IntroductionThere is limited evidence demonstrating the benefits of community-based water, sanitation and hygiene (WASH) programmes on infections with soil-transmitted helminths (STH) and intestinal protozoa. Our study aims to contribute to that evidence base by investigating the effectiveness of combining two complementary approaches for control of STH: periodic mass administration of albendazole, and delivery of a community-based WASH programme.Methods and analysisWASH for WORMS is a cluster-randomised controlled trial to test the hypothesis that a community-based WASH intervention integrated with periodic mass distribution of albendazole will be more effective in reducing infections with STH and protozoa than mass deworming alone. All 18 participating rural communities in Timor-Leste receive mass chemotherapy every 6 months. Half the communities also receive the community-based WASH programme. Primary outcomes are the cumulative incidence of infection with STH. Secondary outcomes include the prevalence of protozoa; intensity of infection with STH; as well as morbidity indicators (anaemia, stunting and wasting). Each of the trial outcomes will be compared between control and intervention communities. End points will be measured 2 years after the first albendazole distribution; and midpoints are measured at 6 months intervals (12 months for haemoglobin and anthropometric indexes). Mixed-methods research will also be conducted in order to identify barriers and enablers associated with the acceptability and uptake of the WASH programme.Ethics and disseminationEthics approval was obtained from the human ethics committees at the University of Queensland, Australian National University, Timorese Ministry of Health, and University of Melbourne. The results of the trial will be published in peer-reviewed journals presented at national and international conferences, and disseminated to relevant stakeholders in health and WASH programmes. This study is funded by a Partnership for Better Health—Project grant from the National Health and Research Council (NHMRC), Australia.Trial registration numberACTRN12614000680662; Pre-results

Dengue infection in international travelers is not infrequent and may be associated with substantial morbidity. Furthermore, an accurate diagnosis of dengue in travelers requires the use of a combination of diagnostic tests. Although a vaccine is not yet available a number of promising candidates are under clinical evaluation. For now travelers should be provided with accurate advice regarding preventive measures when visiting dengue-endemic areas.

Survivors of childhood in Tanzania continue to show high rates of mortality throughout adult life. As the health of adults is essential for the wellbeing of young and old there is an urgent need to develop policies that deal with the causes of adult mortality.

Objective The aim of the present study was to quantify hospital steam steriliser resource consumption to provide baseline environmental data and identify possible efficiency gains. We sought to find the amount of steriliser electricity and water used for active cycles and for idling (standby), and the relationship between the electricity and water consumption and the mass and type of items sterilised. Methods We logged a hospital steam steriliser's electricity and water meters every 5min for up to 1 year. We obtained details of all active cycles (standard 134°C and accessory or 'test' cycles), recording item masses and types. Relationships were investigated for both the weight and type of items sterilised with electricity and water consumption. Results Over 304 days there were 2173 active cycles, including 1343 standard 134°C cycles that had an average load mass of 21.2kg, with 32% of cycles <15kg. Electricity used for active cycles was 32652kWh (60% of total), whereas the water used was 1243495L (79%). Standby used 21457kWh (40%) electricity and 329200L (21%) water. Total electricity and water consumption per mass sterilised was 1.9kWhkg and 58Lkg, respectively. The linear regression model predicting electricity use was: kWh=15.7+ 0.14×mass (in kg; R=0.58, P<0.01). Models for water and item type were poor. Electricity and water use fell from 3kWhkg and 200Lkg, respectively, for 5-kg loads to 0.5kWhkg and 20Lkg, respectively, for 40-kg loads. Conclusions Considerable electricity and water use occurred during standby, load mass was only moderately predictive of electricity consumption and light loads were common yet inefficient. The findings of the present study are a baseline for steam sterilisation's environmental footprint and identify areas to improve efficiencies. What is known about the topic? There is increasing interest in the environmental effects of healthcare. Life cycle assessment ('cradle to grave') provides a scientific method of analysing environmental effects. Although data of the effects of steam sterilisation are integral to the life cycles of reusable items and procedures using such items, there are few data available. Further, there is scant information regarding the efficiency of the long-term in-hospital use of sterilisers. What does this paper add? We quantified, for the first time, long-term electricity and water use of a hospital steam steriliser. We provide useful input data for future life cycle assessments of all reusable, steam-sterilised equipment. Further, we identified opportunities for improved steriliser efficiencies, including rotating off idle sterilisers and reducing the number of light steriliser loads. Finally, others could use our methods to examine steam sterilisers and many other energy-intensive items of hospital equipment. What are the implications for practitioners? We provide useful input data for all researchers examining the environmental footprint of reusable hospital equipment and procedures using such equipment. As a result of the present study, staff in the hospi...