Abstract
BackgroundNational deworming programmes rely almost exclusively on mass drug administration (MDA) to children to control morbidity caused by these parasitic infections. The provision of other interventions, consisting of preventive chemotherapy at high population level coverage together with water, sanitation and hygiene (WaSH) and changes in risk behaviour, should enable sustainable control of soil-transmitted helminths (STH) and schistosomiasis and ultimately interrupt transmission.Methods/DesignTwo interventions will be implemented by the project: (i) community-wide biannual albendazole and annual praziquantel treatment with a target of 80–90% treatment coverage (“expanded MDA”); and (ii) provision of WaSH with behaviour change communication (BCC), within the Wolaita zone, Ethiopia. The project has three study arms: (i) expanded community-wide MDA, WaSH and BCC; (ii) expanded community-wide MDA only; and (iii) annual school-based MDA (the current National STH/schistosomiasis Control Programme). The impact of these interventions will be evaluated through prevalence mapping at baseline and endline (after four rounds of MDA), combined with annual longitudinal parasitological surveillance in defined cohorts of people to monitor trends in prevalence and reinfection throughout the project. Treatment coverage and individual compliance to treatment will be monitored by employing fingerprint biometric technology and barcoded identification cards at treatment. WaSH utilisation will be evaluated through school and household level observations and annual WaSH assessment survey. Complementary qualitative surveys will explore practices, cultural and social drivers of risk behaviours, uptake of WaSH and treatment, and assessing the impact of the BCC.DiscussionThe study has the potential to define an ‘End Game’ for STH and schistosomiasis programmes through provision of multiple interventions. Interrupting transmission of these infections would eliminate the need for long-term repeated MDA, lead to sustained health improvements in children and adults, thereby allowing health systems to focus on other disease control priorities.
Highlights
National deworming programmes rely almost exclusively on mass drug administration (MDA) to children to control morbidity caused by these parasitic infections
Experience in many settings suggest that chemotherapy has the greatest impact in rapidly reducing the burden and morbidity of helminth infections
Studies have shown that the provision of additional interventions should allow the suppression of the prevalence of soil-transmitted helminths (STH) and schistosomiasis infection to very low levels, achieved through MDA, to be sustained once transmission has deemed to be broken in defined settings such that MDA can cease in these settings [49,50,51]
Summary
National deworming programmes rely almost exclusively on mass drug administration (MDA) to children to control morbidity caused by these parasitic infections. Helminth infections caused by soil-transmitted helminths (STH) and schistosomes are among the most prevalent NTDs affecting humans who live in poverty [2,3,4]. Whilst these diseases do not typically cause high mortality, repeated infection from an early age can cause chronic morbidity including malnutrition, growth impairment, and hinder economic development in endemic regions [5,6,7]. Since the intensity of infection typically increases with age to plateau in adulthood [10]
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