Targeting School-aged Children Research Articles

Technophilia: Viable Tool for Actualizing Refugee Education

The use of computers and associated hardware, software, and networks, to provide learning through virtual learning systems have become a means of supplementing the existing traditional teaching method. This innovation, though new in a developing country such as Nigeria, is capable of serving the needs and requirements for improving the quality of education in the numerous Internal Displacement Camps in Nigeria. In this research, the education of school-age children in Internally Displaced Persons (IDP) camps is examined with particular focus on the enrollments, and the quality of provided education. Also, case studies of various African countries’ programs geared towards improving the quality of education, and skilling up her students for employment using various Information and Communication Technology (ICT) tools, are presented. The innovations directly or indirectly yielded positive impacts on national economies of the deploying countries. Targeting school age children in the over 140,000 IDP camps in Nigeria with ICT-based learning, will have the triple effect of quality education, skill acquisition, and reduction in the growing number of IDPs in the camps as a result of unwanted pregnancies. National Communication Commission’s Digital Job Creation for Youth (DJCY), which follows a customized boot camp, with the beneficiaries being offered computers with associated connectivity toolset, and set up as Micro, Small and Medium Enterprise (MSME) after training them in ICT services, is recommended for the youth in the IDP, while immersive learning (VR lens) should be used for interactive learning experience for the younger children, with Google expedition for control of accessed content. The framework for refugee education is adapted to specifically focus on ICT-based education, training, and skill acquisition for refugees. Keywords: Quality Education, Virtual Reality, Google Expedition, Internally Displaced Persons, Education Innovation, National Communication Commission (NCC) CISDI Journal Reference Format Olebara, C.C. (2023): Technophilia: Viable Tool for Actualizing Refugee Education. Computing, Information Systems, Development Informatics & Allied Research Journal. Vol 13 No 4, Pp 31-44 Available online at https://www.isteams.net/cisdijournal. dx.doi.org/10.22624/AIMS/CISDI/V14N4P3

Modeling the Impact of a Highly Potent Plasmodium falciparum Transmission-Blocking Monoclonal Antibody in Areas of Seasonal Malaria Transmission.

Transmission-blocking interventions can play an important role in combating malaria worldwide. Recently, a highly potent Plasmodium falciparum transmission-blocking monoclonal antibody (TB31F) was demonstrated to be safe and efficacious in malaria-naive volunteers. Here we predict the potential public health impact of large-scale implementation of TB31F alongside existing interventions. We developed a pharmaco-epidemiological model, tailored to 2 settings of differing transmission intensity with already established insecticide-treated nets and seasonal malaria chemoprevention interventions. Community-wide annual administration (at 80% coverage) of TB31F over a 3-year period was predicted to reduce clinical incidence by 54% (381 cases averted per 1000 people per year) in a high-transmission seasonal setting, and 74% (157 cases averted per 1000 people per year) in a low-transmission seasonal setting. Targeting school-aged children gave the largest reduction in terms of cases averted per dose. An annual administration of the transmission-blocking monoclonal antibody TB31F may be an effective intervention against malaria in seasonal malaria settings.

Environmental contamination by soil-transmitted helminths ova and subsequent infection in school-age children in Calabar, Nigeria

The prevalence of soil-transmitted helminths (STHs) is linked to poverty, poor environmental hygiene, and poor sanitation. A cross-sectional study was conducted between July and September 2021 targeting school-age children (7–15 years) in Calabar South Local Government Area, Cross River State, Nigeria. Two hundred and forty-four (244) school-age children participated in the study and 240 soil samples were collected from the selected schools. Faecal and soil samples collected were analysed following standard methods. One hundred and thirty-two [132/244; 54.1%] of 244 faecal samples analysed were positive for STHs. Three STHs were present in faecal samples examined; Ascaris lumbricoides (31.6%), Trichuris trichiura (11.9%) and hookworm (8.2%). The prevalence of STHs was highest amongst the 13–15 years age-group (57.4%) and least in the 7–9 years age group (40.7%) (p = 0.319). Females had the highest prevalence rate (55.6%) while 52.3% was recorded in males (p = 0.164). The overall intensity of Ascaris lumbricoides (68.82±3.605 epg) infection was higher than that recorded for hookworm (58.80±7.279 epg) and T. trichiura (55.71±4.460 epg). There was no significant gender and age-related difference in infection intensities (P>0.05). Out of 240 soil samples examined, 156 (65%) were positive for STHs which included Ascaris lumbricoides (23.3%), hookworm (17.5%), Trichuris trichiura (16.3%) and Strongyloides stercoralis (15.8%). Dumpsites recorded the highest prevalence of STHs (72.5%). Ascaris lumbricoides had the highest mean parasite intensity in soil (148.78±12.28). Overall intensity of STHs in soil was significantly higher in dumpsites areas (164.32±20.58) compared to playground and toilet areas (p = 0.030). Our findings reveal that soil-transmitted helminthiases remains a burden amongst school-age children. Furthermore, the high level of contamination of soil with ova/larvae of parasites is a serious public health concern pointing to the need for proper sanitation and health education within the study area. Data present will aid policy makers in establishing measures to reduce the burden of soil-transmitted helminthiases in children as well as the level of contamination in the environment.

Predisposing factors for obesity among school-age children and adolescents in Madinah

Background: Recent research has emphasized the hazards of obesity and overweight by showing the strong connection between high body mass index and co-morbidities. The present study was aimed at assessing the risk factors that may cause an increased incidence of childhood obesity among school-age children and adolescents and discover whether there is a relation between children's lifestyle and the risk of obesity among Madinah's children. Methodology: A case-control study was carried out in Madinah, Saudi Arabia, from November 2019 to April 2021. A total of 593 children had been recruited (326 males, 267 females) using a media-based questionnaire targeting school-age children and adolescents (5-18 years) in Madinah city. Out of the total, 241 cases were obese, 111 were overweight, and 241 were controls. Results: Overweight/ obesity was 8-fold higher in children whose mother's educational level was a middle school [odds ratio (OR): 8.187, 95% confidence interval (CI): 2.394-27.993]. Children who ate a large amount of food compared to their friends were associated with a 5-fold increased risk of overweight/obesity (OR: 5.679, 95% CI: 2.656-12.144). More prolonged screen-time exposure to television or electronic devices resulted in a 3-fold increased risk of overweight/obesity for children who spent 5-7 hours per day (OR: 2.849, 95% CI: 1.032-7.862) Conclusion: Our study found a relationship between being overweight and obese and several risk factors, including mother's education level, amount of food consumption, and screen time.

Age-Related Changes in Listening Effort for Children and Teenagers With Normal Hearing and Cochlear Implants.

A clinically viable measure of listening effort is crucial in safeguarding the educational success of hard-of-hearing students enrolled in mainstream schools. To this end, a novel behavioral paradigm of listening effort targeting school-age children has been designed and reported in Hsu et al. (2017). The current article consists of two follow-up experiments investigating the effects of noise, processing depth, and age in a similar paradigm, first in a group of participants with normal hearing (NH) followed by a sample of school-age cochlear implant (CI) users. Research objectives include the construction of normative values of listening effort and comparing outcomes between age-matched NH and CI participants. In Experiment 1, the listening effort dual-task paradigm was evaluated in a group of 90 NH participants with roughly even age distribution between 6 and 26 years. The primary task asked a participant to verbally repeat each of the target words presented in either quiet or noise, while the secondary task consisted of categorization true-or-false questions "animal" and "dangerous," representing two levels of semantic processing depth. Two outcome measures were obtained for each condition: a classic word recognition score (WRS) and an average response time (RT) measured during the secondary task. The RT was defined as the main listening effort metric throughout the study. Each NH participant's long-term memory retrieval speed and working memory capacity were also assessed through standardized tests. It was hypothesized that adding noise would negatively affect both WRS and RT, whereas an increase in age would see significant improvement in both measures. A subsequent Experiment 2 administered a shortened version of the paradigm to 14 school-age CI users between 5 and 14 years old at a university clinic. The patterns of results from the CI group were expected to approximate those of the NH group, except with larger between-subject variability. For NH participants, while WRS was significantly affected by age and noise levels, RT was significantly affected by age, noise levels, and depth of processing. RT was significantly correlated with long-term memory retrieval speed but not with working memory capacity. There was also a significant interaction effect between age and noise levels for both WRS and RT. The RT data set from the NH group served as a basis to establish age-dependent 95% prediction intervals for expected future observations. For CI participants, the effect of age on the two outcome measures was more visible when target words were presented in quiet. Depending on the condition, between 35.7% and 72.7% of the children with CI exhibited higher-than-norms listening effort as measured by categorization processing times. Listening effort appears to decrease with age from early school-age years to late teenage years. The effects of background noise and processing depth are comparable with those reported in Hsu et al. (2017). Future studies interested in expanding the paradigm's clinical viability should focus on the reduction of testing time while maintaining or increasing the sensitivity and external validity of its outcome measures.

Promoting health-related cardiorespiratory fitness in physical education: A systematic review.

BackgroundThis article aimed to systematically review the contribution of physical education (PE) classes to improve cardiorespiratory fitness (CRF) in children and adolescents; and to define potentially relevant factors for promoting CRF in PE classes.MethodsStudies were identified from searches in ERIC, PubMed, SPORTDiscus, and Web of Science databases. Primary source articles, relating PE classes and CRF, published up to July 2019 in peer-reviewed journals were eligible for inclusion. Specific inclusion criteria were: (a) having cross-sectional or longitudinal and observational or interventional study designs; (b) targeting school-aged children or adolescents; (c) measuring CRF, heart rate or CRF test results as an outcome; (d) having statistical analyses of the CRF, heart rate or CRF test results outcomes reported; (e) focusing on PE classes or PE interventions that did not extended time or frequency of the classes; and (f) published in English, French, Portuguese, or Spanish.ResultsA total of 24 studies met the inclusion criteria. Overall, 10 studies have found a neutral effect of PE classes in students’ CRF, eight studies found that PE indeed contributed to the improvement of CRF and six studies revealed mixed findings, when PE classes where controlled for others variables (e.g. body mass index, intensity). Higher intensity PE classes consistently demonstrated contributions to improving students’ CRF.ConclusionReview findings suggest that PE classes can contribute to the improvement of students’ CRF. Intensity, age and weight status were identified as potentially relevant factors for promoting CRF in PE classes. To improve CRF, higher intensity classes should be provided.

The impact of community-wide, mass drug administration on aggregation of soil-transmitted helminth infection in human host populations

BackgroundSoil-transmitted helminths (STH) are intestinal parasites estimated to infect over 1.5 billion people. Current treatment programmes are aimed at morbidity control through school-based deworming programmes (targeting school-aged children, SAC) and treating women of reproductive age (WRA), as these two groups are believed to record the highest morbidity. More recently, however, the potential for interrupting transmission by treating entire communities has been receiving greater emphasis and the feasibility of such programmes are now under investigation in randomised clinical trials through the Bill & Melinda Gates Foundation funded DeWorm3 studies. Helminth parasites are known to be highly aggregated within human populations, with a small minority of individuals harbouring most worms. Empirical evidence from the TUMIKIA project in Kenya suggests that aggregation may increase significantly after anthelminthic treatment.MethodsA stochastic, age-structured, individual-based simulation model of parasite transmission is employed to better understand the factors that might induce this pattern. A simple probabilistic model based on compounded negative binomial distributions caused by age-dependencies in both treatment coverage and exposure to infection is also employed to further this understanding.ResultsBoth approaches confirm helminth aggregation is likely to increase post-mass drug administration as measured by a decrease in the value of the negative binomial aggregation parameter, k. Simple analytical models of distribution compounding describe the observed patterns well.ConclusionsThe helminth aggregation that was observed in the field was replicated with our stochastic individual-based model. Further work is required to generalise the probabilistic model to take account of the respective sensitivities of different diagnostics on the presence or absence of infection.

Cost of interventions to control schistosomiasis: Asystematic review of the literature.

BackgroundSchistosomiasis, a disease caused by blood flukes of the genus Schistosoma, belongs to the neglected tropical diseases. Left untreated, schistosomiasis can lead to severe health problems and even death. An estimated 800 million people are at risk of schistosomiasis and 250 million people are infected. The global strategy to control and eliminate schistosomiasis emphasizes large-scale preventive chemotherapy with praziquantel targeting school-age children. Other tools are available, such as information, education, and communication (IEC), improved access to water, sanitation, and hygiene (WASH), and snail control. Despite available evidence of the effectiveness of these control measures, analyses estimating the most cost-effective control or elimination strategies are scarce, inaccurate, and lack standardization. We systematically reviewed the literature on costs related to public health interventions against schistosomiasis to strengthen the current evidence-base.MethodologyIn adherence to the PRISMA guidelines, we systematically searched three readily available electronic databases (i.e., PubMed, WHOLIS, and ISI Web of Science) from inception to April 2019 with no language restrictions. Relevant documents were screened, duplicates eliminated, specific rules on studies to consider were defined, and the eligible studies fully reviewed. Costs of schistosomiasis interventions were classified in three groups: (i) preventive chemotherapy; (ii) preventive chemotherapy plus an individual diagnostic test to identify at-risk population; and (iii) test-and-treat interventions.Principal findingsFifteen articles met our inclusion criteria. In general, it was hard to compare the reported costs from the different studies due to different approaches used to estimate and classify the costs of the intervention assessed. Costs varied considerably from one study to another, ranging from US$ 0.06 to US$ 4.46 per person treated. The difference between financial and opportunity costs only played a minimal role in the explanation of the costs’ variation, even if delivery costs were two times higher in the analyses including economic costs. Most of the studies identified in our systematic review focused on sub-Saharan African countries.Conclusions/SignificanceThe degree of transparency of most of the costing studies of schistosomiasis interventions found in the current review was limited. Hence, there is a pressing need for strategies to improve the quality of cost analyses, and higher reporting standards and transparency that should be fostered by peer-review journal policies. Cost information on these interventions is crucial to inform resource allocation decisions and those regarding the affordability of scaling-up interventions.

Insights from quantitative and mathematical modelling on the proposed WHO 2030 goal for schistosomiasis.

Schistosomiasis remains one of the neglected tropical diseases (NTDs) impacting millions of people around the world. The World Health Organization (WHO) recently proposed a goal of elimination as a public health problem (EPHP) for schistosomiasis to be reached by 2030. Current WHO treatment guidelines for achieving EPHP focus on targeting school-aged children. The NTD Modelling Consortium has developed mathematical models to study schistosomiasis transmission dynamics and the impact of control measures. Our modelling insights on Schistosoma mansoni have shown that EPHP is likely to be attainable in low to moderate prevalence settings using the current guidelines. However, as prevalence rises within high prevalence settings, EPHP is less likely to be achieved unless both school-aged children and adults are treated (with coverage levels increasing with the adult burden of infection). We highlight the challenges that are faced by treatment programmes, such as non-adherence to treatment and resurgence, which can hinder progress towards achieving and maintaining EPHP. Additionally, even though EPHP may be reached, prevalence can still be high due to persisting infections. Therefore, without interruption of transmission, treatment will likely have to continue to maintain EPHP. Further modelling work is being carried out, including extending our results to S. haematobium. By providing these modelling insights, we aim to inform discussions on the goals and treatment guidelines for schistosomiasis.

Insights from quantitative and mathematical modelling on the proposed WHO 2030 goal for schistosomiasis.

Schistosomiasis remains one of the neglected tropical diseases (NTDs) impacting millions of people around the world. The World Health Organization (WHO) recently proposed a goal of elimination as a public health problem (EPHP) for schistosomiasis to be reached by 2030. Current WHO treatment guidelines for achieving EPHP focus on targeting school-aged children. The NTD Modelling Consortium has developed mathematical models to study schistosomiasis transmission dynamics and the impact of control measures. Our modelling insights on Schistosoma mansoni have shown that EPHP is likely to be attainable in low to moderate prevalence settings using the current guidelines. However, as prevalence rises within higher settings, EPHP is less likely to be achieved unless both school-aged children and adults are treated (with coverage levels increasing with the adult burden of infection). We highlight the challenges that are faced by treatment programmes, such as non-adherence to treatment and resurgence, which can hinder progress towards achieving and maintaining EPHP. Additionally, even though EPHP may be reached, prevalence can still be high due to persisting infections. Therefore, without elimination of transmission, treatment will likely have to continue to maintain EPHP. Further modelling work is being carried out, including extending our results to S. haematobium. By providing these modelling insights, we aim to inform discussions on the goals and treatment guidelines for schistosomiasis.

An Integrated Approach to Control Soil-Transmitted Helminthiasis, Schistosomiasis, Intestinal Protozoa Infection, and Diarrhea: Protocol for a Cluster Randomized Trial.

BackgroundThe global strategy to control helminthiases (schistosomiasis and soil-transmitted helminthiasis) emphasizes preventive chemotherapy. However, in the absence of access to clean water, improved sanitation, and adequate hygiene, reinfection after treatment can occur rapidly. Integrated approaches might be necessary to sustain the benefits of preventive chemotherapy and make progress toward interruption of helminthiases transmission.ObjectiveThe aim of this study was to assess and quantify the effect of an integrated control package that consists of preventive chemotherapy, community-led total sanitation, and health education on soil-transmitted helminthiasis, schistosomiasis, intestinal protozoa infection, and diarrhea in rural Côte d’Ivoire.MethodsIn a first step, a community health education program was developed that includes an animated cartoon to promote improved hygiene and health targeting school-aged children, coupled with a health education theater for the entire community. In a second step, a cluster randomized trial was implemented in 56 communities of south-central Côte d’Ivoire with 4 intervention arms: (1) preventive chemotherapy; (2) preventive chemotherapy plus community-led total sanitation; (3) preventive chemotherapy plus health education; and (4) all 3 interventions combined. Before implementation of the aforementioned interventions, a baseline parasitologic, anthropometric, and hygiene-related knowledge, attitudes, practices, and beliefs survey was conducted. These surveys were repeated 18 and 39 months after the baseline cross-sectional survey to determine the effect of different interventions on helminth and intestinal protozoa infection, nutritional indicators, and knowledge, attitudes, practices, and beliefs. Monitoring of diarrhea was done over a 24-month period at 2-week intervals, starting right after the baseline survey.ResultsKey results from this cluster randomized trial will shed light on the effect of integrated approaches consisting of preventive chemotherapy, community-led total sanitation, and health education against infections with soil-transmitted helminths, schistosomes, an intestinal protozoa and prevention of diarrhea in a rural part of Côte d’Ivoire.ConclusionsThe research provided new insights into the acceptability, strengths, and limitations of an integrated community-based control package targeting helminthiases, intestinal protozoa infections, and diarrhea in rural communities of Côte d’Ivoire. In the longer term, the study will allow determining the effect of the integrated control approach on infection patterns with parasitic worms and intestinal protozoa, diarrheal incidence, anthropometric measures, and hygiene-related knowledge, attitudes, practices, and beliefs.Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN): 53102033; http://www.isrctn.com/ISRCTN53102033 (Archived by WebCite at http://www.webcitation.org/6wpnXEiHo)Registered Report IdentifierRR1-10.2196/9166

Comparison of school based and supplemental vaccination strategies in the delivery of vaccines to 5-19 year olds in Africa - a systematic review.

Some vaccine preventable diseases (VPDs) still remain a public health burden in many African countries. The occurrence of VPDs in all age groups has led to the realization of the need to extend routine immunisation services to school age children, adolescents and adults. Supplemental immunisation activities (SIAs) and school based vaccinations (SBVs) are common strategies used to complement the expanded programme on immunisation (EPI). This review aimed to assess the effectiveness of SIAs compared to SBVs in the administration of vaccines to 5-19 year olds in Africa. Systematic review methods were used to address our study aim. Several electronic databases were searched up to March 30, 2017 for primary studies investigating the delivery of vaccines via SIAs or SBVs to 5-19 year olds. This search was complemented by browsing reference lists of potential studies obtained from search outputs. Outcomes considered for inclusion were: vaccination coverage, costs of the strategy or its effect on routine immunisation services. Out of the 4938 studies identified, 31 studies met the review inclusion criteria. Both SIAs and SBVs showed high vaccination coverage. However, the SIAs reported higher coverage than SBVs: 91% (95% CI: 84%, 98%) versus 75% (95% CI: 67%, 83%). In most settings, SBVs were reported to be more expensive than SIAs. The SIAs were found to negatively affect routine immunisation services. Both SIAs and SBVs are routinely used to complement the EPI in the delivery of vaccines in Africa. In settings where school enrolment is suboptimal, as is the case in many African countries, our results show SIAs may be more effective in reaching school age children and adolescents than SBVs. Our results re-iterate the importance of evaluating systematic evidence to best inform African authorities on the optimal vaccine delivery strategies targeting school age children and adolescents.

The past matters: estimating intrinsic hookworm transmission intensity in areas with past mass drug administration to control lymphatic filariasis

BackgroundCurrent WHO guidelines for soil-transmitted helminth (STH) control focus on mass drug administration (MDA) targeting preschool-aged (pre-SAC) and school-aged children (SAC), with the goal of eliminating STH as a public health problem amongst children. Recently, attention and funding has turned towards the question whether MDA alone can result in the interruption of transmission for STH. The lymphatic filariasis (LF) elimination programme, have been successful in reaching whole communities. There is the possibility of building upon the infrastructure created for these LF-programmes to enhance the control of STH. Using hookworm as an example, we explore what further MDA coverage might be required to induce interruption of transmission for hookworm in the wake of a successful LF programme.ResultsAnalyses based on the model of STH transmission and MDA impact predict the effects of previous LF control by MDA over five years, on a defined baseline prevalence of STH in an area with a defined transmission intensity (the basic reproductive number R0). If the LF MDA programme achieved a high coverage (70, 70 and 60% for pre-SAC, SAC and adults, respectively) we expect that in communities with a hookworm prevalence of 15%, after 5 years of LF control, the intrinsic R0 value in that setting is 2.47. By contrast, if lower LF coverages were achieved (40, 40 and 30% for pre-SAC, SAC and adults, respectively), with the same prevalence of 15% at baseline (after 5 years of LF MDA), the intrinsic hookworm R0 value is predicted to be 1.67. The intrinsic R0 value has a large effect on the expected successes of follow-up STH programmes post LF MDA. Consequently, the outcomes of identical programmes may differ between these communities.ConclusionTo design the optimal MDA intervention to eliminate STH infections, it is vital to have information on historical MDA programmes and baseline prevalence to estimate the intrinsic transmission intensity for the defined setting (R0). The baseline prevalence alone is not sufficient to inform policy for the control of STH, post cessation of LF MDA, since this will be highly dependent on the intensity and effectiveness of past programmes and the intrinsic transmission intensity of the dominant STH species in any given setting.

Evaluating the variation in the projected benefit of community-wide mass treatment for schistosomiasis: Implications for future economic evaluations

BackgroundThe majority of schistosomiasis control programmes focus on targeting school-aged children. Expanding the use of community-wide mass treatment to reach more adults is under consideration. However, it should be noted that this would require a further increase in programmatic resources, international aid, and commitment for the provision of praziquantel. Consequently, it is important to understand (i) where a change of strategy would have the greatest benefit, and (ii) how generalisable the conclusions of field trials and analytical studies based on mathematical models investigating the impact of community-wide mass treatment, are to a broad range of settings.MethodsIn this paper, we employ a previously described deterministic fully age-structured schistosomiasis transmission model and evaluate the benefit of community-wide mass treatment both in terms of controlling morbidity and eliminating transmission for Schistosoma mansoni, across a wide range of epidemiological settings and programmatic scenarios. This included variation in the baseline relative worm pre-control burden in adults, the overall level of transmission in defined settings, choice of effectiveness metric (basing morbidity calculations on prevalence or intensity), the level of school enrolment and treatment compliance.ResultsCommunity-wide mass treatment was found to be more effective for controlling the transmission of schistosome parasites than using a school-based programme only targeting school-aged children. However, in the context of morbidity control, the potential benefit of switching to community-wide mass treatment was highly variable across the different scenarios analysed. In contrast, for areas where the goal is to eliminate transmission, the projected benefit of community-wide mass treatment was more consistent.ConclusionWhether community-wide mass treatment is appropriate will depend on the local epidemiological setting (i.e. the relative pre-control burden in adults and transmission intensity), and whether the goal is morbidity control or eliminating transmission. This has important implications regarding the generalisability of cost-effectiveness analyses of schistosomiasis interventions. Our results indicate that areas with poor school-enrolment/coverage could benefit more from community-wide treatment of praziquantel and should potentially be prioritised for any change in strategy. This work highlights the importance of not over-generalising conclusions and policy in this area, but of basing decisions on high quality epidemiological data and quantitative analyses of the impact of interventions in a range of settings.

Effectiveness of Albendazole for Hookworm Varies Widely by Community and Correlates with Nutritional Factors: A Cross-Sectional Study of School-Age Children in Ghana.

Mass drug administration (MDA) targeting school-age children is recommended by the World Health Organization for the global control of soil-transmitted helminth (STH) infections. Although considered safe and cost-effective to deliver, benzimidazole anthelminthics are variably effective against the three most common STHs, and widespread use has raised concern about the potential for emerging resistance. To identify factors mediating response to albendazole, we conducted a cross-sectional study of hookworm infection in the Kintampo North Municipality of Ghana in 2011. Among 140 school-age children residing in five contiguous communities, the hookworm prevalence was 59% (82/140). The overall cure rate following administration of single-dose albendazole (400 mg) was 35% (27/76), with a community-wide fecal egg reduction rate (ERR) of 61% (95% confidence interval: 51.8-71.1). Significant disparities were observed in albendazole effectiveness by community, with a cure rate as low as 0% (N = 24) in Jato Akuraa and ERRs ranging from 53% to 95% across the five study sites. Individual host factors associated with response to deworming treatment included time since last meal, pretreatment blood hemoglobin level, and mid-upper arm circumference. These data demonstrate significant community-level variation in the effectiveness of albendazole, even among populations living in close proximity. Identification of host factors that influence response to albendazole, most notably the timing of drug administration and nutritional factors, creates an opportunity to enhance the effectiveness of deworming through targeted interventions. These findings also demonstrate the importance of measuring anthelminthic response as part of the monitoring and evaluation of community-based deworming programs.

Schistosoma mansoni infection after three years of mass drug administration in Sierra Leone

BackgroundSchistosoma mansoni was moderately-highly endemic in the northeast of Sierra Leone. The national neglected tropical disease control program started mass drug administration (MDA) with praziquantel (PZQ) in six districts in 2009 targeting primary school children only. The effort was scaled-up to seven districts in 2010 targeting school aged children (SAC) and at-risk adults. A cross-sectional sentinel site survey was conducted in 2012 after three rounds of MDA to evaluate the impact of the national program.MethodsTwenty-six (26) sentinel sites were randomly selected from the baseline mapping survey sites stratified according to the baseline prevalence into high, moderate or low endemic category. Fifty (50) school children (25 males and 25 females) were randomly selected per site. Fresh stool samples were examined in the field using the Kato Katz technique. The results were compared with the baseline data.ResultsProgram coverage of 94.8%, 77.1% and 81.7% was reported in 2009, 2010 and 2011 respectively. Independent monitoring in 2011 showed program coverage of 83.9%, not significantly different from the reported result in the same year. The overall prevalence of S. mansoni was 16.3% (95% CI: 14.4-18.4%) and mean intensity was 18.98 epg (95% CI: 11.46-26.50 epg) in 2012, representing 67.2% and 85.9% reduction from the baseline respectively. The proportion of moderately and heavily infected children was 3.3% and 1.2%, a significant reduction from 18.2% and 8.8% at baseline respectively.ConclusionsSierra Leone has maintained effective MDA coverage with PZQ since 2009. Three rounds of MDA led to a significant reduction of S. mansoni infection in the country. In line with the significant progress made in controlling schistosomiasis, the national treatment strategy has been reviewed and MDA will be expanded to include school age children in low endemicity districts with the new national objective for the elimination of schistosomiasis. Sierra Leone is well on its way to eliminate schistosomiasis as a public health problem.

Increased transmissibility explains the third wave of infection by the 2009 H1N1 pandemic virus in England

In the 2009 H1N1 pandemic, the United Kingdom experienced two waves of infection, the first in the late spring and the second in the autumn. Given the low level of susceptibility to the pandemic virus expected to be remaining in the population after the second wave, it was a surprise that a substantial third epidemic occurred in the UK population between November 2010 and February 2011, despite no evidence for any significant antigenic evolution of the pandemic virus. Here, we use a mathematical model of influenza transmission embedded within a Bayesian synthesis inferential framework to jointly analyze syndromic, virological, and serological surveillance data collected in England in 2009-2011 and thereby assess epidemiological mechanisms which might have generated the third wave. We find that substantially increased transmissibility of the H1N1pdm09 virus is required to reproduce the third wave, suggesting that the virus evolved and increased fitness in the human host by the end of 2010, or that the very cold weather experienced in the United Kingdom at that time enhanced transmission rates. We also find some evidence that the preexisting heterologous immunity which reduced attack rates in adults during 2009 had substantially decayed by the winter of 2010, thus increasing the susceptibility of the adult population to infection. Finally, our analysis suggests that a pandemic vaccination campaign targeting adults and school-age children could have mitigated or prevented the third wave even at moderate levels of coverage.

Global trends in neglected tropical disease control and elimination: impact on child health

The neglected tropical diseases (NTDs) are a group of 17 lesser known chronic infections which predominantly affect poor and disenfranchised communities. There are a number of NTDs that cause significant...

Mass drug administration significantly reduces infection of Schistosoma mansoni and hookworm in school children in the national control program in Sierra Leone

BackgroundThe first-ever round of school-based mass drug administration (MDA) with praziquantel together with mebendazole targeting school-aged children in endemic districts was conducted in 2009 by the National Neglected Tropical Diseases Control Program. To evaluate the impact of the treatment regimen, a cross-sectional sentinel site survey was conducted 6 months post-MDA.MethodsFifteen sentinel schools from six highly endemic districts (according to data from national and pre-MDA surveys) with Schistosoma mansoni affecting over 50% of the population, and moderate to high prevalence of hookworms (> 20%). Approximately 30 children aged 9-14 years were selected from each school and stool samples (one per student) were examined by the Kato-Katz method.ResultsThe overall prevalence (and intensity) in these sentinel sites pre-MDA of S. mansoni was 69.0% (170.8 epg), hookworm: 41.7% (71.7 epg), Ascaris lumbricoides: 1.8% and Trichuris trichiura: 3.8%. Six months post MDA, the findings were S. mansoni: 38.2% (47.3 epg) and hookworm: 14.5% (8.7 epg), representing a reduction from pre-MDA levels of 44.6% (65.2%) and 72.3% (87.9%) respectively. The proportion of children who were moderately or heavily infected with S. mansoni fell from 35.6% pre MDA to 9.9% post MDA.ConclusionsSignificant reduction in S. mansoni and hookworm infection was achieved by this first round MDA in school-going children in Sierra Leone. This reduction in infection burden can potentially contribute to a reduction of morbidity, such as anaemia, in these children.

Global trends in schistosomiasis control

Schistosomiasis remains a global health problem in the 21st century with an estimated 200 million people in 74 countries infected, of whom 85% are living in sub-Saharan Africa.1 In 2001, at the 54th World Health Assembly, every Member State endorsed resolution WHA 54.19 to promote preventive measures, ensure treatment and mobilize resources for the control of schistosomiasis and soil-transmitted helminths. The goal is to treat between 75% and 100% of all school-age children at risk of morbidity by 2010.2 Praziquantel provides effective, safe, single-dose treatment with few side-effects, offering opportunities for improved schistosomiasis control. A recent Cochrane review evaluating the standard dose for urinary schistosomiasis (praziquantel 40 mg/kg) found it to be as effective as a single dose, resulting in 95% egg reduction.3 WHO advocates mass treatment at schools with frequency of treatment dependent on prevalence and intensity of schistosomiasis infection. To simplify the procedure and reduce costs, a questionnaire has been developed to identify schools requiring treatment. To assist in calculating the required praziquantel dose, a dose-pole method has been developed. This issue of the Bulletin reports on three recent studies to improve schistosomiasis control in Burkina Faso, China and the Philippines.4–6 The Schistosomiasis Control Initiative has been working with six countries in Africa and the results, two years after a single mass treatment in Burkina Faso, are encouraging.4 From the lessons learned, similar strategies may be adopted by other developing countries. The importance of effective community involvement for mass treatment is emphasized in the Philippines study. The possibility of a more effective treatment regimen by using artemether together with praziquantel for acute Schistosoma japonica was investigated in China.5 This study found that there was no improvement in treatment efficacy by using the combination, while using 60 mg/kg praziquantel treatment for 1 day (3 doses) was found to be as effective as 120 mg/kg daily for 6 days. Schistosomiasis morbidity control through chemotherapy has been successful in Brazil and countries in northern Africa. Further, the Schistosomiasis Control Initiative is re-invigorating efforts in Africa. Burkina Faso is one of the lowest-income countries in Africa. The successful campaign reported in this publication is a lesson for other resource-poor countries in Africa, suggesting that the key may lie in political will and combining resources to achieve schistosomiasis control. The reduction in the prevalence of schistosomiasis among school-children after one mass treatment indicates that, by working together using school and community resources, a high coverage can be achieved. This major reduction in infection in Burkina Faso was sustained over two years. Where school attendance is high, schools are the obvious place to treat but, in countries such as Burkina Faso that have a low school enrolment, efforts need to be made to reach the community. Burkina Faso managed to achieve sufficient community involvement to reach these children not in school. The report from the Philippines indicates that efforts there were less successful, suggesting that more effort is needed to involve key stakeholders and increase use of media such as radio to raise awareness.6 Village leaders were primarily responsible for community mobilization and the extent of their support for the programme is unclear, since less than 50% coverage was achieved. Uptake of treatment may be improved by more publicity, identifying key stakeholders early in the programme and agreeing on their roles and responsibilities, and monitoring the implementation of the tasks agreed upon. Until a vaccine is developed, public health initiatives together with known effective chemotherapy are needed to control schistosomiasis morbidity. The decrease in drug prices and the safety of praziquantel can facilitate treatment programmes, and adding deworming to large-scale health campaigns may be a feasible option. Targeting school-age children who bear the greatest parasite burden is an important strategy to improve their growth, development and health status, and it may possibly reduce their risk of HIV infection.7 However with increased prevalence through irrigation, ponds and changing water bodies, other “at risk” populations may need to be included in treatment programmes. ■