1. A health education package halved the incidence of infection with soil-transmitted helminths and led to improvement in hygiene habits.
2. Knowledge of helminth infections significantly impacted its incidence.
Evidence Rating Level: 2 (Good)
Study Rundown: This study demonstrates that health education reduced the risk of infection with soil-transmitted helminths while improving hygiene habits, such as hand-washing. As mass drug administration does not prevent reinfection, health education can help further reduce incidence. Since worldwide burden of infection with soil-transmitted helminths runs in the millions of disability-adjusted life-years, any cost-effective interventions are welcome. This is particularly true in countries with high prevalence of helminth infections, such as China.
Another conclusion from the study is equally important – knowledge and attitudes towards a disease can strongly impact its incidence. In the study, students who are more knowledgeable about the disease had significantly fewer infections. This adds to a mountain of existing evidences that public education should be an integral part of any effort to control infectious disease.
In-Depth [single-blind, unmatched, cluster-randomized]: This cluster-randomized study assessed the efficacy of health education in reducing the incidence of soil-transmitted helminth infections. The study assigned 38 schools in China randomly in a 1:1 ratio to a health-education package or a control package. The study assessed incidence of infection, as well as change in hygiene practices after the 9-month intervention. At the end of intervention, the incidence of infection was 4.1% (95% CI, 2.8 to 5.5) in the intervention group and 8.4% (95% confidence interval [CI], 6.6 to 10.2) in the control group.
Students answered a questionnaire assessing knowledge, attitudes and practices regarding the disease. The education group scored 32.8% (95% CI, 28.5 to 37.1) higher than the control group. Knowledge strongly impacted incidence– each 10% increase in the knowledge score corresponded to a 20% reduction in incidence (P<0.001). Attitude also contributed, as incidence decreased by 10% for each 10% increase in the attitude score (P=0.005).
The rate of hand washing after using the toilet increased from 46.0% at baseline to 98.9% post intervention in the education group. This rate was nearly unchanged in the control group, from 54.0% to 54.2% (P=0.005).
By Xiaozhou Liu and Mitalee Patil
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