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Effects, equity, and cost of school-based and community-wide treatment strategies for soil-transmitted helminths in Kenya: a cluster-randomised controlled trial.
- Source :
-
Lancet (London, England) [Lancet] 2019 May 18; Vol. 393 (10185), pp. 2039-2050. Date of Electronic Publication: 2019 Apr 18. - Publication Year :
- 2019
-
Abstract
- Background: School-based deworming programmes can reduce morbidity attributable to soil-transmitted helminths in children but do not interrupt transmission in the wider community. We assessed the effects of alternative mass treatment strategies on community soil-transmitted helminth infection.<br />Methods: In this cluster-randomised controlled trial, 120 community units (clusters) serving 150 000 households in Kenya were randomly assigned (1:1:1) to receive albendazole through annual school-based treatment targeting 2-14 year olds or annual or biannual community-wide treatment targeting all ages. The primary outcome was community hookworm prevalence, assessed at 12 and 24 months through repeat cross-sectional surveys. Secondary outcomes were Ascaris lumbricoides and Trichuris trichiura prevalence, infection intensity of each soil-transmitted helminth species, and treatment coverage and costs. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT02397772.<br />Findings: After 24 months, prevalence of hookworm changed from 18·6% (95% CI 13·9-23·2) to 13·8% (10·5-17·0) in the annual school-based treatment group, 17·9% (13·7-22·1) to 8·0% (6·0-10·1) in the annual community-wide treatment group, and 20·6% (15·8-25·5) to 6·2% (4·9-7·5) in the biannual community-wide treatment group. Relative to annual school-based treatment, the risk ratio for annual community-wide treatment was 0·59 (95% CI 0·42-0·83; p<0·001) and for biannual community-wide treatment was 0·46 (0·33-0·63; p<0·001). More modest reductions in risk were observed after 12 months. Risk ratios were similar across demographic and socioeconomic subgroups after 24 months. No adverse events related to albendazole were reported.<br />Interpretation: Community-wide treatment was more effective in reducing hookworm prevalence and intensity than school-based treatment, with little additional benefit of treating every 6 months, and was shown to be remarkably equitable in coverage and effects.<br />Funding: Bill & Melinda Gates Foundation, the Joint Global Health Trials Scheme of the Medical Research Council, the UK Department for International Development, the Wellcome Trust, and the Children's Investment Fund Foundation.<br /> (Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under CC-BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)
- Subjects :
- Adolescent
Adult
Animals
Ascariasis diagnosis
Ascariasis epidemiology
Ascaris lumbricoides
Child
Child, Preschool
Cross-Sectional Studies
Female
Hookworm Infections diagnosis
Hookworm Infections epidemiology
Humans
Intention to Treat Analysis
Kenya epidemiology
Male
Middle Aged
Prevalence
Public Health economics
Public Health statistics & numerical data
School Health Services economics
School Health Services statistics & numerical data
Trichuriasis diagnosis
Trichuriasis epidemiology
Trichuris
Young Adult
Albendazole therapeutic use
Anthelmintics therapeutic use
Ascariasis drug therapy
Hookworm Infections drug therapy
Soil parasitology
Trichuriasis drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1474-547X
- Volume :
- 393
- Issue :
- 10185
- Database :
- MEDLINE
- Journal :
- Lancet (London, England)
- Publication Type :
- Academic Journal
- Accession number :
- 31006575
- Full Text :
- https://doi.org/10.1016/S0140-6736(18)32591-1