RESUMEN
BACKGROUND: The goal of soil-transmitted helminthiases (STH) control programmes is to eliminate STH-associated morbidity in the target population by reducing the prevalence of moderate- and heavy-intensity infections and the overall STH infection prevalence mainly through preventive chemotherapy (PC) with either albendazole or mebendazole. Endemic countries should measure the success of their control programmes through regular epidemiological assessments. We evaluated changes in STH prevalence in countries that conducted effective PC coverage for STH to guide changes in the frequency of PC rounds and the number of tablets needed. METHODS: We selected countries from World Health Organization (WHO)'s Preventive Chemotherapy and Transmission control (PCT) databank that conducted ≥5 years of PC with effective coverage for school-age children (SAC) and extracted STH baseline and impact assessment data using the WHO Epidemiological Data Reporting Form, Ministry of Health reports and/or peer-reviewed publications. We used pooled and weighted means to plot the prevalence of infection with any STH and with each STH species at baseline and after ≥5 years of PC with effective coverage. Finally, using the WHO STH decision tree, we estimated the reduction in the number of tablets needed. RESULTS: Fifteen countries in four WHO regions conducted annual or semi-annual rounds of PC for STH for 5 years or more and collected data before and after interventions. At baseline, the pooled prevalence was 48.9% (33.1-64.7%) for any STH, 23.2% (13.7-32.7%) for Ascaris lumbricoides, 21.01% (9.7-32.3%) for Trichuris trichiura and 18.2% (10.9-25.5%) for hookworm infections, while after ≥5 years of PC for STH, the prevalence was 14.3% (7.3-21.3%) for any STH, 6.9% (1.3-12.5%) for A. lumbricoides, 5.3% (1.06-9.6%) for T. trichiura and 8.1% (4.0-12.2%) for hookworm infections. CONCLUSIONS: Countries endemic for STH have made tremendous progress in reducing STH-associated morbidity, but very few countries have data to demonstrate that progress. In this study, the data show that nine countries should adapt their PC strategies and the frequency of PC rounds to yield a 36% reduction in drug needs. The study also highlights the importance of impact assessment surveys to adapt control strategies according to STH prevalence.
Asunto(s)
Albendazol/uso terapéutico , Antihelmínticos/uso terapéutico , Quimioprevención/estadística & datos numéricos , Helmintiasis/prevención & control , Mebendazol/uso terapéutico , Albendazol/provisión & distribución , Animales , Antihelmínticos/provisión & distribución , Ascariasis/epidemiología , Ascariasis/parasitología , Ascariasis/prevención & control , Ascaris lumbricoides/fisiología , Helmintiasis/epidemiología , Helmintiasis/parasitología , Infecciones por Uncinaria/epidemiología , Infecciones por Uncinaria/parasitología , Infecciones por Uncinaria/prevención & control , Humanos , Mebendazol/provisión & distribución , Prevalencia , Suelo/parasitología , Tricuriasis/epidemiología , Tricuriasis/parasitología , Tricuriasis/prevención & control , Trichuris/fisiologíaRESUMEN
In 2004-2005, the school deworming program in Vietnam targeted 2,400,000 school-children in 25 provinces. A questionnaire survey of a random sample of schools throughout the country was organized to validate the teacher feedback, assess the real coverage of the program and estimate the occurrence of side-effects. A total of 91 schools in four different provinces were visited few days after drug distribution. A total of 2,323 children and 80 teachers were questioned. The total cost of the monitoring has been estimated at US dollar 7,000 (less than 10% of the deworming program). The survey demonstrated a coverage of 95% for school-children and of 86.3% for teachers (on average a coverage 2% lower than the one reported by the teachers through forms on the day of drug administration). Approximately 0.4% of those interviewed reported side-effects after deworming, while the occurrence of side effects through routine reports was 0.15%. In both cases, the side effects were described as mild forms of nausea, abdominal pain, or headaches that did no required pharmacological treatment. The survey confirmed the positive results of routine reporting; we consider the survey a cost-effective activity to maintain the control activities under monitoring.
Asunto(s)
Antihelmínticos/administración & dosificación , Helmintiasis/prevención & control , Helmintos/efectos de los fármacos , Parasitosis Intestinales/prevención & control , Mebendazol/administración & dosificación , Servicios de Salud Escolar/organización & administración , Animales , Antihelmínticos/efectos adversos , Antihelmínticos/provisión & distribución , Niño , Control de Enfermedades Transmisibles , Docentes , Salud de la Familia , Encuestas de Atención de la Salud , Helmintos/parasitología , Humanos , Mebendazol/efectos adversos , Mebendazol/provisión & distribución , Evaluación de Programas y Proyectos de Salud , Servicios de Salud Escolar/economía , Encuestas y Cuestionarios , VietnamRESUMEN
School-based deworming programs are one of the most cost-effective public health strategies to reach children with anthelminthics and health education. However, despite their low cost and high health impact, they are not implemented on a large scale. The present survey investigated a school-based deworming program in Ha Giang Province, Vietnam, to assess the community perception and support towards these programs. Information from 81 households, 88 primary school students, 25 teachers and 9 people in charge of commune health stations was collected by structured questionnaires. The survey displayed complete satisfaction and a high level of support within all 4 questioned groups. In addition 96.1% of all parents noticed an improvement in their children's health. The great appreciation of the deworming program by the community is an additional argument to convince decision makers to implement and scale up these programs. Even teachers that did not receive any specific training were able to distribute the drug successfully following the page of written instructions accompanying the drug.
Asunto(s)
Antihelmínticos/administración & dosificación , Helmintiasis/prevención & control , Helmintos/efectos de los fármacos , Parasitosis Intestinales/prevención & control , Mebendazol/administración & dosificación , Padres/psicología , Servicios de Salud Escolar/organización & administración , Adolescente , Animales , Antihelmínticos/efectos adversos , Antihelmínticos/provisión & distribución , Niño , Control de Enfermedades Transmisibles , Comportamiento del Consumidor , Docentes , Salud de la Familia , Encuestas de Atención de la Salud , Helmintos/parasitología , Helmintos/patogenicidad , Humanos , Mebendazol/efectos adversos , Mebendazol/provisión & distribución , Evaluación de Procesos y Resultados en Atención de Salud , Evaluación de Programas y Proyectos de Salud , Servicios de Salud Escolar/economía , Encuestas y Cuestionarios , VietnamRESUMEN
Onchocerciasis is co-endemic with schistosomiasis and intestinal helminths infections, which are all diseases of the rural and the poorest communities in Africa. Community-directed treatment (ComDT) for the control of onchocerciasis is the only functional health approach in most of these communities and the strategy has proven to be effective for onchocerciasis control. This study was conducted to assess the feasibility of integrating ComDT with ivermectin for the control of onchocerciasis, and with praziquantel (PZQ) and mebendazole (MBD) for the control of schistosomiasis and intestinal helminths infections in children aged 5-14 years, and to assess advantages and disadvantages of the integrated ComDT over the routine ComDT and the school-based treatment approach. Integrated ComDT achieved higher treatment coverage (85%) for PZQ and MBD than the school-based treatment approach (79%) among children aged 5-14 years (P = 0.03). There were more reported adverse reactions after treatment with a combination of PZQ and MBD in the school-based treatment approach (33%) than for the combination of ivermectin and MBD on day 1 and PZQ on day 2 in the integrated ComDT (18%). However, all adverse reactions were mild (headache, nausea/vomiting and abdominal pain). The integrated ComDT also achieved higher ivermectin treatment coverage for all ages (81.3%) than routine ComDT (77.2%) (P = 0.0003). To achieve even better coverage for PZQ and MBD among the targeted high risk groups, integrated ComDT should treat all age groups in areas where the prevalence of schistosomiasis and intestinal helminths infections is >50%. This would minimize the shortage of the drugs targeted to treat the high risk groups, as the non-targeted groups, will inevitably demand and receive the treatment from the distributors. The results of this study show that PZQ and MBD treatment for the control of schistosomiasis and intestinal helminths, respectively, can be integrated with ivermectin treatment for the control of onchocerciasis without negatively affecting ivermectin treatment coverage.