A Study of the Cost Effectiveness of Selective Health Interventions for the Control of Intestinal Parasites in Rural Bangladesh

Abstract

The study examined the cost effectiveness of 4 different regimens in reducing the prevalence and intensity of infection of Ascaris lumbricoides, Trichuris trichiura, and hookworm over an 18-mo period in randomized community samples of children aged 2-8 yr living in rural Bangladesh. The household was the unit of randomization in each community. The 4 regimens were (1) only chemotherapy to all household members at the commencement of the study (i.e., at an interval of 18 mo), (2) same as group (1) and regular health education throughout the study period, (3) chemotherapy to all household members at the commencement of the study and subsequent chemotherapy to all children at intervals of 6 mo, and (4) same as group 3 with the addition of regular health education throughout the study period. Health education (through home and school visits and focus group discussions) was aimed at increasing awareness of worm transmission and the disabilities caused by intestinal helminths. Simple ways of improving personal hygiene and sanitation through hand washing, nail trimming, wearing of shoes, and use of a latrine and clean water supplies were encouraged. Because albendazole is a broad spectrum anthelmintic, the cost effectiveness of the 4 interventions were compared by the weighted percentage reduction in prevalence and the weighted percentage reduction in intensities of infection as measured by geometric mean egg loads of all 3 worms combined. The most cost-effective strategy was the single albendazole mass chemotherapy at an interval of 18 mo. The 2 regimens involving health education were the least cost effective.

The impact of a school-based safe water and hygiene programme on knowledge and practices of students and their parents: Nyanza Province, western Kenya, 2006

“…Besides impacting school attendance, the resulting burden of diarrhoeal diseases and parasitic infestations has a negative impact on students' growth, nutritional status, physical activities, cognition, concentration, and school performance [1]. Findings of other research studies have suggested that health education on personal hygiene and interventions to prevent disease caused specifically by parasitic worm infections can have a beneficial impact on the health of students and may be cost effective [16][17][18][19][20][21]. Furthermore, interventions that contribute to decreased absenteeism could facilitate improved learning, and have important implications for the country's development [22].…”

Prevalence and intensity of infections of Ascaris lumbricoides and Trichuris trichiura and associated socio-demographic variables in four rural Honduran communities

“…Hence, knowledge of these factors may help reduce costs of studies for policy formulation, and facilitate implementation of public health interventions designed to reduce the incidence of helminth infections in developing countries with similar environmental conditions and sanitary practices. Community-based mass chemotherapy on a regular basis can meet shortterm objectives of intestinal helminth reduction, and is the most cost-effective method (Mascle-Taylor et al 1999). Health promotion education, the adoption of hygienic practices, and school-based deworming programs can have long-term benefits and have proven effective in other countries (Holland et al 1996, Stolzfus et al 1997, Mascle-Taylor et al 1999.…”

“…Community-based mass chemotherapy on a regular basis can meet shortterm objectives of intestinal helminth reduction, and is the most cost-effective method (Mascle-Taylor et al 1999). Health promotion education, the adoption of hygienic practices, and school-based deworming programs can have long-term benefits and have proven effective in other countries (Holland et al 1996, Stolzfus et al 1997, Mascle-Taylor et al 1999.…”

Evaluación de la nitazoxanida en dosis única y por tres días en parasitosis intestinal

“…4 Para tratamientos masivos contra nemátodos intestinales se han empleado, solos o combinados, el albendazol, 5 levamisol, 6 mebendazol 7 y pamoato de pirantel. 8 El albendazol ha sido efectivo contra ascariasis, enterobiasis e infecciones por céstodos, 9,10 es bien tolerado y fácil de administrar, y se ha usado en campañas masivas en dosis únicas de 400 mg. 11 Sin embargo, se ha observado que el albendazol es menos efectivo en la erradicación de protozoarios, y se teme que en el mundo esté aumentando la resistencia de parásitos a los agentes comúnmente utilizados para quimioprevención masiva. 12 Por esta razón, es importante emprender una búsqueda de nuevas alternativas de quimioprevención poblacional usando agentes que demuestren tener un espectro amplio, fácil esquema de administración, buen perfil de bioseguridad y que, además, el análisis costo-beneficio justifique su uso en el ámbito poblacional.…”