Do shoes reduce hookworm infection in school-aged children on Pemba Island, Zanzibar? A pragmatic trial

• Published in: Transactions of the Royal Society of Tropical Medicine and Hygiene 2014-05, Vol.108 (5), p.297-304
• Main Authors: Bird, Chris, Ame, Shaali, Albonico, Marco, Bickle, Quentin
• Format: Article
• Language: English
• Subjects: Albendazole - administration & dosage; Ancylostomiases; Animals; Anthelmintics - administration & dosage; Biological and medical sciences; Child; Cluster Analysis; Diseases caused by nematodes; Feces - parasitology; Female; Follow-Up Studies; General aspects; Government Programs; Health Education; Helminthic diseases; Hookworm Infections - drug therapy; Hookworm Infections - epidemiology; Hookworm Infections - prevention & control; Humans; Infectious diseases; Male; Medical sciences; Parasitic diseases; Prevalence; Schools; Shoes; Soil - parasitology; Students; Tanzania - epidemiology
• ISSN: 0035-9203; 1878-3503
• DOI: 10.1093/trstmh/tru037

Background A non-blinded, cluster randomised controlled trial to test whether footwear reduces prevalence and intensity of hookworm infection in school-aged children on Pemba Island, Zanzibar. Methods Six schools were randomised to receive shoes and standard care (deworming with albendazole and health education) and six control schools to receive standard care only. Children provided a stool sample to assess prevalence and intensity of infection with soil transmitted helminthiases (Ascaris lumbricoides, Trichuris trichiura and hookworm). Shoes were then distributed to pupils in the intervention schools; deworming took place as part of the government's mass drug administration programme and a further round of stool samples were collected six months later. Results Nine hundred and fifteen children were traced at follow-up (1056 at baseline). As many children wore shoes in the control arm as the intervention arm. There was no difference in hookworm prevalence (23.4% for intervention schools, 21.3% for control schools, p=0.48), and no difference in mean hookworm infection in eggs/gram of stool (18, 1–36 in intervention schools, 18, 7–29 in control schools, p=0.23). Shoe-wearing increased across all schools, from 47.4 to 82.4%. If a child wore shoes at the end of the study, the relative risk of hookworm infection was 0.7 (CI 0.53–0.91). Conclusion Due to contamination, the trial could not conclude that shoes were protective against hookworm infection but the intervention led to behavioural change, and observational data suggest that shoes are protective against hookworm. This trial is registered at ClinicalTrials.gov, NCT01869127.