Integrating sanitation and hygiene education to reduce infection and reinfection by intestinal worms among at-risk children

Our Impact


Teachers and Community Health Workers Trained to Deliver Hygiene Education


School-Aged Children Receive Deworming Treatment


Schools Administering Deworming Medication

The Need

Soil transmitted helminths (STH), commonly known as intestinal worms, have long been known to limit physical and mental growth in children, even affecting earned wages into adulthood. The World Health Organization has called for greater efforts to control STH, in the context of WASH delivery, as a key priority as part of its larger neglected tropical disease (NTD) agenda.

In Vietnam, great progress has been made in health and development, but important work remains to be done in the area of environmental health to ensure that all children are afforded the chance to live healthy, productive lives. STH prevalence is common, reaching 90% in some areas. Several factors make the country especially prone to parasite development including its climate, the common use of fresh manure as fertilizer and lack of proper sanitation facilities and hygiene behaviors. The WHO and UNICEF estimate that roughly a third of the population in Vietnam lack access to improved sanitation, while a hand washing promotion study found that only 24% of caregivers washed their hands with soap after fecal contact.

Together with the provision of deworming medicine to at-risk children, an integrated approach that addresses these multiple risk factors is needed to minimize the risk of re-infection and achieve sustained health outcomes.

Our Approach

With funding from Dubai Cares, the program targets four provinces in Vietnam with poor sanitation coverage and high rates of soil transmitted helminths (STH) infection. STHs cause health problems in children that can negatively affect school attendance and ultimately translate into poor life outcomes.

In close collaboration with Evidence Action’s Deworm the World initiative and the Vietnamese government, our program will deliver deworming medication to an estimated 728,000 school-age children from over 2,800 primary schools. Community health workers and teachers will be trained to administer the medicine to their students at schools and the program will employ a systematic distribution cascade for medicine, training and marketing materials, and reporting, which will ensure a cost-effective and scalable approach.

The provision of deworming medication is complemented by the program’s focus on changing hygiene behaviors among students and their families. Through a carefully designed randomized control experiment, we will be testing several novel approaches for increasing handwashing with soap in schools as well as reducing exposure to STH in the environment. One school-based measure we will be evaluating is a film that was demonstrated to reduce STH reinfection in a recently published trial from China.

Collaboration is key to the success of the deworming program at all levels. On the ground, it leverages the existing infrastructure of schools, teachers, health workers, and local civic groups to implement its activities. It will generate evidence of the impact of an integrated approach and, if borne out by experimental results, will advocate for adoption of an integrated national policy to control STH.

Selected Partners & Funders