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Evaluating the impact of biannual school-based and community-wide treatment on urogenital schistosomiasis in Niger
BACKGROUND: The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) coordinated a five-year study implemented in several countries, including Niger, to provide an evidence-base for programmatic decisions regarding cost-effective approaches to preventive chemotherapy for schist...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7672903/ https://www.ncbi.nlm.nih.gov/pubmed/33203477 http://dx.doi.org/10.1186/s13071-020-04411-9 |
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author | Phillips, Anna E. Tohon, Zilahatou Dhanani, Neerav A. Sofo, Boubacar Gnandou, Issa Sidikou, Boubacar Noma, Adamou Garba Madougou, Bassirou Alto, Oumarou Sebangou, Hannatou Halilou, Kader M. Andia, Roumanatou Garba, Amadou Fenwick, Alan Hamidou, Amina A. |
author_facet | Phillips, Anna E. Tohon, Zilahatou Dhanani, Neerav A. Sofo, Boubacar Gnandou, Issa Sidikou, Boubacar Noma, Adamou Garba Madougou, Bassirou Alto, Oumarou Sebangou, Hannatou Halilou, Kader M. Andia, Roumanatou Garba, Amadou Fenwick, Alan Hamidou, Amina A. |
author_sort | Phillips, Anna E. |
collection | PubMed |
description | BACKGROUND: The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) coordinated a five-year study implemented in several countries, including Niger, to provide an evidence-base for programmatic decisions regarding cost-effective approaches to preventive chemotherapy for schistosomiasis control. METHODS: This was a cluster-randomised trial investigating six possible combinations of annual or biannual community-wide treatment (CWT), school-based treatment (SBT), and holidays from mass treatment over four years. The most intense arm involved two years of annual CWT followed by 2 years of biannual CWT, while the least intensive arm involved one year of annual SBT followed by a year without treatment and two more years of annual SBT. The primary outcome of interest was prevalence and intensity of Schistosoma haematobium among 100 children aged 9–12 years sampled each year. In addition, 100 children aged 5–8 years in their first year of school and 50 adults (aged 20–55 years) were tested in the first and final fifth year of the study. RESULTS: In total, data were collected from 167,500 individuals across 225 villages in nine districts within the Niger River valley, Western Niger. Overall, the prevalence of S. haematobium decreased from baseline to Year 5 across all study arms. The relative reduction of prevalence was greater in biannual compared with annual treatment across all arms; however, the only significant difference was seen in areas with a high starting prevalence. Although adults were not targeted for treatment in SBT arms, a statistically significant decrease in prevalence among adults was seen in moderate prevalence areas receiving biannual (10.7% to 4.8%) SBT (P < 0.001). Adults tested in the annual SBT group also showed a decrease in prevalence between Year 1 and Year 5 (12.2% to 11.0%), but this difference was not significant. CONCLUSIONS: These findings are an important consideration for schistosomiasis control programmes that are considering elimination and support the idea that scaling up the frequency of treatment rounds, particularly in areas of low prevalence, will not eliminate schistosomiasis. Interestingly, the finding that prevalence decreased among adults in SBT arms suggests that transmission in the community can be reduced, even where only school children are being treated, which could have logistical and cost-saving implications for the national control programmes. [Image: see text] |
format | Online Article Text |
id | pubmed-7672903 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-76729032020-11-19 Evaluating the impact of biannual school-based and community-wide treatment on urogenital schistosomiasis in Niger Phillips, Anna E. Tohon, Zilahatou Dhanani, Neerav A. Sofo, Boubacar Gnandou, Issa Sidikou, Boubacar Noma, Adamou Garba Madougou, Bassirou Alto, Oumarou Sebangou, Hannatou Halilou, Kader M. Andia, Roumanatou Garba, Amadou Fenwick, Alan Hamidou, Amina A. Parasit Vectors Research BACKGROUND: The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) coordinated a five-year study implemented in several countries, including Niger, to provide an evidence-base for programmatic decisions regarding cost-effective approaches to preventive chemotherapy for schistosomiasis control. METHODS: This was a cluster-randomised trial investigating six possible combinations of annual or biannual community-wide treatment (CWT), school-based treatment (SBT), and holidays from mass treatment over four years. The most intense arm involved two years of annual CWT followed by 2 years of biannual CWT, while the least intensive arm involved one year of annual SBT followed by a year without treatment and two more years of annual SBT. The primary outcome of interest was prevalence and intensity of Schistosoma haematobium among 100 children aged 9–12 years sampled each year. In addition, 100 children aged 5–8 years in their first year of school and 50 adults (aged 20–55 years) were tested in the first and final fifth year of the study. RESULTS: In total, data were collected from 167,500 individuals across 225 villages in nine districts within the Niger River valley, Western Niger. Overall, the prevalence of S. haematobium decreased from baseline to Year 5 across all study arms. The relative reduction of prevalence was greater in biannual compared with annual treatment across all arms; however, the only significant difference was seen in areas with a high starting prevalence. Although adults were not targeted for treatment in SBT arms, a statistically significant decrease in prevalence among adults was seen in moderate prevalence areas receiving biannual (10.7% to 4.8%) SBT (P < 0.001). Adults tested in the annual SBT group also showed a decrease in prevalence between Year 1 and Year 5 (12.2% to 11.0%), but this difference was not significant. CONCLUSIONS: These findings are an important consideration for schistosomiasis control programmes that are considering elimination and support the idea that scaling up the frequency of treatment rounds, particularly in areas of low prevalence, will not eliminate schistosomiasis. Interestingly, the finding that prevalence decreased among adults in SBT arms suggests that transmission in the community can be reduced, even where only school children are being treated, which could have logistical and cost-saving implications for the national control programmes. [Image: see text] BioMed Central 2020-11-18 /pmc/articles/PMC7672903/ /pubmed/33203477 http://dx.doi.org/10.1186/s13071-020-04411-9 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Phillips, Anna E. Tohon, Zilahatou Dhanani, Neerav A. Sofo, Boubacar Gnandou, Issa Sidikou, Boubacar Noma, Adamou Garba Madougou, Bassirou Alto, Oumarou Sebangou, Hannatou Halilou, Kader M. Andia, Roumanatou Garba, Amadou Fenwick, Alan Hamidou, Amina A. Evaluating the impact of biannual school-based and community-wide treatment on urogenital schistosomiasis in Niger |
title | Evaluating the impact of biannual school-based and community-wide treatment on urogenital schistosomiasis in Niger |
title_full | Evaluating the impact of biannual school-based and community-wide treatment on urogenital schistosomiasis in Niger |
title_fullStr | Evaluating the impact of biannual school-based and community-wide treatment on urogenital schistosomiasis in Niger |
title_full_unstemmed | Evaluating the impact of biannual school-based and community-wide treatment on urogenital schistosomiasis in Niger |
title_short | Evaluating the impact of biannual school-based and community-wide treatment on urogenital schistosomiasis in Niger |
title_sort | evaluating the impact of biannual school-based and community-wide treatment on urogenital schistosomiasis in niger |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7672903/ https://www.ncbi.nlm.nih.gov/pubmed/33203477 http://dx.doi.org/10.1186/s13071-020-04411-9 |
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