A randomized controlled trial to evaluate the impact of combining hygiene education with deworming.

INTERVENTION: The core goal of the study is to assess if adding a hygiene education package, designed to be implemented at scale, to deworming campaigns can improve the success of deworming by reducing the reinfection rate in children. Accordingly, there are two components to the intervention: (i) a hygiene education package; and (ii) distribution of deworming tablets via mass drug administration of deworming medication at schools. Brief name of Intervention: Integrated hygiene education and deworming MDA. A single hygiene education package comprising two components will be evaluated in combination with deworming MDAs: 1) A short cartoon (‘Magic Glasses’) originally evaluated by Bieri and colleagues [Bieri F.A., et al (2013) Health education package to prevent worm infections in Chinese schoolchildren. NEJM (368): 1603‐1612]. This cartoon, approximately 14 minutes in duration, explains to children: (a) how STH infections are transmitted (e.g. poor sanitation practices such as defecating in fields rather than using latrines; poor hygiene practices such as not washing hands after defecating or not washing food before eating); (b) the health consequences of STH infections (e.g. abdominal pain, diarrhoea, fatigue, lack of concentration at school); and (c) how children can minimize their risk of being infected by STH by improving their hygiene and sanitation habits. 2) A pamphlet, based on the Magic Glasses cartoon. This pamphlet shows screenshots from the cartoon, aiming to reinforce the key messages from the cartoon about how children can change their hygiene and sanitation habits to minimize their risk of STH infection. The intervention will comprise teachers showing the Magic Glasses cartoon to their students twice during the academic year. The first delivery of the hygiene education package will be the week prior to a government‐implemented deworming MDA; the second delivery of the intervention will be approximately 6 months later: 1) During the first delivery of the intervention, teachers will show the Magic Glasses cartoon to their students twice during a single class period, in combination with teachers distributing pamphlets to the children to take home. This first delivery will take place as part of a broader deworming program ‐‐ government‐implemented school‐based deworming MDAs will take place annually in the province of Phu Tho, targeting all primary schools (children aged 6‐11 years old). School‐based deworming MDAs in Phu Tho (and throughout Vietnam) are conducted by local health workers visiting schools and distributing a single tablet (either albendazole [400 milligrams] or mebendazole [500 milligrams]) to each child present on the day. A mop‐up day is conducted three to four days later to deworm children who were not able to receive a tablet on the first day due to absence, illness, etc. The intervention to be tested in this study will leverage the government‐implemented, province‐wide, school‐based deworming MDA in Phu Tho which will take place in November, 2017. 2) The second delivery of the intervention will also entail teachers showing the Magic Glasses cartoon (twice) in a single class period; however, for the second delivery, there will be no pamphlets distributed, nor deworming MDA conducted. The integrated intervention will target all primary school classes (grade 1‐5; age 6‐11 years old). CONDITION: Soil‐transmitted helminthiasis PRIMARY OUTCOME: STH infection, as assessed by Kato‐Katz thick smear analysis of stool samples Depending on school infrastructure, the Magic Glasses cartoon could be shown either on a one classroom/grade at a time basis or some other combination of classrooms – schools will be free to devise their own mechanism of how to deliver the intervention, with the only stipulation that they ensure the cartoon is displayed on a clearly visible screen (some schools will utilize computers and projectors, while others will utilize a television (TV) and video compact disc (VCD) player; the cartoon will be provided to schools on a VCD). Adherence of the schools to showing the video will be assessed through a simple form filled‐in by teachers. This form will report if the video was or was not shown at each of the two expected delivery times. Fidelity to a specific teaching regime will not be assessed: this is an effectiveness study designed to evaluate whether the integrated intervention can be implemented at scale in the particular context under consideration, not under rigid experimental conditions. SECONDARY OUTCOME: Change in hygiene and sanitation practices as assessed by a questionnaire specifically designed around the key hygiene and sanitation messages conveyed in the Magic Glasses cartoon pertinent to the transmission of STH. Change in knowledge of STH infections, as assessed by a questionnaire specifically designed around the information conveyed in the Magic Glasses cartoon pertinent to STH infections. INCLUSION CRITERIA: The target population of this intervention is primary school children (grade 1 to 5; age 6‐11 years old) receiving deworming treatment as part of an annual province‐wide school‐based deworming MDA in Phu Tho. All children from participating schools will receive the intervention designated to their cohort, but the study will be based on studying children from grade 4 (age 9‐10 years old). At each participating school, all children from grade 4 will be recruited to a longitudinal cohort.