Acceptability and effectiveness of Ujiplus®- a school meal fortified with a natural anthelminthic agent for control of Schistosoma mansoni

Abstract

Background: Mass chemotherapy is currently the recommended approach for control of schistosomiasis. However, there is concern that this might not be financially sustainable over extended periods and the increasing drug pressure is likely to favor resistant parasite genotypes. We formulated a local and easier to implement alternative; porridge flour fortified with papaya seeds extracts (UjiPlus®) as a potential antischistosoma compound and evaluated it's acceptability and efficacy. Methods and materials: A total of 346 children aged 3–6 yrs. [x̃ = 4.5; IQR = 4–5] were enrolled. UjiPlus® was provided daily through a school feeding program for 4 consecutive weeks. Stool samples were collected from each child at baseline (week zero) and follow-up (week 4) and subjected to Kato-Katz microscopic examination for Schistosoma mansoni egg/s presence and infection intensity by two independent microscopists. Results: At baseline 294 participants provided a stool sample. At follow-up (FU) 247 participants provided a stool sample, of these 52 had not provided a sample at baseline. Compliance data to UjiPlus® was available for 237 children; 105(44.3%), 107(45.2%), 18(7.6%), 5(2.1%), and 2(0.8%) missed taking UjiPlus® for 0 days (100% compliance), 1–3 days, 4–6 days, 7–9 days and 10 or more days respectively. Reasons for non-compliance included absenteeism due to minor illnesses not related to UjiPlus® (n = 77), truancy (n = 31), family related issues (n = 16); some participants had been sent home to collect UjiPlus® cooking fuel fee (n = 9) while some refused to take UjiPlus® due to stomach-ache (n = 3) or diarrhoea (n = 1) caused by drinking the porridge. Side effects were observed in 16 children, with 2 reporting 3 and 1 reporting 2 side effects. These included Stomach-ache (n = 5), vomit (n = 4), cough (n = 4), running nose (n = 3), diarrhea (n = 2), nausea (n = 2) and body rush (n = 1). The overall prevalence of Schistosoma mansoni infections at baseline and follow-up was 39.8% vs. 30.4% [P = 0.022; RR = 1.31; 95% CI (1.04–1.66)]. Among the infected mean egg counts were 183.2 epg vs. 161.3 epg. Conclusion: In these preliminary results, UjiPlus® was well accepted and tolerated in the children population. UjiPlus® also yielded a reduction in Schistosoma mansoni prevalence and infection intensity.