Schistosomiasis Consortium For Operational Research And Evaluation Research Articles

Sustaining Control of Schistosomiasis Mansoni in Western Côte d'Ivoire: Results from a SCORE Study, One Year after Initial Praziquantel Administration.

BackgroundThe Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) has launched several large-scale trials to determine the best strategies for gaining and sustaining control of schistosomiasis and transitioning toward elimination. In Côte d’Ivoire, a 5-year cluster-randomized trial is being implemented in 75 schools to sustain the control of schistosomiasis mansoni. We report Schistosoma mansoni infection levels in children one year after the initial school-based treatment (SBT) with praziquantel and compare with baseline results to determine the effect of the intervention.MethodologyThe baseline cross-sectional survey was conducted in late 2011/early 2012 and the first follow-up in May 2013. Three consecutive stool samples were collected from 9- to 12-year-old children in 75 schools at baseline and 50 schools at follow-up. Stool samples were subjected to duplicate Kato-Katz thick smears. Directly observed treatment (DOT) coverage of the SBT was assessed and the prevalence and intensity of S. mansoni infection compared between baseline and follow-up.Principal FindingsThe S. mansoni prevalence in the 75 schools surveyed at baseline was 22.1% (95% confidence interval (CI): 19.5–24.4%). The DOT coverage was 84.2%. In the 50 schools surveyed at baseline and one year after treatment, the overall prevalence of S. mansoni infection decreased significantly from 19.7% (95% CI: 18.5–20.8%) to 12.8% (95% CI: 11.9–13.8%), while the arithmetic mean S. mansoni eggs per gram of stool (EPG) among infected children slightly increased from 92.2 EPG (95% CI: 79.2–105.3 EPG) to 109.3 EPG (95% CI: 82.7–135.9 EPG). In two of the 50 schools, the prevalence increased significantly, despite a DOT coverage of >75%.Conclusions/SignificanceOne year after the initial SBT, the S. mansoni prevalence had decreased. Despite this positive trend, an increase was observed in some schools. Moreover, the infection intensity among S. mansoni-infected children was slightly higher at the 1-year follow-up compared to the baseline situation. Our results emphasize the heterogeneity of transmission dynamics and provide a benchmark for the future yearly follow-up surveys of this multi-year SCORE intervention study.

Sustaining control of schistosomiasis mansoni in moderate endemicity areas in western Côte d’Ivoire: a SCORE study protocol

BackgroundSchistosomiasis is a parasitic disease that occurs in the tropics and subtropics. The mainstay of control is preventive chemotherapy with praziquantel. In Africa, an estimated 230 million people require preventive chemotherapy. In western Côte d’Ivoire, infections with Schistosoma mansoni are widespread. To provide an evidence-base for programme decisions about preventive chemotherapy to sustain control of schistosomiasis, a 5-year multi-country study with different treatment arms has been designed by the Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) and is currently being implemented in various African settings, including Côte d’Ivoire.Methods/DesignWe report the study protocol, including ethics statement and insight from a large-scale eligibility survey carried out in four provinces in western Côte d’Ivoire. The study protocol has been approved by the ethics committees of Basel and Côte d’Ivoire. A total of 12,110 children, aged 13–14 years, from 264 villages were screened for S. mansoni using duplicate Kato-Katz thick smears from single stool samples. Among the schools with a S. mansoni prevalence of 10-24%, 75 schools were selected and randomly assigned to one of three treatment arms. In each school, three stool samples are being collected from 100 children aged 9–12 years annually and one stool sample from 100 first-year students at baseline and in the final year and subjected to duplicate Kato-Katz thick smears. Cost and coverage data for the different intervention arms, along with environmental, political and other characteristics that might impact on the infection prevalence and intensity will be recorded in each study year, using a pretested village inventory form.DiscussionThe study will document changes in S. mansoni infection prevalence and intensity according to different treatment schemes. Moreover, factors that determine the effectiveness of preventive chemotherapy will be identified. These factors will help to develop reasonable measures of force of transmission that can be used to make decisions about the most cost-effective means of lowering prevalence, intensity and transmission in a given setting. The gathered information and results will inform how to effectively sustain control of schistosomiasis at a low level in different social-ecological contexts.Trial registrationISRCTN99401114 (date assigned: 12 November 2014).

Morbidity control of schistosomiasis by mass drug administration: how can we do it best and what will it take to move on to elimination?

The World Health Organization (WHO) has, for some time, encouraged countries endemic for schistosomiasis to control morbidity from this disease through mass drug administration (MDA) of the well-tolerated drug, praziquantel (PZQ). With the London Declaration in January 2012 and the promise by Merck Serono to eventually donate 250 million PZQ tablets per year, most endemic countries in sub-Saharan Africa have now developed national plans to do MDA for schistosomiasis morbidity control. More recently, based on two World Health Assembly (WHA) resolutions (WHA 54.19 & WHA 65.21) on schistosomiasis, countries are further encouraged to eliminate schistosomiasis, where feasible. The fight against schistosomiasis is therefore in a critical period of tremendous opportunities and equal challenges. How do we do the most effective job of MDA? What tools do we need to do this job better? How will we know when to move from morbidity control to elimination? What combinations of interventions, beyond MDA, are needed to eliminate transmission? The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) has its Secretariat at the University of Georgia and with programs in more than 26 institutions in 19 countries it is trying to answer these very practical questions through multiple large field-based studies and the evaluation or development of better diagnostics for schistosomiasis. This presentation will summarize the current status of morbidity control and elimination programs and the operational research by SCORE that we hope will provide much-needed answers for national program managers so they can most effectively pursue these critical public health programs.

Community Health Workers' Experiences and Perspectives on Mass Drug Administration for Schistosomiasis Control in Western Kenya: The SCORE Project

Abstract. The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) includes communitywide treatment in areas with ≥ 25% prevalence of schistosomiasis along the shores of Lake Victoria using community health workers (CHWs). The CHWs are key drivers in community-owned mass drug administration (MDA) intervention programs. We explored their experiences and perceptions after initial MDA participation. Unstructured open-ended group discussions were conducted after completion of MDA activities. Narratives were obtained from CHWs using a digital audio recorder during the group discussion, transcribed verbatim and translated into English where applicable. Thematic decomposition of data was done using ATLAS.t.i. software. From the perspective of the CHWs, factors influencing MDA compliance included drug side effects, food supply stability, and conspiracy theories about the "real" purpose of treatment. The interest of CHWs to serve as community drug distributors stemmed from both intrinsic and extrinsic factors. Feedback from CHWs can promote more effective MDA in rural Kenyan communities.

Schistosomiasis collection at NHM (SCAN)

BackgroundThe Natural History Museum (NHM) is developing a repository for schistosomiasis-related material, the Schistosomiasis Collection at NHM (SCAN) as part of its existing Wolfson Wellcome Biomedical Laboratory (WWBL). This is timely because a major research and evaluation effort to understand control and move towards elimination of schistosomiasis in Africa has been initiated by the Schistosomiasis Consortium for Operational Research and Evaluation (SCORE), resulting in the collection of many important biological samples, including larval schistosomes and snails. SCAN will collaborate with a number of research groups and control teams and the repository will acquire samples relevant to both immediate and future research interest. The samples collected through ongoing research and field activities, WWBL’s existing collections, and other acquisitions will be maintained over the long term and made available to the global research community for approved research purposes. Goals include: · Consolidation of the existing NHM schistosome and snail collections and transfer of specimens into suitable long-term storage systems for DNA retrieval, · Long-term and stable storage of specimens collected as part of on going field programmes initially in Africa especially relating to the SCORE research programmes, · Provision of access to snail and schistosome collections for approved research activities.