Comparison of School-Based and Community-Wide Mass Drug Administration for Schistosomiasis Control in an Area of Western Kenya with High Initial Schistosoma mansoni Infection Prevalence: A Cluster Randomized Trial
We conducted a cluster randomized trial comparing the target population and timing of mass drug administration (MDA) with praziquantel for control of schistosomiasis in villages in western Kenya with high initial prevalence (> 25%) according to a harmonized protocol developed by the Schistosomias...
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Published in | The American journal of tropical medicine and hygiene Vol. 102; no. 2; pp. 318 - 327 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
Published |
United States
Institute of Tropical Medicine
01.02.2020
The American Society of Tropical Medicine and Hygiene |
Subjects | |
Online Access | Get full text |
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Summary: | We conducted a cluster randomized trial comparing the target population and timing of mass drug administration (MDA) with praziquantel for control of schistosomiasis in villages in western Kenya with high initial prevalence (> 25%) according to a harmonized protocol developed by the Schistosomiasis Consortium for Operational Research and Evaluation. A total of 150 villages were randomized into six treatment arms (25 villages per arm), were assessed at baseline, and received two or four rounds of MDA using community-wide (CWT) or school-based (SBT) treatment over 4 years. In the fifth year, a final evaluation was conducted. The primary outcomes were prevalence and intensity of
infections in children aged 9-12 years, each year their village received MDA. Baseline and year 5 assessments of first-year students and adults were also performed. Using Poisson and negative binomial regression with generalized estimating equations, we found similar effects of CWT and SBT MDA treatment strategies in children aged 9-12 years: significant reductions of prevalence of infection in all arms and of heavy-intensity (≥ 400 eggs/gram) infections in most arms but no significant differences between arms. Combined arms of villages that received four rounds of treatment had greater reduction than villages in arms that only received two rounds of treatment. Surprisingly, we also found benefits of SBT for first-year primary students and adults, who never received treatment in those arms. Our data support the use of annual SBT for control programs when coupled with attention to infections in younger children and occasional treatment of adults. |
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Bibliography: | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-News-1 ObjectType-Feature-3 content type line 23 Financial support: This work was supported by the University of Georgia Research Foundation, Inc., which was funded by the Bill & Melinda Gates Foundation for the SCORE Project. Authors’ addresses: W. Evan Secor, Ryan E. Wiegand, and Susan P. Montgomery, US Centers for Disease Control and Prevention, Atlanta, GA, E-mails: was4@cdc.gov, fwk2@cdc.gov, and zqu6@cdc.gov. Diana M. S. Karanja and Maurice R. Odiere, Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya, E-mails: diana@cohesu.org and mauriceodiere@gmail.com. Disclosures: Pauline Mwinzi was the principal investigator who oversaw the execution of this study when it was performed. However, because she is now the regional advisor on schistosomiasis with the African Regional Office of the WHO, she has chosen to forego authorship to avoid any appearance of a conflict of interest or undue influence of the findings of the study. This work is published with the permission of the Director, Kenya Medical Research Institute. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the CDC. |
ISSN: | 0002-9637 1476-1645 |
DOI: | 10.4269/ajtmh.19-0626 |