Impact of the “BALatrine” Intervention on Soil-Transmitted Helminth Infections in Central Java, Indonesia: A Pilot Study

Abstract

Many latrine campaigns in developing countries fail to be sustained because the introduced latrine is not appropriate to local socio-economic, cultural and environmental conditions, and there is an inadequate community health education component. We tested a low-cost, locally designed and constructed all-weather latrine (the “BALatrine”), together with community education promoting appropriate hygiene-related behaviour, to determine whether this integrated intervention effectively controlled soil-transmitted helminth (STH) infections. We undertook a pilot intervention study in two villages in Central Java, Indonesia. The villages were randomly allocated to either control or intervention with the intervention village receiving the BALatrine program and the control village receiving no program. STH-infection status was measured using the faecal flotation diagnostic method, before and eight months after the intervention. Over 8 months, the cumulative incidence of STH infection was significantly lower in the intervention village than in the control village: 13.4% vs. 27.5% (67/244 vs. 38/283, p < 0.001). The intervention was particularly effective among children: cumulative incidence 3.8% (2/53) for the intervention vs. 24.1% (13/54) for the control village (p < 0.001). The integrated BALatrine intervention was associated with a reduced incidence of STH infection. Following on from this pilot study, a large cluster-randomised controlled trial was commenced (ACTRN12613000523707).

Health Risk Assessment for Exposure to Nitrate in Drinking Water in Central Java, Indonesia

“…The present study was conducted in two villages in Wonosobo, Central Java, Indonesia, namely Desa (village) Losari and Desa Topengan. These villages are located on the foothills of Mount Sindoro and Mount Bismo, respectively, and are currently acting as control villages in a large-scale latrine (“BALatrine”) intervention trial [ 10 ]. Average precipitation in Wonosobo is higher in February (wet season) compared to August (443 mm vs. 93 mm rainfall) [ 16 ].…”

“…Surface water, such as that from springs and rivers, is subject to environmental contamination, and is the water source for 18% of the people in Indonesia [ 8 ]. Approximately 10% of the Indonesian population practice open defecation [ 9 ], but among rural communities this rate is as high as 55% [ 10 ]. Given the presence of nitrogen compounds in urine and feces, open defecation contributes to nitrate in the drinking water [ 11 ].…”

Trends of Water, Sanitation, and Hygiene (WASH) Research in Indonesia: A Systematic Review

“…Most of the research was conducted in the provinces located in Java Islands (Figure 6). The province with the most frequent WASH research location in Indonesia was West Java with 29 articles, e.g., [22], Jakarta with 28 articles, e.g., [16], Central Java with 27 articles, e.g., [23], and East Java with 27 articles, e.g., [24]. All those provinces were located on the Java Island which has the best research facilities in Indonesia.…”

The Contribution of Community Health Education to Sustainable Control of the Neglected Zoonotic Diseases

“…The “BALatrine”, an all-weather latrine designed and tested in Bali Indonesia, has been developed to be buildable with local materials and to be used during the wet season with a removable U-bend attachment or during the dry season as a dry pit latrine. This allows the use of the latrine in all seasons and the construction makes latrines more accessible to locals in rural and poor areas ( 50 ). Since ending open defecation is an important step in preventing transmission of STH and many other neglected tropical diseases, community engagement with the building of latrines and input into the designs used contribute to the acceptance and use of the BALatrines ( 50 ).…”

“…This allows the use of the latrine in all seasons and the construction makes latrines more accessible to locals in rural and poor areas ( 50 ). Since ending open defecation is an important step in preventing transmission of STH and many other neglected tropical diseases, community engagement with the building of latrines and input into the designs used contribute to the acceptance and use of the BALatrines ( 50 ).…”