Back to Search
Start Over
Effectiveness of school-based preventive chemotherapy strategies for sustaining the control of schistosomiasis in Côte d'Ivoire: Results of a 5-year cluster randomized trial
- Source :
- PLoS Neglected Tropical Diseases, PLoS Neglected Tropical Diseases, Vol 15, Iss 1, p e0008845 (2021)
- Publication Year :
- 2020
-
Abstract
- Background Preventive chemotherapy using praziquantel is the mainstay for schistosomiasis control. However, there is little evidence on what is supposed to be the most effective school-based treatment strategy to sustain morbidity control. The aim of this study was to compare differences in Schistosoma mansoni prevalence and infection intensity between three different schedules of school-based preventive chemotherapy in an area with moderate prevalence of S. mansoni in Côte d’Ivoire. Methodology Seventy-five schools were randomly assigned to one of three intervention arms: (i) annual school-based preventive chemotherapy with praziquantel (40 mg/kg) over four years; (ii) praziquantel treatment only in the first two years, followed by two years whithout treatment; and (iii) praziquantel treatment in years 1 and 3 without treatment in-between. Cross-sectional parasitologic surveys were carried out prior to each round of preventive chemotherapy. The difference in S. mansoni prevalence and infection intensity was assessed by multiple Kato-Katz thick smears, among children aged 9–12 years at the time of each survey. First-grade children, aged 5–8 years who had never received praziquantel, were also tested at baseline and at the end of the study. Principal findings Overall, 7,410 children aged 9–12 years were examined at baseline and 7,223 at the final survey. The baseline prevalence of S. mansoni was 17.4%, 20.2%, and 25.2% in arms 1, 2, and 3, respectively. In the final year, we observed the lowest prevalence of 10.4% in arm 1, compared to 18.2% in arm 2 and 17.5% in arm 3. The comparison between arms 1 and 2 estimated an odds ratio (OR) of 0.52 but the difference was not statistically significant (95% confidence interval (CI) = 0.23–1.16). Likewise the difference between arms 1 and 3 lacked statistical significance (OR = 0.55, 95% CI = 0.23–1.29). There was no noteworthy difference observed between arms 2 and 3 (OR = 1.06, 95% CI = 0.64–1.75). The lowest S. mansoni fecal egg counts in the final year survey were observed in arm 1 (7.9 eggs per gram of stool (EPG)). However, compared with 11.5 EPG in arm 2 and 15.4 EPG in arm 3, the difference lacked statistical significance. There were 4,812 first-grade children examined at baseline and 4,513 in the final survey. The overall prevalence of S. mansoni in these children slightly decreased in arms 1 (from 4.5% to 3.6%) and 2 (from 4.7% to 4.3%), but increased in arm 3 (from 6.8% to 7.9%). However, there was no significant difference in prevalence and infection intensity observed between study arms. Conclusions/significance The three treatment schedules investigated led to a reduction in the prevalence and intensity of S. mansoni infection among children aged 9–12 years. Comparing intervention arms at the end of the study, no statistically significant differences were observed between annual treatement and the other two treatment schedules, neither in reduction of prevalence nor intensity of infection. It is important to combine our results with those of three sister trials conducted simultaneously in other African countries, before final recommendations can be drawn.<br />Author summary The World Health Organization (WHO) recommends preventive chemotherapy with praziquantel as the global strategy for morbidity control of schistosomiasis. The guidelines include target groups and treatment frequencies based on prevalence in school-age children. However, these recommendations are based on expert opinion. The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) put forward a series of cluster-randomized trials in different African countries, including Côte d’Ivoire, to identify the most suitable approach to gain and sustain the control of schistosomiasis. Results from Côte d’Ivoire did not show statistically significant differences between three school-based treatment schedules (i.e., annual treatment over four years; treatment only in the first two years, followed by two years whithout treatment; and treatment every other year without treatment in-between) in reducing prevalence and intensity of Schistosoma mansoni infection among children aged 9–12 years. The results in first-grade children with an age of 5–8 years entering school who had never received deworming drugs showed no significant difference in the prevalence and intensity of S. mansoni infection between the different treatments at the study end, suggesting that the three strategies were not significantly different for reducing the disease transmission in affected communities. However, our data should be combined with other SCORE studies carried out elsewhere in Africa. A meta-analysis including the results of the sister trials could help to conclude and make more generic recommendations.
- Subjects :
- Male
Schistosoma Mansoni
Cross-sectional study
Physiology
Eggs
RC955-962
Social Sciences
Pediatrics
Praziquantel
law.invention
Feces
Families
0302 clinical medicine
Medical Conditions
Randomized controlled trial
Sociology
law
Reproductive Physiology
Arctic medicine. Tropical medicine
Prevalence
Medicine and Health Sciences
Schistosomiasis
030212 general & internal medicine
Child
Children
Eggs per gram
Schools
Pharmaceutics
Eukaryota
Infectious Diseases
Helminth Infections
Child, Preschool
Schistosoma
Cluster Trials
Female
Public aspects of medicine
RA1-1270
Pediatric Infections
medicine.drug
Research Article
Neglected Tropical Diseases
medicine.medical_specialty
Drug Research and Development
030231 tropical medicine
Research and Analysis Methods
Chemoprevention
Education
03 medical and health sciences
Drug Therapy
Statistical significance
Internal medicine
Helminths
medicine
Parasitic Diseases
Animals
Humans
Chemotherapy
Clinical Trials
Pharmacology
business.industry
Public Health, Environmental and Occupational Health
Organisms
Biology and Life Sciences
Odds ratio
medicine.disease
Tropical Diseases
Invertebrates
Confidence interval
Schistosomiasis mansoni
Cote d'Ivoire
Cross-Sectional Studies
Age Groups
People and Places
Population Groupings
Clinical Medicine
business
Zoology
Subjects
Details
- ISSN :
- 19352735
- Volume :
- 15
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- PLoS neglected tropical diseases
- Accession number :
- edsair.doi.dedup.....30e4d0d58617c35bc08cf220007c0868