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Objectives: To evaluate the effectiveness and cost-effectiveness of integrating seasonal malaria chemoprevention (SMC) with mass drug administration for helminth control among school-aged children living in communities where the burden of malaria and helminths is high in Ghana, West Africa., Methods: This cluster randomised controlled trial will enrol 1200 children aged 5-10 years. Eligible children randomised to intervention clusters will receive SMC drugs (sulphadoxine-pyrimethamine plus amodiaquine) and anthelminthic drugs for soil-transmitted helminths-(albendazole), and for schistosomiasis (praziquantel), while children randomised to control clusters will receive SMC drugs alone. Pre- and post-intervention blood, urine and stool samples will be collected from children in both clusters. The effectiveness of the concomitant delivery will be determined by checking whether the combination of SMC and anthelminthic drugs prevents anaemia in the children randomised to the intervention clusters compared to the children in the control clusters. Cost analysis and cost-effectiveness of this integrated delivery approach will be determined by estimating the incremental costs and effects of co-administration of SMC drugs with mass drug administration of anthelminthic drugs compared to SMC alone, including cost savings due to cases of moderate and severe anaemia averted., Expected Findings: The findings of this study will provide evidence to inform public health recommendations for an integrated control of malaria and helminths among children living in the poorest countries of the world., (© 2024 The Author(s). Tropical Medicine & International Health published by John Wiley & Sons Ltd.)

Objective: To evaluate the cost-effectiveness of three strategies for the control of taeniasis in a community, in terms of cost per case treated., Methods: A study was conducted in South India to determine the prevalence of taeniasis by screening stool samples from 653 randomly chosen subjects, for coproantigens. The costs incurred in the project were used to estimate the cost per case screened and treated. A one-way sensitivity analysis was carried out for varying rates of taeniasis, different screening strategies and mass therapy. Further sensitivity analysis was carried out with different manpower and test costs., Results: The rate of taeniasis as detected by ELISA for coproantigen was 3 per 1000 (2 of 653 samples). Our study showed that mass therapy without screening for taeniasis would be the most economical strategy in terms of cost per case treated if field workers are employed exclusively for either mass therapy or screening. For each strategy, costs per case treated are higher at low prevalence of taeniasis, with a sharp rise below 15%., Conclusions: In places that are endemic for taeniasis and neurocysticercosis, mass therapy or screening for taeniasis should be considered. Screening by stool microscopy is not cost-effective in terms of cost per case of taeniasis treated owing to its low sensitivity. Although the cost per case of taeniasis treated is high at low prevalence of taeniasis for all options, incorporating mass therapy into existing mass drug distribution programmes might prove to be the most cost-effective control strategy., (© 2011 Blackwell Publishing Ltd.)

A country-wide description of the distribution of soil-transmitted helminths in Uganda is reported, based on data for 20-185 school-children from 271 schools. The overall prevalence of Ascaris lumbricoides, Trichuris trichiura and hookworm was 6.3%, 5.0% and 43.5%, respectively. The prevalence of A. lumbricoides and T. trichiura was unevenly distributed in the country with prevalence greatest in south-western Uganda whereas hookworm was generally more homogeneously distributed. Based on preliminary cost analysis of an ongoing school-based control programme, the financial delivery cost per school-child treated with albendazole is estimated to be between US dollar 0.04 and 0.08 in different districts.

Previous surveys in Myanmar indicate that soil-transmitted helminths (STH) are a significant public health problem. However the majority of these surveys are small scale or hospital based. To date there has been no countrywide assessment of the prevalence and intensity of STH infection. We conducted a survey (June 2002-June 2003) to assess the magnitude of STH infection in school age children in each of the different ecological areas of the country. In each area, five schools were selected and from each one, 50 children were randomly chosen. Parasitological and nutritional data were collected from each child. We found an overall prevalence of infection of 69%: 18% had a moderate-heavy intensity of infection, 22% were anaemic. A pilot exercise to treat 25,000 school age children in the 200 schools of Nyangdone Township tested the strategy before scaling up and to generate some rough costings. A crude calculation of the expenditure to buy and deliver the drugs, including the costs incurred in the teacher training, concluded that the cost per child was approximately 0.05 USD.

Background: A project to improve integrated control of schistosomiasis in the primary health care system of northern Senegal was implemented from February 1995 until September 1999, shortly after a Schistosoma mansoni outbreak. The activities included additional training of doctors and nurses in symptom-based treatment and making praziquantel (PZQ) available for an affordable price., Objective: To investigate staff performance and the availability and costs of diagnostic materials and PZQ at the end of this intervention project., Methods: We performed structured interviews with staff from 55 health care facilities in five districts., Results: Respondents from 23 health care facilities reported both S. haematobium and S. mansoni in the coverage area, 32 reported only S. haematobium and three only S. mansoni. The average cost to patients for consultation, diagnosis, treatment and transportation to a referral health care facility was approximately 1.60 Euro. Fifty-seven per cent of the health care facilities with reported S. haematobium in the coverage area treated patients presenting with haematuria on symptoms; 56% of the health care facilities with reported S. mansoni in the coverage area treated patients presenting with blood in stool on symptoms. Thirteen per cent performed a diagnostic test for patients presenting with haematuria and 12% for patients presenting with blood in stool. The remainder, approximately one-third of the health care facilities, referred their patients to another facility for a diagnostic test. Implementation of symptom-based treatment in all health care facilities will reduce the total costs by 0.43 Euro (29%) for patients infected with S. haematobium and 0.78 Euro (46%) for patients infected with S. mansoni. Of the 53 health care facilities with schistosomiasis in their area, 37 had PZQ in stock of which 33 (88%) sold PZQ for the recommended retail price of 0.15 Euro per tablet (or 0.60 Euro per course of four tablets) or lower., Conclusion: Four years after the start of the intervention project, patients presenting with schistosomiasis related symptoms can generally expect proper diagnosis and treatment at all levels of the health care system in Northern Senegal, either at the initial visited health care facility or after referral. However, a further reduction of the total costs of treatment is still possible by a better implementation of symptom-based treatment and further reduction of the costs of PZQ.

This paper presents the results of an evaluation of community perception of two large-scale, government-run, school-based health programmes delivering anthelmintic drugs to primary school children, in Ghana (80 442 children in 577 schools) and Tanzania (110 000 children in 352 schools). Most teachers (96% in Ghana and 98% in Tanzania) were positive about their role in the programme, including administration of anthelmintic drugs, and parents and children fully accepted their taking on this role. The benefits of the programme were apparent to teachers, parents and children in terms of improved health and well-being of the children. Over 90% of parents in both Ghana and Tanzania indicated a willingness to pay for the continuation of drug treatment. The evaluation also highlighted areas that are critical to programme effectiveness, such as communication between schools and parents, the issue of collaboration between the health and education sectors, parents' perception of the importance of helminth infection as a serious and chronic health problem (compared with more acute and life threatening illnesses such as malaria), and who should pay for treatment of side-effects.

School health programmes are the basis of the strategy defined by WHO to reduce morbidity due to soil-transmitted nematodes and schistosomes in school age populations in developing countries. However, low rates of school enrollment can be a major factor limiting their success. In the present study enrolled children were informed by teachers on the date of the next deworming campaign and were invited to pass along this information to parents, siblings and friends of school-age. On the day of the deworming campaign, teachers were instructed to administer anthelminthics to enrolled and not enrolled school-age children present at school. In the month following the treatment day, information about coverage was collected by questionnaire in 257 households in two regions of Unguja Island, Zanzibar. Over 89% of school age children resulted treated (98.9% of those enrolled plus 60% of those not enrolled). The additional cost of treating non-enrolled is limited to the cost of providing additional doses of anthelminthic drug in each school. Non-enrolled school age children can easily, successfully and inexpensively included in school based deworming campaign. Managers of control programmes are invited to test this method adapting it in their particular and cultural environment.