Meta-analysis and public policy: Reconciling the evidence on deworming.

The WHO recommends mass drug administration (MDA) for intestinal worm infections in areas with over 20% infection prevalence. Recent Cochrane meta-analyses endorse treatment of infected individuals but recommend against MDA. We conducted a theory-agnostic random-effects meta-analysis of the effect of multiple-dose MDA and a cost-effectiveness analysis. We estimate significant effects of MDA on child weight (0.15 kg, 95% CI: 0.07, 0.24; P < 0.001), mid-upper arm circumference (0.20 cm, 95% CI: 0.03, 0.37; P = 0.02), and height (0.09 cm, 95% CI: 0.01, 0.16; P = 0.02) when prevalence is over 20% but not on Hb (0.06 g/dL, 95% CI: -0.01, 0.14; P = 0.1). These results suggest that MDA is a cost-effective intervention, particularly in the settings where it is recommended by the WHO.

Bridging the vitamin A and deworming coverage gap among underserved populations in India through government and civil society organization partnerships.

BACKGROUND: Vitamin A deficiency (VAD) is a major public health problem in India, where approximately 62% of children under five have low retinol levels (< 70 µmol/L). This study aims to (1) evaluate vitamin A supplementation (VAS) and deworming (VAS + D) coverage in Nagaland state through government and civil society organization (CSO) partnerships, (2) examine socio-demographic barriers and facilitators to VAS + D coverage, (3) examine associations between socio-demographic characteristics and source of VAS coverage (i.e., government vs. CSOs), and (4) estimate the impact of VAS on health outcomes due to increased coverage through government and CSO partnerships. METHODS: A cross-sectional statewide coverage survey was conducted in Nagaland, India with 1,272 caregivers of children 6-59 months. Household socio-demographic data and VAS + D exposure variables were collected via quantitative survey. Univariate analyses were used to assess the associations between the independent and outcome variables; odds ratios were computed to measure the strength of the association at a significance level of < 0.05. The Lives Saved Tool (LiST) was used to estimate the impact of increased VAS coverage on child undernutrition, morbidity and mortality. RESULTS: Most children (77.2%) received VAS in the past six months, with 28.1% receiving VAS in capsule form (provided primarily by CSOs) and 70.2% received VAS in syrup form (provided primarily by government). Total deworming coverage was 74.2%, with 43.5% receiving both VAS and deworming. Lower pre-school enrollment was a barrier to receiving VAS (47.4% not enrolled vs. 80.9% enrolled, p < 0.001). A barrier to receiving VAS + D was lack of knowledge of benefits (p < 0.001). Based on LiST modeling, increasing VAS coverage by 22% through CSOs resulted in an estimated 114 stunting cases averted, 25,017 diarrhea cases averted, and 9 lives saved in 2019 in Nagaland State. CONCLUSIONS: Government and CSO partnerships can reduce disparities in VAS coverage and decrease under-five child morbidity and mortality.

Investigating the effect of a school-based WASH intervention on soil-transmitted helminth and schistosome infections and nutritional status of school children in Ethiopia: a quasi-experimental study.

BACKGROUND: The impact of access to improved water, sanitation and hygiene (WASH) and health education on large-scale deworming programs aimed at controlling soil-transmitted helminth (STH) and schistosome (SCH) infections has not been well studied. We assessed the additional impact of improved WASH infrastructure and health education at schools on STH and SCH infections in Ethiopia. METHODS: The study used a quasi-experimental design under which 30 schools were assigned to either an intervention (15 schools) or control (15 schools) arm. Both arms received a standard deworming treatment and lunch. In the intervention arm, improved WASH and health education were provided. At three consecutive time points (baseline in 2013, 2014 and 2015), the prevalence and intensity of STH and SCH infections and the nutritional status [hemoglobin concentrations and physical growth (height and weight)] were determined. To verify whether interventions were successfully implemented, the WASH status at school and the student knowledge, attitudes and practices related to WASH (WASH-KAP) were recorded. Differences in metrics between arms at baseline (2013) and follow-up (2015) were assessed both within and between the arms. RESULTS: A significant increase in scores for both the school WASH and student KAP was found in the intervention arm, indicating successful implementation of the intervention. The prevalence of any STH infection was significantly reduced in the intervention arm but not in the control arm (F = 4.486, p = 0.034). There was a significantly greater reduction in the intensity of infection of hookworm and Ascaris lumbricoides compared to baseline in both arms. The intervention did not affect school children's height-for-age z-score (intervention arm * time coef = 0.12, p = 0.400) and body mass index-for-age z-scores (intervention * time coef = - 0.06, p = 0.526). Hemoglobin concentrations increased significantly more in the control than the intervention arm (coef = - 0.16, p = 0.006). CONCLUSIONS: Although the intervention did increase school WASH and student WASH-KAP, our study found poor evidence of the additional benefit of improved WASH and health education to deworming and school food programs on parasite re-infection and the health outcomes of children.

Feasibility of delivering vitamin A supplementation (VAS) and deworming through routine community health services in Siaya County, Kenya: A cross-sectional study.

Vitamin A deficiency and soil-transmitted helminth infection are serious public health problems in Kenya. The coverage of vitamin A supplementation and deworming medication (VASD) provided through mass campaigns is generally high, yet with a cost that is not sustainable, while coverage offered through routine health services is low. Alternative strategies are needed that achieve the recommended coverage of >80% of children twice annually and can be managed by health systems with limited resources. We undertook a study from September to December 2021 to compare the feasibility and coverage of VASD locally delivered by community health volunteers (CHV) ("intervention arm") to that achieved by the bi-annual Malezi Bora campaign event ("control arm"). This comparative cross-sectional study was conducted in sub-counties of Siaya County using both qualitative and quantitative methods. VASD were offered through the CHS in Alego Usonga and through Malezi Bora in Bondo Sub-County. Coverage was assessed by a post-event coverage survey among caregivers of children aged 6-59 months (n = 307 intervention; n = 318 control). Key informant interviews were conducted with n = 43 personnel across both modalities, and 10 focus group discussions were conducted with caregivers of children aged 6-59 months to explore knowledge, attitudes and perceptions of the two strategies. VAS coverage by CHV was 90.6% [95% CI: 87.3-93.9] compared to 70.4% [95% CI: 65.4-75.4] through the Malezi Bora, while deworming coverage was 73.9% [95% CI: 69.0-78.7] and 54.7% [95% CI: 49.2-60.2], respectively. With sufficient training and oversight, CHV can achieve superior coverage to campaigns.

Survey on sanitary practices and knowledge about infectious diseases among equine owners in the State of Rio Grande do Norte, Brazil.

As the primary decision-maker about the health, nutrition, and well-being of their horses, owners' knowledge of correct management practices and clinical changes can potentially affect the immediate health of their horses, in addition to having an impact on the prevention of disease spread in the herd. The adoption of management practices to prevent the introduction and spread of pathogens depends on various factors, including demographics, awareness of the problem, perceived responsibility, previously held beliefs, and sociocultural norms. This study aimed to evaluate the health management practices and the level of knowledge about infectious diseases of equine owners in the state of Rio Grande do Norte, Brazil. A cross-sectional study was conducted by distributing a questionnaire to horse owners in Rio Grande do Norte, Brazil. The participants included horse owners irrespective of the duration of ownership, experience, or sports practiced. In addition to the hygiene and management of animals, the questionnaire addressed topics related to the facilities where the horses were kept. Three hundred and two horse owners distributed in 60 of the 167 municipalities in the state of Rio Grande do Norte participated in this study. Among the interviewed owners, 63.90% (193/302) answered that they do not quarantine animals introduced into the herd or those visiting the property. Regarding the deworming program, 95.03% (287/302) of the owners regularly dewormed their animals. However, more than half of the participants sought veterinary guidance (54.30%). Investing in educational programs and increasing the awareness of equine owners in the state of Rio Grande do Norte about the main infectious diseases in horses is essential toward improving sanitary management and the general health of animals. Informed owners play an essential role in creating safer environments for their horses, thereby contributing to the sustainability of the equine industry.

Como principal tomador de decisão sobre a saúde, nutrição e bem-estar de seus cavalos, o conhecimento dos proprietários sobre práticas corretas de manejo e mudanças clínicas pode potencialmente afetar a saúde imediata de seus cavalos, além de ter um impacto na prevenção de propagação das doenças no rebanho. A adoção de práticas de manejo para prevenir a introdução e disseminação de patógenos depende de uma variedade de fatores, incluindo dados demográficos, consciência do problema, responsabilidade percebida, crenças anteriores e normas socioculturais. Este trabalho teve como objetivo avaliar as práticas de manejo da saúde e o nível de conhecimento sobre doenças infecciosas de proprietários de equinos no estado do Rio Grande do Norte, Brasil Brasil. As amostras incluíram proprietários de cavalos, independentemente da duração da posse, experiência ou esporte praticado. O questionário abordou temas relacionados às instalações onde os cavalos eram mantidos, além do manejo higiênico-sanitário dos animais. Participaram do estudo 302 proprietários de cavalos distribuídos em 60 dos 167 municípios do estado do Rio Grande do Norte. Dentre os proprietários entrevistados, 63,90% (193/302) responderam que não colocam em quarentena os animais introduzidos no rebanho ou que estão visitando a propriedade. Em relação ao programa de desverminação, 95,03% (287/302) proprietários administravam vermifugação regularmente aos seus animais. No entanto, pouco mais da metade procura orientação veterinária (54,30%). Investir em programas de educação e conscientização dos proprietários de equinos do estado do Rio Grande do Norte sobre as principais doenças infecciosas em equinos é fundamental para melhorar o manejo sanitário e a saúde geral dos animais. Proprietários informados desempenham um papel essencial na criação de ambientes mais seguros para os cavalos, contribuindo para a sustentabilidade da indústria equina como um todo.

Combination with Annual Deworming Treatments Does Not Enhance the Effects of PCV2 Vaccination on the Development of TB in Wild Boar Populations.

Vaccination against PCV2 has been proven to be an effective measure to reduce the severity of TB in wild boar. The combination of this measure with strategies focused on treating other key concomitant pathogens, such as nematodes, could be a useful strategy. This study assesses whether a combination of deworming treatments and PCV2 vaccination may reduce the prevalence and severity of TB in wild boar. The study was conducted on five game estates in mid-western Spain where four groups of wild boar were produced: control, vaccinated, dewormed and vaccinated-dewormed. Wild boars from all groups were hunted between 2017 and 2020, and all of them received a TB diagnosis based on pathological and microbiological tests. Generalised linear models were used to explore the effect of deworming and PCV2 vaccination on TB prevalence and severity. PCV2-vaccinated animals showed lower probabilities of suffering severe TB lesions. However, no differences regarding TB severity were found between dewormed and non-dewormed wild boar. PCV2 vaccination reduces TB severity in wild boar. However, annual deworming does not produce a long-term parasitological reduction that can influence the development of TB in wild boar, nor does it improve the effect of PCV2 vaccination on TB.

Water, sanitation and hygiene (WASH) practices and deworming improve nutritional status and anemia of unmarried adolescent girls in rural Bangladesh.

BACKGROUND: In Bangladesh, undernutrition and anemia are more occurrent among adolescent girls. BRAC, the largest non-governmental organization (NGO), has been implementing a community-based nutrition education service package targeting adolescent girls for reducing their undernutrition and anemia. OBJECTIVE: We aimed to explore the underlying factors associated with nutritional status and anemia among adolescent girls under the BRAC nutrition program areas to improve their existing intervention package. METHODOLOGY: We conducted a cross-sectional and comparative study in 2016, in 24 upazilas of Bogra, Barguna, Comilla, Dinajpur, Feni, Jessore, and Meherpur districts where the BRAC nutrition program was implemented while the remaining 27 upazilas of those districts were selected as comparison area. We followed a multistage cluster random sampling for selecting 1620 unmarried adolescent girls aged 10-19 years for interviewing in the intervention and comparison areas. Data were collected on socio-demographic information, dietary intake, morbidity, water, sanitation, and hygiene (WASH) practice, anthropometry, and serum hemoglobin (Hb) level by using a pre-structured questionnaire. The nutritional status of the adolescent girls was expressed as height-for-age Z (HAZ) and body mass index-for-age Z (BMIZ) score, while anemia referred to the serum Hb at the level of below 12 g/dl for adolescent girls. All statistical analyses were done in STATA version 17 (Chicago Inc.). FINDINGS: The prevalence of stunting (22.9% vs. 22.5%), thinness (12% vs. 14%), and anemia (34.5% vs. 37.3%) exhibited similarities between the intervention and comparison regions. Stunting and thinness were predictors for each other for this population group. Our findings indicated that adolescent girls who were not washing hands with soap after defecation were likely to be stunted [AOR 1.51 (95% CI 1.12-2.04)], and who did not utilize sanitary latrines had an increased likelihood of being thin [AOR 2.38 (95% CI 1.11-5.08)]. Conversely, those who did not watch television [AOR 1.69 (95% CI 1.12-2.56)] and did not have deworming tablets [AOR 1.33 (95% CI 1.07-1.64)] in the 6 months leading up to the interview had a 69% and 33% higher probability of being anemic, respectively. CONCLUSION: For sustainable improvement in the undernutrition and anemia of adolescent girls, integration of WASH, consistent administration of deworming tablets and broadcasting awareness programs through television are urgent to scale up the nutrition intervention programs in similar settings like Bangladesh.

Community-wide versus school-based targeted deworming for soil-transmitted helminth control in school-aged children in Vietnam: the CoDe-STH cluster-randomised controlled trial.

Background: Soil-transmitted helminth (STH) infection control programs typically consist of school-based preventive chemotherapy (PC) targeted to school-aged children. STH reservoirs in untreated community members contribute to ongoing transmission in children. The CoDe-STH (Community Deworming against STH) trial, conducted in Dak Lak province, Vietnam, between October 2019 and November 2020, aimed to determine whether community-wide mass drug administration (MDA) is more effective than school-based targeted PC in reducing STH prevalence and intensity in children. Methods: In this two-arm cluster randomised controlled trial, 64 primary schools were randomly assigned 1:1 to receive either school-based targeted PC ("school arm") or community-wide MDA ("community arm"). A single dose of albendazole 400 mg was used for deworming. The primary outcome was hookworm prevalence in schoolchildren, measured using quantitative real-time PCR. We also measured infection intensity for Necator americanus only, using qPCR cycle threshold (Ct) values converted into eggs per gram of faeces (EPG). Analysis was by intention to treat. The trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619000309189). Findings: The analysis included 4955 children in the school arm and 5093 children in the community arm. N. americanus was the dominant STH species. The relative reduction in hookworm prevalence was not significantly different between the school arm (30.1%, 95% confidence interval [CI] 20.5-36.9) and the community arm (34.6%, 95% CI 19.9-49.4). Due to lower baseline prevalence than expected, the study was underpowered to detect a difference in prevalence reduction between the study arms. The community arm showed significantly greater relative reduction in N. americanus infection intensity (56.0%, 95% CI 39.9-72.1) compared to the school arm (3.4%, 95% CI -24.7 to 31.4). The community arm also showed greater relative reduction in prevalence of moderate-to-heavy intensity (≥2000 EPG) N. americanus infections (81.1%; 95% CI 69.7-92.6) compared to the school arm (39.0%, 95% CI 13.7-64.2). Interpretation: Although no impact was seen on overall prevalence, community-wide MDA was more effective in lowering N. americanus infection intensity in schoolchildren compared to school-based targeted PC, measured 12 months after one round of albendazole deworming with high coverage. Funding: National Health and Medical Research Council, Australia (APP1139561).

Model-based geostatistical design and analysis of prevalence for soil-transmitted helminths in Kenya: Results from ten-years of the Kenya national school-based deworming programme.

Background: Kenya is endemic for soil-transmitted helminths (STH) with over 6 million children in 27 counties currently at-risk. A national school-based deworming programme (NSBDP) was launched in 2012 with a goal to eliminate parasitic worms as a public health problem. This study used model-based geostatistical (MBG) approach to design and analyse the impact of the NSBDP and inform treatment strategy changes. Methods: A cross-sectional study was used to survey 200 schools across 27 counties in Kenya. The study design, school selection and analysis followed the MBG approach which incorporated historical data on treatment, morbidity and environmental covariates to efficiently predict the helminths prevalence in Kenya. Results: Overall, the NSBDP geographic area prevalence for any STH was estimated to sit between 2 % and <10 % with a high predictive probability of >0.999. Species-specific thresholds were between 2 % and <10 % for Ascaris lumbricoides, 0 % to <2 % for hookworm, and 0 % to <2 % for Trichuris trichiura, all with high predictive probability of >0.999. Conclusions: Based on the World Health Organization guidelines, STH treatment requirements can now be confidently refined. Ten counties may consider suspending treatment and implement appropriate surveillance system, while another 10 will require treatment once every two years, and the remaining seven will require treatment once every year.

Relationships of deworming drug consumption and animal protein intake with stunting.

By the end of 2022, the nationwide incidence of stunting remained high, including in Lampung Province, where it was 15.8%, above the target of 14% to be achieved by 2024. Since 2019, stunting has become a national priority due to suspected factors such as low nutrition intake, especially from animal protein sources, high rates of worm infections, and low compliance of under-fives in consuming deworming drugs. Therefore, this research aimed to analyze the relationship between deworming consumption, adequacy of animal protein intake, and stunting incidence in children aged 12-59 months in Bandar Lampung in 2022. This research used an analytic survey with a cross-sectional approach to analyze the relationship between deworming consumption, adequacy of animal protein intake, and stunting in under-fives at two priority stunting handling neighbourhoods in Bandar Lampung, namely Way Gubak and Karang Maritim. The sample consisted of 262 under fives and their mothers who visited the integrated health post in the selected neighbourhoods from November to December 2022, and the data obtained were analyzed using logistic regression. The results revealed a relationship between the consumption of an deworming and varying animal protein consumption with stunting incidence. This indicated a need to promote the importance of consuming deworming and adequate consumption of animal protein with variation to prevent stunting in children in Bandar Lampung.

Selective Anthelmintic Treatment in Horses in Sweden Based on Coprological Analyses: Ten-Year Results.

In Sweden, routine deworming has been used for several decades; however, to slow down the development of anthelmintic resistance, selective treatment is currently recommended. As part of a monitoring programme, equestrian premises submitted faecal samples to the National Veterinary Institute (SVA) twice per year between 2008 and 2017. Analyses for strongyles (small and large), tapeworms and ascarids, followed by premise-specific advice regarding deworming and parasite control strategies, were provided. In total, 43,330 faecal samples, collected from 26,625 horses on 935 premises in springtime (March to June), were analysed by quantitative or semi-quantitative flotation. Moreover, Strongylus vulgaris was detected by larval culture or PCR. Between 4 and 11% of individual horses tested positive for S. vulgaris and 3-10% were shedding tapeworm eggs. There were recurrent high and low egg shedders; 75% of horses with S. vulgaris appeared to have been recently introduced into the herd; the proportion of S. vulgaris-positive premises increased when individual samples rather than pooled samples were used. Based on the results of S. vulgaris diagnostics and strongyle egg-shedding level, 59% of the horses did not need to be dewormed.

Helminth infection in horses - a cross-sectional study from stables in Lower Silesia (Poland).

Parasitosis in horses may be uncontrolled and expose breeders and owners to serious financial losses or, possibly, to the loss of animals. Therefore, the prevention and monitoring of the development of parasitic diseases should play an important role in the breeding process. The aim of this study was to confirm the influence of factors such as age, breed, herd size, deworming program, and type of anthelmintics, on the prevalence and intensity of parasites (helminths) in domestic horses in Lower Silesia. The study was carried out between August and November of 2020. The samples of horse feces were collected from 50 different stables in the area of Lower Silesia, Poland. A total of 286 individuals from various breeds were examined. Detailed analysis revealed that the mean age of infected horses was significantly lower than in uninfected horses. The mean time since the last deworming procedure was almost twice as low in uninfected horses than in infected ones. Additionally, the deworming agent affects the prevalence of infection. The analysis was also performed for the same factors in reference to quantitative data. The mean EPG was four-fold higher in juvenile horses than in adults and three-fold higher when the horses were dewormed with the use of fenbendazole instead of ivermectin or ivermectin with praziquantel combined.

A positive consequence of the COVID-19 pandemic: how the counterfactual experience of school closures is accelerating a multisectoral response to the treatment of neglected tropical diseases.

Global access to deworming treatment is one of the public health success stories of low-income countries in the twenty-first century. Parasitic worm infections are among the most ubiquitous chronic infections of humans, and early success with mass treatment programmes for these infections was the key catalyst for the neglected tropical disease (NTD) agenda. Since the launch of the 'London Declaration' in 2012, school-based deworming programmes have become the world's largest public health interventions. WHO estimates that by 2020, some 3.3 billion school-based drug treatments had been delivered. The success of this approach was brought to a dramatic halt in April 2020 when schools were closed worldwide in response to the COVID-19 pandemic. These closures immediately excluded 1.5 billion children not only from access to education but also from all school-based health services, including deworming. WHO Pulse surveys in 2021 identified NTD treatment as among the most negatively affected health interventions worldwide, second only to mental health interventions. In reaction, governments created a global Coalition with the twin aims of reopening schools and of rebuilding more resilient school-based health systems. Today, some 86 countries, comprising more than half the world's population, are delivering on this response, and school-based coverage of some key school-based programmes exceeds those from January 2020. This paper explores how science, and a combination of new policy and epidemiological perspectives that began in the 1980s, led to the exceptional growth in school-based NTD programmes after 2012, and are again driving new momentum in response to the COVID-19 pandemic. This article is part of the theme issue 'Challenges and opportunities in the fight against neglected tropical diseases: a decade from the London Declaration on NTDs'.

Laser-based killing of a macroparasite inside its live invertebrate host.

Clearing infection is an essential step to address many issues in host-parasite interactions but is challenging when dealing with endoparasites of large size relative to that of their host. Here, we took advantage of the lethality, contactless and versatility of high-energy laser beam to achieve it, using thorny-headed worms (Acanthocephala) and their amphipod intermediate host as a model system. We show that laser-based de-parasitization can be achieved using 450 nm Blue Diode Laser targeting carotenoid pigments in the bird acanthocephalan Polymorphus minutus. Using proboscis evagination failure and DNA degradation to establish parasite death, we found that 80% P. minutus died from within-host exposure to 5 pulses of 50 ms duration, 1.4 W power. Survival of infected gammarids 11 days after laser treatment was 60%. Preliminary tests were also performed with Nanosecond-Green Laser targeting lipids in Pomphorhynchus tereticollis, another acanthocephalan parasite. We discuss the efficiency and side-effect of laser treatment in this host-parasite system and highlight the perspectives that this technology more generally offers in parasitology.

Canine gastrointestinal parasites perceptions, practices, and behaviours: A survey of dog owners in Australia.

Many species of canine gastrointestinal (GI) parasites are known to be zoonotic meaning that dog owners' management and practices are key to preventing exposure of humans and dogs as well as contamination of the environment. As Australia has one of the highest rates of pet ownership in the world, we administered an online questionnaire to dog owners across the nation to assess their perceptions, practices, and behaviours towards canine GI parasites. Descriptive analysis was performed to summarise perceptions and management practices. Factors associated with the suitability of parasiticide treatments applied were investigated using uni- and multivariable ordinal regression. Just over a half of dog owners considered parasites as very or extremely important for their dog's health (59%) and less than a half as very or extremely important for human health (46%). Although the majority of dog owners stated that they deworm their dogs (90%), only the 28% followed best practice guidelines, i.e. administered a monthly prophylactic treatment all-year round. A large proportion of respondent dog owners administered prophylactic treatment at an inappropriate frequency (48%) or did not treat for canine GI parasites at all (24%). Attending vet visits at least once a year or once every six months and having a very comfortable or prosperous financial position were significantly associated with following best deworming prophylaxis guidelines. This study demonstrates that a proportion of dog owners in Australia is not complying with best practice regarding the control of canine GI parasites and is potentially exposing themselves and their dogs to the risk of infections. Veterinarians are called to implement dog owner's education, raise their awareness on the threats canine parasitic diseases pose to both dogs and humans and finally, encourage them to follow a monthly prophylactic treatment for canine GI parasites all year round.

Strategies to Decrease the Prevalence of Soil-Transmitted Helminths in Central India.

Background Intestinal parasites are a major public health problem in tropical countries. Over 1.5 billion people are infected with soil-transmitted helminths (STH), of which 225 million are in India. Parasitic infections are associated with poor sanitation, lack of safe potable water, and improper hygiene. Materials and Methods The study was undertaken to ascertain the impact of control strategies, namely open-defecation free drive and mass drug administration of single dose albendazole. Stool samples received at AIIMS Bhopal Microbiology laboratory, across all age groups, were studied for protozoan trophozoites/cysts and helminthic ova. Results Out of 4,620 stool samples, 389 (8.41%) were positive either for protozoal or helminthic infections. Protozoan infections were more common than helminthic infections with Giardia duodenalis infection being the most common, 201 (51.67%), followed by Entamoeba histolytica , 174 (44.73%). The helminthic infections constituted 14 (3.5%) of the positive stool samples with Hookworm ova in 6 (1.5%) cases. Conclusion This study proves that strategies, namely "Swachh Bharat Abhiyan" and "National Deworming Day" started in 2014 and 2015 led to significant reduction of intestinal parasite infections in Central India, with a higher reduction of STH compared with protozoan parasite infection being ascribed to the activity spectrum of albendazole.

Efficacy and safety of praziquantel preventive chemotherapy in Schistosoma mansoni infected school children in Southern Ethiopia: A prospective cohort study.

Background: The World Health Organization recommends efficacy and safety surveillance of anti-helminths used in mass drug administration campaigns. We evaluated the effectiveness of single-dose praziquantel against Schistosoma mansoni infection, and the safety of praziquantel plus albendazole preventive chemotherapy (PC) in Schistosoma mansoni infected school children (n = 512) in Southern Ethiopia. Method: Stool examinations were done using thick smear Kato-Katz at baseline, week-4, and week-8 of post-Mass drug administration (MDA) to assess praziquantel efficacy. Participants were followed for MDA-associated adverse events up to day 7 of post-MDA. The primary and secondary study outcomes were praziquantel efficacy (parasitological cure and egg reduction rates) and MDA-associated adverse events (AEs), respectively. Result: The overall cure rates at week-4 and week-8 were 89.1% (95%CI = 86.1-91.7) and 87.5% (95%CI = 83.6-90.8), respectively. Cure rates among moderate-to-heavily infected children were significantly lower (p = 0.001) compared to those with light infection at week-4 (84.4% vs. 91.1%, p = 0.03) and week-8 (78.6% vs. 91.9%, respectively). Older children had a higher cure rate than younger ones at week-8 (90.1% vs. 79.5%, p = 0.01). Among those who were Schistosoma egg-free (cured) at week 4, 7.8% became egg-positive at week 8. The overall egg reduction rate (ERR) at week-4 and week-8 were 93.5% and 91.3%, respectively, being lower among the 5-9 years old age groups (p = 0.01) at week-8. The proportion of children who remained schistosoma egg-positive throughout the study follow-up period was 4.6%, and their ERR at week-4 and week-8 was 50% and 51%, respectively, which is below the 90% World Health Organization threshold for efficacy. The incidence of experiencing at least one type of MDA-associated AEs were 17.0% (95%CI = 13.8%-20.5%); abdominal pain, headache, and vomiting were the most common. The proportion of mild, moderate, and severe AEs was 63.2%, 26.3%, and 10.5%, respectively. Females experienced more AEs than males (p = 0.03). Conclusion: Single-dose praziquantel is still effective for the treatment of intestinal schistosomiasis. Praziquantel and albendazole preventive chemotherapy is safe and tolerable, and associated AEs are mostly mild-to-moderate and transient. However, the reduced PZQ effectiveness in moderate-to-heavy infection and observed AEs in about one-fifth of infected children underscores the need for better treatment strategies and surveillance for early detection of parasite resistance and management of AEs.

Regular deworming and seasonality are potential challenges but also offer opportunities for hookworm elimination.

The global health community has targeted the elimination of neglected tropical diseases (NTDs) including soil-transmitted helminthiasis by 2030. The elimination strategy has not changed from that of control using regular mass drug administration (MDA) with albendazole, WASH and education. Already doubts have been expressed about this achievement, principally because drugs do not interrupt transmission. We report here the findings of a cohort study aimed to identify host modifiable and environmental factors associated with hookworm infection and reinfection in rural communities in Kintampo North Municipality, Ghana. Faecal samples of 564 consented participants were screened for intestinal parasites at baseline, 9 months and 24 months using the Kato-Katz method. At each time point, positive cases were treated with a single dose of albendazole (400 mg) and their samples were again screened 10-14 days post-treatment to record treatment failures. The hookworm prevalence at the three-time points was 16.7%, 9.22% and 5.3% respectively, whilst treatment failure rates were 17.25%, 29.03% and 40.9% respectively. The intensities of hookworm infection (in eggs per gram) at the time points were 138.3, 40.5 and 135, which showed a likely association with wet and dry seasons. We posit that the very low intensity of hookworm infections in humans during the dry season offers a window of opportunity for any intervention that could drastically reduce the community worm burden before the rainy season.

Factors Associated with Deworming Medication Utilization among Pregnant Women in Benin: Evidence from the Demographic and Health Survey.

Deworming medication utilization is a useful strategy to reduce the burden of anemia among pregnant women. Yet, we know very little about the prevalence and correlates of deworming medication utilization among pregnant women in sub-Saharan Africa, including Benin. To address this void in the literature, we used the 2017-2018 Benin Demographic and Health Survey and applied logistic regression analysis to explore the demographic, socioeconomic, and healthcare factors associated with deworming medication utilization in Benin. We found that deworming medication coverage was 65% at the national level. We observed that women aged 35-49 years were less likely to use deworming medication compared to those aged 15-24 years (OR = 0.79, p < 0.01). Compared to Christian women, Muslim women (OR = 0.70, p < 0.01) and women of other religions (OR = 0.51, p < 0.01) were also less likely to use deworming medication. Moreover, women with lower levels of education and household wealth, as well as unemployed women, were less likely to use deworming medication in comparison to their educated, richer, and employed counterparts. Women who visited ANC fewer than eight times were also less likely to use deworming medication compared to their counterparts who did so eight times or more (OR = 0.65, p < 0.001). Based on these findings, we discussed several implications for policymakers.