***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The impact of improved water , sanitation , and hygiene ( WASH ) access on mitigating illness is well documented , although impact of school-based WASH on school-aged children has not been rigorously explored . We conducted a cluster-r and omized trial in Nyanza Province , Kenya to assess the impact of a school-based WASH intervention on diarrhoeal disease in primary -school pupils . Two study population s were used : schools with a nearby dry season water source and those without . Pupils attending ' water-available ' schools that received hygiene promotion and water treatment ( HP&WT ) and sanitation improvements showed no difference in period prevalence or duration of illness compared to pupils attending control schools . Those pupils in schools that received only the HP&WT showed similar results . Pupils in ' water-scarce ' schools that received a water-supply improvement , HP&WT and sanitation showed a reduction in diarrhoea incidence and days of illness . Our study revealed mixed results on the impact of improvements to school WASH improvements on pupil diarrhoea Background The control of soil-transmitted helminth ( STH ) infections currently relies on the large-scale administration of single-dose oral albendazole or mebendazole . However , these treatment regimens have limited efficacy against hookworm and Trichuris trichiura in terms of cure rates ( CR ) , whereas fecal egg reduction rates ( ERR ) are generally high for all common STH species . We compared the efficacy of single-dose versus triple-dose treatment against hookworm and other STHs in a community-based r and omized controlled trial in the People 's Republic of China . Methodology /Principal findings The hookworm CR and fecal ERR were assessed in 314 individuals aged ≥5 years who su bmi tted two stool sample s before and 3–4 weeks after administration of  single-dose oral albendazole ( 400 mg ) or mebendazole ( 500 mg ) or triple-dose albendazole ( 3 × 400 mg over 3 consecutive days ) or mebendazole ( 3 × 500 mg over 3 consecutive days ) . Efficacy against T. trichiura , Ascaris lumbricoides , and Taenia spp . was also assessed . Albendazole  cured significantly more hookworm infections than mebendazole in both treatment regimens ( single dose : respective CRs 69 % ( 95 % confidence interval [ CI ] : 55–81 % ) and 29 % ( 95 % CI : 20–45 % ) ; triple dose : respective CRs 92 % ( 95 % CI : 81–98 % ) and 54 % ( 95 % CI : 46–71 % ) ) . ERRs followed the same pattern ( single dose : 97 % versus 84 % ; triple dose : 99.7 % versus 96 % ) . Triple-dose regimens outperformed single doses against T. trichiura ; three doses of mebendazole – the most efficacious treatment tested – cured 71 % ( 95 % CI : 57–82 % ) . Both single and triple doses of either drug were highly efficacious against A. lumbricoides ( CR : 93–97 % ; ERR : all > 99.9 % ) . Triple dose regimens cured all Taenia spp . infections , whereas single dose applications cured only half of them . Conclusions / Significance Single-dose oral albendazole is more efficacious against hookworm than mebendazole . To achieve high CRs against both hookworm and T. trichiura , triple-dose regimens are warranted . Trial Registration www.controlled-trials.com IS RCT Worldwide , lack of access to safe drinking water together with inadequate sanitation and hygiene is an overwhelming contributor to approximately 4 billion cases of illness annually . This study was set out to underst and the effects of hygiene and sanitation interventions on targeted health outcomes including diarrhoeal prevalence in children ’s of Turkana District , Kenya . The interventions undertaken included capacity building and empowerment approach to trigger communities to dem and hygiene and sanitation facilities . Three hundred mothers were r and omly sample d in a baseline survey carried out in 2007 and in a post-intervention survey carried out in 2008 ( a repeat cross-sectional study design ) . Specimens were collected for microbiological tests of key diarrhoea related pathogens . Overall , Faecal coliform counts per 100 ml sample had significant variations between 2007 and 2008 ; in Kakuma , reduced from 88 to 30.2 colony units ( P = 0.005 ) , Lodwar Central where the number reduced from 91 to 17.3 units ( P = 0.003 ) , and in Lokichogio Division , the number reduced from 63.8 to 23.6 units ( P = 0.006 ) . From the 230 stool sample s examined , the proportion of children from whom infectious pathogens of Proteus spp . was isolated reduced from 16 to 7 % while Escherichia coli reduced from 54 to 41 % . Overall , prevalence of diarrhoea related microbes in  children aged < 5 years reduced from 91.3 % in 2007 to 78.3 % after intervention ( 2008 ) . It is notable that sanitation and hygiene promotion leads to significant reduction of diarrhoea prevalence in children aged < 5 years . Its application should therefore be up-scaled in re source constrained areas Background To control soil-transmitted helminth ( STH ) infections , the World Health Organization recommends school-based deworming programs with a health hygiene education component . The effect of such health hygiene interventions , however , has not been adequately studied . The objective of the present study was to determine the effectiveness of a health hygiene education intervention on the occurrence of STH re-infection four months post-de-worming . Methodology /Principal Findings An open-label pair-matched cluster-r and omized trial was conducted in Grade 5 schoolchildren of 18 primary schools ( 9 intervention and 9 control ) in the Peruvian Amazon . Baseline assessment included interview with a pre-tested question naire and collection of single stool specimens that were examined using the single Kato-Katz thick smear . All schoolchildren were then treated with single-dose albendazole ( 400 mg ) . Schoolchildren in intervention schools then received 1 ) an initial one hour in-class activity on health hygiene and sanitation and 30-minute refresher activities every two weeks over four months ; and 2 ) a half-day workshop for teachers and principals , while children in control schools did not . Four months later , STH infection was re-assessed in all schools by laboratory technologists blinded to intervention status . From April 21–October 20 , 2010 , a total of 1,089 schoolchildren ( 518 and 571 from intervention and control schools , respectively ) participated in this study . Intervention children scored significantly higher on all aspects of a test of STH-related knowledge compared with control children ( aOR = 18·4 ; 95 % CI : 12·7 to 26·6 ) . The intensity of Ascaris lumbricoides infection at follow-up was statistically significantly lower ( by 58 % ) in children in intervention schools compared with children in control schools ( aIRR = 0·42 ; 95 % CI = 0·21 to 0·85 ) . No significant changes in hookworm or Trichuris trichiura intensity were observed . Conclusions / Significance A school-based health hygiene education intervention was effective in increasing STH knowledge and in reducing Ascaris lumbricoides infection . The benefits of school-based periodic deworming programs are likely to be enhanced when a sustained health hygiene education intervention is integrated into school curricula We evaluated whether an educational intervention that was effective in reducing  childhood diarrhea  also improved childhood nutritional status .  Fifty-one communities of 38 families each were r and omized to receive the intervention or no intervention . During 1 y of follow-up the rate of diarrhea ( per 100 wk ) in children less than 6 y in the intervention group was 5.89 episodes whereas that in the nonintervention group was 7.55 episodes ( protective efficacy 22 % ; p less than 0.0001 ) . During the same follow-up period children in both groups exhibited comparable patterns of weight gain ; 1 y after the intervention the mean weight for age of children in both groups was 76 % of the NCHS st and ard . No significant differences were observed in the proportion of each group that experienced a major deterioration or improvement of nutritional status . We conclude that an intervention that reduces rates of  childhood diarrhea  may not necessarily also improve nutritional status SUMMARY OBJECTIVE To determine the impact after 2 years of a water and health education ( W/HE ) programme on  ocular Chlamydia trachomatis infection and trachoma . METHODS We r and omized 12 trachoma-endemic communities in Maradi , Niger 1:1 to W/HE intervention and control arms and collected data on 10 of the 12 villages . In the intervention villages , at least one clean water well was constructed , and a 3 month , modest health education programme was provided immediately prior to the 2 year survey . We censused all households , and 557 children ages 1 - 5 years were r and omly selected as sentinel children and examined at baseline and at one and 2 years from baseline . Trachoma was clinical ly assessed and a swab taken and analyzed for C. trachomatis . Tetracycline eye ointment was provided to all children in either arm during the surveys who had signs of trachoma . RESULTS Infection with C. trachomatis declined slightly , and not significantly , in the children in the control villages over the 2 years , from 15 % to 11 % . The decline in infection was more pronounced , and significant , in the children in the intervention villages , from 26 % to 15 % . However , the change in infection rates in the intervention villages was not significantly different from the change in infection rates in the control villages ( P = 0.39 , and 0.11 for change from baseline to 1 year and 2 year , respectively ) . There was also no difference in the change in overall trachoma rates between the two arms . CONCLUSION These data suggest that the provision of water plus a modest health education programme did not result in a significant difference in trachoma or ocular C. trachomatis infection in endemic communities in Niger . A more substantial health education intervention is likely necessary to produce change BACKGROUND Community-led total sanitation ( CLTS ) uses participatory approaches to mobilise communities to build their own toilets and stop open defecation . Our aim was to undertake the first r and omised trial of CLTS to assess its effect on child health in Koulikoro , Mali . METHODS We did a cluster-r and omised trial to assess a CLTS programme  implemented by the Government of Mali . The study population included households in rural villages ( clusters ) from the Koulikoro district of Mali ; every household had to have at least one child aged younger than 10 years . Villages were r and omly assigned ( 1:1 ) with a computer-generated sequence by a study investigator to receive CLTS or no programme . Health outcomes included diarrhoea ( primary outcome ) , height for age , weight for age , stunting , and underweight . Outcomes were measured 1·5 years after intervention delivery ( 2 years after enrolment ) among children younger than 5 years . Participants were not masked to intervention assignment . The trial is registered with Clinical Trials.gov , number NCT01900912 . FINDINGS We recruited participants between April 12 , and June 23 , 2011 . We assigned 60 villages ( 2365 households ) to receive the CLTS intervention and 61 villages ( 2167 households ) to the control group . No differences were observed in terms of diarrhoeal prevalence among children in CLTS and control villages ( 706 [ 22 % ] of 3140 CLTS children vs 693 [ 24 % ] of 2872 control children ; prevalence ratio [ PR ] 0·93 , 95 % CI 0·76 - 1·14 ) . Access to private latrines was almost twice as high in intervention villages ( 1373 [ 65 % ] of 2120 vs 661 [ 35 % ] of 1911 households ) and reported open defecation was reduced in female ( 198 [ 9 % ] of 2086 vs 608 [ 33 % ] of 1869 households ) and in male ( 195 [ 10 % ] of 2004 vs 602 [ 33 % ] of 1813 households ) adults . Children in CLTS villages were taller ( 0·18 increase in height-for-age Z score , 95 % CI 0·03 - 0·32 ; 2415 children ) and less likely to be stunted ( 35 % vs 41 % , PR 0·86 , 95 % CI 0·74 - 1·0 ) than children in control villages . 22 % of children were underweight in CLTS compared with 26 % in control villages ( PR 0·88 , 95 % CI 0·71 - 1·08 ) , and the difference in mean weight-for-age Z score was 0·09 ( 95 % CI -0·04 to 0·22 ) between groups . In CLTS villages , younger children at enrolment ( < 2 years ) showed greater improvements in height and weight than older children . INTERPRETATION In villages that received a behavioural sanitation intervention with no mon 
    Output:
    
A total of 171 studies met the review 's inclusion criteria , including 64 studies not included in the previous review s. Overall , the evidence suggests that sanitation is protective against diarrhea , active trachoma , some STH infections , schistosomiasis , and height-for-age , with no protective effect for other anthropometric outcomes .
This review confirms positive impacts of sanitation on aspects of health .