Increasing Compliance with Mass Drug Administration Programs for Lymphatic Filariasis in India through Education and Lymphedema Management Programs

Global elimination of lymphatic filariasis requires giving drugs at least annually to populations who live at risk of becoming infected with the parasite. At least 80% of people at risk need to take the drugs annually for 5 or more years to stop transmission of the infection. People suffering from the long-term effects of infection, such as swollen legs, benefit from programs that teach self-care of their affected limbs. In this study, we assessed the impact of an educational campaign that, after addressing previously identified predictors of compliance, significantly improved drug compliance. The specific factors improving compliance included knowing about the drug distribution in advance, knowing that everyone is at risk for acquiring the infection, knowing that the drug distribution was for lymphatic filariasis prevention, and knowing at least one component of leg care. We also found that areas with programs to assist people with swollen legs had greater increases in compliance. This research provides evidence that program evaluation can be used to improve drug compliance. In addition, our work shows for the first time that programs to benefit people with swollen legs caused by lymphatic filariasis also increase the participation of people without disease in drug treatment programs

A Multicentre Randomized Controlled Trial of the Efficacy and Safety of Single-Dose Praziquantel at 40 mg/kg vs. 60 mg/kg for Treating Intestinal Schistosomiasis in the Philippines, Mauritania, Tanzania and Brazil

Control of urinary and intestinal schistosomiasis is based on mass administration of praziquantel at the World Health Organization (WHO) recommended dose of 40 mg/kg, though some countries use 60 mg/kg. This multi-country randomized clinical trial compared the efficacy (cure and egg reduction rates three weeks post-treatment) and safety of these two doses for treating intestinal schistosomiasis in 856 patients in Brazil, Mauritania and Tanzania (Schistosoma mansoni), and The Philippines (S. japonicum). Transmission and infection intensities varied across the sites, but there was no bias or heterogeneity in efficacy outcomes. The two doses are equally effective in curing intestinal schistosomiasis; the higher dose may be less well tolerated, though effects are generally mild and transient. In endemic areas people can be re-infected; one year post-treatment patients on 60 mg/kg had fewer re-infections but this finding is difficult to explain. This study was conducted to respond to the demand for evidence about the dose of praziquantel when deployed in endemic countries. The results, along with those of systematic reviews, support the current WHO recommendation for using praziquantel at 40 mg/kg and should inform policy decisions in countries. The Philippines has already changed from 60 to 40 mg/kg after this study

High Burden of Soil-Transmitted Helminthiases in Preschool-Age Children in Masbate: A Decade of Implementation of the Integrated Helminth Control Program in the Philippines

This study aimed to describe the status of soil-transmitted helminthiases (STH) control in preschool-age children (PSAC) in four municipalities in Masbate Province, Philippines, a decade after the implementation of the Integrated Helminth Control Program. This cross sectional study, which included 1,224 PSAC, utilized Kato-Katz technique to determine parasitological status. Secondary data were reviewed to obtain deworming coverage in the selected municipalities. Results showed a prevalence of STH and a prevalence of moderate-heavy intensity STH of 72% and 41%, respectively, while the deworming coverage in the province in 2013 was 71%. None of the municipalities met the global target on prevalence of moderate-heavy intensity STH of below 1, while only Cawayan met the national target for STH prevalence of below 50%. The deworming coverage in the province was below the global and national targets of 75% and 85%, respectively. The failure to meet these targets may be related to challenges with coverage of mass drug administration, water, sanitation, and hygiene (WASH), health promotion, and other factors, such as poverty. Recommended strategies to meet global and national targets include increasing access to deworming, improving WASH and health promotion and education, and addressing factors contributing to STH, such as poverty. The War on Worms Campaign, which improved helminth control outcomes in various sites in the country, may be adopted

Uptake of mass drug administration programme for schistosomiasis control in Koome Islands, Central Uganda.

INTRODUCTION: Schistosomiasis is one of the neglected tropical diseases targeted for elimination in Uganda through the Mass Drug Administration (MDA) programme. Praziquantel has been distributed using community resource persons in fixed sites and house-to-house visits; however the uptake is still below target coverage. In 2011/2012 MDA exercise, uptake stood at 50% yet WHO target coverage is 75% at community level. We assessed the uptake of MDA and the associated factors in Koome Islands, Central Uganda. METHODS: In March 2013, we conducted a mixed methods cross sectional study in 15 randomly selected villages. We interviewed a total of 615 respondents aged 18 years and above using semi structured questionnaires and five key informants were also purposively selected. Univariate and multivariate analysis was done. MDA uptake was defined as self reported swallowing of praziquantel during the last (2012) MDA campaign. We conducted key informant interviews with Ministry of Health, district health personnel and community health workers. RESULTS: Self reported uptake of praziquantel was 44.7% (275/615), 95% confidence interval (CI) 40.8-48.7%. Of the 275 community members who said they had swallowed praziquantel, 142 (51.6%) reported that they had developed side effects. Uptake of MDA was more likely if the respondent was knowledgeable about schistosomiasis transmission and prevention (adjusted odds ratio [AOR] 1.85, 95% CI 1.22-2.81) and reported to have received health education from the health personnel (AOR 5.95, 95% CI 3.67-9.65). Service delivery challenges such as drug shortages and community health worker attrition also influenced MDA in Koome Islands. CONCLUSIONS: Uptake of MDA for schistosomiasis control in Koome was sub optimal. Lack of knowledge about schistosomiasis transmission and prevention, inadequate health education and drug shortages are some of the major factors associated with low uptake. These could be addressed through routine health education and systematic drug supply for the successful elimination of schistosomiasis on the islands