02901nas a2200241   4500000000100000008004100001653003900042653003100081653003600112653002800148653002500176653002100201653001800222653001900240653001800259100001300277700001300290700001500303245015300318856003300471300000700504520214800511       2018                            d10aNeglected tropical diseases (NTDs)10aSoil-transmitted helminths10aHelminthiasis dynamics in Ghana10apreventive chemotherapy10aSchool-aged children10aHigh-risk adults10aAge-structure10aInfection risk10aCost analysis1 aMubayi A1 aThakur M1 aMohammed R00aOptimizing age-structured and risk-based mass drug administration against soil-transmitted helminthiasis in Ghana using cost-effectiveness analysis.  uhttps://tinyurl.com/y745edzu  a203 a<p>&nbsp;Soil-transmitted helminthiasis (STH), a neglected tropical disease (NTD) remains a major health problem all over the world including Ghana, which has STH prevalence of 25.4%. To control the disease, the government of Ghana currently concentrates on implementing mass drug administration (MDA) efforts focusing only among school-aged children. However, various studies have suggested that focusing on only a specific group for MDA may not be cost-effective. Moreover, some adults such as teachers and school-workers spend large fraction of their time with children, who shed more parasite in environment due to unhygienic behavior, and thus have a higher risk of getting infected as compared to other adults. In this study we use a mathematical model to evaluate age-structured and risk-based policies for implementing MDA while capturing transmission dynamics of STH in Ghana. A cost model was developed that included various costs related to MDA to study cost-effectiveness of current policies of MDA in Ghana against novel policies to control STH in Ghana. We carry out analysis for five different scenarios— I: no MDA (baseline), II: current MDA policy (focusing children) in Ghana, III: MDA for different age groups (adults and children groups) for unlimited budget, IV: MDA for different age groups with limitations of number of individuals treated, and, V: MDA for different groups based on their risk of getting infected (adults school workers (high-risk group), adults non-school workers and children groups). Our results suggest that it might be more cost-effective to allocate treatment through MDA to at least some proportion of adults along with children. In case of unlimited budget, the best strategy in Scenario IV would be to treat approximately 22% of adults and approximately 45% of children. The most cost-effective among the 5 scenarios is suggested through scenario V, where high-risk adults group and children are provided MDA at higher level than low-risk adults. In conclusion, age-structured and risk-based allocation of treatment and resources is crucial to reducing STH load in developing countries.</p>