I agree Elisabeth...
Given such a high level of OD, and the lengthy survival of helminth eggs (especially ascaris) in warm tropical soils, the lack of impact is hardly surprising. It's a shame the abstract is worded in quite a misleading way.

Yael

OD = open defecation (moderator's comment)

Thanks, Neil.
This is another example of the difficulties of proving the elusive effects of improved sanitation on health. There are just so many factors involved.

I've only read the abstract (the paper is behind a paywall) but looking at this sentence:

At the last follow-up, open defecation was practiced by 66.1% of respondents in the control arm versus 40.2% of respondents in the intervention arm (P = 0.005).

I feel like saying: are you kidding? 40% of people still practicing open defecation in the intervention group?? No wonder there is no noticeable difference in health outcomes!?

We found no evidence that the WASH intervention resulted in additional reductions in STH infections beyond that achieved with deworming alone over the 2-year trial period. The role of WASH on STH infections over a longer period of time and in the absence of deworming remains to be determined.

See you,
Elisabeth

Dear SuSanA colleagues,

I am forwarding the abstract below from William Brieger and the Tropical Health Update (a useful news service: This email address is being protected from spambots. You need JavaScript enabled to view it.)

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Subject: [tropicalhealth] Water, Sanitation, and Hygiene for WORMS: A Cluster-Randomized Controlled Trial of the Impact of a Community-Integrated Water, Sanitation, and Hygiene and Deworming Intervention on Soil-Transmitted Helminth Infections | The American Journal of Tropical Medicine and Hygiene

www.ajtmh.org/content/journals/10.4269/a...0705?emailalert=true

Water, sanitation, and hygiene (WASH) interventions have been proposed as an important complement to deworming programs for sustainable control of soil-transmitted helminth (STH) infections. We aimed to determine whether a community-based WASH program had additional benefits in reducing STH infections compared with community deworming alone. We conducted the WASH for WORMS cluster-randomized controlled trial in 18 rural communities in Timor-Leste. Intervention communities received a WASH intervention that provided access to an improved water source, promoted improved household sanitation, and encouraged handwashing with soap. All eligible community members in intervention and control arms received albendazole every 6 months for 2 years. Primary outcomes, such as infection with each STH, were measured using multiplex real-time quantitative polymerase chain reaction. We compared outcomes between study arms using generalized linear mixed models, accounting for clustering at community, household, and individual levels. At study completion, the integrated WASH and deworming intervention did not have an effect on infection with Ascaris spp. (relative risk [RR] 2.87, 95% confidence interval [CI]: 0.66–12.48, P = 0.159) or Necator americanus (RR 0.99, 95% CI: 0.52–1.89, P = 0.987), compared with deworming alone. At the last follow-up, open defecation was practiced by 66.1% (95% CI: 54.2–80.2) of respondents in the control arm versus 40.2% (95% CI: 25.3–52.6) of respondents in the intervention arm (P = 0.005). We found no evidence that the WASH intervention resulted in additional reductions in STH infections beyond that achieved with deworming alone over the 2-year trial period. The role of WASH on STH infections over a longer period of time and in the absence of deworming remains to be determined.

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Best wishes, Neil