Abstract

Background: Soil-transmitted helminths (STH) are among the most common parasitic infections globally, disproportionately affecting children. Treatment of STH in Kenya is often targeted at preschool (PSAC) and school aged (SAC) children delivered through annual mass drug administration (MDA) in primary schools. Understanding group-specific prevalence and dynamics between treatment and coverage is critical for continued treatment success. This study aims to provide detailed information on group-specific infection prevalence and relative reductions (RR), and their relationships with treatment coverage over time. Additionally, it aims to quantify the correlation between the observed school level infection prevalence and treatment coverage.Methods: Secondary analysis of existing data collected between 2012 and 2018 by the monitoring and evaluation (M&E) program of the National School-Based Deworming (NSBD) program was used. The M&E program conducted surveys utilizing cross-sectional study design, at four survey time points, in a nationally-representative sample of schoolchildren across counties in Kenya. In each participating school, the program randomly sampled 108 children per school, of both groups. Infection prevalence was estimated using binomial regression, RR in prevalence using multivariable mixed effects model, statistical correlations using structural equation modeling, and change-point-analysis using the binary segmentation algorithm.Results: Overall, STH prevalence for PSAC was 33.7, 20.2, 19.0, and 17.9% during Year 1 (Y1), Year 3 (Y3), Year 5 (Y5), and Year 6 (Y6) surveys, respectively with an overall RR of 46.9% (p = 0.001) from Y1 to Y6. Similarly, overall STH prevalence for SAC was 33.6, 18.4, 14.7, and 12.5% during Y1, Y3, Y5, and Y6 surveys, respectively with an overall RR of 62.6% (p < 0.001). An overall (all time points) significant but very weak negative correlation was found between treatment coverage and undifferentiated STH prevalence (r = −0.144, p = 0.002) among PSAC but not in SAC. Further, we observed inter-county heterogeneity variation in infection prevalence, RR, as well as correlations.Conclusion: The analysis showed that after six rounds of MDA, prevalence of STH has significantly declined among both groups of children, however not to a point where it is not a public health problem (below 1%). The analysis, additionally established an overall significant but weak negative correlation between treatment coverage and prevalence, indicating that the current treatment coverage might not be sufficient to drive the overall STH prevalence to below 1%. These findings will allow STH control programs in Kenya to make decisions that will accelerate the attainment of STH elimination as a public health problem.

Highlights

  • Soil-transmitted helminths (STH) primarily Ascaris lumbricoides, Trichuris trichuira, and the hookworms; Necator americanus and Ancylostoma duodenale are among the most widespread neglected tropical diseases (NTDs) globally, affecting more than 1.5 billion people each year [1]

  • For preschool aged children (PSAC) group, during Year 1 (Y1), Year 3 (Y3), Year 5 (Y5), and Year 6 (Y6) pre-treatment survey points, children aged 2–4 years were included in the analysis in 166 schools (1,949 children), 159 schools (1,366 children), 164 schools (1,992 children), and 94 schools (781 children), respectively

  • For school aged children (SAC) group, during Y1, Y3, Y5, and Y6 pre-treatment survey points, children aged 5–14 years were included in the analysis in 173 schools (16,134 children), 173 schools (16,528 children), 172 schools (15,973 children), and 100 schools (8,936 children), respectively

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Summary

Introduction

Soil-transmitted helminths (STH) primarily Ascaris lumbricoides, Trichuris trichuira, and the hookworms; Necator americanus and Ancylostoma duodenale are among the most widespread neglected tropical diseases (NTDs) globally, affecting more than 1.5 billion people each year [1]. The current World Health Organization (WHO) guidelines for the control of STH recommend provision of treatment through mass drug administration (MDA) to vulnerable groups, namely, preschool aged children (PSAC), school aged children (SAC), and women of childbearing age (WCA) [2,3,4]. Under the guidelines both infection monitoring and treatment through MDA focus primarily on treatment frequency driven by undifferentiated prevalence for SAC, with MDA recommended for PSAC and WCA in situations where sustainable delivery mechanisms exist [2]. It aims to quantify the correlation between the observed school level infection prevalence and treatment coverage

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