Abstract
BackgroundAn increasing number of countries in Africa and elsewhere are developing national plans for the control of neglected tropical diseases. A key component of such plans is school-based deworming (SBD) for the control of soil-transmitted helminths (STHs) and schistosomiasis. Monitoring and evaluation (M&E) of national programmes is essential to ensure they are achieving their stated aims and to evaluate when to reduce the frequency of treatment or when to halt it altogether. The article describes the M&E design of the Kenya national SBD programme and presents results from the baseline survey conducted in early 2012.MethodsThe M&E design involves a stratified series of pre- and post-intervention, repeat cross-sectional surveys in a representative sample of 200 schools (over 20,000 children) across Kenya. Schools were sampled based on previous knowledge of STH endemicity and were proportional to population size. Stool (and where relevant urine) samples were obtained for microscopic examination and in a subset of schools; finger-prick blood samples were collected to estimate haemoglobin concentration. Descriptive and spatial analyses were conducted. The evaluation measured both prevalence and intensity of infection.ResultsOverall, 32.4% of children were infected with at least one STH species, with Ascaris lumbricoides as the most common species detected. The overall prevalence of Schistosoma mansoni was 2.1%, while in the Coast Province the prevalence of S. haematobium was 14.8%. There was marked geographical variation in the prevalence of species infection at school, district and province levels. The prevalence of hookworm infection was highest in Western Province (25.1%), while A. lumbricoides and T. trichiura prevalence was highest in the Rift Valley (27.1% and 11.9%). The lowest prevalence was observed in the Rift Valley for hookworm (3.5%), in the Coast for A. lumbricoides (1.0%), and in Nyanza for T. trichiura (3.6%). The prevalence of S. mansoni was most common in Western Province (4.1%).ConclusionsThe current findings are consistent with the known spatial ecology of STH and schistosome infections and provide an important empirical basis on which to evaluate the impact of regular mass treatment through the school system in Kenya.
Highlights
An increasing number of countries in Africa and elsewhere are developing national plans for the control of neglected tropical diseases
This paper describes the overall study design of the monitoring and evaluation (M&E) of the Kenya national school-based deworming programme and presents results from the baseline survey
Errors in recording information in the field meant that information on age and sex of children were available for 21,312 children (99.0%) and 21,342 children (99.1%), respectively
Summary
An increasing number of countries in Africa and elsewhere are developing national plans for the control of neglected tropical diseases. Chronic infections can have insidious effects on childhood development, including growth and cognitive development, whilst heavy infections may result in serious clinical disease Both chronic and intense infections are most common in school-age children who are the natural targets for school-based chemotherapy programmes. In 2001, the World Health Assembly endorsed the WHA 54.19 resolution that urged countries to control morbidity due to STH infection through regular deworming of schoolaged children, setting a target to deworm 75% of the school children [2] In support of this resolution, an important recent development was the large scale donation of deworming drugs by pharmaceutical companies in 2010, with GlaxoSmithKline donating 400 million albendazole tablets per year and Johnson & Johnson donating 200 million mebendazole tablets per year. As programmes are scaled-up there is a scientific imperative to monitor the efficacy of treatment and to rigorously document the impact of treatment on infection and health outcomes
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