Hand hygiene intervention to optimise soil-transmitted helminth infection control among primary school children: the Mikono Safi cluster randomised controlled trial in northwestern Tanzania

BMC Medicine

Humphrey Mazigo¹  Jeremiah Seni²  Sarah Rockowitz³  Jeroen Ensink⁴  Robert Dreibelbis⁴  Simon Sichalwe⁵  Elialilia Okello⁵  Onike Mcharo⁵  Kenneth Makata⁵  Christian Hansen⁶  Heiner Grosskurth⁷  Saidi Kapiga⁷  Philip Ayieko⁷  Julius Mngara⁸  Safari Kinung’hi⁸ 

[1] Department of Medical Parasitology and Entomology, Catholic University of Health and Allied Sciences (CUHAS), Mwanza, Tanzania;Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences (CUHAS), Mwanza, Tanzania;Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA;London School of Hygiene and Tropical Medicine, London, UK;Mwanza Intervention Trials Unit (MITU), Mwanza, Tanzania;Mwanza Intervention Trials Unit (MITU), Mwanza, Tanzania;London School of Hygiene and Tropical Medicine, London, UK;Mwanza Intervention Trials Unit (MITU), Mwanza, Tanzania;London School of Hygiene and Tropical Medicine, London, UK;National Institute for Medical Research (NIMR), Mwanza, Tanzania;National Institute for Medical Research (NIMR), Mwanza, Tanzania;

关键词: Soil-transmitted helminth;    Ascaris lumbricoides;    Trichuris trichiura;    Mass drug administration;    Deworming;    Hand hygiene;    Handwashing;    School children;    Cluster randomised trial;    Tanzania;   

DOI  :  10.1186/s12916-021-01987-6

来源: Springer

【 摘 要 】

BackgroundSoil-transmitted helminth (STH) infections are highly prevalent in resource-limited countries. We assessed the effect of a combination intervention aiming to enhance handwashing with soap on STH reinfection following mass drug administration among primary school children in Kagera region, Northwestern Tanzania.MethodsWe conducted a cluster randomised trial in sixteen primary schools with known high STH prevalence. Schools were randomly assigned in a 1:1 ratio to either receive the intervention or continue with routine health education. The intervention included teacher-led classroom teaching, parental engagement sessions, environmental modifications and improved handwashing stations. The evaluation involved two cross-sectional surveys in a representative sample of students, with the end-line survey conducted 12 months after the baseline survey. The primary outcome was the combined prevalence of Ascaris lumbricoides and Trichuris trichiura infections at the end-line survey. Secondary outcomes included reported handwashing behaviour, the prevalence and intensity of individual STHs, and hand contamination with STH ova and coliform bacteria. End-line STH prevalence and intensity were adjusted for baseline differences of potential confounders.ResultsAt the end-line survey, 3081 school children (1566 from intervention schools and 1515 from control schools) provided interview data and stool specimens. More school children in the intervention group reported the use of water and soap during handwashing compared to school children in the control group (58% vs. 35%; aOR=1.76, 95%CI 1.28–2.43, p=0.001). The combined prevalence of A. lumbricoides and T. trichiura infections was 39% in both trial arms (aOR = 1.19; 95%CI 0.74–1.91). The prevalence of A. lumbricoides was 15% in the intervention and 17% in the control arm (aOR =1.24, 95%CI 0.59–2.59) and that of T. trichiura was 31% in both arms (aOR=1.17, 95%CI 0.73–1.88). No significant differences were found for STH infection intensity in both the main study and the hand contamination sub-study.ConclusionsThe intervention was effective in increasing reported handwashing behaviour at school, but failed to show a similar effect in the home. The intervention had no effect on STH infection, possibly due to infection in the home environment, other transmission routes such as contaminated water or food or limited changes in school children’s handwashing behaviour.Trial registrationThe trial was registered on June 21, 2017, by the International Standard Randomised Controlled Trial Number (ISRCTN45013173).

【 授权许可】

CC BY