Cluster randomized trial comparing school-based mass drug administration schedules in areas of western Kenya with moderate initial prevalence of Schistosoma mansoni infections
| Autor: | Karanja, Diana M. S., Awino, Emmy K., Wiegand, Ryan E., Okoth, Edward, Abudho, Bernard O., Mwinzi, Pauline N. M., Montgomery, Susan P., Secor, W. Evan |
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| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Male
lcsh:Arctic medicine. Tropical medicine Schools Time Factors lcsh:RC955-962 lcsh:Public aspects of medicine education lcsh:RA1-1270 Schistosoma mansoni World Health Organization Kenya Drug Administration Schedule Praziquantel Schistosomiasis mansoni Feces Schistosomicides parasitic diseases Prevalence Animals Humans Female Child Students Research Article |
| Zdroj: | PLoS Neglected Tropical Diseases PLoS Neglected Tropical Diseases, Vol 11, Iss 10, p e0006033 (2017) |
| ISSN: | 1935-2735 1935-2727 |
| Popis: | Background Mass drug administration (MDA) using praziquantel is the WHO-recommended approach for control of schistosomiasis. However, few studies have compared the impact of different schedules of MDA on the resultant infection levels. We wished to evaluate whether annual MDA was more effective than less frequent treatments for reducing community-level prevalence and intensity of Schistosoma mansoni infections. Methods We performed a cluster randomized trial (ISRCTN 14849830) of 3 different MDA frequencies over a 5 year period in 75 villages with moderate (10%-24%) initial prevalence of S. mansoni in school children in western Kenya. Praziquantel was distributed by school teachers to students either annually, the first 2 years, or every other year over a 4 year period. Prevalence and intensity of infection were measured by stool examination in 9–12 year old students using the Kato-Katz method at baseline, each treatment year, and for the final evaluation at year 5. S. mansoni prevalence and intensity were also measured in first year students at baseline and year 5. Results Twenty-five schools were randomly assigned to each arm. S. mansoni prevalence and infection intensity in 9–12 year old students significantly decreased within each arm from baseline to year 5 but there were no differences between arms. There were no differences in infection levels in first year students either within or between arms. Conclusions Strategies employing 2 or 4 rounds of MDA had a similar impact in schools with moderate initial prevalence, suggesting that schistosomiasis control can be sustained by school-based MDA, even if provided only every other year. Author summary The World Health Organization (WHO) guidelines recommend mass drug administration (MDA) of praziquantel for control of schistosomiasis. The target group for and the frequency of treatment are based on infections levels in school age children at the initiation of the control program. However, these guidelines have not been rigorously evaluated. Through the Schistosomiasis Consortium for Operational Research and Evaluation (SCORE), we had the opportunity to compare the impact of school-based treatment in an area of western Kenya with moderate (10%-24%) initial prevalence of Schistosoma mansoni infections. We found that providing MDA every year or every other year over a 4 year period provided similar benefits for reducing prevalence and intensity of infection in the final evaluation at year 5. Annual or biennial MDA moved villages from the “moderate risk” to the “low risk category” prescribed in the WHO guidelines. The results from this study and parallel SCORE studies in other African countries should provide the evidence base necessary for improved WHO guidelines for schistosomiasis. |
| Databáze: | OpenAIRE |
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