Should the Goal for the Treatment of Soil Transmitted Helminth (STH) Infections Be Changed from Morbidity Control in Children to Community-Wide Transmission Elimination?

Anderson, Roy M.; Turner, Hugo C.; Truscott, James E.; Hollingsworth, T. Déirdre; Brooker, Simon

doi:10.1371/journal.pntd.0003897

Cited by 117 publications

(131 citation statements)

References 21 publications

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“…Non-school aged population should not be excluded from any treatment activity, as neglecting them can be a source for community re-infection especially in the case of Hookworm infection [17].…”

Section: Discussionmentioning

confidence: 99%

Water Resource, Hygienic Practice, and Soil Transmitted Helminthiasis in Some Rural Communities of Osun State, Nigeria

Fafunwa¹,

Mogaji²,

Oluwole³

et al. 2017

JWARP

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Provision of water, sanitation and hygiene (WASH) resources has been advocated as necessary add-on strategy for sustainable control of soil-transmitted helminthiasis (STH) alongside annual mass drug administration (MDA) of albendazole to endemic communities. This study investigated the burden of STH and status of WASH resources in eight rural communities in Aiyedaade LGA, Osun State, Nigeria. Four of the communities were supported with improved water and hygiene resources (Category A), and another four supported only with improved water resources (Category B). Two hundred and sixteen (216) fresh stool samples were collected from consenting community members and screened for Ascaris lumbricoides, Hookworm and Trichuris trichiura infections using ether concentration method. The status and condition of WASH resources were determined using questionnaire and physical observation. An overall prevalence of 35.2% was observed for any STH infection. Species' prevalence of Ascaris lumbricoides, Hookworm and Trichuris trichiura prevalence was 33.8%, 22.7%, and 0.5% respectively. Intensity of STH infection was significantly higher in Category A communities than in Category B communities. The prevalence of STH in Category A communities was higher (42.0%) than that in Category B communities (30.1%). There were significant differences (p = 0.000) in STH infections between the two categories. The status of improved water supply was not significantly different (p = 0.3153) in the two categories. Knowledge, attitude, and practices about STH, its transmission and control were low in both categories of communities. These results imply that current implementation of WASH which tends to focus on resource distribution, equity, and coverage, is unlikely to impact on STH transmission and control. Therefore, it is necessary for WASH providers to consider STH transmission control in their planning and implementation

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Section: Discussionmentioning

confidence: 99%

Water Resource, Hygienic Practice, and Soil Transmitted Helminthiasis in Some Rural Communities of Osun State, Nigeria

Fafunwa¹,

Mogaji²,

Oluwole³

et al. 2017

JWARP

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“…In this issue, Clarke et al provide a review of empirical evidence on community-wide and child-targeted treatment strategies and show that treating adults in addition to children will have indirect benefits for children, particularly for roundworm [1]. This meta-analysis validates existing mathematical modelling [2] and cost-effectiveness analyses [3,4] highlighting the potential benefits of expanding of STH control programmes to all age groups. However, questions remain about how to scale-up to mass treatment, and whether this would really allow programmes to become finite in their scope, meaning breaking transmission.…”

mentioning

confidence: 69%

“…Furthermore, at the heart of current debates are questions around the health impact of STH and whether the target of the global programme should be minimising morbidity in children through long-term deworming or breaking transmission [2]. Precise estimates for pathways from infection with STH to poor child development, as well as the mediating effects of nutrition and anaemia, are still lacking.…”

mentioning

confidence: 99%

A strengthening evidence-base for mass deworming, but questions remain

Koukounari

Hollingsworth

2017

The Lancet

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“…These studies suggest that targeted programmes may not significantly impact the overall level of transmission [41, 42] and that child-focused strategies may be ineffective in reducing the overall community burden of the disease, particularly in areas where hookworm infections are predominant [43, 44]. Therefore, expanding treatment programmes to the whole community may result in improved STH control [42]. Cost-effectiveness modelling has demonstrated that community-based drug administration programmes for STH control are highly cost-effective when compared with treatment of school-aged children only [44, 45].…”

Section: Introductionmentioning

confidence: 99%

Investigating the differential impact of school and community-based integrated control programmes for soil-transmitted helminths in Timor-Leste: the (S)WASH-D for Worms pilot study protocol

Clarke

Clements

Bryan

et al. 2016

Pilot Feasibility Stud

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BackgroundWater, sanitation and hygiene (WASH) interventions represent an important component of soil-transmitted helminth (STH) infection control, alongside the administration of anthelmintic drugs, which are generally targeted to school-aged children. Recent modelling studies have suggested that STH control programmes should be broadened to include all age groups across the community. We describe the protocol for a pilot study investigating the impact of school-versus-community-based delivery of integrated WASH and deworming programmes on STH infections in school-aged children in Timor-Leste.MethodsThe (S)WASH-D for Worms pilot is a two-arm, non-randomised cluster intervention study. The aims are to determine feasibility and acceptability of the intervention and study procedures and to establish proof of principle for the hypothesis that STH control programmes directed to the entire community will lead to greater reductions in STH infections in children than programmes directed only to school-aged children. Of the six participating communities, three receive a school-based integrated WASH and deworming programme and three additionally receive a community-based integrated WASH and deworming programme. The primary outcomes are the proportions of eligible children who enrol in the study and participate in the data collection, and outcomes relating to WASH and deworming programme completion, coverage, and use. Secondary outcomes are the cumulative incidence and mean intensity of STH infection in school-aged children at 6-month follow-up, mean haemoglobin concentration and several anthropometric indices. Results will inform the design of a cluster-randomised controlled trial (RCT).DiscussionThis pilot study is being conducted in preparation for a cluster-RCT investigating the differential impact of school- and community-based integrated STH control programmes on STH infections in school-aged children. It aims to establish feasibility and proof of principle, while results of the subsequent RCT could have significant implications for global STH control policy.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12615001012561 Electronic supplementary materialThe online version of this article (doi:10.1186/s40814-016-0109-4) contains supplementary material, which is available to authorized users.

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Should the Goal for the Treatment of Soil Transmitted Helminth (STH) Infections Be Changed from Morbidity Control in Children to Community-Wide Transmission Elimination?

Cited by 117 publications

References 21 publications

Water Resource, Hygienic Practice, and Soil Transmitted Helminthiasis in Some Rural Communities of Osun State, Nigeria

Water Resource, Hygienic Practice, and Soil Transmitted Helminthiasis in Some Rural Communities of Osun State, Nigeria

A strengthening evidence-base for mass deworming, but questions remain

Investigating the differential impact of school and community-based integrated control programmes for soil-transmitted helminths in Timor-Leste: the (S)WASH-D for Worms pilot study protocol

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