Effect of a community-led sanitation intervention on child diarrhoea and child growth in rural Mali: a cluster-randomised controlled trial

Abstract

Bill & Melinda Gates Foundation.

Effect of an integrated intervention package of preventive chemotherapy, community-led total sanitation and health education on the prevalence of helminth and intestinal protozoa infections in Côte d’Ivoire

“…Especially open-defecation in close proximity to the households, which probably serves as the main source for infections and transmission via flies, plummeted in both adults (before: 75.0%, after: 16.7%) and children (before: 78.3%, after: 4.5%). Similarly to findings from a CLTS trial in rural Mali [13], household heads from intervention communities significantly more often reported washing hands after defecating. The intervention significantly increased perceptions of open defecation as polluting the environment among beneficiary communities.…”

“…Over the past decade, CLTS as a means to prevent diarrhoeal diseases has gained traction and is being applied at large scale in various low-and middle-income countries [22,35]. Yet, there is relatively little scientific inquiry about the specific effects of CLTS alone or in combination with other interventions against neglected tropical diseases [13,[36][37][38][39], and hence, the public health impact of CLTS [40]. We discuss the effect of an integrated package of interventions, placing emphasis on latrine construction by the community, levels of helminth and intestinal protozoa infections, infection patterns at follow-up and people's behaviour and attitudes (e.g.…”

“…While recent randomised controlled trials assessing the effect of water, sanitation and hygiene (WASH) on the prevalence and incidence of intestinal parasite infections and diarrhoeal diseases revealed somewhat mixed results, integrated approaches consisting of preventive chemotherapy, WASH interventions and health education were more effective [9][10][11][12] than single interventions [13]. It is important to note that measurability of protective effects from sanitation interventions depends on social-ecological contexts (e.g.…”

Sanitation and Religion in South Asia: What Accounts for Differences across Countries?

“…1.Literature in the medical and epidemiological fields link poor sanitation to poor nutritional outcomes and child height (Pickering, Djebbari, Lopez, Coulibaly, & Alzua, 2015) through diarrhoea (Checkley et al, 2004), intestinal parasites (Esrey, Potash, Roberts, & Shiff, 1991), and environmental enteropathy (Humphrey, 2009). A meta-analysis conducted by Gertler et al (2015) uses experimentally-induced variation in open defecation to identify a causal effect of open defecation on child height.…”

An Integrated Approach to Control Soil-Transmitted Helminthiasis, Schistosomiasis, Intestinal Protozoa Infection, and Diarrhea: Protocol for a Cluster Randomized Trial (Preprint)

“…A previous pilot study in Côte d'Ivoire revealed that CLTS coupled with health education and preventive chemotherapy has the potential to decrease the incidence of helminth and intestinal protozoa infection, though heterogeneity from one community to another rendered interpretation of the results somewhat difficult [32]. Notwithstanding, a recent cluster randomised study in Mali found no effect of CLTS on diarrhoea 18 months after implementation of the intervention, but a significant beneficial effect on children's anthropometric measures, as children from the intervention group were significantly less stunted [59]. Of note, the authors used a cross-sectional design for assessing diarrhoea incidence at two time points (baseline and endline).…”