There is limited evidence demonstrating the benefits of community-based water, sanitation and hygiene (WASH) programs on infections with soil transmitted helminths (STH) and intestinal protozoa. Our study aims to contribute to that evidence base by investigating the effectiveness of combining two complementary approaches for STH control: periodic mass administration of albendazole and delivery of a community-based WASH program.
WASH for WORMS is a cluster-randomised controlled trial to test the hypothesis that a community-based WASH intervention integrated with periodic mass albendazole distribution will be more effective reducing infections with STH and protozoa than mass deworming alone.
All 24 rural villages in Timor-Leste receive mass chemotherapy every six months. Half the communities also receive the community-based WASH program. Primary outcomes are the cumulative incidence of infection with STH. Secondary outcomes include the prevalence of protozoa; intensity of infection with STH; as well as morbidity indicators (anaemia, stunting and wasting). Each of the trial outcomes will be compared between control and intervention communities. Endpoints will be measured 2 years after the first albendazole distribution; and midpoints are measured at 6 months intervals (12 months for haemoglobin and anthropometric indexes). Mixed-methods research will also be conducted in order to identify barriers and enablers associated with the acceptability and uptake of the WASH program.
This is the first RCT assessing the impact of an integrated community intervention comprised of WASH and mass albendazole distribution on infections with STH and intestinal protozoa.
Results of this study will provide evidence on the benefits of inter-sectoral collaboration between health and infrastructure sectors in order to achieve more effective and sustainable STH control.