Assessing the Impact of a Community-Led Total Sanitation Intervention on Soil-Transmitted Helminth Prevalence in Rural Madagascar: A Short Report

Soil-transmitted helminths (STHs) are a notable public health burden in rural Madagascar. Community-led total sanitation (CLTS) programmes are implemented to improve sanitation, but their specific effect on STH prevalence requires more local evidence. This short report assessed the impact of a CLTS intervention on STH prevalence among school-aged children in a rural Madagascan district. A cross-sectional survey was conducted in villages that had completed CLTS implementation and in matched control villages without the intervention. Stool samples from children were analysed using the Kato-Katz technique to detect STH eggs. Prevalence was compared between groups. STH prevalence was lower in CLTS villages (18%) than in control villages (31%). The reduction was most pronounced for Ascaris lumbricoides. Hookworm infection rates showed a less substantial decline. The CLTS intervention was associated with a reduced overall STH prevalence, supporting its role in integrated control strategies. The differential impact by species indicates persistent transmission pathways for some STHs. CLTS should be sustained and combined with periodic deworming for more comprehensive control. Further research should investigate factors sustaining hookworm transmission post-CLTS. Neglected tropical diseases, sanitation, helminthiasis, public health intervention, community engagement. This report provides local evidence on CLTS effectiveness for STH control in Madagascar, informing national sanitation and disease control policy.