Impact on a national helminth control programme on infection and morbidity in Ugandan schoolchildren

Abstract

Objective We aimed to assess the health impact of a national control programme targeting schistosomiasis and intestinal nematodes in Uganda, which has provided population-based anthelmintic chemotherapy since 2003. Methods We conducted longitudinal surveys on infection status, haemoglobin concentration and clinical morbidity in 1871 randomly selected schoolchildren from 37 schools in eight districts across Uganda at three time points -before chemotherapy and after one year and two years of annual mass chemotherapy. Findings Mass treatment with praziquantel and albendazole led to a significant decrease in the intensity of Schistosoma mansoni -70% (95% confidence interval (CI): 66-73%) after one year and 82% (95% CI: 80-85%) after two years of treatment. Intensity of hookworm infection also decreased (75% and 93%; unadjusted). There was a significant increase in haemoglobin concentration after one (0.135 g/dL (95% CI: 0.126-0.144)) and two years (0.303 g/dL (95% CI: 0.293-0.312)) of treatment, and a significant decrease in signs of early clinical morbidity. The impact of intervention on S. mansoni prevalence and intensity was similar to that predicted by mathematical models of the impact of chemotherapy on human schistosomiasis. Improvements in haemoglobin concentration were greatest among children who were anaemic or harbouring heavy S. mansoni infection at baseline. Conclusion Anthelmintic treatment delivered as part of a national helminth control programme can decrease infection and morbidity among schoolchildren and improve haemoglobin concentration. Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español.

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

“…In subgroup analysis (see Table D in S3 Text), we observed statistical significance when we combined those studies characterized by having two chemotherapeutic interventions performed in the study population, and those having a follow-up time greater than 24 months. A study that followed only school children [21] reported an important reduction in the prevalence of portal vein dilation after treatment (Table D in S1 Text). Among all the studies in this category, significant heterogeneity was observed (Fig 2), but this was reduced in the stratification by subgroups (Table D in S3 Text).…”

Spatial heterogeneity of haemoglobin concentration in preschool-age children in sub-Saharan Africa

“…In highly endemic populations, micronutrients are being distributed as part of parasite control programmes to reduce the burden of anaemia. 2,[25][26][27][28][29][30][31] We have used data collected and georeferenced by the Demographic and Health Surveys (DHS), together with highresolution continental maps of selected environmental variables, Abstracts in ‫,عريب‬ 中文, Français, Pусский and Español at the end of each article.…”

In Vitro Praziquantel Test Capable of Detecting Reduced In Vivo Efficacy in Schistosoma mansoni Human Infections

“…The Ugandan National Government, with assistance from the Schistosomiasis Control Initiative (SCI), has administered mass PZQ treatment over 7 years, with infection prevalences greatly reduced from 33.4–49.3% to 9.7–29.6% and intensities reduced from 105.7–386.8 eggs per gram (epg) of feces to 11.6–84.1 epg in the first 2 years alone 2,3. Analyses of qualitative data from the control program within Uganda are also reporting an increased demand for continued treatment, likely to lead to further widespread PZQ use 4.…”