Effectiveness of a pre-treatment snack on the uptake of mass treatment for schistosomiasis in Uganda: a cluster randomized trial.

Simon Muhumuza,Fred Nuwaha,Anne Katahoire,Annette Olsen,Agnes N Kiragga,Sanjeev Krishna

doi:10.1371/journal.pmed.1001640

Simon Muhumuza, Fred Nuwaha + Show 4 more

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https://doi.org/10.1371/journal.pmed.1001640

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Abstract

School-based mass treatment with praziquantel is the cornerstone for schistosomiasis control in school-aged children. However, uptake of treatment among school-age children in Uganda is low in some areas. The objective of the study was to examine the effectiveness of a pre-treatment snack on uptake of mass treatment. In a cluster randomized trial carried out in Jinja district, Uganda, 12 primary schools were randomized into two groups; one received education messages for schistosomiasis prevention for two months prior to mass treatment, while the other, in addition to the education messages, received a pre-treatment snack shortly before mass treatment. Four weeks after mass treatment, uptake of praziquantel was assessed among a random sample of 595 children in the snack schools and 689 children in the non-snack schools as the primary outcome. The occurrence of side effects and the prevalence and mean intensity of Schistosoma mansoni infection were determined as the secondary outcomes. Uptake of praziquantel was higher in the snack schools, 93.9% (95% CI 91.7%-95.7%), compared to that in the non-snack schools, 78.7% (95% CI 75.4%-81.7%) (p = 0.002). The occurrence of side effects was lower in the snack schools, 34.4% (95% CI 31.5%-39.8%), compared to that in the non-snack schools, 46.9% (95% CI 42.2%-50.7%) (p = 0.041). Prevalence and mean intensity of S. mansoni infection was lower in the snack schools, 1.3% (95% CI 0.6%-2.6%) and 38.3 eggs per gram of stool (epg) (95% CI 21.8-67.2), compared to that in the non-snack schools, 14.1% (95% CI 11.6%-16.9%) (p = 0.001) and 78.4 epg (95% CI 60.6-101.5) (p = 0.001), respectively. Our results suggest that provision of a pre-treatment snack combined with education messages achieves a higher uptake compared to the education messages alone. The use a pre-treatment snack was associated with reduced side effects as well as decreased prevalence and intensity of S. mansoni infection. www.ClinicalTrials.gov NCT01869465

Highlights

Schistosomiasis is a major global public health problem especially in sub-Saharan Africa [1,2,3]
Our results suggest that provision of a pre-treatment snack combined with education messages achieves a higher uptake compared to the education messages alone
The use a pre-treatment snack was associated with reduced side effects as well as decreased prevalence and intensity of S. mansoni infection

Summary

Introduction

Schistosomiasis is a major global public health problem especially in sub-Saharan Africa [1,2,3]. The target is to provide regular treatment of at least 75% of school-age children at risk of morbidity in order to keep the worm burden in individuals low and confined [3] In these countries, praziquantel is mainly delivered through school-based health programs at low cost [14,15,16]. The parasites turn into larvae and migrate to the liver, where they become juvenile worms These mature into 10–20 mm long adult worms and take up residence in the veins draining the gut or bladder where they mate and release eggs, some of which pass into the feces and go back into water where they hatch and infect fresh snails. In Africa alone, schistosomiasis kills about 280,000 people annually

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