I was very interested to see this discussion about the paper on WASH and Helminths, and their critique of the latest WHO guide (2011). WHO guidelines and recommendations are normally based on a very rigorous process, although I could not find a description of the methodology in the latest guide. It would be especially valuable to hear a response from the authors of the WHO guide to this latest critique. I note that there has as yet been no published response on the PLoS NTD website, even though the original paper was published in April.

As a general comment, such "post-publication peer review" is valuable and is to be encouraged.

By the way, I enjoy participating in the SuSanA forum and am glad to be in touch with Elisabeth and others to promote communication between SusSanA and HIFA (Healthcare Information For All forum - www.hifa2015.org ).

Neil Pakenham-Walsh, Coordinator, HIFA

I was going to launch into an explanation of why I think this paper supports my position as discussed on this threat, but I thought maybe I would be just repeating myself.

For me the most important section of this report - which, incidentally I think is a bit contradictory at times - is this one:

There is very little literature that indicates direct WASH impact on helminth control. We believe there is an urgent need to conduct epidemiological research, including appropriately structured intervention trials and mathematical modelling studies to evaluate the effect of integrated interventions on helminth infections and infection-associated morbidity. Existing evidence is already strong enough to support complementing drug-based interventions with the provision of WASH for all but more work can be done to determine intervention thresholds for the selected WASH indicators to be incorporated into decision trees such as those presented in the annexes of the WHO guidelines

And I don't even think this is just about helminths, the same can be said for other faecal pathogens. We need to know how well different interventions actually work.

This is a really interesting paper talking about WASH and helminth infection and policy

www.plosntds.org/article/info%3Adoi%2F10...51#pntd-0002651-g001


++++++++++++++++

Added by moderator:

Water, Sanitation, and Hygiene (WASH): A Critical Component for Sustainable Soil-Transmitted Helminth and Schistosomiasis Control

Authors:
Suzy J. Campbell, Georgia B. Savage, Darren J. Gray, Jo-An M. Atkinson, Ricardo J. Soares Magalhães, Susana V. Nery, James S. McCarthy, Yael Velleman, James H. Wicken, Rebecca J. Traub, Gail M. Williams, Ross M. Andrews, Archie C. A. Clements

From the conclusions:

Conclusion

Progress towards achieving global control of helminths crucially depends on sustainable solutions that move beyond treating symptoms towards reducing exposure. With that in mind, it is necessary to augment chemotherapy with WASH and other interventions such as health promotion to achieve a cumulative impact of preventing reinfection and providing the greatest and most sustainable gains for helminth control and elimination. We believe that a strong justification exists to revise the WHO guidelines in the face of the abovementioned shortcomings. Such revision will result in a much-enhanced document that covers the full spectrum of short- and longer-term interventions for more holistic STH and schistosomiasis control. Impact indicators for WASH, in addition to disease-related indicators such as prevalence of infection, should define the success of a control programme and guide decisions as to when such programmes should cease. This would ensure current gains in helminth control are built upon beyond the current dependence on chemotherapy.