Integrated Community-Based Intervention Strategies for Accelerating Neglected Tropical Disease Control in Nigeria’s Northeast: A Randomised Implementation Trial

Integrating health education, water sanitation and hygiene improvements, and preventive chemotherapy delivery into unified community platforms has been proposed as a transformative approach to accelerating NTD control, but rigorous randomised implementation trial evidence for this model in Nigeria's conflict-affected northeast is absent. This doctoral research designs, implements, and evaluates an integrated community-based NTD intervention strategy in Adamawa, Borno, and Yobe States in Nigeria's northeast through a cluster-randomised implementation trial. Forty communities were randomised 1:1 to receive the integrated intervention package (preventive chemotherapy plus structured WASH behaviour change communication plus vector control) or the standard-of-care control arm (preventive chemotherapy alone). Primary outcomes were reductions in STH, schistosomiasis, and LF prevalence and intensity at 12 and 24 months post-intervention. Secondary outcomes included bednet use, open defecation rates, handwashing compliance, and drug uptake coverage. Process evaluation assessed implementation fidelity, community acceptance, and unit cost of integrated delivery. Evidence from 2020 to 2024 from sub-Saharan African implementation research suggests 40 to 60 percent greater NTD prevalence reductions in integrated platforms compared with chemotherapy alone. This trial generates the first randomised implementation evidence for integrated NTD programming in northeastern Nigeria, producing generalizable implementation blueprints. Findings will be submitted to the Federal Ministry of Health, USAID Nigeria, and the Lancet Global Health. Keywords: integrated NTD intervention, cluster-randomised trial, northeast Nigeria, WASH, preventive chemotherapy.