Abstract
Many latrine campaigns in developing countries fail to be sustained because the introduced latrine is not appropriate to local socio-economic, cultural and environmental conditions, and there is an inadequate community health education component. We tested a low-cost, locally designed and constructed all-weather latrine (the “BALatrine”), together with community education promoting appropriate hygiene-related behaviour, to determine whether this integrated intervention effectively controlled soil-transmitted helminth (STH) infections. We undertook a pilot intervention study in two villages in Central Java, Indonesia. The villages were randomly allocated to either control or intervention with the intervention village receiving the BALatrine program and the control village receiving no program. STH-infection status was measured using the faecal flotation diagnostic method, before and eight months after the intervention. Over 8 months, the cumulative incidence of STH infection was significantly lower in the intervention village than in the control village: 13.4% vs. 27.5% (67/244 vs. 38/283, p < 0.001). The intervention was particularly effective among children: cumulative incidence 3.8% (2/53) for the intervention vs. 24.1% (13/54) for the control village (p < 0.001). The integrated BALatrine intervention was associated with a reduced incidence of STH infection. Following on from this pilot study, a large cluster-randomised controlled trial was commenced (ACTRN12613000523707).
Highlights
The global prevalence of infection with soil-transmitted helminths (STH) remains high, with 1.5 billion people infected worldwide, many of them children [1]
98.8% of the residents had a monthly income below 1 M Indonesian Rupiah (IDR) or about US$70, whereas in the intervention village the comparable percentage was 97.2% (p = 0.017)
This is an ongoing challenge in low resource settings where public sewerage system infrastructure rarely exists, on-site sanitation systems are either improperly designed or poorly functioning, and open defecation is seen as culturally acceptable, especially in rural areas [25,26]
Summary
The global prevalence of infection with soil-transmitted helminths (STH) remains high, with 1.5 billion people infected worldwide, many of them children [1]. The prevalence of STH infection in Indonesia is high at 45–65%, with areas having poor sanitation reaching 80% prevalence [3]. In Central Java, research into STH infection among elementary school children by Laksono and later the Health Department, found an infection prevalence of 84–96% [4,5]. A recent systematic review and meta-analysis concluded that “integrated control approaches emphasizing health education and environmental sanitation are needed to interrupt transmission of STH” [8]. Interventions that improve the hygienic disposal of faeces to reduce soil and/or water contamination have been identified as a key strategy to control transmission and prevent related diseases [9,10,11]
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