Study design

The study was designed as a non-randomized clustered controlled trial. It describes a longitudinal cohort of children that were followed-up for a period of two years. The intervention group consisted of public elementary schools implementing the FIT programme interventions, including:

Daily handwashing with soap as a group activity,

Daily toothbrushing with 0.3 ml of toothpaste (containing 1450 ppm free available fluoride) as a group activity,

Biannual deworming with a single dose of albendazole or mebendazole (400 mg tablet) as part of the respective national government-coordinated deworming programme.

Access to water and soap is a prerequisite for the practice of these daily hygiene activities. Therefore, the FIT programme supported the construction and maintenance of group washing facilities, which serve as a starting point for stepwise improvement of other aspects of WinS, such as availability of appropriate sanitation facilities. Group washing facilities consisted of prefabricated facilities containing several water slots to accommodate many students for group hygiene activities [16]. Educational staff in the intervention schools received practical guidance and training materials, but no further support to implement the programme activities. The control group included public elementary schools that implemented nothing else than the regular government health education curriculum and biannual deworming as part of the national deworming programme. The national deworming programme has been implemented since 2004, 1999, and 2005 in Cambodia, Indonesia and Lao PDR respectively. Baseline data were collected in 2012 - two weeks before the implementation of the FIT programme - and follow-up data were collected 24 months later in 2014.

The study’s original methodology and protocol was developed in the Philippines in 2009 [17]. The HOS in Cambodia, Indonesia and Lao PDR followed a similar methodology.