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BackgroundRepeated mass drug administration (MDA) of antihelminthics to at-risk populations is still the main strategy for the control of soil-transmitted helminth (STH) infections. However, MDA, as a stand-alone intervention, does not prevent reinfection. Accordingly, complementary measures to prevent STH reinfection, such as health education and improved sanitation, as part of an integrated control approach, are required to augment the effectiveness of MDA for optimal efficiency and sustainability. ObjectiveThe aim of this study is to determine the impact and generalizability of a school-based health education package entitled The Magic Glasses for STH prevention in the Philippines. MethodsWe conducted a cluster randomized controlled intervention trial, involving 2020 schoolchildren aged 9-10 years, in 40 schools in Laguna Province, Philippines, to evaluate the impact of the school-based health education package for the prevention of STHs. The trial was conducted over the course of 1 year (June 2016 to July 2017). A total of 20 schools were randomly assigned to the intervention arm, in which The Magic Glasses Philippines health education package was delivered with the standard health education activities endorsed by the Philippines Department of Health (DOH) and the Department of Education (DepEd). The other 20 schools comprised the control arm of the study, where the DOH/DepEd’s standard health education activities were done. At baseline, parasitological assessments and a knowledge, attitude, and practice survey were carried out in all schools. In addition, height, weight, and hemoglobin levels were obtained from each child (after parental consent), and their school attendance and academic performance in English and mathematics were accessed from the school records. The baseline and 2 follow-up surveys were completed using the same study measurements and quality-control assessments. ResultsKey results from this cluster randomized intervention trial will shed light on the impact that The Magic Glasses health education package will have against STH infections in schoolchildren in the province of Laguna, located on the Island of Luzon, in the Calabarzon Region of the Philippines. ConclusionsThe results of the trial will be used to assess the generalizability of the impact of The Magic Glasses health education package in different epidemiological and cultural settings, providing evidence for translation of this health education package into public health policy and practice in the Asian region and beyond. Trial RegistrationAustralian New Zealand Clinical Trials Registry number ACTRN12616000508471; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368849 International Registered Report Identifier (IRRID)DERR1-10.2196/18419

Objective In the year 2000, the Philippines' Department of Health adopted mass chemotherapy using praziquantel to eliminate schistosomiasis. Mass treatment was offered to an eligible population of 30 187 residents of 50 villages in Western Samar, the Philippines, in 2004 as part of an ongoing epidemiological study, Schistosomiasis Transmission and Ecology in the Philippines (STEP), aimed at measuring the effect of irrigation on infection with schistosomiasis. This paper descdbes the mass-treatment activities and factors associated with participation. Methods Advocacy, information dissemination and social mobilization activities were conducted before mass chemotherapy. Village leaders were primarily responsible for community mobilization. Mass treatment was offered in village meeting halls and schools. Participation proportions were estimated based on the 2002-2003 census. Community involvement was measured using a participation index; A Bayesian hierarchical logistic regression model was fitted to estimate the association between sociodemographic factors and residents coming to the treatment site. Findings A village-level average of 53.1% of residents (range: 21.1-85.3) came to the treatment site, leading to a mass-treatment coverage with an average of 48.3% (range: 15.8-80.7). At the individual level, participation proportions were higher among males, preschool and school-age children, non-STEP participants and among those who provided a stool sample. At the village-level, better community involvement was associated with increased participation whereas a larger census was associated with decreased participation. Conclusion The conduct of mass treatment in the 50 villages resulted in far lower participation than expected. This raises concern for the ongoing mass-treatment initiatives now taking place in developing countries. Une traduction en francais de ce resume figure a la fin de l'article. Al final del articulo se facilita una traduccion al espanol. Objectif En 2000, le ministere de la sante philippin a adopte la chimiotherapie de masse par le praziquantel pour eliminer la schistosomiase. Le traitement de masse a ete propose a une population justiciable de ce traitement, composee de 30 187 habitants de 50 villages du Samar occidental, aux Philippines, en 2004, dans le cadre d'une etude epidemiologique en cours, le projet STEP sur la transmission et l'ecologie de la schistosomiase aux Philippines. Ce projet STEP vise a mesurer l'impact de l'irrigation sur l'infection par la schistosomiase. Le present article decrit les operations de traitement de masse et ies facteurs lies a la participation a ce traitement. Methodes Des operations de sensibilisation, de diffusion de l'information et de mobilisation sociale ont ete menees avant la chimiotherapie de masse. Ce sont principalement les chefs de village qui ont assure la mobilisation communautaire. Le traitement a ete propose dans les salles de reunion et les ecoles des villages. Les taux de participation ont ete estimes sur la base du recensement de 2002-2003. L'implication de la communaute a ete mesuree par un indice de participation. Un modele de regression logistique hierarchique bayesien a ete applique pour estimer l'association entre des facteurs sociodemographiques et la venue des habitants sur le site de traitement. Resultats En moyenne dans les villages, 53,1% des habitants (plage de variation : 21,1--85,3) se sont rendus sur le site de traitement, ce qui donne un taux de couverture moyen de 48,3 % (plage de variation : 15,8--80,7). Au niveau individuel, le taux de participation etait plus eleve chez les hommes, les enfants d'age prescolaire et scolaire, les personnes ne participant pas au projet STEP et ceux ayant fourni un echantillon de selles. A l'echelle des villages, une plus grande implication de la communaute etait associee a une plus forte participation, tandis qu'un recensement plus large etait associe a une faible participation. Conclusion Le traitement de masse realise dans 50 villages a donne lieu a une participation bien plus reduite que prevu. Cette observation est preoccupante pour les initiatives de traitement de masse en cours actuellement dans les pays en developpement. Objetivo En el ano 2000, el Ministerio de Salud de Filipinas adopto la antibioticoterapia masiva con prazicuantel como medio de eliminacion de la esquistosomiasis. En 2004 se ofrecio tratamiento masivo a una poblacion idonea de 30 187 residentes en 50 aldeas de Samar occidental, Filipinas, como parte de un estudio epidemiologico en curso--Transmision y Ecologia de la Esquistosomiasis en Filipinas (STEP)--concebido para medir el efecto del riego en la infeccion por esquistosoma. En este articulo se describen las actividades de tratamiento masivo y los factores asociados a la participacion. Metodos Antes de la antibioticoterapia masiva se llevaron a cabo actividades de promocion, difusion de informacion y movilizacion social. Los lideres de aldea fueron los principales responsables de la movilizacion comunitaria. Se ofrecio tratamiento masivo en las salas de reunion y las escuelas de las aldeas. Los porcentajes de participacion se estimaron a partir dei censo de 2002-2003, y la implicacion de la comunidad se midio empieando un indice de participacion. Se aplico un modelo jerarquico bayesiano de regresion logistica para estimar la relacion entre los factores sociodemograficos y la visita de los residentes al centro de tratamiento. Resultados A nivel de aldea, acudieron al centro de tratamiento una media dei 53,1% de los residentes (intervalo: 21,1-85,3), lo que se tradujo en una cobertura de tratamiento masivo del 48,3% (intervalo: 15,8-80,7). A nivel individual, los porcentajes de participacion fueron mayores entre los hombres, los ninos en edad preescolar y escolar, los participantes ajenos a STEP y las personas que proporcionaron una muestra de heces. A nivel de aldea, una mayor implicacion de la comunidad se asocio a una mayor participacion; esta disminuia en cambio cuanto mayor era el censo. Conclusion La practica del tratamiento masivo en las 50 aldeas estudiadas se asocio a una participacion muy inferior a la prevista. Esto Suscita preocupacion en relacion con las iniciativas de tratamiento masivo que se estan Ilevando a cabo en los paises en desarrollo., Introduction Schistosomiasis remains a major public health problem in the Philippines. Some 6.7 million people distributed in 1212 villages (barangays), predominantly in the islands of Leyte, Samar and areas of [...]

Background Among the 6.7 million people living in areas of the Philippines where infection with Schistosoma japonicum is considered endemic, even within small geographical areas levels of infection vary considerably. In general, the ecological drivers of this variability are not well described. Unlike other schistosomes, S. japonicum is known to infect several mammalian hosts. However, the relative contribution of different hosts to the transmission cycle is not well understood. Here, we characterize the transmission dynamics of S. japonicum using data from an extensive field study and a mathematical transmission model. Methods and Findings In this study, stool samples were obtained from 5,623 humans and 5,899 potential nonhuman mammalian hosts in 50 villages in the Province of Samar, the Philippines. These data, with variable numbers of samples per individual, were adjusted for known specificities and sensitivities of the measurement techniques before being used to estimate the parameters of a mathematical transmission model, under the assumption that the dynamic transmission processes of infection and recovery were in a steady state in each village. The model was structured to allow variable rates of transmission from different mammals (humans, dogs, cats, pigs, domesticated water buffalo, and rats) to snails and from snails to mammals. First, we held transmission parameters constant for all villages and found that no combination of mammalian population size and prevalence of infectivity could explain the observed variability in prevalence of infection between villages. We then allowed either the underlying rate of transmission (a) from snails to mammals or (b) from mammals to snails to vary by village. Our data provided substantially more support for model structure (a) than for model structure (b). Fitted values for the village-level transmission intensity from snails to mammals appeared to be strongly spatially correlated, which is consistent with results from descriptive hierarchical analyses. Conclusions Our results suggest that the process of acquiring mammalian S. japonicum infection is more important in explaining differences in prevalence of infection between villages than the process of snails becoming infected. Also, the contribution from water buffaloes to human S. japonicum infection in the Philippines is less important than has been recently observed for bovines in China. These findings have implications for the prioritization of mitigating interventions against S. japonicum transmission. The Editors' Summary of this article follows the references., Introduction Modern, inexpensive pharmaceuticals are dramatically reducing the burden of disease caused by schistosomes and other waterborne macroparasites in resource-poor settings [1,2]. Many of the national programs delivering these anthelmintics [...]

Objective To estimate the association between the intensity of animal infection with Schistosoma japonicum and human infection in Western Samar province, the Philippines. Methods We conducted an observational cross-sectional study of 1425 households in 50 villages. Stool samples were collected on each of 1-3 days from 5623 humans, 1275 cats, 1189 dogs, 1899 pigs, 663 rats and 873 water buffalo. Intensity of infection with S. japonicum was measured by the number of eggs per gram (EPG). Egg counts were done using the Kato-Katz method. We used a Bayesian hierarchical cumulative Iogit model, with adjustments for age, sex, occupation and measurement error. Findings The adjusted proportions of humans lightly infected (classified as 1-100 EPG) was 17.7% (95% Bayesian credible interval = 15.3-20.2%); the proportion classified as at least moderately infected (>100 EPG) was 3.2% (2.2-4.6%).The crude parasitological results for animals indicated that 37 cats (2.9%), 228 dogs (19.2%), 39 pigs (2.1%), 199 rats (30.0%) and 28 water buffalo (3.2%) were infected. In univariate analyses the odds ratios corresponding to a unit increase in the mean number of EPG at the village-level in dogs was 1.05 (1.01-1.09), in cats 1.35 (1.02-1.78), in pigs 1.16 (0.24- 5.18) and in rats 1.00 (1.00-1.01). Mean EPG values in cats, dogs, pigs and rats were correlated with one another. This confounding made interpreting the odds ratios difficult, but the odds ratios for dogs and cats were more consistent. Conclusion S. japonicum is endemic in areas of the Philippines despite implementation of control programmes. This may be due to the association of infections in dogs and cats with human infections. Infection control in dogs and cats is challenging, and there is a need to develop new methods to control transmission across all species. Resume Associations transversales entre l'intensite des infestations animale et humaine par Schistosoma japonicum dans la province du Samar occidental, aux Philippines Objectif Evaluer l'association entre l'intensite de l'infestation des animaux par Schistosoma japonicum et l'infestation des etres humains par cette espece dans la province du Samar occidental, aux Philippines. Methodes Une etude transversale d'observation a ete menee aupres de 1425 menages, dans 50 villages. Des echantillons de selles ont ete recueillis quotidiennement sur une periode de 3 jours, aupres de 5623 etres humains, 1275 chats, 1189 chiens, 1899 porcs, 663 rats et 873 buffles d'eau. L'intensite de l'infestation par S. japonicum a ete mesuree par le nombre d'oeufs par gramme (EPG). Le comptage des oeufs a ete effectue par la methode de Kato-Katz. Un modele logit hierarchise cumulatif de type bayesien, avec des ajustements pour tenir compte de l'age, du sexe, de la profession et de l'erreur de mesure, a ete utilise. Resultats La proportion ajustee d'etres humains legerement infestes (categorie correspondant a 1-100 EPG) etait de 17,7 % (intervalle de credibilite bayesien a 95 % = 15,3- 20,2 %) et celle d'humains moderement infestes (> 100 EPG) de 3,2 % (2,2 a 4,6 %). Les resultats parasitologiques bruts pour les animaux ont indique que 37 chats (2,9 %), 228 chiens (49,2 %), 39 porcs (2,1 %), 199 rats (30,0 %) et 28 buffles d'eau (3,2 %) etaient infestes. Dans les analyses monovariees, les odds-ratios correspondant a l'augmentation d'une unite du nombre moyen d'EPG au niveau du village chez les chiens etait de 1,05 (1,01-1,09), chez les chats de 1,35 (1,02-1,78), chez les porcs de 1,16 (0,24-5,18) et chez les rats de 1,00 (1,00-1,01). Les valeurs moyennes de l'EPG chez les chats, les chiens, les porcs et les rats etaient correlees entre elles. Ce facteur de confusion a rendu difficile l'interpretation des odds-ratios, mais on a constate une plus grande stabilite entre les odds-ratios pour les chiens et les chats. Conclusion S. japonicum est endemique dans certaines zones des Philippines en depit de la mise en oeuvre de programmes de lutte. Cette situation peut etre due a l'association d'infestations canines et felines a des infestations humaines. La lutte contre l'infestation des chiens et des chats represente un vrai defi et il est necessaire de mettre au point de nouvelles methodes pour endiguer la transmission entre les especes. Resumen Asociacion transversal entre la intensidad de los casos de infeccion pot Schistosoma japonicum en los animales y en el hombre en la provincia de Samar occidental, Filipinas Objetivo Estimar la relacion entre la intensidad de las infecciones animales por Schistosoma japonicum y la de la infeccion humana correspondiente en la provincia de Samar occidental de Filipinas. Metodos Realizamos un estudio transversal observacional de 1425 hogares en 50 aldeas. Se recogieron muestras de heces de forma diaria durante 1-3 dias en 5623 personas, 1275 gatos, 1189 perros, 1899 cerdos, 663 ratas y 873 bufalos de agua. La intensidad de la infeccion por S. japonicum se midio en funcion del numero de huevos por gramo (HPG). Los recuentos de huevos se hicieron mediante el metodo de Kato-Katz, y utilizamos un modelo logit acumulativo jerarquico de tipo bayesiano, con ajustes para la edad, el sexo, la ocupacion y el error de medicion. Resultados La proporcion ajustada de personas con infeccion ligera (1-100 HPG) fue del 17,7% (intervalo creible bayesiano del 95% = 15,3%-20,2%), y la proporcion clasificada como afectada moderadamente (HPG > 100) fue del 3,2% (2,2%-4,6%). Los resultados parasitologicos brutos para los animales mostraron que estaban infectados 37 gatos (2,9%), 228 perros (19,2%), 39 cerdos (2,1%), 199 ratas (30,0%) y 28 bufalos de agua (3,2%). En los analisis con una variable las razones de posibilidades (OR) correspondientes a un aumento de una unidad del numero medio de HPG a nivel de aldea fueron de 1,05 (1,01-1,09) en los perros, 1,35 (1,02-1,78) en las gatos, 1,16 (0,24-5,18) en los cerdos, y 1,00 (1,00-1,01) en las ratas. Los valores medios de HPG en los gatos, perros, cerdos y ratas estaban correlacionados entre si. Este factor de confusion dificulto la interpretacion de las OR, pero las OR de perros y gatos fueron mas coherentes. Conclusion S. japonicum es endemico en algunas zonas de Filipinas pese a la puesta en practica de los programas de control. Ello puede deberse a la asociacion de la infeccion en perros y gatos a las infecciones humanas. El control de la infeccion en esas dos especies no resulta facil, de ahi la necesidad de desarrollar nuevos metodos para controlar la transmision a traves de todas las especies., [TEXT NOT REPRODUCIBLE IN ASCII] Introduction Schistosomiasis affects 200 million people in 74 countries worldwide; 120 million of these are symptomatic and 20 million have severe disease. (1) Unlike the [...]