A strengthening evidence-base for mass deworming, but questions remain

Koukounari, Artemis; Hollingsworth, T. Déirdre

doi:10.1016/s0140-6736(16)32452-7

Cited by 4 publications

(3 citation statements)

References 12 publications

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“…Above all, the likelihood of prevalence of helminth infections > 20% in the study sites consistent to other studies pointed out the need for transmission elimination plans including mass deworming. The success may depend upon the increased investment to address the research gaps through the appropriate use of sensitive diagnostic tools to detect persistent infections and polyparasitism apart from the conventional K-K method [29, 30].…”

Section: Discussionmentioning

confidence: 99%

Emerging neglected helminthiasis and determinants of multiple helminth infections in flood-prone township in Myanmar

et al. 2019

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BackgroundMyanmar has similar agro-based ecology and environmental risks as others in the Greater Mekong sub-region leading to the broad array of helminthic infections. Basic health staff (BHS) from the public sector forms a key stakeholder group in deworming interventions. The study aimed to ascertain the prevalence and determinants of multiple species helminth infections to promote township-level integrated interventions.MethodsA cross-sectional implementation research study in 2017 covered randomly selected 240 households in four villages of Shwegyin Township. Trained interviewers administered the pre-tested structured questionnaire to either the household head or the assigned person concerning their knowledge, perceptions, practices, food habits, and deworming experience. Concomitantly, the research team collected a single stool sample from each of 698 participants (age range of 8 months to 87 years) from 93% (224/240) of eligible households and examined by Kato-Katz smear microscopy. Eventually, 16 BHS joined the interactive dialogue session based on research evidence and knowledge translated for further validation.ResultsThe estimated prevalence of at least one helminth infection was 24% [168/698; 95% CI 21.0–27.0]. Apart from the soil-transmitted helminths (14%), zoonotic helminths especially Taenia spp. (0.7%) and Schistosoma spp. (3%) were detected. Almost half of the seasonally mobile gold panning workers (12/25; 48%) and 46% of pre-school-age children had helminth infections. Community risk groups at riverside villages had significantly higher multiple species helminth infection than those from inland villages (AOR = 10.9; 95% CI 4.9–24.2). Gold panning workers had higher infection rates than other categories (AOR = 2.5; 95% CI 0.6–9.5) but not significant. In flood-prone areas, householders failed to follow the guidelines to construct/re-construct specific type of sanitary latrines and challenges remained in disseminating health messages for community engagement. The innovative ideas recapitulated by BHS included the integration of health talks during the sessions for small agricultural loans and to harness advocacy with water, sanitation, and hygiene interventions.ConclusionsThe emerging evidence of neglected zoonotic helminths required attention to introduce the periodic mopping-up and the “selective deworming plan” for vulnerable groups to cover the missed targets. Further multidisciplinary research to confirm the intermediate hosts and vectors of zoonotic helminths in the environment is essential for surveillance and response.Electronic supplementary materialThe online version of this article (10.1186/s41182-018-0133-6) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Emerging neglected helminthiasis and determinants of multiple helminth infections in flood-prone township in Myanmar

et al. 2019

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“…Meta-analysis and meta-regression are observational research that depends on the quality of the studies that are included. As previously noted by others [31], the level of evidence for many NTD clinical studies has to be categorized as only “very low, low, or moderate quality”. That said, is has been the chronic underfunding of clinical trials (performed in resource limited settings) that has been an important part of the ‘neglect’ of NTDs.…”

Section: Discussionmentioning

confidence: 99%

“…The perceived quality of individual studies was assessed, but not formally quantified in our analysis because of specific limiting features found in many NTD trials [31]. A summary of study design and quality factors for each included study is presented in supplemental information file S2 Text: ‘Study design and quality features for included studies’.…”

Section: Methodsmentioning

confidence: 99%

Decline in infection-related morbidities following drug-mediated reductions in the intensity of Schistosoma infection: A systematic review and meta-analysis

et al. 2017

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BackgroundSince 1984, WHO has endorsed drug treatment to reduce Schistosoma infection and its consequent morbidity. Cross-sectional studies suggest pre-treatment correlation between infection intensity and risk for Schistosoma-related pathology. However, evidence also suggests that post-treatment reduction in intensity may not reverse morbidity because some morbidities occur at all levels of infection, and some reflect permanent tissue damage. The aim of this project was to systematically review evidence on drug-based control of schistosomiasis and to develop a quantitative estimate of the impact of post-treatment reductions in infection intensity on prevalence of infection-associated morbidity.Methodology/Principal findingsThis review was registered at inception with PROSPERO (CRD42015026080). Studies that evaluated morbidity before and after treatment were identified by online searches and searches of private archives. Post-treatment odds ratios or standardized mean differences were calculated for each outcome, and these were correlated to treatment-related egg count reduction ratios (ERRs) by meta-regression. A greater ERR correlated with greater reduction in odds of most morbidities. Random effects meta-analysis was used to derive summary estimates: after treatment of S. mansoni and S. japonicum, left-sided hepatomegaly was reduced by 54%, right-sided hepatomegaly by 47%, splenomegaly by 37%, periportal fibrosis by 52%, diarrhea by 53%, and blood in stools by 75%. For S. haematobium, hematuria was reduced by 92%, proteinuria by 90%, bladder lesions by 86%, and upper urinary tract lesions by 72%. There were no consistent changes in portal dilation or hemoglobin levels. In sub-group analysis, age, infection status, region, parasite species, and interval to follow-up were associated with meaningful differences in outcome.Conclusion/SignificanceWhile there are challenges to implementing therapy for schistosomiasis, and praziquantel therapy is not fully curative, reductions in egg output are significantly correlated with decreased morbidity and can be used to project diminution in disease burden when contemplating more aggressive strategies to minimize infection intensity.

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Spotlight on experiences of medicine unavailability: access to medicines challenges for NCDs and NTDs - the contrasting cases of insulin and praziquantel

Wells

Chappuis

Beran

2020

Expert Review of Clinical Pharmacology

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A strengthening evidence-base for mass deworming, but questions remain

Cited by 4 publications

References 12 publications

Emerging neglected helminthiasis and determinants of multiple helminth infections in flood-prone township in Myanmar

Emerging neglected helminthiasis and determinants of multiple helminth infections in flood-prone township in Myanmar

Decline in infection-related morbidities following drug-mediated reductions in the intensity of Schistosoma infection: A systematic review and meta-analysis

Spotlight on experiences of medicine unavailability: access to medicines challenges for NCDs and NTDs - the contrasting cases of insulin and praziquantel

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