Abstract

BackgroundSoil-transmitted helminth (STH) infections remain a public health concern in sub-Saharan Africa. School-based mass drug administration (MDA) using the anthelminthic drug Mebendazole/Albendazole have succeeded in controlling morbidity associated to these diseases but failed to interrupt their transmission. In areas were filarial diseases are co-endemic, another anthelminthic drug (Ivermectin) is distributed to almost the entire population, following the community-directed treatment with ivermectin (CDTI) strategy. Since Ivermectin is a broad spectrum anthelmintic known to be effective against STH, we conducted cross-sectional surveys in two health districts with very contrasting histories of Ivermectin/Albendazole-based PC in order to investigate whether CDTI might have contributed in STH transmission interruption.MethodologyCross-sectional surveys were conducted in two health districts with similar socio-environmental patterns but with very contrasting CDTI histories (Akonolinga health district where CDTI was yet to be implemented vs. Yabassi health district where CDTI has been ongoing for two decades). Stool samples were collected from all volunteers aged >2 years old and analyzed using the Kato-Katz technique. Infections by different STH species were compared between Akonolinga and Yabassi health districts to decipher the impact of Ivermectin/Albendazole-based MDA on STH transmission.Principal findingsA total of 610 and 584 participants aged 2–90 years old were enrolled in Akonolinga and Yabassi health districts, respectively. Two STH species (Ascaris lumbricoides and Trichuris trichiura) were found, with prevalence significantly higher in Akonolinga health district (43.3%; 95% CI: 38.1–46.6) compared to Yabassi health district (2.5%; 95% CI: 1.1–5.1) (chi-square: 90.8; df: 1; p < 0.001).Conclusion/significanceThese findings (i) suggest that Mebendazole- or Albendazole-based MDA alone distributed only to at-risk populations might not be enough to eliminate STH, (ii) support the collateral impact of Ivermectin/Albendazole MDA on A. lumbricoides and T. trichiura infections, and (iii) suggest that Ivermectin/Albendazole-based PC could accelerate STH transmission interruption.

Highlights

  • Soil-transmitted helminth (STH) infection is caused by different species of parasitic nematode worms including the roundworm (Ascaris lumbricoides), the whipworm (Trichuris trichiura) and hookworms (Necator americanus and Ancylostoma duodenale)

  • Regarding compliance to MEB-based preventive chemotherapy (PC), of the 312 preschool- and school-aged children recruited in the Akonolinga health district, 236 (75.6%; 95% CI: 70.6%-80.1%) reported to have taken MEB at least once

  • An increasing trend was observed in the number of IVM +ALB-based PC, while a decreasing trend was observed in the number of MEB-based mass drug administration (MDA), as per interviewees’ declarations

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Summary

Introduction

Soil-transmitted helminth (STH) infection is caused by different species of parasitic nematode worms including the roundworm (Ascaris lumbricoides), the whipworm (Trichuris trichiura) and hookworms (Necator americanus and Ancylostoma duodenale). Morbidity of STH is directly linked to worm burden and the PLOS NEGLECTED TROPICAL DISEASES Feasibility of STH elimination using Ivermectin/Albendazole-based preventive chemotherapy greater the number of worms in an infected person, the greater the severity of the disease. STH control strategies are currently focused on preventive chemotherapy (PC) with broad spectrum anthelminthic drugs, with the aim of alleviating morbidity through reductions in parasite burdens [5]. Soil-transmitted helminth (STH) infections remain a public health concern in sub-Saharan Africa. Since Ivermectin is a broad spectrum anthelmintic known to be effective against STH, we conducted cross-sectional surveys in two health districts with very contrasting histories of Ivermectin/Albendazole-based PC in order to investigate whether CDTI might have contributed in STH transmission interruption

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