Investigating the effect of a school-based WASH intervention on soil-transmitted helminth and schistosome infections and nutritional status of school children in Ethiopia: a quasi-experimental study
Abstract Background The impact of access to improved water, sanitation and hygiene (WASH) and health education on large-scale deworming programs aimed at controlling soil-transmitted helminth (STH) and schistosome (SCH) infections has not been well studied. We assessed the additional impact of impro...
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| Format: | Article |
| Language: | English |
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BMC
2024-03-01
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| Series: | Parasites & Vectors |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13071-024-06155-2 |
| _version_ | 1797259510367125504 |
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| author | Gemechu Tadesse Yonas Wuletaw Kalkidan Mekete Heven Sime Elodie Yard Laura Appleby Jack Grimes Nigussie Dejene Iain Gardiner Adama Kazienga Souheila Abbeddou Michael French Bruno Levecke Lesley Drake |
| author_facet | Gemechu Tadesse Yonas Wuletaw Kalkidan Mekete Heven Sime Elodie Yard Laura Appleby Jack Grimes Nigussie Dejene Iain Gardiner Adama Kazienga Souheila Abbeddou Michael French Bruno Levecke Lesley Drake |
| author_sort | Gemechu Tadesse |
| collection | DOAJ |
| description | Abstract Background The impact of access to improved water, sanitation and hygiene (WASH) and health education on large-scale deworming programs aimed at controlling soil-transmitted helminth (STH) and schistosome (SCH) infections has not been well studied. We assessed the additional impact of improved WASH infrastructure and health education at schools on STH and SCH infections in Ethiopia. Methods The study used a quasi-experimental design under which 30 schools were assigned to either an intervention (15 schools) or control (15 schools) arm. Both arms received a standard deworming treatment and lunch. In the intervention arm, improved WASH and health education were provided. At three consecutive time points (baseline in 2013, 2014 and 2015), the prevalence and intensity of STH and SCH infections and the nutritional status [hemoglobin concentrations and physical growth (height and weight)] were determined. To verify whether interventions were successfully implemented, the WASH status at school and the student knowledge, attitudes and practices related to WASH (WASH-KAP) were recorded. Differences in metrics between arms at baseline (2013) and follow-up (2015) were assessed both within and between the arms. Results A significant increase in scores for both the school WASH and student KAP was found in the intervention arm, indicating successful implementation of the intervention. The prevalence of any STH infection was significantly reduced in the intervention arm but not in the control arm (F = 4.486, p = 0.034). There was a significantly greater reduction in the intensity of infection of hookworm and Ascaris lumbricoides compared to baseline in both arms. The intervention did not affect school children’s height-for-age z-score (intervention arm * time coef = 0.12, p = 0.400) and body mass index-for-age z-scores (intervention * time coef = − 0.06, p = 0.526). Hemoglobin concentrations increased significantly more in the control than the intervention arm (coef = − 0.16, p = 0.006). Conclusions Although the intervention did increase school WASH and student WASH-KAP, our study found poor evidence of the additional benefit of improved WASH and health education to deworming and school food programs on parasite re-infection and the health outcomes of children. Graphical Abstract |
| first_indexed | 2024-04-24T23:10:34Z |
| format | Article |
| id | doaj.art-88a27eecbea145e0bf1a045e90902628 |
| institution | Directory Open Access Journal |
| issn | 1756-3305 |
| language | English |
| last_indexed | 2024-04-24T23:10:34Z |
| publishDate | 2024-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Parasites & Vectors |
| spelling | doaj.art-88a27eecbea145e0bf1a045e909026282024-03-17T12:17:12ZengBMCParasites & Vectors1756-33052024-03-0117111510.1186/s13071-024-06155-2Investigating the effect of a school-based WASH intervention on soil-transmitted helminth and schistosome infections and nutritional status of school children in Ethiopia: a quasi-experimental studyGemechu Tadesse0Yonas Wuletaw1Kalkidan Mekete2Heven Sime3Elodie Yard4Laura Appleby5Jack Grimes6Nigussie Dejene7Iain Gardiner8Adama Kazienga9Souheila Abbeddou10Michael French11Bruno Levecke12Lesley Drake13Ethiopian Public Health InstituteEthiopian Public Health InstituteEthiopian Public Health InstituteEthiopian Public Health InstitutePartnership for Child DevelopmentPartnership for Child DevelopmentDepartment of Civil and Environmental Engineering, South Kensington Campus, Imperial College LondonPartnership for Child DevelopmentPartnership for Child DevelopmentDepartment of Translational Physiology, Infectiology and Public Health, Faculty of Veterinary Medicine, Ghent UniversityDepartment of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent UniversityRTI InternationalDepartment of Translational Physiology, Infectiology and Public Health, Faculty of Veterinary Medicine, Ghent UniversityPartnership for Child DevelopmentAbstract Background The impact of access to improved water, sanitation and hygiene (WASH) and health education on large-scale deworming programs aimed at controlling soil-transmitted helminth (STH) and schistosome (SCH) infections has not been well studied. We assessed the additional impact of improved WASH infrastructure and health education at schools on STH and SCH infections in Ethiopia. Methods The study used a quasi-experimental design under which 30 schools were assigned to either an intervention (15 schools) or control (15 schools) arm. Both arms received a standard deworming treatment and lunch. In the intervention arm, improved WASH and health education were provided. At three consecutive time points (baseline in 2013, 2014 and 2015), the prevalence and intensity of STH and SCH infections and the nutritional status [hemoglobin concentrations and physical growth (height and weight)] were determined. To verify whether interventions were successfully implemented, the WASH status at school and the student knowledge, attitudes and practices related to WASH (WASH-KAP) were recorded. Differences in metrics between arms at baseline (2013) and follow-up (2015) were assessed both within and between the arms. Results A significant increase in scores for both the school WASH and student KAP was found in the intervention arm, indicating successful implementation of the intervention. The prevalence of any STH infection was significantly reduced in the intervention arm but not in the control arm (F = 4.486, p = 0.034). There was a significantly greater reduction in the intensity of infection of hookworm and Ascaris lumbricoides compared to baseline in both arms. The intervention did not affect school children’s height-for-age z-score (intervention arm * time coef = 0.12, p = 0.400) and body mass index-for-age z-scores (intervention * time coef = − 0.06, p = 0.526). Hemoglobin concentrations increased significantly more in the control than the intervention arm (coef = − 0.16, p = 0.006). Conclusions Although the intervention did increase school WASH and student WASH-KAP, our study found poor evidence of the additional benefit of improved WASH and health education to deworming and school food programs on parasite re-infection and the health outcomes of children. Graphical Abstracthttps://doi.org/10.1186/s13071-024-06155-2Soil-transmitted helminthsSchistosomesDewormingWASHHealth educationQuasi-random experiment |
| spellingShingle | Gemechu Tadesse Yonas Wuletaw Kalkidan Mekete Heven Sime Elodie Yard Laura Appleby Jack Grimes Nigussie Dejene Iain Gardiner Adama Kazienga Souheila Abbeddou Michael French Bruno Levecke Lesley Drake Investigating the effect of a school-based WASH intervention on soil-transmitted helminth and schistosome infections and nutritional status of school children in Ethiopia: a quasi-experimental study Parasites & Vectors Soil-transmitted helminths Schistosomes Deworming WASH Health education Quasi-random experiment |
| title | Investigating the effect of a school-based WASH intervention on soil-transmitted helminth and schistosome infections and nutritional status of school children in Ethiopia: a quasi-experimental study |
| title_full | Investigating the effect of a school-based WASH intervention on soil-transmitted helminth and schistosome infections and nutritional status of school children in Ethiopia: a quasi-experimental study |
| title_fullStr | Investigating the effect of a school-based WASH intervention on soil-transmitted helminth and schistosome infections and nutritional status of school children in Ethiopia: a quasi-experimental study |
| title_full_unstemmed | Investigating the effect of a school-based WASH intervention on soil-transmitted helminth and schistosome infections and nutritional status of school children in Ethiopia: a quasi-experimental study |
| title_short | Investigating the effect of a school-based WASH intervention on soil-transmitted helminth and schistosome infections and nutritional status of school children in Ethiopia: a quasi-experimental study |
| title_sort | investigating the effect of a school based wash intervention on soil transmitted helminth and schistosome infections and nutritional status of school children in ethiopia a quasi experimental study |
| topic | Soil-transmitted helminths Schistosomes Deworming WASH Health education Quasi-random experiment |
| url | https://doi.org/10.1186/s13071-024-06155-2 |
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