The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia.
Research School of Population Health, Australian National University, Canberra, Australia.
Am J Trop Med Hyg. 2019 Mar;100(3):750-761. doi: 10.4269/ajtmh.18-0705.
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 spp. (relative risk [RR] 2.87, 95% confidence interval [CI]: 0.66-12.48, = 0.159) or (RR 0.99, 95% CI: 0.52-1.89, = 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 ( = 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.
水、环境卫生和个人卫生（WASH）干预措施被提议作为控制土壤传播性蠕虫（STH）感染的可持续性的驱虫方案的重要补充。我们旨在确定基于社区的 WASH 方案是否与单纯的社区驱虫相比，在减少 STH 感染方面具有额外的益处。我们在东帝汶的 18 个农村社区开展了 WASH for WORMS 集群随机对照试验。干预社区接受了 WASH 干预措施，包括提供改善的水源、促进家庭环境卫生改善以及鼓励用肥皂洗手。干预和对照组的所有符合条件的社区成员每 6 个月接受阿苯达唑治疗，为期 2 年。主要结局是通过多重实时定量聚合酶链反应测量每种 STH 的感染情况。我们使用广义线性混合模型比较了研究臂之间的结果，考虑了社区、家庭和个体层面的聚类。在研究完成时，综合的 WASH 和驱虫干预措施对感染 spp.（相对风险 [RR] 2.87，95%置信区间 [CI]：0.66-12.48， = 0.159）或 （RR 0.99，95% CI：0.52-1.89， = 0.987）没有影响，与单纯驱虫相比。在最后一次随访时，对照组中有 66.1%（95% CI：54.2-80.2）的受访者仍在露天排便，而干预组中有 40.2%（95% CI：25.3-52.6）的受访者仍在露天排便（ = 0.005）。我们没有发现证据表明，在为期 2 年的试验期间，WASH 干预措施在单独驱虫之外，对 STH 感染的额外减少有任何作用。在更长的时间内以及在没有驱虫的情况下，WASH 对 STH 感染的作用仍有待确定。
