Systematic review of community-based, school-based, and combined delivery modes for reaching school-aged children in mass drug administration programs for schistosomiasis
Open Access
- 27 October 2017
- journal article
- review article
- Published by Public Library of Science (PLoS) in PLoS Neglected Tropical Diseases
- Vol. 11 (10), e0006043
- https://doi.org/10.1371/journal.pntd.0006043
Abstract
The mainstay of current schistosomiasis control programs is mass preventive chemotherapy of school-aged children with praziquantel. This treatment is delivered through school-based, community-based, or combined school- and community-based systems. Attaining very high coverage rates for children is essential in mass schistosomiasis treatment programs, as is ensuring that there are no persistently untreated subpopulations, a potential challenge for school-based programs in areas with low school enrollment. This review sought to compare the different treatment delivery methods based both on their coverage of school-aged children overall and on their coverage specifically of non-enrolled children. In addition, qualitative community or programmatic factors associated with high or low coverage rates were identified, with suggestions for overall coverage improvement. This review was registered prospectively with PROSPERO (CRD 42015017656). Five hundred forty-nine publication of potential relevance were identified through database searches, reference lists, and personal communications. Eligible studies included those published before October 2015, written in English or French, containing quantitative or qualitative data about coverage rates for MDA of school-aged children with praziquantel. Among the 22 selected studies, combined community- and school-based programs achieved the highest median coverage rates (89%), followed by community-based programs (72%). School-based programs had both the lowest median coverage of children overall (49%) and the lowest coverage of the non-enrolled subpopulation of children. Qualitatively, major factors affecting program success included fear of side effects, inadequate education about schistosomiasis, lack of incentives for drug distributors, and inequitable distribution to minority groups. This review provides an evidence-based framework for the development of future schistosomiasis control programs. Based on our results, a combined community and school-based delivery system should maximize coverage for both in- and out-of-school children, especially when combined with interventions such as snacks for treated children, educational campaigns, incentives for drug distributors, and active inclusion of marginalized groups. ClinicalTrials.gov CRD42015017656 Schistosomiasis is a chronic inflammatory condition, caused by parasitic flukes, that affects over 290 million people worldwide. Consequences of infection include anemia, stunted growth, liver abnormalities, and subfertility. Currently, the main approach to schistosomiasis control involves mass preventive treatment of school-aged children in endemic areas. The treatment, praziquantel, can be distributed through school-based, community-based, or combined school- and community-based systems. The first part of this systematic review compared the three delivery modes and found that combined delivery resulted in the best overall coverage of school-aged children, with community-only delivery the next-best approach. School-only delivery not only had the lowest overall coverage, but especially fell behind in targeting children not enrolled in school. As a whole, these results support the more frequent use of a combined approach to delivery in order to achieve the highest coverage rates and ensure that out-of-school children are not left persistently untreated. In the second part of this review the qualitative factors affecting program success were examined. The results indicate that overall treatment coverage can be improved via small interventions, such as snacks for participating children to reduce drug side effects, educational campaigns about schistosomiasis, incentives for drug distributors, and active inclusion of marginalized groups.Keywords
Funding Information
- University of Georgia Research Foundation
This publication has 39 references indexed in Scilit:
- Increasing teacher motivation and supervision is an important but not sufficient strategy for improving praziquantel uptake in Schistosoma mansonicontrol programs: serial cross sectional surveys in UgandaBMC Infectious Diseases, 2013
- A Review of Factors That Influence Individual Compliance with Mass Drug Administration for Elimination of Lymphatic FilariasisPLoS Neglected Tropical Diseases, 2013
- Factors associated with coverage of praziquantel for schistosomiasis control in the community-direct intervention (CDI) approach in Mali (West Africa)Infectious Diseases of Poverty, 2013
- Uptake of Preventive Treatment for Intestinal Schistosomiasis among School Children in Jinja District, Uganda: A Cross Sectional StudyPLOS ONE, 2013
- Projecting the Long-Term Impact of School- or Community-Based Mass-Treatment Interventions for Control of Schistosoma InfectionPLoS Neglected Tropical Diseases, 2012
- Integrated community-directed intervention for schistosomiasis and soil transmitted helminths in western Kenya – a pilot studyParasites & Vectors, 2012
- Implementing Preventive Chemotherapy through an Integrated National Neglected Tropical Disease Control Program in MaliPLoS Neglected Tropical Diseases, 2012
- Schistosomiais and Soil-Transmitted Helminth Control in Niger: Cost Effectiveness of School Based and Community Distributed Mass Drug AdministrationPLoS Neglected Tropical Diseases, 2011
- Can coverage of schistosomiasis and soil transmitted helminthiasis control programmes targeting school-aged children be improved? New approachesParasitology, 2009
- Schistosoma japonicum Reinfection after Praziquantel Treatment Causes Anemia Associated with InflammationInfection and Immunity, 2006