03461nas a2200313 4500000000100000008004100001260002000042653003100062653003100093653001700124653002900141100001600170700001200186700001500198700001100213700001400224700001400238700001200252700001500264700001100279700001500290700001500305700001200320700001200332700001400344700001500358245011900373520265500492 2020 d bResearch Square 10 aSchistosomiasis haematobia 10 aUrogenital schistosomiasis 10 aPraziquantel 10 aCommunity-wide treatment 1 aPhillips AE 1 aTohon Z 1 aDhanani NA 1 aSofo B 1 aGnandou I 1 aSidikou B 1 aNoma AG 1 aMadougou B 1 aAlto O 1 aSebangou H 1 aHalilou KM 1 aAndia R 1 aGarba A 1 aFenwick A 1 aHamidou AA 00 aEvaluating the Impact of Biannual School-Based and Community-Wide Treatment on Urogenital Schistosomiasis in Niger 3 aAbstract
Background The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) coordinated a five-year study implemented in several countries, including Niger, to provide an evidence-base for programmatic decisions regarding cost-effective approaches to preventive chemotherapy for schistosomiasis control. Methods This was a cluster-randomised trial investigating six possible combinations of annual or biannual community-wide treatment (CWT), school-based treatment (SBT), and holidays from mass treatment over four years. The most intense arm involved two years of annual CWT followed by two years of biannual CWT, while the least intensive arm involved one year of annual SBT followed by a year without treatment and two more years of annual SBT. The primary outcome of interest was prevalence and intensity of S. haematobium among 100 children aged 9-to-12-years sampled each year. In addition, 100 children aged 5-to-8 years in their first year of school and 50 adults (aged 20-to-55 years) were tested in the first and final fifth year of the study. Results In total, data was collected from 167,500 individuals across 225 villages in nine districts within the Niger River valley, Western Niger. Overall, prevalence of S. haematobium decreased from baseline to Year 5 across all study arms. The relative reduction of prevalence was greater in biannual compared with annual treatment across all arms, however, the only significant difference was seen in areas with a high starting prevalence. Although adults were not targeted for treatment in SBT arms, a statistically significant decrease in prevalence among adults was seen in moderate prevalence areas receiving biannual (10.7% to 4.8%) SBT (p<0.001). Adults tested in the annual SBT group also showed a decrease in prevalence between Year 1 and Year 5 (12.2% to 11.0%), but this difference was not significant.Conclusions These findings are an important consideration for schistosomiasis control programs that are considering elimination and support the idea that scaling up the frequency of treatment rounds, particularly in areas of low prevalence, will not eliminate schistosomiasis. Interestingly, the finding that prevalence decreased among adults in SBT arms suggests that transmission in the community can be reduced, even where only school children are being treated, which could have logistical and cost-saving implications for the national control programmes.