A Critical Appraisal of Control Strategies for Soil-Transmitted Helminths

Interventions that lead to reductions in soil-transmitted helminths (STHs) include chemotherapy with anthelmintic drugs and improvements in water, sanitation, and hygiene (WASH). In this opinion article we aim to determine the evidence for optimal approaches for STH control. First we explore the evidence for the above interventions. We then appraise two integration strategies: current chemotherapy-oriented integrated neglected tropical disease (NTD) control and expanded ‘multicomponent integration’, which includes integrated chemotherapy, WASH, and other intervention strategies. While multicomponent integrated control may be an effective approach to sustainably reduce STH transmission, there is a need for evidence to prove the feasibility of this approach.

TrendsChemotherapy and improving water, sanitation, and hygiene (WASH) are recognized interventions against soil-transmitted helminths (STHs). There is strong evidence that chemotherapy rapidly reduces STH burdens. There is insufficient evidence that chemotherapy benefits long-term health or that WASH impacts any STH outcome. Carefully designed trials are needed to strengthen this evidence base.Integrated neglected tropical disease (NTD) control and elimination simultaneously reduces the burden of multiple diseases and can achieve high treatment coverage. This will have limited success in STH control due to rapid reinfection rates.Integration should focus on primary prevention and intersectoral cooperation and permanent infrastructure that may reduce STH transmission. Evaluation is needed to prove that integrated NTD control contributes to health-system strengthening.