Governance, organization, accountability and sustainability of a region-wide school-based deworming program in Loreto, Peru

Abstract

Chau Cuica was the name given by the regional government of Loreto in Peru for its school-based deworming program which was initiated in 2012 with a donation of mebendazole from an international non-governmental organization. Embedded in the program from the start was a sentinel surveillance component which consisted of 16 sentinel schools representing Loreto's seven provinces. Coverage rates varied between 35% and 61% over the first two years of the program (and seven deworming cycles). Initial prevalences of soil-transmitted helminth infections were high, with 82.4% of schoolchildren having at least one infection and prevalences of both A. lumbricoides and T. trichiura infections both exceeding 60%. After two years, these prevalences had dropped to 56% for any STH infection, 38% for A. lumbricoides and 34% for T. trichiura. Importantly, the proportions of children with moderate and heavy infections also dropped. Both the regional Ministry of Health and the Ministry of Education were jointly charged to implement this deworming program. The program's costs were estimated to be approximately 22 cents (USD) per child per deworming cycle. The responsibility for the surveillance component was initially undertaken by research partners from a local NGO and a Canadian university, which transferred gradually over the course of the deworming program to being entirely the responsibility of the Ministry of Health. This regional deworming program may serve as a model for other jurisdictions who are planning a school-based deworming program with an integrated surveillance component to monitor impact.

Preventive chemotherapy in one year reduces by over 80% the number of individuals with soil-transmitted helminthiases causing morbidity: results from meta-analysis

“…Ten publications10–19 were identified according the inclusion criteria: reporting MHI information at baseline and after a number of years of PC from 8 countries in 4 WHO regions (Table 1); Some publications16;18 reported follow-up measurements at different intervals from a single baseline, while others 10,11 reported multiple baseline and multiple follow-up in different areas of the country. In some cases10–13 baseline and follow up data were presented in different publications.…”

Associated factors of the co-occurrence of trachoma and soil-transmitted helminthiases in children 1 to 9 years old in rural communities of the Amazon basin in Loreto Department, Peru: Results from a population-based survey

“…Almost half of the children aged 1–9 years in the district surveyed had an infection with at least one species of STH (49.49%), despite deworming of children in Loreto Department since 2012 [ 20 ]. This might be related to the low coverage of deworming reported in our study (20.91%), but it could also be possible that parents and guardians did not know or remember if their children were dewormed at the schools, resulting in a memory bias.…”

“…These provinces were considered likely at the highest risk of trachoma based on historical reports of trachoma cases published in a study that compiled data between 1895 and 2000 [ 9 ] and because they share borders with trachoma foci in Brazil and Colombia [ 10 ]. These provinces were also considered at high risk of STH infections due to previous studies showing high prevalence and intensity of infections in preschool and school-age children in rural communities of Iquitos, capital of Loreto’s Department [ 15 , 17 ], reported low deworming coverage [ 20 ], and insufficient access to safe water and sanitation [ 23 ]. The latter are also known risk factors associated with the occurrence of trachoma.…”

“…lumbricoides that dropped to 1.8%). However, rural communities bordering Colombia and Brazil in the Loreto Department, that have insufficient access to safe water and sanitation, and not optimal deworming coverage [ 20 ], have not been evaluated to determine the epidemiological status of STH. Trachoma and STH are diseases affecting poor, unprivileged, and socioeconomically disadvantaged communities [ 21 , 22 ], which are characteristics of the populations living in the Amazon basin in the border of Peru with Brazil and Colombia.…”

Ruling out early trimester pregnancy when implementing community-based deworming programs

“…This district has a high prevalence of STH infections in all three high risk groups (i.e. school-age children, preschool-age children and women of reproductive age, including pregnant women) [8,31,32]. A catchment area of five sub-districts was randomly selected from a list of sub-districts surrounding the three main health centers in Belén (the Centro de Salud de Belén, the Centro de Salud 9 de Octubre, and the Centro de Salud 6 de Octubre).…”