Instruction in Behavior Modification Can Significantly Alter Soil-transmitted Helminth (STH) Re-infection Following Therapeutic De-worming

Five elementary ("prototypic") schools located in five districts in central Java were selected and the children examined for helminth infections (Ascaris, Trichuris, hookworm). They were de-wormed with a course of mebendazole and provided with 6-7 months of "behavioral remediation instruction" (BRI). In other ("control") schools, children were treated with mebendazole but were not provided BRI. The objective was to determine the effectiveness of BRI in minimizing infection/re-infection following deworming. After the 6-7 month course of BRI in the prototypic schools, all the children (in both the prototypic and control schools) were re-examined for geohelminth infection. The schools in two of the five districts were omitted from further analysis because the overall prevalence of infection was low (<10%) and the infections were dominated by hookworm which are only moderately susceptible to mebendazole. Comparisons of prototypic and control schools in the other three districts provided compelling evidence that BRI was quite effective in reducing both the frequency and intensity of infection with Ascaris and Trichuris. We suggest that instructing children and adults corrects personal habits which are conducive to infection and can be an effective and safe substitute for repeated deworming, reducing the opportunity for the emergence of drug-resistant helminthes, which should prolong the time benzimidazoles may be used for treatment of geohelminth infection.