土壤传播的蠕虫(STH)感染在资源有限的国家非常普遍。我们评估了Kagera地区小学生在接受大规模药物管理后,旨在加强用肥皂洗手的联合干预措施对STH再感染的影响。坦桑尼亚西北部。
我们在已知STH患病率较高的16所小学中进行了一项集群随机试验。学校以1:1的比例随机分配,以接受干预或继续进行常规健康教育。干预包括教师主导的课堂教学,家长参与会议,环境改造和改进洗手站。评估涉及两个代表性学生样本的横断面调查,基线调查后12个月进行了最终调查。主要结果是在最终调查中,A虫和Trichuris虫感染的合并患病率。次要结果包括报告的洗手行为,个别STHs的患病率和强度,以及STH卵和大肠杆菌的手部污染。终线STH患病率和强度根据潜在混杂因素的基线差异进行调整。
在终点测量时,3081名学童(1566名来自干预学校,1515名来自控制学校)提供了访谈数据和粪便标本。与对照组的学童相比,干预组中更多的学童报告洗手时使用了水和肥皂(58%vs.35%;aOR=1.76,95CI1.28-2.43,p=0.001)。在两个试验组中,龙曲霉和Trichura感染的合并患病率为39%(aOR=1.19;95CI0.74-1.91)。在干预组中,A.lumbricoides的患病率为15%,在对照组中为17%(aOR=1.24,95CI0.59-2.59),而T.trichiura的患病率在两组中均为31%(aOR=1.17,95CI0.73-1.88)。在主要研究和手部污染子研究中,STH感染强度均未发现显着差异。
干预措施有效地增加了学校报告的洗手行为,但在家里没有表现出类似的效果。干预对STH感染没有影响,可能是由于家庭环境中的感染,其他传播途径,如污染的水或食物,或学校儿童洗手行为的有限变化。
该试验于2017年6月21日通过国际标准随机对照试验编号(ISRCTN45013173)注册。
Soil-transmitted helminth (STH) infections are highly prevalent in resource-limited countries. We assessed the effect of a combination intervention aiming to enhance handwashing with soap on STH reinfection following mass drug administration among primary school children in Kagera region, Northwestern Tanzania.
We conducted a cluster randomised
trial in sixteen primary schools with known high STH prevalence. Schools were randomly assigned in a 1:1 ratio to either receive the intervention or continue with routine health education. The intervention included teacher-led classroom teaching, parental engagement sessions, environmental modifications and improved handwashing stations. The evaluation involved two cross-sectional surveys in a representative sample of students, with the end-line survey conducted 12 months after the baseline survey. The primary outcome was the combined prevalence of Ascaris lumbricoides and Trichuris trichiura infections at the end-line survey. Secondary outcomes included reported handwashing behaviour, the prevalence and intensity of individual STHs, and hand contamination with STH ova and coliform bacteria. End-line STH prevalence and intensity were adjusted for baseline differences of potential confounders.
At the end-line survey, 3081 school children (1566 from intervention schools and 1515 from control schools) provided interview data and stool specimens. More school children in the intervention group reported the use of water and soap during handwashing compared to school children in the control group (58% vs. 35%; aOR=1.76, 95%CI 1.28-2.43, p=0.001). The combined prevalence of A. lumbricoides and T. trichiura infections was 39% in both
trial arms (aOR = 1.19; 95%CI 0.74-1.91). The prevalence of A. lumbricoides was 15% in the intervention and 17% in the control arm (aOR =1.24, 95%CI 0.59-2.59) and that of T. trichiura was 31% in both arms (aOR=1.17, 95%CI 0.73-1.88). No significant differences were found for STH infection intensity in both the main
study and the hand contamination sub-
study.
The intervention was effective in increasing reported handwashing behaviour at school, but failed to show a similar effect in the home. The intervention had no effect on STH infection, possibly due to infection in the home environment, other transmission routes such as contaminated water or food or limited changes in school children\'s handwashing behaviour.
The
trial was registered on June 21, 2017, by the International Standard Randomised Controlled
Trial Number ( ISRCTN45013173) .