Differential impact of mass and targeted praziquantel delivery on schistosomiasis control in school-aged children: A systematic review and meta-analysis

Abstract

BackgroundSchistosomiasis is a widespread public health concern in the poorest regions of the world. The principal control strategy is regular praziquantel administration to school-aged children in endemic areas. With calls for the elimination of schistosomiasis as a public health problem, expanding praziquantel delivery to all community members has been advocated. This systematic review and meta-analysis compares the impact of community-wide and child-targeted praziquantel distribution on schistosomiasis prevalence and intensity in school-aged children.Methodology/Principal findingsWe searched MEDLINE, Embase and Web of Science to identify papers that reported schistosome prevalence before and after praziquantel administration, either to children only or to all community members. Extracted data included Schistosoma species, drug administration strategy, number of treatment rounds, follow-up interval and prevalence and intensity before and after treatment. We used inverse variance weighted generalised linear models to examine the impact of mass versus targeted drug administration on prevalence reduction, and weighted boxplots to examine the impact on infection intensity reduction. This study is registered with PROSPERO, number CRD42018095377.In total, 34 articles were eligible for systematic review and 28 for meta-analysis. Schistosoma mansoni was reported in 20 studies; Schistosoma haematobium in 19 studies, and Schistosoma japonicum in two studies. Results of generalised linear models showed no detectable difference between mass and targeted treatment strategies on prevalence reduction in school-aged children for S. mansoni (odds ratio 0.47, 95%CI 0.13–1.68, p = 0.227) and S. haematobium (0.41, 95%CI 0.06–3.03, p = 0.358). Box plots also showed no apparent differences in intensity reduction between the two treatment strategies.Conclusions/SignificanceThe results of this meta-analysis do not support the hypothesis that community-wide treatment is more effective than targeted treatment at reducing schistosomiasis infections in children. This may be due to the relatively small number of included studies, insufficient treatment coverage, persistent infection hotspots and unmeasured confounders. Further field-based studies comparing mass and targeted treatment are required.

Analytical and Clinical Assessment of a Portable, Isothermal Recombinase Polymerase Amplification (RPA) Assay for the Molecular Diagnosis of Urogenital Schistosomiasis

“…Efforts to reduce both the transmission of schistosomes and morbidity associated with schistosomiasis rely primarily on preventative chemotherapy (PC) through mass drug administration (MDA) of the anthelmintic drug, praziquantel [ 12 , 13 , 14 , 15 ]. In adopting this strategy, significant gains have been made in reducing the overall burden of disease throughout many areas of sub-Saharan Africa [ 16 , 17 ]. As the number of individuals infected, as well as the intensity of infection within those infected individuals, is diminished, however, a sharp decline in transurinal egg output causes great difficulty in reliably detecting individuals with low levels of infection using standard diagnostic methods—urine-egg microscopy and haematuria-detecting lateral-flow strips [ 18 , 19 , 20 , 21 ].…”

Pulmonary vascular disease in Africa: Lessons from registries

“…PH is in fact the commonest cause of death in patients with severe left EMF 34 , due to both left ventricular diastolic dysfunction; chronic thromboembolism is a second mechanism related to detachment of emboli from thrombus inside an aneurismal right atrium. The patient we present had also schistosomiasis, still a common cause of PVD in Africa 35 , despite mass and targeted administration of praziquantel to schoolchildren and adults in many countries 36–38 .…”

A cost analysis of options for schistosomiasis control MDA programs targeting children aged five years and below in uMkhanyakude District of KwaZulu-Natal Province, South

“…The total cost was calculated based on the number of children where the economies of scale were highest. Costeffectiveness was calculated based on the average cost of treating an additional child to achieve the 75% treatment coverage that is recommended by the WHO [28,29]. The cost proportions were calculated by comparing the contributions of each cost line to the total cost of treating 75% of the children aged ve years and below in uMkhanyakude district.…”