02632nas a2200289   4500000000100000008004100001653003900042653003500081653000900116100001500125700001200140700001500152700001400167700001300181700001600194700001300210700001700223700001500240700001100255700001500266700001500281700001500296700001800311245019700329520180200526022001402328       2019                            d10aNeglected tropical diseases (NTDs)10aSoil-transmitted heminth (STH)10aWASH1 aVaz Nery S1 aTraub R1 aMcCarthy J1 aClarke NE1 aAmaral S1 aLlewellyn S1 aWeking E1 aRichardson A1 aCampbell S1 aGray D1 aVallely AJ1 aWilliams G1 aAndrews RM1 aClements AC A00aWASH for WORMS: A cluster-randomized controlled trial of the impact of a community-integrated water, sanitation, and hygiene and deworming intervention on soil-transmitted helminth infections.3 a<p>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. Primary outcomes, such as infection with each STH, were 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.</p>
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