Once a year school-based deworming with praziquantel and albendazole combination may not be adequate for control of urogenital schistosomiasis and hookworm infection in Matuga District, Kwale County, Kenya

Abstract

BackgroundNeglected tropical diseases (NTDs) predominantly occur in resource poor settings where they often present a serious public health burden. Sustained global advocacy has been important in raising awareness of NTDs and the relatively low cost for control of helminthic NTDs using preventive chemotherapy. This enthusiasm was boosted at the London declaration on NTDs in 2012 through commitments by different partners to avail resources required for control of NTDs particularly those that employ preventive chemotherapy as the major intervention strategy. Subsequently, national NTD programmes are responding to these new opportunities by implementing preventive chemotherapy including school-based deworming (SBD). Further, with the availability of increased resources, both financial and pharma, the optimal strategies for implementing preventive chemotherapy in highly endemic settings are under debate and this paper goes some way to addressing this issue in a specific setting in coastal Kenya.MethodsWe conducted a repeated cross-sectional study in Matuga District, Kwale County, Kenya to evaluate the effect of school-based co-administration of praziquantel and albendazole against urogenital schistosomiasis and soil-transmitted helminth (STH) infections. A total of 1022 school children in 5 study schools were tested for the infections in urine and stool samples during a baseline survey in September 2009. The presence of Schistosoma haematobium infection was determined by the urine filtration method while STH infections were determined by Kato-Katz technique.ResultsUrogenital schistosomiasis and hookworm infection were the major parasitic infections among the children in the study area. There was significant decrease in both prevalence and intensity of S. haematobium infection after treatment but varying levels of rebound were observed during the period between the treatments. The school-based treatment, however, did not have any significant effect on both the prevalence and intensity of hookworm infection.ConclusionsOnce per year SBD programmes may not be adequate for controlling hookworm infection and urogenital schistosomiasis in rural areas of Kwale County. There is a need to consider expanded preventive chemotherapy strategies that will allow inclusion of the adult populations. Community-based health education campaigns focusing on increasing household latrine ownership and use, as a complementary measure to control STH and urogenital schistosomiasis in similar settings, may also be useful.

Impact of community-based integrated mass drug administration on schistosomiasis and soil-transmitted helminth prevalence in Togo

“…mansoni was low for both groups and the difference in prevalence was of borderline statistical significance. Rebound of hookworm and schistosomiasis infection has been described elsewhere [14–16]. We observed no significant rebound of infection for S .…”

Effectiveness of Albendazole for Hookworm Varies Widely by Community and Correlates with Nutritional Factors: A Cross-Sectional Study of School-Age Children in Ghana

“…[13][14][15] However, despite the favorable financial profile of MDA, evidence in support of sustainable health and educational benefits from deworming is lacking, as results from carefully controlled trials vary widely. [16][17][18][19][20] Beyond the individual health impact, questions have also been raised about the degree to which current deworming strategies are likely to achieve widespread disease control or elimination in endemic areas. For example, MDA programs that only treat children enrolled in formal education will not reach those who do not regularly attend, nor will it address the potentially significant adult reservoirs of infection within targeted communities.…”

Perceptions about interventions to control schistosomiasis among the Lake Victoria island communities of Koome, Uganda

“…Although effective, it does have its drawbacks. Praziquantel does not kill immature schistosomes [12] and therefore does not clear all infection with single treatment, especially in individuals with high intensity infection [13, 14]. Since praziquantel does not prevent re-infection, the treatment must be provided repeatedly on a regular basis and the side effects can be unpleasant [15].…”