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Summary Background Over the past 20 years, schistosomiasis control has been scaled up. Preventive chemotherapy with praziquantel is the main intervention. We aimed to assess the effect of preventive chemotherapy on schistosomiasis prevalence in sub-Saharan Africa, comparing 2000–10 with 2011–14 and 2015–19. Methods In this spatiotemporal modelling study, we analysed survey data from school-aged children (aged 5–14 years) in 44 countries across sub-Saharan Africa. The data were extracted from the Global Neglected Tropical Diseases database and augmented by 2018 and 2019 survey data obtained from disease control programmes. Bayesian geostatistical models were fitted to Schistosoma haematobium and Schistosoma mansoni survey data. The models included data on climatic predictors obtained from satellites and other open-source environmental databases and socioeconomic predictors obtained from various household surveys. Temporal changes in Schistosoma species prevalence were estimated by a categorical variable with values corresponding to the three time periods (2000–10, 2011–14, and 2015–19) during which preventive chemotherapy interventions were scaled up. Findings We identified 781 references with relevant geolocated schistosomiasis survey data for 2000–19. There were 19 166 unique survey locations for S haematobium and 23 861 for S mansoni, of which 77% (14 757 locations for S haematobium and 18 372 locations for S mansoni) corresponded to 2011–19. Schistosomiasis prevalence among school-aged children in sub-Saharan Africa decreased from 23·0% (95% Bayesian credible interval 22·1–24·1) in 2000–10 to 9·6% (9·1–10·2) in 2015–19, an overall reduction of 58·3%. The reduction of S haematobium was 67·9% (64·6–71·1) and that of S mansoni 53·6% (45·2–58·3) when comparing 2000–10 with 2015–19. Interpretation Our model-based estimates suggest that schistosomiasis prevalence in sub-Saharan Africa has decreased considerably, most likely explained by the scale-up of preventive chemotherapy. There is a need to consolidate gains in the control of schistosomiasis by means of preventive chemotherapy, coupled with other interventions to interrupt disease transmission. Funding European Research Council and WHO.

Background Guinea reported its first case of COVID-19 on March 12, 2020. Soon thereafter, a national state of emergency was declared, all land borders were closed, schools were shut down, and public gatherings were limited. Many health activities, including field-based activities targeting neglected tropical diseases (NTDs), were paused. The World Health Organization (WHO) issued updated guidance on the resumption of NTD field-based activities on July 27, 2020. In response, the Guinea Ministry of Health (MoH) and its partners planned and resumed mass drug administration (MDA) in mid-August to September 2020 in 19 health districts. Methodology/principal findings A risk-benefit assessment was conducted to identify potential risks associated with the MDA in the COVID-19 context. Following this assessment, a risk mitigation plan with barrier measures was developed to guide MDA implementation. These measures included COVID-19 testing for all national staff leaving Conakry, mask wearing, social distancing of two meters, and hand washing/sanitizing. A checklist was developed and used to monitor compliance to risk mitigation measures. Data on adherence to risk mitigation measures were collected electronically during the MDA. A total of 120 checklists, representing 120 community drug distributor (CDD) teams (two CDDs per team) and 120 households, were completed. Results indicated that washing or disinfecting hands was practiced by 68.3% of CDD teams, compared to 45.0% among households. Face masks to cover the mouth and nose were worn by 79.2% of CDD teams, while this was low among households (23.3%). In 87.5% of households, participants did not touch the dose pole and in 88.3% of CDD teams, CDDs did not touch the hands of the participants while giving the drugs. A large majority of CDD teams (94.2%) and household members (94.2%) were willing to participate in the MDA despite the pandemic. The epidemiological coverage was ≥65% for lymphatic filariasis, onchocerciasis and soil-transmitted helminths in 10 out of 19 HDs and ≥75% for schistosomiasis for school-aged children in 7 out of 11 HDs. Conclusions/significance Guinea was one of the first countries in Africa to resume MDA activities during the COVID-19 pandemic without causing an observed increase of transmission. The development of a risk mitigation plan and a method to monitor adherence to barrier measures was critical to this unprecedented effort. The rapid incorporation of COVID-19 barrier measures and their acceptance by CDDs and household members demonstrated both the adaptability of the National NTD Program to respond to emerging issues and the commitment of the MoH to implement NTD programs., Author summary Following the guidance from World Health Organization (WHO) on April 1, 2020 in the COVID-19 pandemic, the Guinea Ministry of Health (MoH) suspended mass drug administration (MDA) for neglected tropical diseases. WHO updated guidance on the resumption of field-based NTD activities on July 27, 2020 and the Guinea MoH and its partners planned and resumed MDA in mid-August to September 2020 in 19 health districts. The risks related to the process of MDA were assessed and a contingency plan and tools were developed to guide MDA implementation during the pandemic, adopting risk mitigation measures, such as testing for all national staff leaving Conakry, mask wearing, social distancing of 2 meters, and hand washing. A supervision checklist was used by supervisors to monitor compliance with these measures by the community drug distributors (CDDs) and household members during door-to-door MDA. It was shown that 68.3% of CDD teams practiced hand washing or sanitizing, compared to 45.0% by household members, and 64.2% of CDD teams respected social distancing of two meters during their distribution at households. There were 79.2% of CDD teams and 23.3% of household members wearing face masks. Among household participants 87.5% did not touch the dose pole and among CDD teams 88.3% did not touch the hands of the participants while giving the drugs. CDD teams and household participants (both 94.2%) were equally willing to participate in the MDA despite the COVID-19 context. The treatment coverage for lymphatic filariasis, onchocerciasis and soil-transmitted helminths was more than 65% in 10 out of 19 HDs and that for schistosomiasis was more than 75% for SAC in 7 out of 11 HDs. Guinea was one of the first countries in Africa to successfully resume MDA activities during the COVID-19 pandemic. The development of a risk mitigation plan and a method to monitor adherence to barrier measures was critical to this unprecedented effort.

A national mapping of human schistosomiasis was conducted in Benin to provide the baseline epidemiological data required to implement the national strategy for schistosomiasis control and elimination to achieve the WHO's goal of reaching at least 75% of school-age children in endemic areas by 2020.Parasitological surveys were conducted from 2013 to 2015, among 19,250 children aged 8-14 years randomly sampled in 385 units (schools/villages) across all districts. Urine and stool samples were examined using parasite-egg filtration for urine samples and the Kato-Katz technique for stool specimens.Human schistosome eggs from two major species (S. haematobium and S. mansoni) were detected in the surveyed population with variable prevalence and parasite intensity. Urinary schistosomiasis due to S. haematobium was widely distributed and detected in 76/77 districts with a national average prevalence of 17.56% (95 °CI:16.80%- 18.32%), compared to S. mansoni detected in 28/77 districts with a national prevalence of 2.45% (95 °CI:2.14%-2.76%). The combined national prevalence of schistosomiasis, defined by infections with either or both schistosome species was 19.78% (95% CI:18.90% -20.49%), and was detected in 76/77 districts. Based on our findings, 31 districts were classified as low-risk (0% and10%); 37 as moderate-risk (≥10% and50%); and 8 as high-risk (≥50%) of schistosome infection. No infection was detected in Kpomassè district in this study. In several districts where the two species were endemic with prevalence ≥10%, S. haematobium was the most prevalent schistosome species. Boys were relatively more infected than girls (18.29% v 16.82%, p = 0.007). Of note, heavy infections with S. haematobium (50 eggs/10 mL) were detected in several districts of Atacora, Donga, Borgou, Collines, Ouémé and Atlantique departments.The schistosomiasis mapping reported here clearly present a nationwide view of the epidemiological pattern of Schistosoma infections and the baseline data for implementing an effective control strategy by preventive chemotherapy (PCT). Although PCT might not be required in 32/77 districts, a yearly and bi-annual deworming is needed in 2 and 43 districts, respectively. If no environmental change occurs, and no mass treatment is delivered, prevalence is likely to remain stable for many years owing to poor hygiene and sanitation.

Countries across West Africa began reporting COVID-19 cases in February 2020. By March, the pandemic began disrupting activities to control and eliminate neglected tropical diseases (NTDs) as health ministries ramped up COVID-19–related policies and prevention measures. This was followed by interim guidance from the WHO in April 2020 to temporarily pause mass drug administration (MDA) and community-based surveys for NTDs. While the pandemic was quickly evolving worldwide, in most of West Africa, governments and health ministries took quick action to implement mitigation measures to slow the spread. The U.S. Agency for International Development’s (USAID) Act to End NTDs | West program (Act | West) began liaising with national NTD programs in April 2020 to pave a path toward the eventual resumption of activities. This process consisted of first collecting and analyzing COVID-19 epidemiological data, policies, and standard operating procedures across the program’s 11 countries. The program then developed an NTD activity restart matrix that compiled essential considerations to restart activities. By December 2020, all 11 countries in Act | West safely restarted MDA and certain surveys to monitor NTD prevalence or intervention impact. Preliminary results show satisfactory MDA program coverage, meaning that enough people are taking the medicine to keep countries on track toward achieving their NTD disease control and elimination goals, and community perceptions have remained positive. The purpose of this article is to share the lessons and best practices that have emerged from the adoption of strategies to limit the spread of the novel coronavirus during MDA and other program activities.

Purpose: Trachoma was suspected to be endemic in parts of the Democratic Republic of the Congo (DRC). We aimed to estimate prevalences of trachomatous inflammation–follicular (TF), trichiasis, and water and sanitation (WASH) indicators in suspected-endemic Health Zones. Methods: A population-based prevalence survey was undertaken in each of 46 Health Zones across nine provinces of DRC, using Global Trachoma Mapping Project methods. A two-stage cluster random sampling design was used in each Health Zone, whereby 25 villages (clusters) and 30 households per cluster were sampled. Consenting eligible participants (children aged 1–9 years and adults aged ≥15 years) were examined for trachoma by GTMP-certified graders; households were assessed for access to WASH. Results: A total of 32,758 households were surveyed, and 141,853 participants (98.2% of those enumerated) were examined for trachoma. Health Zone-level TF prevalence in 1–9-year-olds ranged from 1.9–41.6%. Among people aged ≥15 years, trichiasis prevalences ranged from 0.02–5.1% (95% CI 3.3–6.8). TF prevalence in 1–9-year-olds was ≥5% in 30 Health Zones, while trichiasis prevalence was ≥0.2% in 37 Health Zones. Conclusion: Trachoma is a public health problem in 39 of 46 Health Zones surveyed. To meet elimination targets, 37 Health Zones require expanded trichiasis surgery services while 30 health zones require antibiotics, facial cleanliness and environmental improvement interventions. Survey data suggest that trachoma is widespread: further surveys are warranted.

Schistosomiasis, one of the 17 neglected tropical diseases listed by the World Health Organization, presents a substantial public health and economic burden. Of the 261 million people requiring preventive chemotherapy for schistosomiasis in 2013, 92% of them lived in sub-Saharan Africa and only 12.7% received preventive chemotherapy. Moreover, in 2010, the WHO reported that schistosomiasis mortality could be as high as 280 000 per year in Africa alone. In May 2012 delegates to the sixty-fifth World Health Assembly adopted resolution WHA65.21 that called for the elimination of schistosomiasis, and foresees the regular treatment of at least 75% of school age children in at-risk areas. The resolution urged member states to intensify schistosomiasis control programmes and to initiate elimination campaigns where possible. Despite this, in June 2015, schistosomiasis was indicated to have the lowest level of preventive chemotherapy implementation in the spectrum of neglected tropical diseases. It was also highlighted as the disease most lacking in progress. This is perhaps unsurprising, given that it was also the only NTD with access to drug donations but without a coalition of stakeholders that collaborates to boost commitment and implementation. As a consequence, and to ensure that the WHO NTDs Roadmap Targets of 2012 and World Health Assembly Resolution WHA65.21 are met, the Global Schistosomiasis Alliance (GSA) has been set up. Diverse and representative, the GSA aims to be a partnership of endemic countries, academic and research institutions, international development agencies and foundations, international organizations, non-governmental development organizations, private sector companies and advocacy and resource mobilisation partners. Ultimately, the GSA calls for a partnership to work for the benefit of endemic countries by addressing health inequity and rural poverty. Electronic supplementary material The online version of this article (doi:10.1186/s40249-017-0280-8) contains supplementary material, which is available to authorized users.

Schistosomiasis is a neglected tropical disease (NTD) affecting about 260 million people worldwide. Elimination of schistosomiasis remains a challenge because of high reinfection rates and limitations of current treatment guidelines and disease control interventions. Despite over 70 years of research on schistosome cercariae anti-penetrants, a personal protective product (PPP) remains elusive for the prevention of schistosomiasis. In this paper we explore perceptions of topical PPPs to identify potential opportunities and barriers in the development, promotion, and use as a tool to control and prevent schistosomiasis. Results from key informant interviews suggest that despite recognized benefits of a cercarial anti-penetrant, translation of research into a practical PPP for endemic areas is hindered by two critical issues: (1) minimal available evidence to demonstrate effective and practical use of topically applied products in community-based settings and (2) limitations of current business models to sustain product availability among high-risk groups in low-income settings. Additionally, introduction of a PPP would require an intensive behavioral change communication strategy to reinforce and enable routine use of the product. The potential additive impact of a PPP on reducing point of source infections, in combination with a comprehensive elimination strategy that includes preventive drug treatment, snail control, and improved water and sanitation, may still present an effective strategy to reduce moderate to high intensity of infection among high-risk groups, but requires additional translational research and business model development.

In Africa, onchocerciasis and lymphatic filariasis (LF) are co-endemic in many areas. Current efforts to eliminate both diseases are through ivermectin-based mass drug administration (MDA). Years of ivermectin distribution for onchocerciasis may have interrupted LF transmission in certain areas. The Kédougou region, Senegal, is co-endemic for LF and onchocerciasis. Though MDA for onchocerciasis started in 1988, in 2014 albendazole had not yet been added for LF. The objective of this study was to assess in an integrated manner the LF and onchocerciasis status in the three districts of the Kédougou region after ≥10 years of ivermectin-based MDA. The study employed an African Programme for Onchocerciasis Control (APOC) onchocerciasis-related methodology. In the three districts, 14 villages close to three rivers that have Simulium damnosum breeding sites were surveyed. Convenience sampling of residents ≥5 years old was performed. Assessment for LF antigenemia by immunochromatographic testing (ICT) was added to skin snip microscopy for onchocerciasis. Participants were also tested for antibodies against Wb123 (LF) and Ov16 (onchocerciasis) antigens. In two districts, no participants were ICT or skin snip positive. In the third district, 3.5% were ICT positive and 0.7% were skin snip positive. In all the three districts, Wb123 prevalence was 0.6%. Overall, Ov16 prevalence was 6.9%. Ov16 prevalence among children 5–9 years old in the study was 2.5%. LF antigenemia prevalence was still above treatment threshold in one district despite ≥10 years of ivermectin-based MDA. The presence of Ov16 positive children suggested recent transmission of Onchocerca volvulus. This study showed the feasibility of integrated evaluation of onchocerciasis and LF but development of integrated robust methods for assessing transmission of both LF and onchocerciasis are needed to determine where MDA can be stopped safely in co-endemic areas., Author Summary Onchocerciasis and lymphatic filariasis (LF) are neglected tropical diseases caused by infection with filarial parasites, Onchocerca volvulus and Wuchereria bancrofti or Brugia species respectively. Efforts to eliminate both diseases are through ivermectin-based mass drug administration (MDA) for onchocerciasis and MDA with albendazole and ivermectin or diethylcarbamazine for LF. Both diseases overlap significantly in Africa and years of ivermectin-based MDA for onchocerciasis in co-endemic areas may have decreased or interrupted W. bancrofti transmission. Senegal is co-endemic for both diseases. As of 2014, 37 LF endemic districts had not received specific treatment for LF; however, eight of these districts had been receiving ivermectin-based MDA for onchocerciasis for more than 10 years. Here we estimated, using an APOC onchocerciasis-related methodology, the status of LF and onchocerciasis in three districts of Senegal after more than 10 years of ivermectin-based MDA for onchocerciasis. We demonstrated the feasibility of integrated evaluation of LF and onchocerciasis. The results showed that W. bancrofti antigenemia prevalence in one district was ≥1%. In the districts where we did not detect LF antigenemia among the participants a more robust evaluation like a transmission assessment survey among children is still needed to determine if the infection rate for W. bancrofti is below the transmission threshold and MDAs for LF are not needed. Despite the small sample of children included in this study, the onchocerciasis antibody prevalence among them was above the threshold recommended to stop MDA. This study provides another example of the complexities that encompass stop MDA decision-making in onchocerciasis and LF co-endemic areas.

Background Schistosomiasis (SCH) and soil-transmitted helminthiasis (STH) are widely distributed in the Democratic Republic of the Congo (DRC) and constitute a serious public health problem. As recommended by the World Health Organization (WHO), before launching mass chemotherapy to control these diseases, parasitological surveys were conducted in sentinel sites in six health zones (HZs) in Bandundu and Maniema provinces. Baseline prevalence and intensity of infection for SCH and STH were determined to establish the appropriate treatment plan using Praziquantel (PZQ) and Albendazole (ALB). Methods Parasitological surveys were conducted from April to May 2015 in twenty-six selected sampling units (schools) for baseline mapping in six HZs: Fifty school children (25 females and 25 males) aged 9–15 years were randomly selected per sampling unit. A total of 1300 samples (urine and stool) were examined using haematuria dipsticks, parasite-egg filtration and the point-of-care Circulating Cathodic Antigen (POC-CCA) assay for urine samples and the Kato-Katz technique for stool specimens. Results Three species of schistosomes (S. mansoni, S. haematobium and S. intercalatum) and three groups of STH (hookworm, Ascaris and Trichuris) were detected at variable prevalence and intensity among the schools, the HZs and the provinces. In Bandundu, no SCH was detected by either Kato-Katz or the POC-CCA technique, despite a high prevalence of STH with 68% and 80% at Kiri and Pendjua HZs, respectively. In Maniema, intestinal schistosomiasis was detected by both Kato-Katz and POC-CCA with an average prevalence by Kato-Katz of 32.8% and by POC-CCA of 42.1%. Comparative studies confirmed the greater sensitivity (and operational feasibility) of the POC-CCA test on urine compared to Kato-Katz examination of stool for diagnosing intestinal schistosomiasis even in areas of comparatively light infections. STH was widely distributed and present in all HZs with a mean prevalence (95% CI) of 59.62% (46.00–65.00%). The prevalence of hookworm, roundworm and whipworm were 51.62% (32.40%–71.50%), 15.77% (0.50%–39.60%) and 13.46 (0.50%–33.20%), respectively. Conclusion This study provided the evidence base for implementing programs targeting SCH and STH in these Health Zones. Observations also reinforce the operational value and feasibility of the POC-CCA test to detect S. mansoni and, for the first time, S. intercalatum infections in a routine NTD program setting.

In 2006 the U.S. Agency for International Development (USAID) established the Neglected Tropical Disease (NTD) Control Program to support national governments in developing successful, cost-efficient NTD programs that integrate disease-specific programs into coordinated national initiatives, in accord with the World Health Organiza- tion recommendations. A 3-stage "roll-out package" has been developed for effectively integrating and scaling up such programs to full-national scale. Stage-1 lays the groundwork—identifying NTD leadership within the Ministry of Health, conducting a national Situation Analysis, formulating a multiyear Plan of Action, and undertaking a funding gap analysis. Stage-2 focuses on scaling up the integrated NTD program—convening national stakeholder meetings, developing annual work plans, carrying out disease mapping, and establishing monitoring and evaluation activities. Stage-3 aims at ensuring effective management—identifying clear roles and responsibilities for partners, and creating a central coordi- nating mechanism. Assessment and reassessment of these complex NTD programs that target literally billions of people are essential to establish "best practice" strategies for long-term public health success. Underpinning most of these initiatives are enormous dona- tions from private sector pharmaceutical companies 3-7 of the specific medications that can be used to treat each disease safely, simply, and effectively through large-scale PCT. The treatment regimens vary from administration once or twice per year to once every 2 years, given either to entire populations at-risk for the disease(s) (i.e., mass drug administration (MDA)) or targeted to specific at-risk groups, such as school-age chil- dren or specific occupational groups. Although it is unques- tioned that these donations† are absolutely necessary for the current global initiatives, it is also important to recognize that the donations alone are not sufficient. There must be two addi- tional, essential spheres of partnership: first, with the minis- tries of health (MOHs) of the affected countries who, together with other public sectors (e.g., education), take responsibility for responding to the very great public health challenge of reaching and treating all the targeted at-risk populations; and second, with funding and technical assistance that can aid the ministries to carry out these programs in countries with insuf- ficient domestic resources to address these challenges alone. A principal source of this external funding support in recent years has been the U.S. Agency for International Develop- ment (USAID). In 2006, USAID established the NTD Control Program, implemented by RTI International, with the expressed purpose of supporting national governments to develop suc- cessful, cost-efficient NTD control programs that integrate or bundle their disease-specific programs into coordinated initiatives and then to link these programs effectively with other elements of their established national health delivery systems. The achievements of the first seven countries partici- pating in this USAID-supported NTD Control Program during its first 3 years have been reviewed in detail. 8 Table 1 summa- rizes key quantitative elements from that earlier description with more current, updated information that includes the NTD Control Program's fourth year. Although these results can be recognized as only output measures not yet trans- lated into impact measures—which are of greatest impor- tance to health and economic development in these affected countries—still it is clear that by any standard, the accomplish- ments of these national NTD control programs after just a few years of operation are both remarkable and commendable. It should not be surprising, however, that the accomplish- ments of these national programs did not come easily or without challenges. Indeed, many lessons were learned over time as good practices became better, better practices became best practices, and best practices improved and evolved into evidence-based policy that can be shared across countries. Because the expansion of integrated national NTD control programs worldwide is still in its infancy, and since many more countries still need to begin their programmatic activi- ties, this report is meant to capture the early experiences of countries introducing and/or scaling up integrated NTD activ- ities during the NTD Control Program's first 4 years and to

In 2006, the United States Agency for International Development established the Neglected Tropical Disease (NTD) Control Program to facilitate integration of national programs targeting elimination or control of lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminthiasis and blinding trachoma. By the end of year 3, 12 countries were supported by this program that focused first on disease mapping where needed, and then on initiating or expanding disease-specific programs in a coordinated/integrated fashion. The number of persons reached each year increased progressively, with a cumulative total during the first three years of 98 million persons receiving 222 million treatments with donated drugs valued at more than $1.4 billion. Geographic coverage increased substantially for all these infections, and the program has supported training of more than 220,000 persons to implement the programs. This current experience of the NTD Control Program demonstrates clearly that an integrated approach to control or eliminate these five neglected diseases can be effective at full national scale.

As national programmes respond to the new opportunities presented for scaling up preventive chemotherapy programmes for the coadministration of drugs to target lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminthiasis, and trachoma, possible synergies between existing disease-specific policies and protocols need to be examined. In this report we compare present policies for mapping, monitoring, and surveillance for these diseases, drawing attention to both the challenges and opportunities for integration. Although full integration of all elements of mapping, monitoring, and surveillance strategies might not be feasible for the diseases targeted through the preventive chemotherapy approach, there are opportunities for integration, and we present examples of integrated strategies. Finally, if advantage is to be taken of scaled up interventions to address neglected tropical diseases, efforts to develop rapid, inexpensive, and easy-to-use methods, whether disease-specific or integrated, should be increased. We present a framework for development of an integrated monitoring and evaluation system that combines both integrated and disease-specific strategies.

Correspondence: eugene Justine Kongnyuy Child and reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, United Kingdom Tel +44 151 705 3705 Fax +44 151 705 3329 email kongnyuy@liverpool.ac.uk. Background: Clinical audit has been showed to improve professional practice from the providers’ perspective. However, little is known about the effect of audit on the quality of care from clients’ perspective. Objective: To assess the effectiveness of criterion-based audit to improve obstetric care from both the health professionals’ and clients’ perspectives. Methods: We conducted electronic searches of MEDLINE, EMBASE, and Cochrane Library in June 2009 for randomized controlled trials (RCTs) and before-and-after studies that assessed the effect of criterion-based audit on health outcomes or mothers/clients’ perception of obstetric care. Results: Twenty-three studies (one RCT and 22 before-and-after studies) involving 33,911 participants met our inclusion criteria. Only one of these studies assessed the effect of audit on quality of care from the mothers/clients’ perspective. Ninety-six percent (22/23) of studies showed significant improvement in at least one standard measured. In general clinical audit led to moderate improvements in obstetric care and the effect of audit depended on baseline adherence to clinical standards. Conclusions: Clinical audit is associated with moderate improvements in obstetric care from both the health professionals’ and mothers/clients’ perspectives. Audit has been used in obstetrics to improve quality mainly from one dimension, namely the health professionals’ perspective. Midwives/doctors should consider the use of audit to improve quality of care from the mothers/clients’ view.

Background Lymphatic filariasis (LF) is among the 10 neglected tropical diseases targeted for control or elimination by 2020. For LF elimination, the World Health Organization (WHO) has proposed a comprehensive strategy including (i) interruption of LF transmission through large-scale annual treatment (or mass drug administration (MDA)) of all eligible individuals in endemic areas, and (ii) alleviation of LF-associated suffering through morbidity management and disability prevention. In Cameroon, once-yearly mass administration of ivermectin and albendazole has been implemented since 2008. The aim of this study was to assess progress towards the elimination goal, looking specifically at the impact of six rounds of MDA on LF transmission in northern Cameroon. Methodology The study was conducted in the North and Far North Regions of Cameroon. Five health districts that successfully completed six rounds of MDA (defined as achieving a treatment coverage ≥ 65% each year) and reported no positive results for Wuchereria bancrofti microfilariaemia during routine surveys following the fifth MDA were grouped into three evaluation units (EU) according to WHO criteria. LF transmission was assessed through a community-based transmission assessment survey (TAS) using an immunochromatographic test (ICT) for the detection of circulating filarial antigen (CFA) in children aged 5–8 years old. Principal findings A total of 5292 children (male/female ratio 1.04) aged 5–8 years old were examined in 97 communities. Positive CFA results were observed in 2, 8 and 11 cases, with a CFA prevalence of 0.13% (95% CI: 0.04–0.46) in EU#1, 0.57% (95% CI: 0.32–1.02) in EU#2, and 0.45% (95% CI: 0.23–0.89) in EU#3. Conclusion/Significance The positive CFA cases were below WHO defined critical cut-off thresholds for stopping treatment and suggest that transmission can no longer be sustained. Post-MDA surveillance activities should be organized to evaluate whether recrudescence can occur., Author summary Lymphatic filariasis (LF) affects more than 120 million people worldwide, and is considered the second leading cause of permanent and long-term disability. In response to the important burden of this disease, the World Health Organization (WHO) elaborated a strategic plan to eliminate LF as a public health problem through annual preventive chemotherapy (PC), repeated for at least six years, and reaching at least 65% of the population at risk. To date, about 5.63 billion cumulative treatments have been delivered since 2000, and more than 300 million people no longer require PC thanks to successful implementation of the WHO strategy. In Cameroon, PC for LF has been implemented since 2008. The aim of this study was to assess whether the transmission of LF has been interrupted. Cross-sectional surveys were conducted in three evaluation units (EU) in northern Cameroon. The LF prevalence observed in each of these EU was lower than the threshold of infection below which transmission is likely no longer sustainable, suggesting that the transmission of LF has been interrupted in the study area.

Background Mapping the distribution of schistosomiasis is essential to determine where control programs should operate, but because it is impractical to assess infection prevalence in every potentially endemic community, model-based geostatistics (MBG) is increasingly being used to predict prevalence and determine intervention strategies. Methodology/Principal Findings To assess the accuracy of MBG predictions for Schistosoma haematobium infection in Ghana, school surveys were evaluated at 79 sites to yield empiric prevalence values that could be compared with values derived from recently published MBG predictions. Based on these findings schools were categorized according to WHO guidelines so that practical implications of any differences could be determined. Using the mean predicted values alone, 21 of the 25 empirically determined ‘high-risk’ schools requiring yearly praziquantel would have been undertreated and almost 20% of the remaining schools would have been treated despite empirically-determined absence of infection – translating into 28% of the children in the 79 schools being undertreated and 12% receiving treatment in the absence of any demonstrated need. Conclusions/Significance Using the current predictive map for Ghana as a spatial decision support tool by aggregating prevalence estimates to the district level was clearly not adequate for guiding the national program, but the alternative of assessing each school in potentially endemic areas of Ghana or elsewhere is not at all feasible; modelling must be a tool complementary to empiric assessments. Thus for practical usefulness, predictive risk mapping should not be thought of as a one-time exercise but must, as in the current study, be an iterative process that incorporates empiric testing and model refining to create updated versions that meet the needs of disease control operational managers., Author Summary The challenge of accurately mapping schistosomiasis is a daunting one – particularly because of the highly focal distribution of the disease. Ideally, of course, each specific treatment area would be assessed for infection prevalence and then treated appropriately based on guidelines of the World Health Organization. In practice, however, this is not possible, and a variety of short-cutting techniques have been developed to meet these mapping needs, including geospatial predictive mapping. This paper assesses the accuracy of model-based geostatistics (MBG) predictions for determining treatments projections in Ghana by comparing previously published data using MBG predictions with empirically derived prevalence values for schistosomiasis from school surveys completed at 79 sites. We found that using predictive mapping alone would not have provided reliable information for mass drug administration (MDA) planning – resulting in overtreatment in some areas and most importantly under-treatment in areas that needed it most. Based on our findings, predictive risk mapping cannot be a one-time exercise but must instead be a process that incorporates empiric testing and model refining to create optimised spatial decision support tools that meet the needs of disease control operational managers.

In 2013, Benin developed strategies to control neglected tropical diseases and one of the first step was the disease mapping of the entire country in order to identify endemic districts of schistosomiasis and soil transmitted helminths (STH). This study was carried out in 30 of the 77 districts of Benin. Of these 30 districts 22 were previously treated for Lymphatic Filariasis (LF) using the Ivermectin and Albendazole combination. In each district, five schools were selected and 50 children aged 8 to 14 years were sampled in each school, making a total of 250 children sampled in the district. The schools were selected mainly according to their proximity to lakes or any bodies of water that were likely to have been used by the children. Samples of faeces and urine were collected from each pupil. Urinary schistosomiasis was identified using the urine filtration technique while STH and intestinal schistosomiasis were identified through the Kato Katz method. Overall a total of 7500 pupils were surveyed across 150 schools with a gender ratio of 1:1. Hookworm was identified in all 30 districts with a prevalence ranging from 1.2% (95%CI: 0.0-2.5) to 60% (95%CI: 53.9-66.1). Ascaris lumbricoides was detected in 19 districts with a prevalence rate between 1% (95%CI: 0.0-2.2) and 39% (95%CI: 32.9-45.0). In addition to these common STH, Trichuris trichiura, Enterobius vermicularis and Strongyloides stercoralis were found at low prevalence. Only 16 districts were endemic to Schistosoma mansoni, while 29 districts were endemic to S. haematobium. The S. haematobium prevalence ranged from 0.8% (95% CI: 0.0-1.9) to 56% (95% CI: 50.2-62.5) while the prevalence of S. mansoni varied from 0.4% (95%CI: 0.0-1.2) to 46% (95% CI: 39.8-52.2). The 22 districts, where LF was successfully eliminated, still require mass drug administration (MDA) of albendazole indicating that school-based MDA would be needed even after LF elimination in districts co-endemic to LF and STH in Benin.