PUBLIC HEALTH

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Efficacy of Handwashing with Soap and Nail Clipping on Intestinal Parasitic Infections in School-Aged Children

 

Intestinal parasitic infections are highly endemic among school-aged children in resource-limited settings. To lower their impact, preventive measures should be implemented that are sustainable with available resources. As a result, a study, published online in Pols Medicine (9 June 2015), was performed to assess the impact of handwashing with soap and nail clipping on the prevention of intestinal parasite reinfections.

 

In this trial, 367 parasite-negative school-aged children (aged 6-15 years of age) were randomly assigned to receive both, one or the other, or neither of the interventions in a 2×2 factorial design. Assignment sequence was concealed. After 6 months of follow-up, stool samples were examined using direct, concentration, and Kato-Katz methods. Hemoglobin levels were determined using a HemoCue spectrometer. The primary study outcomes were prevalence of intestinal parasite reinfection and infection intensity. The secondary outcome was anemia prevalence. Analysis was by intention to treat. Main effects were adjusted for gender, age, drinking water source, latrine use, pre-treatment parasites, handwashing with soap and nail clipping at baseline, and the other factor in the additive model.

 

Results showed that 14% of the children in the handwashing with soap intervention group were reinfected versus 29% in the groups with no handwashing with soap. Similarly, 17% of the children in the nail clipping intervention group were reinfected versus 26% in the groups with no nail clipping. Also, following the intervention, 13% of the children in the handwashing group were anemic versus 23% in the groups with no handwashing with soap. The prevalence of anemia did not differ significantly between children in the nail clipping group and those in the groups with no nail clipping.

 

According to the authors, handwashing with soap at key times and weekly nail clipping significantly decreased intestinal parasite reinfection rates. Furthermore, the handwashing intervention significantly reduced anemia prevalence in children. The authors noted that the intensive follow-up and monitoring during this study made it such that the assessment of the observed intervention benefits was under rather ideal circumstances, and hence the study could possibly overestimate the effects when compared to usual conditions. It was proposed that the next step should be implementing pragmatic studies and developing more effective approaches to promote and implement handwashing with soap and nail clipping at larger scales.

 

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