Abstract
SummaryBackgroundIn Sri Lanka, deworming programmes for soil-transmitted helminth infections became an integral part of school health in the 1960s, whereas routine antenatal deworming with mebendazole started in the 1980s. A 2003 national soil-transmitted helminth survey done among schoolchildren found an overall prevalence of 6·9%. In our study, we aimed to reassess the national prevalence of soil-transmitted helminth infections to enable implementation of a more focused control programme that targets smaller administrative areas at risk of continued transmission.MethodsWe did a cross-sectional, school-based, national survey using multistage stratified cluster sampling, covering all nine provinces as well as populations at high risk of soil-transmitted helminth infections living in urban slums and in plantation-sector communities. Our study population was children aged 5–7 years attending state schools. Faecal samples were collected and analysed with duplicate modified Kato-Katz smears. We modelled the risk of soil-transmitted helminth infection using generalised linear mixed-effects models, and we developed prevalence maps to enable informed decision making at the smallest health administrative level in the country.FindingsBetween Jan 23 and May 9, 2017, we recruited 5946 children from 130 schools; 4276 (71·9%) children provided a faecal sample for examination. National prevalence of soil-transmitted helminth infection was 0·97% (95% CI 0·63–1·48) among primary schoolchildren. Prevalence in the high-risk communities surveyed was higher than national prevalence: 2·73% (0·75–6·87) in urban slum communities and 9·02% (4·29–18·0) in plantation sector communities. Our prevalence maps showed that the lowest-level health administrative regions could be categorised into low risk (prevalence <1%), high risk (prevalence >10%), or intermediate risk (1–10%) areas.InterpretationOur survey findings indicate that the national prevalence of soil-transmitted helminth infection has continued to decline in Sri Lanka. On the basis of WHO guidelines, we recommend discontinuation of routine deworming in low-risk areas, continuation of annual deworming in high-risk areas, and deworming once every 2 years in intermediate-risk areas, for at least 4 years.FundingTask Force for Global Health and WHO.
Highlights
Mass deworming programmes directed against soiltransmitted helminths are among the largest public health programmes in low-income and lower-middle-income countries, as measured by coverage.[1]
WHO has reported that over 1 billion treatments that are effective against soiltransmitted helminth infections were delivered each year in 2015 and 2016.2,3 existing WHO guidelines focus on morbidity control through mass deworming,[4] modelling studies[5] in the past decade suggest that it might be possible to interrupt transmission through expanded, community-wide, mass drug administration
Much higher prevalences than those have been consistently reported in surveys done in the plantation sector of Sri Lanka: 89·7% in 1992,9 and 29·0% in 2009.10 Several previous studies[11] have shown that soil-transmitted helminth preva lences in urban slum dwellers are higher than those in rural areas of Sri Lanka
Summary
Mass deworming programmes directed against soiltransmitted helminths are among the largest public health programmes in low-income and lower-middle-income countries, as measured by coverage.[1]. Much higher prevalences than those have been consistently reported in surveys done in the plantation sector of Sri Lanka: 89·7% in 1992,9 and 29·0% in 2009.10 Several previous studies[11] have shown that soil-transmitted helminth preva lences in urban slum dwellers are higher than those in rural areas of Sri Lanka. Both plantation sector and urban slums are known to have poor housing and sanitation compared with that of the rest of the country
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