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An integrated approach to fight parasitic worms and diarrhoea

Background: The global strategy to control helminthiasis is preventive chemotherapy that is the regular administration of anthelminthic drugs to at-risk populations in a vertical approach. Re-infection after treatment can occur rapidly as long as access to clean water and adequate sanitation has not been improved and hygiene behaviour remains unchanged. Integrated approaches are necessary in order achieve control and elimination in the longer term. Furthermore, integrated approaches hold promise for enhancement of cost-effectiveness of interventions, and hence sustainability of control activities in countries with limited resources.

Goal: The overarching goal of this project is to assess and quantify the effect of an integrated control approach (i.e. preventive chemotherapy combined with community-led total sanitation (CLTS) and community health education programme (CHEP)) on reinfection patterns of soil-transmitted helminths, schistosomes and intestinal protozoa, and diarrhoea in 40 communities in south-central Côte d’Ivoire.

Methods: In a first step, the CHEP will be developed, that includes an animated cartoon for hygiene and health that is targeted at school-aged children and a community health theatre for the entire community. The cartoon will be screen-played in 20 schools. In a second step, a community randomized intervention trial in 40 communities will benefit from different intervention packages (integrated control packages). A baseline parasitological and hygiene related KAPB surveys will take place. Monitoring of diarrhoea during 24 months at a 2-week interval will be implemented as well. After the baseline survey interventions will take place. While all 40 communities will receive preventive chemotherapy, 10 communities will additionally receive a CHEP intervention, another 10 will receive a CLTS intervention, and 10 communities will receive both CHEP and CLTS interventions. The parasitological, anthropometric and KAPB surveys will be repeated 12 and 24 months after the baseline to evaluate the effect of preventive chemotherapy coupled with CLTS and/or CHEP, compared to preventive chemotherapy alone.

Expected results: The effect of an integrated control approach (i.e. preventive chemotherapy combined with community-led total sanitation (CLTS) and community health education programme (CHEP)) on reinfection patterns of soil-transmitted helminths, schistosomes and intestinal protozoa, and diarrhoea will be assessed.