Campbell SJ, Savage GB, Gray DJ, Atkinson J-AM, Soares Magalhes RJ, et al. (2014) Water, Sanitation, and Hygiene (WASH): A Critical Component for Sustainable Soil-Transmitted Helminth and Schistosomiasis Control. PLoS Negl Trop Dis 8(4): e2651. doi:10.1371/journal.pntd.0002651
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The paper concludes: 'Progress towards achieving global control of helminths crucially depends on sustainable solutions that move beyond treating symptoms towards reducing exposure. With that in mind, it is necessary to augment chemotherapy with WASH and other interventions such as health promotion to achieve a cumulative impact of preventing reinfection and providing the greatest and most sustainable gains for helminth control and elimination. We believe that a strong justification exists to revise the WHO guidelines in the face of the abovementioned shortcomings. Such revision will result in a much-enhanced document that covers the full spectrum of short- and longer-term interventions for more holistic STH and schistosomiasis control. Impact indicators for WASH, in addition to disease-related indicators such as prevalence of infection, should define the success of a control programme and guide decisions as to when such programmes should cease. This would ensure current gains in helminth control are built upon beyond the current dependence on chemotherapy.'
The authors concede 'There is very little literature that indicates direct WASH impact on helminth control' but claim that 'existing evidence is already strong enough to support complementing drug-based interventions with the provision of WASH for all'.
'The WHO guidelines published in 2002 were the first such document of its kind. It admirably articulated a large volume of technical information to assist programme managers develop prevention and control strategies. The more recent version [http://whqlibdoc.who.int/publications/2011/9789241548267_eng.pdf - dated 2011], however, does not seem to have progressed considerably from the earlier version. Rather, the recognition in the 2002 version that resources must not be diverted prematurely in countries where morbidity has been significantly reduced but transmission continues mitigates risk more appropriately than the current second edition guidelines. We believe there is a strong justification for a further revision to be undertaken.'
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