Hand hygiene intervention to optimize helminth infection control: Design and baseline results of Mikono Safi–An ongoing school-based cluster-randomised controlled trial in NW Tanzania

Abstract

Introduction Soil transmitted helminths (STH) can affect over 50% of children in some parts of Tanzania. Control measures involve annual deworming campaigns in schools, but re-infection is rapid. This paper presents the design and baseline survey results of an ongoing school-based cluster-randomised controlled trial in Kagera region, NW Tanzania. The trial aims to determine whether the effect of routine deworming on the prevalence of Ascaris lumbricoides and Trichuris trichiura infections among school aged children can be sustained when combined with a behaviour change intervention promoting handwashing with water and soap. Methods As part of the trial, a total of 16 schools were randomised to receive the intervention (N = 8) or as controls (N = 8). Randomisation was stratified per district and restricted to ensure pre-trial STH prevalence was balanced between study arms. The combination intervention to be tested comprises class-room based teacher-led health education, improvement of handwash stations, coloured nudges to facilitate handwashing and parental engagement sessions. The impact evaluation involves two cross-sectional surveys conducted at baseline and endline. The objectives of the baseline survey were: (i) to confirm whether the deworming campaign was successful, and identify and treat students still infected about 2 weeks after deworming, (ii) to document any baseline differences in STH prevalence between trial arms, and (iii) to assess handwashing behaviours, and access to water and sanitation at school and home. We randomly sampled 35 students per class in Grades 1–6 (an average of 200 children per school), stratified to ensure equal representation between genders. Assenting students were interviewed using a structured questionnaire and asked to provide a stool specimen. Results Results of the baseline survey conducted about 2 weeks after deworming shows balanced demographic and STH prevalence data across trial arms. We observed a low prevalence of ascariasis (< 5%) as expected; however, the prevalence of trichuriasis was still about 35% in both arms. Conclusion The randomisation procedure was successful in achieving a balanced distribution of demographic characteristics and helminth infections between trial arms. The intervention is being rolled out. The current deworming treatment regimen may need to be revised with regards to the treatment of trichuriasis.

The Relationship Between Soil-transmitted Helminth Infections and Clean and Healthy Living Behavior

“…Children who are barefoot when they are outside the house are susceptible to Ascaris lumbricoides infection [28]. A previous study reported that preschool-age children and children who walk barefoot may be at an increased risk of STH burden [29].…”

Does a school-based intervention to engage parents change opportunity for handwashing with soap at home? Practical experience from the Mikono Safi trial in Northwestern Tanzania

“…This qualitative research was nested in the Mikono Safi trial which was conducted in 16 schools (8 intervention and 8 control schools) in Kagera region in Northwestern Tanzania [ 24 , 25 ]. Kagera region is predominantly rural and is comprised of 8 districts with an estimated population of over 2.7 million [ 26 ].…”

“…Details of the Mikono Safi trial have been published elsewhere [ 24 , 25 ]. Briefly, the trial aimed to determine whether the effect of routine de-worming on the prevalence of Ascaris lumbricoides and Trichuris trichiura infections among school aged children can be sustained when combined with a behaviour change intervention promoting handwashing with water and soap [ 24 , 25 ]. The intervention involved classroom-based hygiene promotion and structural change within the school environment.…”

“…Games, posters and sets of comic-type pictures were used to deliver the lessons that focused on important emotional drivers that would motivate the school children to adopt better hygiene. The structural change within the school environment included low-cost, replicable infrastructure modifications on school grounds, including installation of handwashing facilities near school latrines, construction of footpaths connecting the handwashing station to the toilet block, and nudges to prompt hand washing behaviour [ 24 ].…”

“…However, a review of WASH interventions shows conflicting results on relationship of these interventions with STH infection [ 23 ]. Few trials have tested how parental engagement activities as part of a comprehensive WASH intervention can motivate parents and guardians to improve their sanitation and handwashing situation at home [ 24 ]. This paper reports results of a qualitative study conducted to assess the influence of school-based parental engagement activities regarding STH infection on WASH conditions and practices at home.…”