The Impact of a School-Based Hygiene, Water Quality and Sanitation Intervention on Soil-Transmitted Helminth Reinfection: A Cluster-Randomized Trial
Open accessAbstract
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.
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Improving school-based WASH can reduce other hygiene-related diseases, such as soil-transmitted helminth (STH) infection.
“Improving school-based WASH can also reduce other hygiene-related diseases, such as soil-transmitted helminth (STH) infection [7,21,22].”
From Water, Sanitation and Hygiene (WASH) in Schools in Low-Income Countries: A Review of Evidence of Impact (2019) · cites this paper as [22]
Cites
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Freeman, M. C., Stocks, M. E., Cumming, O., Jeandron, A., Higgins, J. P. T., Wolf, J., Prüss‐Ustün, A., Bonjour, S., Hunter, P. R., Fewtrell, L., et al. (2014) · Tropical Medicine & International Health · doi:10.1111/tmi.12339 · Cited by 524 · see citing works
Self-citationFreeman, M. C., Garn, J. V., Sclar, G. D., Boisson, S., Medlicott, K., Alexander, K. T., Penakalapati, G., Anderson, D., Mahtani, A. G., Grimes, J. E. T., et al. (2017) · International Journal of Hygiene and Environmental Health · doi:10.1016/j.ijheh.2017.05.007 · Cited by 358 · see citing works
Self-citationGrimes, J. E. T., Croll, D., Harrison, W. E., Utzinger, J., Freeman, M. C., & Templeton, M. R. (2014) · PLoS neglected tropical diseases · doi:10.1371/journal.pntd.0003296 · Cited by 296 · see citing works
McMichael, C. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16030359 · Cited by 220 · see citing works
“2013 [22] Kenya Cluster-randomized trial 40 government primary schools.”
BackgroundInfluentialTrinies, V., Garn, J. V., Chang, H. H., & Freeman, M. C. (2016) · The American Society of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.15-0757 · Cited by 106 · see citing works
Self-citationPickering, A. J., Njenga, S. M., Steinbaum, L., Swarthout, J., Lin, A., Arnold, B. F., Stewart, C. P., Dentz, H. N., Mureithi, M., Chieng, B., et al. (2019) · PLOS Medicine · doi:10.1371/journal.pmed.1002841 · Cited by 95 · see citing works
Chard, A. N., Garn, J. V., Chang, H. H., Clasen, T., & Freeman, M. C. (2019) · Journal of Global Health · doi:10.7189/jogh.09.020402 · Cited by 81 · see citing works
Self-citationGera, T., Shah, D., & Sachdev, H. S. (2018) · Indian Pediatrics · doi:10.1007/s13312-018-1279-3 · Cited by 77 · see citing works
- Authors
- Freeman, M. C., Clasen, T., Brooker, S. J., Akoko, D. O., & Rheingans, R.
- Affiliations
- Emory University (US)
- Kenya Medical Research Institute (KE)
- University of Florida (US)
- Great Lakes University of Kisumu (KE)
- Venue
- The American Society of Tropical Medicine and Hygiene
- Published
- 2013-11-06
- Volume
- 89
- Issue
- 5
- Pages
- 875-883
- ISSN
- 0002-9637 (ISSN-L)
- 1476-1645
- PMC
- PMC3820330
- OpenAlex
- W2151506147
- Cited by
- 140
- References
- 1
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 11 · 2023: 6 · 2022: 7 · 2021: 14 · 2020: 11 · 2019: 21 · 2018: 16 · 2017: 8 · 2016: 17 · 2015: 9 · 2014: 11 · 2012: 1
- FWCI
- 10.48
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Tropical Medicine and Hygiene (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Funders
- Wellcome Trust (092654, 098045)
- Topics
- Life Sciences › Immunology and Microbiology › Parasitology › Parasites and Host Interactions
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Health Sciences › Veterinary › Small Animals › Helminth infection and control
- Keywords
- soil-transmitted helminths, school-based deworming, school sanitation, water quality, hygiene education, Ascaris lumbricoides, Trichuris trichiura, hookworm, Schistosoma mansoni, elementary school students
- MeSH terms
- Adolescent, Animals, Ascariasis, Child, Female, Hookworm Infections, Humans, Hygiene, Kenya, Male, Sanitation, Schistosoma mansoni, Schistosomiasis, Schools, Soil, Trichuris, Prevalence, Ascaris lumbricoides, Water Quality
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