Cargando…

The Impact of Intensive Versus Standard Anthelminthic Treatment on Allergy-related Outcomes, Helminth Infection Intensity, and Helminth-related Morbidity in Lake Victoria Fishing Communities, Uganda: Results From the LaVIISWA Cluster-randomized Trial

BACKGROUND: The prevalence of allergy-related diseases is increasing in low-income countries. Parasitic helminths, common in these settings, may be protective. We hypothesized that intensive, community-wide, anthelminthic mass drug administration (MDA) would increase allergy-related diseases, while...

Descripción completa

Detalles Bibliográficos
Autores principales: Sanya, Richard E, Nkurunungi, Gyaviira, Hoek Spaans, Remy, Nampijja, Margaret, O’Hara, Geraldine, Kizindo, Robert, Oduru, Gloria, Kabuubi Nakawungu, Prossy, Niwagaba, Emmanuel, Abayo, Elson, Kabagenyi, Joyce, Zziwa, Christopher, Tumusiime, Josephine, Nakazibwe, Esther, Kaweesa, James, Muwonge Kakooza, Fred, Akello, Mirriam, Lubyayi, Lawrence, Verweij, Jaco, Nash, Stephen, van Ree, Ronald, Mpairwe, Harriet, Tukahebwa, Edridah, Webb, Emily L, Elliott, Alison M
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6495012/
https://www.ncbi.nlm.nih.gov/pubmed/30202872
http://dx.doi.org/10.1093/cid/ciy761
_version_ 1783415321431900160
author Sanya, Richard E
Nkurunungi, Gyaviira
Hoek Spaans, Remy
Nampijja, Margaret
O’Hara, Geraldine
Kizindo, Robert
Oduru, Gloria
Kabuubi Nakawungu, Prossy
Niwagaba, Emmanuel
Abayo, Elson
Kabagenyi, Joyce
Zziwa, Christopher
Tumusiime, Josephine
Nakazibwe, Esther
Kaweesa, James
Muwonge Kakooza, Fred
Akello, Mirriam
Lubyayi, Lawrence
Verweij, Jaco
Nash, Stephen
van Ree, Ronald
Mpairwe, Harriet
Tukahebwa, Edridah
Webb, Emily L
Elliott, Alison M
author_facet Sanya, Richard E
Nkurunungi, Gyaviira
Hoek Spaans, Remy
Nampijja, Margaret
O’Hara, Geraldine
Kizindo, Robert
Oduru, Gloria
Kabuubi Nakawungu, Prossy
Niwagaba, Emmanuel
Abayo, Elson
Kabagenyi, Joyce
Zziwa, Christopher
Tumusiime, Josephine
Nakazibwe, Esther
Kaweesa, James
Muwonge Kakooza, Fred
Akello, Mirriam
Lubyayi, Lawrence
Verweij, Jaco
Nash, Stephen
van Ree, Ronald
Mpairwe, Harriet
Tukahebwa, Edridah
Webb, Emily L
Elliott, Alison M
author_sort Sanya, Richard E
collection PubMed
description BACKGROUND: The prevalence of allergy-related diseases is increasing in low-income countries. Parasitic helminths, common in these settings, may be protective. We hypothesized that intensive, community-wide, anthelminthic mass drug administration (MDA) would increase allergy-related diseases, while reducing helminth-related morbidity. METHODS: In an open, cluster-randomized trial (ISRCTN47196031), we randomized 26 high-schistosomiasis-transmission fishing villages in Lake Victoria, Uganda, in a 1:1 ratio to receive community-wide intensive (quarterly single-dose praziquantel plus albendazole daily for 3 days) or standard (annual praziquantel plus 6 monthly single-dose albendazole) MDA. Primary outcomes were recent wheezing, skin prick test positivity (SPT), and allergen-specific immunoglobulin E (asIgE) after 3 years of intervention. Secondary outcomes included helminths, haemoglobin, and hepatosplenomegaly. RESULTS: The outcome survey comprised 3350 individuals. Intensive MDA had no effect on wheezing (risk ratio [RR] 1.11, 95% confidence interval [CI] 0.64–1.93), SPT (RR 1.10, 95% CI 0.85–1.42), or asIgE (RR 0.96, 95% CI 0.82–1.12). Intensive MDA reduced Schistosoma mansoni infection intensity: the prevalence from Kato Katz examinations of single stool samples from each patient was 23% versus 39% (RR 0.70, 95% CI 0.55–0.88), but the urine circulating cathodic antigen test remained positive in 85% participants in both trial arms. Hookworm prevalence was 8% versus 11% (RR 0.55, 95% CI 0.31–1.00). There were no differences in anemia or hepatospenomegaly between trial arms. CONCLUSIONS: Despite reductions in S. mansoni intensity and hookworm prevalence, intensive MDA had no effect on atopy, allergy-related diseases, or helminth-related pathology. This could be due to sustained low-intensity infections; thus, a causal link between helminths and allergy outcomes cannot be discounted. Intensive community-based MDA has a limited impact in high-schistosomiasis-transmission fishing communities, in the absence of other interventions. CLINICAL TRIALS REGISTRATION: ISRCTN47196031.
format Online
Article
Text
id pubmed-6495012
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-64950122019-05-07 The Impact of Intensive Versus Standard Anthelminthic Treatment on Allergy-related Outcomes, Helminth Infection Intensity, and Helminth-related Morbidity in Lake Victoria Fishing Communities, Uganda: Results From the LaVIISWA Cluster-randomized Trial Sanya, Richard E Nkurunungi, Gyaviira Hoek Spaans, Remy Nampijja, Margaret O’Hara, Geraldine Kizindo, Robert Oduru, Gloria Kabuubi Nakawungu, Prossy Niwagaba, Emmanuel Abayo, Elson Kabagenyi, Joyce Zziwa, Christopher Tumusiime, Josephine Nakazibwe, Esther Kaweesa, James Muwonge Kakooza, Fred Akello, Mirriam Lubyayi, Lawrence Verweij, Jaco Nash, Stephen van Ree, Ronald Mpairwe, Harriet Tukahebwa, Edridah Webb, Emily L Elliott, Alison M Clin Infect Dis Articles and Commentaries BACKGROUND: The prevalence of allergy-related diseases is increasing in low-income countries. Parasitic helminths, common in these settings, may be protective. We hypothesized that intensive, community-wide, anthelminthic mass drug administration (MDA) would increase allergy-related diseases, while reducing helminth-related morbidity. METHODS: In an open, cluster-randomized trial (ISRCTN47196031), we randomized 26 high-schistosomiasis-transmission fishing villages in Lake Victoria, Uganda, in a 1:1 ratio to receive community-wide intensive (quarterly single-dose praziquantel plus albendazole daily for 3 days) or standard (annual praziquantel plus 6 monthly single-dose albendazole) MDA. Primary outcomes were recent wheezing, skin prick test positivity (SPT), and allergen-specific immunoglobulin E (asIgE) after 3 years of intervention. Secondary outcomes included helminths, haemoglobin, and hepatosplenomegaly. RESULTS: The outcome survey comprised 3350 individuals. Intensive MDA had no effect on wheezing (risk ratio [RR] 1.11, 95% confidence interval [CI] 0.64–1.93), SPT (RR 1.10, 95% CI 0.85–1.42), or asIgE (RR 0.96, 95% CI 0.82–1.12). Intensive MDA reduced Schistosoma mansoni infection intensity: the prevalence from Kato Katz examinations of single stool samples from each patient was 23% versus 39% (RR 0.70, 95% CI 0.55–0.88), but the urine circulating cathodic antigen test remained positive in 85% participants in both trial arms. Hookworm prevalence was 8% versus 11% (RR 0.55, 95% CI 0.31–1.00). There were no differences in anemia or hepatospenomegaly between trial arms. CONCLUSIONS: Despite reductions in S. mansoni intensity and hookworm prevalence, intensive MDA had no effect on atopy, allergy-related diseases, or helminth-related pathology. This could be due to sustained low-intensity infections; thus, a causal link between helminths and allergy outcomes cannot be discounted. Intensive community-based MDA has a limited impact in high-schistosomiasis-transmission fishing communities, in the absence of other interventions. CLINICAL TRIALS REGISTRATION: ISRCTN47196031. Oxford University Press 2019-05-15 2018-09-08 /pmc/articles/PMC6495012/ /pubmed/30202872 http://dx.doi.org/10.1093/cid/ciy761 Text en © The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Articles and Commentaries
Sanya, Richard E
Nkurunungi, Gyaviira
Hoek Spaans, Remy
Nampijja, Margaret
O’Hara, Geraldine
Kizindo, Robert
Oduru, Gloria
Kabuubi Nakawungu, Prossy
Niwagaba, Emmanuel
Abayo, Elson
Kabagenyi, Joyce
Zziwa, Christopher
Tumusiime, Josephine
Nakazibwe, Esther
Kaweesa, James
Muwonge Kakooza, Fred
Akello, Mirriam
Lubyayi, Lawrence
Verweij, Jaco
Nash, Stephen
van Ree, Ronald
Mpairwe, Harriet
Tukahebwa, Edridah
Webb, Emily L
Elliott, Alison M
The Impact of Intensive Versus Standard Anthelminthic Treatment on Allergy-related Outcomes, Helminth Infection Intensity, and Helminth-related Morbidity in Lake Victoria Fishing Communities, Uganda: Results From the LaVIISWA Cluster-randomized Trial
title The Impact of Intensive Versus Standard Anthelminthic Treatment on Allergy-related Outcomes, Helminth Infection Intensity, and Helminth-related Morbidity in Lake Victoria Fishing Communities, Uganda: Results From the LaVIISWA Cluster-randomized Trial
title_full The Impact of Intensive Versus Standard Anthelminthic Treatment on Allergy-related Outcomes, Helminth Infection Intensity, and Helminth-related Morbidity in Lake Victoria Fishing Communities, Uganda: Results From the LaVIISWA Cluster-randomized Trial
title_fullStr The Impact of Intensive Versus Standard Anthelminthic Treatment on Allergy-related Outcomes, Helminth Infection Intensity, and Helminth-related Morbidity in Lake Victoria Fishing Communities, Uganda: Results From the LaVIISWA Cluster-randomized Trial
title_full_unstemmed The Impact of Intensive Versus Standard Anthelminthic Treatment on Allergy-related Outcomes, Helminth Infection Intensity, and Helminth-related Morbidity in Lake Victoria Fishing Communities, Uganda: Results From the LaVIISWA Cluster-randomized Trial
title_short The Impact of Intensive Versus Standard Anthelminthic Treatment on Allergy-related Outcomes, Helminth Infection Intensity, and Helminth-related Morbidity in Lake Victoria Fishing Communities, Uganda: Results From the LaVIISWA Cluster-randomized Trial
title_sort impact of intensive versus standard anthelminthic treatment on allergy-related outcomes, helminth infection intensity, and helminth-related morbidity in lake victoria fishing communities, uganda: results from the laviiswa cluster-randomized trial
topic Articles and Commentaries
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6495012/
https://www.ncbi.nlm.nih.gov/pubmed/30202872
http://dx.doi.org/10.1093/cid/ciy761
work_keys_str_mv AT sanyaricharde theimpactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT nkurunungigyaviira theimpactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT hoekspaansremy theimpactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT nampijjamargaret theimpactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT oharageraldine theimpactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT kizindorobert theimpactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT odurugloria theimpactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT kabuubinakawunguprossy theimpactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT niwagabaemmanuel theimpactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT abayoelson theimpactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT kabagenyijoyce theimpactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT zziwachristopher theimpactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT tumusiimejosephine theimpactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT nakazibweesther theimpactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT kaweesajames theimpactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT muwongekakoozafred theimpactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT akellomirriam theimpactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT lubyayilawrence theimpactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT verweijjaco theimpactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT nashstephen theimpactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT vanreeronald theimpactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT mpairweharriet theimpactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT tukahebwaedridah theimpactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT webbemilyl theimpactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT elliottalisonm theimpactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT theimpactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT sanyaricharde impactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT nkurunungigyaviira impactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT hoekspaansremy impactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT nampijjamargaret impactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT oharageraldine impactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT kizindorobert impactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT odurugloria impactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT kabuubinakawunguprossy impactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT niwagabaemmanuel impactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT abayoelson impactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT kabagenyijoyce impactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT zziwachristopher impactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT tumusiimejosephine impactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT nakazibweesther impactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT kaweesajames impactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT muwongekakoozafred impactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT akellomirriam impactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT lubyayilawrence impactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT verweijjaco impactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT nashstephen impactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT vanreeronald impactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT mpairweharriet impactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT tukahebwaedridah impactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT webbemilyl impactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT elliottalisonm impactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial
AT impactofintensiveversusstandardanthelminthictreatmentonallergyrelatedoutcomeshelminthinfectionintensityandhelminthrelatedmorbidityinlakevictoriafishingcommunitiesugandaresultsfromthelaviiswaclusterrandomizedtrial