Abstract-In rural Indonesia, soil-transmitted helminth (STH) infections cause health problems and impair social development. We investigated whether those problems could be solved by the use of household latrines (the 'BALatrine'). Our method was to study two villages, of which only one had household latrines. The dependent variables were environmental contamination (Escherichia coli in well water), STH-related illnesses and symptoms, and absence from work or school due to bowel infections. The village with latrines had less E. coli contamination. STH-related illnesses and symptoms were less prevalent among participants who had a latrine than among those who did not. Absence from work or school due to bowel infection was much less common among participants who had a latrine than among those who did not (6.2% vs 40.3%). In conclusion, the BALatrine could have important public-health and social benefits, and that hypothesis should be tested in a controlled longitudinal study.

An integrated approach to health promotion has been widely adopted since the 1986 Ottawa Charter to promote better health and support community-based projects. Complementing the skills of experts, there is a need for community engagement for social and environmental change, with a focus on settings for health promotion initiatives. A sanitation and hygiene project from an Indonesian village setting illustrates the value of using an integrated approach. Village communities took communal action to reduce open defecation by building and using household latrines, while behavioural change was facilitated through health education sessions. The support of "decision-makers" in the community, such as the religious leaders, the village leaders and the army was vital. Medication (Albendazole) was provided to ensure that those infected with soil-transmitted helminth (STH) were effectively treated. The study suggests that an integrated, socio-ecological approach can help to reduce STH infection and improve villagers' health and well-being.