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

Cara Hernandez, Catherine Gross Gross, Sarah Claire Loeb Loeb
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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. 
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透过WASH、卫生教育和社区参与,超越MDA控制STH感染
全球有超过15亿人受到土壤传播蠕虫(STH)感染的影响:类蚓蛔虫、钩虫和毛线虫(Ercumen et al., 2019)。疾病负担主要落在没有充足的水、环境卫生和个人卫生(WASH)的低收入和中等收入国家(LMICs)身上,因为传播主要是通过被感染粪便污染的土壤发生的(Khan等人,2019)。感染控制通常依赖于每年以学校为基础的大规模药物管理(MDA),然而,MDA不是一个长期的解决方案,因为它不会中断环境传播(Khan等人,2019;Vaz Nery等人,2019,Ziegelbauer等人,2012)。必须改善WASH基础设施和卫生行为,以减少STH感染的环境传播(Ecrumen et al., 2019)。WASH工作包括获得安全管理的水源和厕所以及适当的粪便管理(Worrell等人,2016年)。然而,WASH基础设施的改善必须为社区所接受,并与行为改变相结合,才能实现全部效益(al - delaimy et al., 2014;Parker et al., 2008;Watson et al., 2017)。社区参与使社区参与干预措施的设计、实施和评估,以提高其可接受性和最大限度地提高可持续性(Clarke et al., 2018;Muluneh等人,2020),从而提高了MDA和WASH干预措施的能力,以实现STH感染的长期和可持续减少(Clark等人,2018;Gyorkos et al., 2013;Muluneh et al., 2020)。这篇综述的目的是研究干预措施的影响、方法和收获,这些干预措施补充了全球控制STH感染的努力,并展示了社区参与实践如何提高干预措施的有效性。
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