Impact of a national helminth control programme on infection and morbidity in Ugandan schoolchildren
Bulletin of the World Health Organization
Vector Control Division, Ministry of Health, PO Box 1661, Kampala, Uganda; Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom; Schistosomiasis Control Initiative, Imperial College, London, United Kingdom; Zoology Department, Natural History Museum, London, United Kingdom
Objective: We aimed to assess the health impact of a national control programme targeting schistosomiasis and intestinal nematodes in Uganda, which has provided population-based anthelmintic chemotherapy since 2003. Methods: We conducted longitudinal surveys on infection status, haemoglobin concentration and clinical morbidity in 1871 randomly selected schoolchildren from 37 schools in eight districts across Uganda at three time points - before chemotherapy and after one year and two years of annual mass chemotherapy. Findings: Mass treatment with praziquantel and albendazole led to a significant decrease in the intensity of Schistosoma mansoni - 70% (95% confidence interval (CI): 66-73%) after one year and 82% (95% CI: 80-85%) after two years of treatment. Intensity of hookworm infection also decreased (75% and 93%; unadjusted). There was a significant increase in haemoglobin concentration after one (0.135 g/dL (95% CI: 0.126-0.144)) and two years (0.303 g/dL (95% CI: 0.293-0.312)) of treatment, and a significant decrease in signs of early clinical morbidity. The impact of intervention on S. mansoni prevalence and intensity was similar to that predicted by mathematical models of the impact of chemotherapy on human schistosomiasis. Improvements in haemoglobin concentration were greatest among children who were anaemic or harbouring heavy S. mansoni infection at baseline. Conclusion: Anthelmintic treatment delivered as part of a national helminth control programme can decrease infection and morbidity among schoolchildren and improve haemoglobin concentration.
albendazole; praziquantel; chemotherapy; disease prevalence; disease severity; health impact; health survey; hemoglobin; morbidity; national strategy; nematode; schistosomiasis; student; vaccination; adolescent; article; child; female; health program; health survey; hemoglobin determination; human; infection control; longitudinal study; major clinical study; male; mass screening; morbidity; prevalence; Schistosoma mansoni; schistosomiasis; Uganda; Adolescent; Albendazole; Ancylostoma; Animals; Anthelmintics; Child; Female; Health Promotion; Helminthiasis; Hookworm Infections; Humans; Male; National Health Programs; Praziquantel; Program Evaluation; Prospective Studies; Schistosoma mansoni; Schistosomiasis; School Health Services; Uganda; Africa; East Africa; Sub-Saharan Africa; Uganda; Ancylostomatoidea; Nematoda; Schistosoma mansoni; Vermes