WASH for WORMS: a cluster-randomized controlled trial of the impact of a community integrated water, sanitation, and hygiene and deworming intervention on soil-transmitted helminth infections

Water, sanitation, and hygiene (WASH) interventions have been proposed as an important complement to deworming programs for sustainable control of soil-transmitted helminth (STH) infections. We aimed to determine whether a community-based WASH program had additional benefits in reducing STH infections compared with community deworming alone. We conducted the WASH for WORMS cluster-randomized controlled trial in 18 rural communities in Timor-Leste. Intervention communities received a WASH intervention that provided access to an improved water source, promoted improved household sanitation, and encouraged handwashing with soap. All eligible community members in intervention and control arms received albendazole every 6 months for 2 years. The primary outcomes were infection with each STH, measured using multiplex real-time quantitative polymerase chain reaction. We compared outcomes between study arms using generalized linear mixed models, accounting for clustering at community, household, and individual levels. At study completion, the integrated WASH and deworming intervention did not have an effect on infection with Ascaris spp. (relative risk [RR] 2.87, 95% confidence interval [CI]: 0.66-12.48, P = 0.159) or Necator americanus (RR 0.99, 95% CI: 0.52-1.89, P = 0.987), compared with deworming alone. At the last follow-up, open defecation was practiced by 66.1% (95% CI: 54.2-80.2) of respondents in the control arm versus 40.2% (95% CI: 25.3-52.6) of respondents in the intervention arm (P = 0.005). We found no evidence that the WASH intervention resulted in additional reductions in STH infections beyond that achieved with deworming alone over the 2-year trial period. The role of WASH on STH infections over a longer period of time and in the absence of deworming remains to be determined

WASH for WORMS: a cluster-randomized controlled trial of the impact of a community integrated water, sanitation, and hygiene and deworming intervention on soil-transmitted helminth infections

Water, sanitation, and hygiene (WASH) interventions have been proposed as an important complement to deworming programs for sustainable control of soil-transmitted helminth (STH) infections. We aimed to determine whether a community-based WASH program had additional benefits in reducing STH infections compared with community deworming alone. We conducted the WASH for WORMS cluster-randomized controlled trial in 18 rural communities in Timor-Leste. Intervention communities received a WASH intervention that provided access to an improved water source, promoted improved household sanitation, and encouraged handwashing with soap. All eligible community members in intervention and control arms received albendazole every 6 months for 2 years. The primary outcomes were infection with each STH, measured using multiplex real-time quantitative polymerase chain reaction. We compared outcomes between study arms using generalized linear mixed models, accounting for clustering at community, household, and individual levels. At study completion, the integrated WASH and deworming intervention did not have an effect on infection with Ascaris spp. (relative risk [RR] 2.87, 95% confidence interval [CI]: 0.66-12.48, P = 0.159) or Necator americanus (RR 0.99, 95% CI: 0.52-1.89, P = 0.987), compared with deworming alone. At the last follow-up, open defecation was practiced by 66.1% (95% CI: 54.2-80.2) of respondents in the control arm versus 40.2% (95% CI: 25.3-52.6) of respondents in the intervention arm (P = 0.005). We found no evidence that the WASH intervention resulted in additional reductions in STH infections beyond that achieved with deworming alone over the 2-year trial period. The role of WASH on STH infections over a longer period of time and in the absence of deworming remains to be determined

Tectonic control on the eruptive dynamics at Mt. Etna Volcano (Sicily) during the 2001 and 2002–2003 eruptions

The eruptive events of the July–August 2001 and October 2002–January 2003 at Mt. Etna provide new insights for reconstructing the complex geometry of the feeding system and their relationship to regional tectonics. The 2001 eruption took place mainly on the upper southern sector of the volcano. The eruption was preceded by a large earthquake swarm for a few days before its onset and accompanied by ground deformation and fracturing. The development of surface cracking along with the seismic pattern has allowed us to recognize three distinct eruptive systems (the SW–NE, NNW–SSE and N–S systems) which have been simultaneously active. Such eruptive systems are only the upper portions of a complex feeding system that was fed at the same time by two distinct magmas. The SW–NE and NNW–SSE systems, connected with the SE crater conduit, were fed by magma coming from depth, whereas the N–S system served instead as an ascending pathway for an amphibole-bearing magma residing in a shallow reservoir. The eruptive activity started again on October 2002 on the NE Rift Zone, where about 20 eruptive vents were aligned between 2500 and 1900 m a.s.l., and on the southern flank, from the central crater to the Montagnola. The onset of eruptive activity was accompanied by a seismic swarm. As in the 2001 eruptive event, two independent feeding systems formed, characterized by distinct magmas. The SW–NE system controlled the feeding of the Northeast Rift and was accommodated by left-lateral displacement along the WNW–ESE trending Pernicana Fault. The N–S system fed the eruptions on the southern flank. Moreover, the associated crustal deformation triggered seismic reactivation of tectonic structures in the eastern flank of the volcano and offshore. These two last eruptions indicate that at Mt. Etna the ascent of magma, as well as the accommodation of deformation, is strongly dominated by local extensional structures that are connected to a regional tectonic regime