Moving Beyond MDA to Control STH Infections through WASH, Hygiene Education, and Community Engagement

Abstract

Over 1.5 billion people worldwide are afflicted by soil-transmitted helminth (STH) infections: Ascaris lumbricoides, hookworm, and Trichuris trichiura (Ercumen et al., 2019). The disease burden falls mainly on low and middle-income countries (LMICs) without adequate water, sanitation, and hygiene (WASH), since transmission mainly occurs through soil contaminated with infected feces (Khan et al., 2019). Infection control has typically relied on annual school-based mass drug administration (MDA), however, MDA is not a long-term solution because it does not interrupt environmental transmission (Khan et al., 2019; Vaz Nery et al., 2019, Ziegelbauer et al., 2012).  WASH infrastructure and hygiene behavior must be improved to reduce environmental transmission of STH infections (Ecrumen et al., 2019). WASH efforts include access to safely managed water sources and latrines and adequate fecal management (Worrell et al., 2016). However, WASH infrastructure improvements must be accepted by the community and coupled with behavior change to achieve full benefits (Al-Delaimy et al., 2014; Parker et al., 2008; Watson et al., 2017). Community engagement centers communities in the design, implementation, and evaluation of interventions to increase their acceptability and maximize sustainability (Clarke et al., 2018; Muluneh et al., 2020), thus improving the ability of MDA and WASH interventions to achieve long-term and sustainable reductions in STH infections (Clark et al., 2018; Gyorkos et al., 2013; Muluneh et al., 2020). The objective of this review is to examine the impact, methods, and takeaways from interventions that supplement MDA on efforts to control STH infections globally and demonstrates how community engagement practices can augment the effectiveness of interventions.