Abstract
In 2008, Bangladesh initiated Preventive Chemotherapy (PCT) for school-age children (SAC) through bi-annual school-based mass drug administration (MDA) to control Soil-Transmitted Helminth (STH) infections. In 2016, the Ministry of Health and Family Welfare's Program on Lymphatic Filariasis Elimination and STH (ELFSTH) initiated district-level community impact assessments with Children Without Worms (CWW) using standardized, population-based sampling to measure the post-intervention STH burden across all ages (≥ 1 yr) for the three STH species. The Integrated Community-based Survey for Program Monitoring (ICSPM) was developed by CWW and was used to survey 12 districts in Bangladesh from 2017-2020. We excluded the first two district data as piloting caused some sampling errors and combined the individual demographic and parasite-specific characteristics from the subsequent 10 districts, linking them with the laboratory data for collective analysis. Our analysis identified district-specific epidemiologic findings, important for program decisions. Of the 17,874 enrolled individuals, our results are based on 10,824 (61.0%) stool samples. Overall, the prevalence of any STH species was substantially reduced to 14% from 79.8% in 2005. The impact was similar across all ages. STH prevalence was 14% in 10 districts collectively, but remained high in four districts, despite their high reported PCT coverage in previous years. Among all, Bhola district was unique because it was the only district with high T.trichuris prevalence. Bangladesh successfully lowered STH prevalence across all ages despite targeting SAC only. Data from the survey indicate a significant number of adults and pre-school age children (PSAC) were self-deworming with purchased pills. This may account for the flat impact curve across all ages. Overall prevalence varied across surveyed districts, with persistent high transmission in the northeastern districts and a district in the central flood zone, indicating possible service and ecological factors. Discrepancies in the impact between districts highlight the need for district-level data to evaluate program implementation after consistent high PCT coverage.
Highlights
In 2001, the World Health Organization (WHO) recommended that member states control Soil-Transmitted Helminthiasis (STH) morbidity through preventive chemotherapy (PCT) in endemic regions
This paper presents how these results are applicable for use by the ELFSTH program towards future program actions, and how this approach can assist other advanced NTD programs around the world
We believe that adults may have a more regulated bowel routine while younger kids cannot be forced to produce it at a given time
Summary
In 2001, the World Health Organization (WHO) recommended that member states control Soil-Transmitted Helminthiasis (STH) morbidity through preventive chemotherapy (PCT) in endemic regions. The recommended guidance utilizes a school-based platform to target one high-risk group, school-age children (SAC) through mass drug administration (MDA) to achieve at least 75% coverage consistently for five years. Once this is achieved, an impact assessment survey is recommended [1]. Bangladesh bears a high burden of STH. By January 2020, Bangladesh had completed 23 rounds of schoolbased bi-annual MDA with Mebendazole. Bangladesh receives the largest Mebendazole donation of all endemic countries (approximately 20% of the global donation) and has an excellent supply chain record over the past 5 years (SCF-NTD data: CWW retrieved 15 June 2020)
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