Plain English Summary
Background and study aims:
Parasitic worms (helmiths) are organisms that live in the intestine and feed off their living hosts. They are among the most common type of infections worldwide, especially in poor and deprived communities. They are spread by eggs present in human faeces which in turn contaminate soil in areas where sanitation is poor. An infection can cause malnutrition, physical and mental retardation, and reduced work performance in older age. Previous surveys undertaking in the Kagera Region of Tanzania have found that more than 70% of primary school children aged 6 – 12 years in some schools suffer from parasitic worm infections. This is also the case in other parts of Tanzania (and other resource-limited countries) in spite of annual deworming campaigns that are conducted in schools by the national control programme for neglected tropical diseases. Deworming campaigns remain a cost-effective way to treat these infections, but they do not target the route cause and so many experience repeated infections. An integrated approach that combines deworming with sustainable hygiene behaviour change could prove an effective way to control parasitic worm infections. The aim of this study is to find out whether the effects of routine deworming campaigns in primary schools in Africa can be enhanced and sustained by combining it with an appropriate Water, Sanitation and Hygiene (WASH) behaviour change program to improve hand-washing practices.
Who can participate?
Primary school aged children attending participating primary schools.
What does the study involve?
Participating schools are randomly allocated to one of two groups. At the start of the study, children attending schools in both groups undergo annual deworming using deworming medication. Schools in the first group then continue as normal. Schools in the second group take part in the behaviour change program. This involves teacher-led health education in primary schools, low-cost structural improvements of water supply and sanitation (e.g. soap dispensers), nudges to increase students intention to wash hands after defecation (e.g. painted footpaths that connect toilets with hand-wash stations), and a one-off screening of students for current worm infection combined with feedback of results to parents and health information given to students’ parents (with the intention to increase parents’ awareness and concern). One year after enrolment, all students complete a follow-up survey to see if they are infected with worms.
What are the possible benefits and risks of participating?
Participants may benefit from increased knowledge and skills on hand-washnig behaviour, preventing them from bacterial infections. Treatment with albendazole may improve the general health status of children, reduce potential aneaemia and improve their cognitive (mental) capacity. There are no notable risks however, treatment with albendazole may cause temporary nausea and questions on hygiene may be perceived as sensitive or embarrassing.
Where is the study run from?
The study is run from Mwanza Intervention Trials Unit and takes place in 16 primary schools in the Kagera Region (Tanzania)
When is study starting and how long is it expected to run for?
October 2016 to December 2018
Who is funding the study?
Department for International Development (UK)
Who is the main contact?
1. Professor Heiner Grosskurth (scientific)
2. Professor Saidi Kapiga (scientific)
Prof Heiner Grosskurth
Prof Saidi Kapiga
Mwanza Intervention Trials Unit (MITU)
National Institute for Medical Research
Mwanza Centre (NIMR Mwanza)
Cluster-randomised controlled trial to evaluate the effectiveness of an intervention for improving handwashing behaviour on the prevalence of soil transmitted helminth infections among primary school children in NW Tanzania
Mikono Safi Study
Among children with a high prevalence of soil transmitted helminth infections in-spite of annual deworming, a hand washing intervention will be effective in reducing the prevalence and intensity of Ascaris lumbricoides and Trichuris trichiura infections.
1. Medical Research Coordinating Committee (MRCC), National Institute for Medical Research,18/05/2017, ref: Nu NIMR/HQ/R.8a/Vol. IX/2497
2. Ethics Committee of the London School of Hygiene and Tropical Medicine, ref: 11868
Open-label single-centre cluster randomised controlled trial
Primary study design
Secondary study design
Cluster randomised trial
Patient information sheet
Not available in web format, please use contact details to request a participant information sheet
1. Soil transmitted helminth infections
2. Water, sanitation and hygiene (WASH) related behaviour
Participanting schools are randomised within geographical strata (districts). There are three districts (Bukoba Urban District, Bukoba Rural District and Muleeba District). Randomisation to either the intervention or control arm is done through a computer generator.
Both intervention and control arm schools participate in an annual deworming campaign, timed to start just before the intervention. Deworming is done with single dose Albendazole (400 mg orally). Following deworming with Albendazole in both arms of the study, students will participate in a baseline survey involving a stool examination to determine whether they have a helminth infection. Those still infected will be immediately re-treated with Albendazole
Intervention arm: Schools participants in a combination intervention with 4 components:
1. Teacher-led health education delivered in 3 sessions of about 2 hours each, over a period of 9 months
2. Low-cost structural improvements with respect to water supply and sanitation (e.g. continuous provision of hand wash stations and soap dispensers)
3. Nudges to increase students intention to wash hands after defecation (colour painted footpaths)
4. One-time screening of students for current worm infection at beginning of intervention, combined with feedback of results to parents and health information given to students’ parents.
Participants in this arm receive a behavioural intervention after this to improve their hand washing behaviour.
Control arm: Schools continue with business as usual.
One year after enrollment, participants in both arms complete a follow-up survey to determine whether they are infected or reinfected. Reinfected students are treated again.
Primary outcome measures
Combined prevalence of ascariasis and trichuriasis in students’ stool samples is measured by microscopy using the formol-ether concentration method to identify helminth ova, at baseline and about 12 months after initial deworming.
Secondary outcome measures
1. Hand-washing behaviour in schools (reported and observed) and at home (reported only) by administering structured questionnaires and records respectively at baseline and 12 months after deworming
2. Intensity (worm egg count) of ascariasis and trichuriasis infections is measured by microscopy, counting helminth ova in samples of about 2 grams, at baseline and 12 months after deworming
3. Levels of hand contamination with worm eggs and E. coli bacteria is measured by a previously validated concentration procedure and microscopy, applied to hand-rinse samples, obtained at 12 months after deworming
4. Prevalence and intensity of hookworm infection is measured by microscopy at baseline and 12 months after deworming
Overall trial start date
Overall trial end date
Participant inclusion criteria
1. Primary school students
2. Male and female
3. Attending classes 1 - 6
4. aged 6 - 12 years
Target number of participants
16 clusters (primary schools) with 200 participants per school; 3200 children in total
Participant exclusion criteria
1. Student not giving assent
2. Parent or guardian refusing consent
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
Mwanza Intervention Trials Unit (MITU)
National Institute for Medical Research Tanzania Mwanza Centre Isamilo Road
London School of Hygiene and Tropical Medicine (LSHTM)
Department for International Development, UK Government
Department for International Development, DFID
Funding Body Type
Funding Body Subtype
Results and Publications
Publication and dissemination plan
Planned publication of the results of the trial in a high-impact peer reviewed journal by or before December 2019. We also intend to issue policy briefs by about June 2019.
IPD sharing statement:
The datasets generated during the current study will be made available upon request from the PI Prof Saidi Kapiga (firstname.lastname@example.org), following approval from the Trial Steering Committee (TSC) and after the MITU research team has had an opportunity to publish the results of the trial, but latest within 2 years of the end of data collection (which is expected for December 2018 at the latest).
Intention to publish date
Participant level data
Available on request
Results - basic reporting