TY - JOUR

T1 - Five-year impact of different multi-year mass drug administration strategies on childhood Schistosoma mansoni-associated morbidity

T2 - A combined analysis from the schistosomiasis consortium for operational research and evaluation cohort studies in the Lake Victoria Regions of Kenya and Tanzania

AU - Shen, Ye

AU - Wiegand, Ryan E.

AU - Olsen, Annette

AU - King, Charles H.

AU - Kittur, Nupur

AU - Binder, Sue

AU - Zhang, Feng

AU - Whalen, Christopher C.

AU - Secor, William Evan

AU - Montgomery, Susan P.

AU - Mwinzi, Pauline N.M.

AU - Magnussen, Pascal

AU - Kinung'hi, Safari

AU - Campbell, Carl H.

AU - Colley, Daniel G.

PY - 2019

Y1 - 2019

N2 - The WHO recommends mass treatment with praziquantel as the primary approach for Schistosoma mansoni-related morbidity control in endemic populations. The Schistosomiasis Consortium for Operational Research and Evaluation implemented multi-country, cluster-randomized trials to compare effectiveness of community-wide and school-based treatment (SBT) regimens on prevalence and intensity of schistosomiasis. To assess the impact of two different treatment schedules on S. mansoni-associated morbidity in children, cohort studies were nested within the randomized trials conducted in villages in Kenya and Tanzania having baseline prevalence ≥ 25%. Children aged 7-8 years were enrolled at baseline and followed to ages 11-12 years. Infection intensity and odds of infection were reduced bothinvillages receiving four yearsofannual community-wide treatment (CWT) and those who received biennial SBTover 4 years. These regimens were also associated with reduced odds of undernutrition and reduced odds of portal vein dilationatfollow-up. However, neither hemoglobin levels nor the prevalence of the rare abnormal patternCliver scores on ultrasound improved. For the combined cohorts, growth stunting worsened in the areas receiving biennial SBT, and maximal oxygen uptake as estimated by fitness testing scores declined under both regimens. After adjusting for imbalance in starting prevalence between study arms, children in villages receiving annual CWT had significantly greater decreases in infection prevalence and intensity than those villages receiving biennial SBT. Although health-related quality-of-life scores improved in both study arms, children in the CWT villages gained significantly more. We conclude that programs using annual CWT are likelyto achieve better overallS.mansoni morbidity control than those implementing only biennial SBT.

AB - The WHO recommends mass treatment with praziquantel as the primary approach for Schistosoma mansoni-related morbidity control in endemic populations. The Schistosomiasis Consortium for Operational Research and Evaluation implemented multi-country, cluster-randomized trials to compare effectiveness of community-wide and school-based treatment (SBT) regimens on prevalence and intensity of schistosomiasis. To assess the impact of two different treatment schedules on S. mansoni-associated morbidity in children, cohort studies were nested within the randomized trials conducted in villages in Kenya and Tanzania having baseline prevalence ≥ 25%. Children aged 7-8 years were enrolled at baseline and followed to ages 11-12 years. Infection intensity and odds of infection were reduced bothinvillages receiving four yearsofannual community-wide treatment (CWT) and those who received biennial SBTover 4 years. These regimens were also associated with reduced odds of undernutrition and reduced odds of portal vein dilationatfollow-up. However, neither hemoglobin levels nor the prevalence of the rare abnormal patternCliver scores on ultrasound improved. For the combined cohorts, growth stunting worsened in the areas receiving biennial SBT, and maximal oxygen uptake as estimated by fitness testing scores declined under both regimens. After adjusting for imbalance in starting prevalence between study arms, children in villages receiving annual CWT had significantly greater decreases in infection prevalence and intensity than those villages receiving biennial SBT. Although health-related quality-of-life scores improved in both study arms, children in the CWT villages gained significantly more. We conclude that programs using annual CWT are likelyto achieve better overallS.mansoni morbidity control than those implementing only biennial SBT.

U2 - 10.4269/ajtmh.19-0273

DO - 10.4269/ajtmh.19-0273

M3 - Journal article

C2 - 31407653

AN - SCOPUS:85075960078

VL - 101

SP - 1336

EP - 1344

JO - Journal. National Malaria Society

JF - Journal. National Malaria Society

SN - 0002-9637

IS - 6

ER -