Helminths
    Hygiene
    Soil
    Randomized Controlled Trials
    Water
    Infection
    Confidence Intervals
    Necator americanus
    Ascaris
    Albendazole
    Hand Disinfection
    Soaps
    Defecation
    Multiplex Polymerase Chain Reaction
    Rural Population
    Cluster Analysis
    Linear Models
    Outcome Assessment (Health Care)

    Cite this

    Vaz Nery, Susana ; Traub, Rebecca J. ; McCarthy, James S. ; Clarke, Naomi E. ; Amaral, Salvador ; Llewellyn, Stacey ; Weking, Edmund ; Richardson, Alice ; Campbell, Suzy J. ; Gray, Darren J. ; Vallely, Andrew J. ; Williams, Gail M. ; Andrews, Ross M. ; Clements, Archie C.A. / WASH for WORMS : A Cluster-Randomized Controlled Trial of the Impact of a Community Integrated Water, Sanitation, and Hygiene and Deworming Intervention on Soil-Transmitted Helminth Infections. In: The American Journal of Tropical Medicine and Hygiene . 2019 ; Vol. 100, No. 3. pp. 750-761.
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    abstract = "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.",
    author = "{Vaz Nery}, Susana and Traub, {Rebecca J.} and McCarthy, {James S.} and Clarke, {Naomi E.} and Salvador Amaral and Stacey Llewellyn and Edmund Weking and Alice Richardson and Campbell, {Suzy J.} and Gray, {Darren J.} and Vallely, {Andrew J.} and Williams, {Gail M.} and Andrews, {Ross M.} and Clements, {Archie C.A.}",
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    language = "English",
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    Vaz Nery, S, Traub, RJ, McCarthy, JS, Clarke, NE, Amaral, S, Llewellyn, S, Weking, E, Richardson, A, Campbell, SJ, Gray, DJ, Vallely, AJ, Williams, GM, Andrews, RM & Clements, ACA 2019, 'WASH for WORMS: A Cluster-Randomized Controlled Trial of the Impact of a Community Integrated Water, Sanitation, and Hygiene and Deworming Intervention on Soil-Transmitted Helminth Infections', The American Journal of Tropical Medicine and Hygiene , vol. 100, no. 3, pp. 750-761. https://doi.org/10.4269/ajtmh.18-0705

    WASH for WORMS : A Cluster-Randomized Controlled Trial of the Impact of a Community Integrated Water, Sanitation, and Hygiene and Deworming Intervention on Soil-Transmitted Helminth Infections. / Vaz Nery, Susana; Traub, Rebecca J.; McCarthy, James S.; Clarke, Naomi E.; Amaral, Salvador; Llewellyn, Stacey; Weking, Edmund; Richardson, Alice; Campbell, Suzy J.; Gray, Darren J.; Vallely, Andrew J.; Williams, Gail M.; Andrews, Ross M.; Clements, Archie C.A.

    In: The American Journal of Tropical Medicine and Hygiene , Vol. 100, No. 3, 01.03.2019, p. 750-761.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - WASH for WORMS

    T2 - A Cluster-Randomized Controlled Trial of the Impact of a Community Integrated Water, Sanitation, and Hygiene and Deworming Intervention on Soil-Transmitted Helminth Infections

    AU - Vaz Nery, Susana

    AU - Traub, Rebecca J.

    AU - McCarthy, James S.

    AU - Clarke, Naomi E.

    AU - Amaral, Salvador

    AU - Llewellyn, Stacey

    AU - Weking, Edmund

    AU - Richardson, Alice

    AU - Campbell, Suzy J.

    AU - Gray, Darren J.

    AU - Vallely, Andrew J.

    AU - Williams, Gail M.

    AU - Andrews, Ross M.

    AU - Clements, Archie C.A.

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    AB - 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.

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