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

BACKGROUND: Soil-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...

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Autores principales: Makata, Kenneth, Ensink, Jeroen, Ayieko, Philip, Hansen, Christian, Sichalwe, Simon, Mngara, Julius, Mcharo, Onike, Mazigo, Humphrey, Seni, Jeremiah, Dreibelbis, Robert, Rockowitz, Sarah, Okello, Elialilia, Grosskurth, Heiner, Kinunghi, Safari, Kapiga, Saidi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8139108/
https://www.ncbi.nlm.nih.gov/pubmed/34016091
http://dx.doi.org/10.1186/s12916-021-01987-6
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author Makata, Kenneth
Ensink, Jeroen
Ayieko, Philip
Hansen, Christian
Sichalwe, Simon
Mngara, Julius
Mcharo, Onike
Mazigo, Humphrey
Seni, Jeremiah
Dreibelbis, Robert
Rockowitz, Sarah
Okello, Elialilia
Grosskurth, Heiner
Kinunghi, Safari
Kapiga, Saidi
author_facet Makata, Kenneth
Ensink, Jeroen
Ayieko, Philip
Hansen, Christian
Sichalwe, Simon
Mngara, Julius
Mcharo, Onike
Mazigo, Humphrey
Seni, Jeremiah
Dreibelbis, Robert
Rockowitz, Sarah
Okello, Elialilia
Grosskurth, Heiner
Kinunghi, Safari
Kapiga, Saidi
author_sort Makata, Kenneth
collection PubMed
description BACKGROUND: Soil-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. METHODS: We 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. RESULTS: At 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 1.282.43, p=0.001). The combined prevalence of A. lumbricoides and T. trichiura infections was 39% in both trial arms (aOR = 1.19; 95%CI 0.741.91). The prevalence of A. lumbricoides was 15% in the intervention and 17% in the control arm (aOR =1.24, 95%CI 0.592.59) and that of T. trichiura was 31% in both arms (aOR=1.17, 95%CI 0.731.88). No significant differences were found for STH infection intensity in both the main study and the hand contamination sub-study. CONCLUSIONS: The 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 childrens handwashing behaviour. TRIAL REGISTRATION: The trial was registered on June 21, 2017, by the International Standard Randomised Controlled Trial Number (ISRCTN45013173).
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spelling pubmed-81391082021-05-21 Hand hygiene intervention to optimise soil-transmitted helminth infection control among primary school children: the Mikono Safi cluster randomised controlled trial in northwestern Tanzania Makata, Kenneth Ensink, Jeroen Ayieko, Philip Hansen, Christian Sichalwe, Simon Mngara, Julius Mcharo, Onike Mazigo, Humphrey Seni, Jeremiah Dreibelbis, Robert Rockowitz, Sarah Okello, Elialilia Grosskurth, Heiner Kinunghi, Safari Kapiga, Saidi BMC Med Research Article BACKGROUND: Soil-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. METHODS: We 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. RESULTS: At 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 1.282.43, p=0.001). The combined prevalence of A. lumbricoides and T. trichiura infections was 39% in both trial arms (aOR = 1.19; 95%CI 0.741.91). The prevalence of A. lumbricoides was 15% in the intervention and 17% in the control arm (aOR =1.24, 95%CI 0.592.59) and that of T. trichiura was 31% in both arms (aOR=1.17, 95%CI 0.731.88). No significant differences were found for STH infection intensity in both the main study and the hand contamination sub-study. CONCLUSIONS: The 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 childrens handwashing behaviour. TRIAL REGISTRATION: The trial was registered on June 21, 2017, by the International Standard Randomised Controlled Trial Number (ISRCTN45013173). BioMed Central 2021-05-21 /pmc/articles/PMC8139108/ /pubmed/34016091 http://dx.doi.org/10.1186/s12916-021-01987-6 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Makata, Kenneth
Ensink, Jeroen
Ayieko, Philip
Hansen, Christian
Sichalwe, Simon
Mngara, Julius
Mcharo, Onike
Mazigo, Humphrey
Seni, Jeremiah
Dreibelbis, Robert
Rockowitz, Sarah
Okello, Elialilia
Grosskurth, Heiner
Kinunghi, Safari
Kapiga, Saidi
Hand hygiene intervention to optimise soil-transmitted helminth infection control among primary school children: the Mikono Safi cluster randomised controlled trial in northwestern Tanzania
title Hand hygiene intervention to optimise soil-transmitted helminth infection control among primary school children: the Mikono Safi cluster randomised controlled trial in northwestern Tanzania
title_full Hand hygiene intervention to optimise soil-transmitted helminth infection control among primary school children: the Mikono Safi cluster randomised controlled trial in northwestern Tanzania
title_fullStr Hand hygiene intervention to optimise soil-transmitted helminth infection control among primary school children: the Mikono Safi cluster randomised controlled trial in northwestern Tanzania
title_full_unstemmed Hand hygiene intervention to optimise soil-transmitted helminth infection control among primary school children: the Mikono Safi cluster randomised controlled trial in northwestern Tanzania
title_short Hand hygiene intervention to optimise soil-transmitted helminth infection control among primary school children: the Mikono Safi cluster randomised controlled trial in northwestern Tanzania
title_sort hand hygiene intervention to optimise soil-transmitted helminth infection control among primary school children: the mikono safi cluster randomised controlled trial in northwestern tanzania
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8139108/
https://www.ncbi.nlm.nih.gov/pubmed/34016091
http://dx.doi.org/10.1186/s12916-021-01987-6
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