Effectiveness of the BALatrine intervention on soil-transmitted helminth infections in Central Java, Indonesia: a cluster-randomised controlled trial

Background: Soil-transmitted helminths (STH) continue to pose a significant global health challenge, particularly in areas lacking improved sanitation and safe drinking water. While preventive chemotherapy helps control infections, to prevent reinfection sustainable solutions require additional approaches, such as improved sanitation infrastructure and health education, to prevent reinfection. In this study, we present the results of a trial aimed at evaluating the effectiveness of an integrated BALatrine intervention to prevent STH infections in Central Java, Indonesia.Methods: We conducted a cluster randomised controlled trial involving 2,155 participants in 8 sub-village clusters between October 2016 and October 2017. Intervention villages received mass drug administration (MDA), the BALatrine, and community hygiene education, while the control group received only MDA. We compared outcomes between study arms using a generalized-estimating-equation (GEE), with a p-value of less than 0.05 considered statistically significant. This trial is registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12613000523707).Findings: At baseline, the prevalence of any STH infection was 14.6% (95% CI: 12.6–16.6) in the control group versus 13.9% (95% CI: 11.8–16.4) in the intervention group. At the follow-up, the BALatrine intervention had a significant overall effect on any STH infection (adjusted OR: 0.2, 95% CI: 0.2–0.3). Stratifying by STH species also showed a significant effectiveness of 100% for Ascaris lumbricoides and 95% for hookworm (adjusted OR = 0.05, 95%CI: 0.01–0.21), but the reduction in Trichuris trichiura was not statistically significant (adjusted OR = 0.73, 95%CI: 0.48–1.11).Interpretation: The integrated BALatrine intervention was associated with a reduced incidence of overall STH infections, particularly Ascaris lumbricoides, and hookworm. This study highlights the potential interventions that focus on sanitation and hygiene, combined with health education and treatment to control and eliminate STH infections.