Abstract
BackgroundSchool-based deworming is widely implemented in various countries to reduce the burden of soil-transmitted helminths (STHs), however, the frequency of drug administration varies in different settings. In this study, we compared the impact of a single annual treatment and 4-monthly treatment over a follow-up among Kenyan school children, and investigated the factors associated with residual infection.MethodsWe performed a secondary analysis of data from a randomized trial investigating whether deworming for STHs alters risk of acquiring malaria. Children received either a single treatment or 4-monthly albendazole treatments were followed longitudinally from February 2014 to October 2014. The relative impact of treatment and factors associated with residual infections were investigated using mixed-effects regression models. Predisposition to infection was assessed based on Spearman’s rank and Kendall’s Tau correlation coefficients.ResultsIn the 4-monthly treatment group, the proportion of children infected with hookworm decreased from 59.9 to 5.7%, while Ascaris lumbricoides infections dropped from 55.7 to 6.2%. In the single treatment group, hookworm infections decreased over the same time period from 58.7 to 18.3% (12.6% absolute difference in reduction, 95% CI: 8.9–16.3%), and A. lumbricoides from 56.7 to 23.3% (17.1% absolute difference in reduction, 95% CI: 13.1–21.1%). There was strong evidence for predisposition to both STH types. Residual hookworm infection among children on 4-monthly treatment were associated with male sex and baseline nutritional status, whereas A. lumbricoides infection was associated with individual and school-level infection at baseline, latrine cleanliness at schools.ConclusionsThis study found that 4-monthly treatment w more effective than single annual treatment. Repeated treatments led to dramatic reductions in the intensities of STHs, but did not completely clear infections among school children in Kenya, a presumed reflection of reinfection in a setting where there is ongoing transmission.
Highlights
School-based deworming is widely implemented in various countries to reduce the burden of soil-transmitted helminths (STHs), the frequency of drug administration varies in different settings
The majority of infections were due to hookworm or A. lumbricoides, and only 1% of children were infected with T. trichiura
Our results show that 4-monthly treatments were more effective than a single annual treatment
Summary
School-based deworming is widely implemented in various countries to reduce the burden of soil-transmitted helminths (STHs), the frequency of drug administration varies in different settings. Soil-transmitted helminths (STHs: Ascaris lumbricoides, Trichuris trichiura, and hookworms) are some of the most common parasites that infect humans [1,2,3] These parasites can be readily treated using single-dose, safe, and often donated benzimidazole drugs, including albendazole and mebendazole. At final follow-up, it was found that 6% of children in the 4-monthly treatment group were still infected with either hookworm or A. lumbricoides infection despite receiving up to four rounds of albendazole treatment Motivated by this observation, the aims of the present analysis were to (i) quantify the impact of repeated versus single annual treatment on levels of hookworm and A. lumbricoides infection, (ii) investigate any evidence for predisposition to infection among repeatedly treated children, and (iii) identify factors associated with residual infections at the 15-month follow-up point
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