Mikono Safi Study - Hand hygiene intervention to optimise helminthic infections control: a cluster-randomised controlled trial in NW Tanzania

INTERVENTION: Participanting schools are randomised within geographical strata (districts). There are three districts (Bukoba Urban District, Bukoba Rural District and Muleeba District). Randomisation to either the intervention or control arm is done through a computer generator. Both intervention and control arm schools participate in an annual deworming campaign, timed to start just before the intervention. Deworming is done with single dose Albendazole (400 mg orally). Following deworming with Albendazole in both arms of the study, students will participate in a baseline survey involving a stool examination to determine whether they have a helminth infection. Those still infected will be immediately re‐treated with Albendazole Intervention arm: Schools participants in a combination intervention with 4 components: 1. Teacher‐led health education delivered in 3 sessions of about 2 hours each, over a period of 9 months 2. Low‐cost structural improvements with respect to water supply and sanitation (e.g. continuous provision of hand wash stations and soap dispensers) 3. Nudges to increase students intention to wash hands after defecation (colour painted footpaths) 4. One‐time screening of students for current worm infection at beginning of intervention, combined with feedback of results to parents and health information given to students’ parents. Participants in this arm receive a behavioural intervention after this to improve their hand washing behaviour. Control arm: Schools continue with business as usual. One year after enrollment, participants in both arms complete a follow‐up survey to determine whether they are infected or reinfected. Reinfected students are treated again. CONDITION: 1. Soil transmitted helminth infections 2. Water, sanitation and hygiene (WASH) related behaviour ; Infections and Infestations ; 1. Soil transmitted helminth infections 2. Water, sanitation and hygiene (WASH) related behaviour PRIMARY OUTCOME: Combined prevalence of ascariasis and trichuriasis in students’ stool samples is measured by microscopy using the formol‐ether concentration method to identify helminth ova, at baseline and about 12 months after initial deworming. SECONDARY OUTCOME: 1. Hand‐washing behaviour in schools (reported and observed) and at home (reported only) by administering structured questionnaires and records respectively at baseline and 12 months after deworming; 2. Intensity (worm egg count) of ascariasis and trichuriasis infections is measured by microscopy, counting helminth ova in samples of about 2 grams, at baseline and 12 months after deworming; 3. Levels of hand contamination with worm eggs and E. coli bacteria is measured by a previously validated concentration procedure and microscopy, applied to hand‐rinse samples, obtained at 12 months after deworming; 4. Prevalence and intensity of hookworm infection is measured by microscopy at baseline and 12 months after deworming; INCLUSION CRITERIA: 1. Primary school students 2. Male and female 3. Attending classes 1 ‐ 6 4. aged 6 ‐ 12 years