03694nas a2200553   4500000000100000008004100001260003700042653002400079653005700103653002700160653002300187653003500210653003800245653001400283653001800297100001400315700001500329700001400344700001500358700001400373700001400387700001900401700001400420700001600434700001700450700001300467700001500480700001400495700001400509700001100523700001500534700001500549700002000564700001700584700001300601700001700614700001200631700001300643700001300656700001400669700002500683700001100708245009200719856009900811300000900910490000700919520220000926022001403126       2023                            d  bPublic Library of Science (PLoS)10aInfectious Diseases10aPublic Health, Environmental and Occupational Health10aSchool-based deworming10aCommunity-wide MDA10amass drug administration (MDA)10aSoil-Transmitted Helminths (STHs)10aReporting10aDeWorm3 Trial1 aSheahan W1 aAnderson R1 aAruldas K1 aAvokpaho E1 aGalagan S1 aGoodman J1 aHoungbégnon P1 aIsrael GJ1 aJanagaraj V1 aKaliappan SP1 aMeans AR1 aMorozoff C1 aPearman E1 aRamesh RM1 aRoll A1 aSchaefer A1 aSimwanza J1 aWitek-McManus S1 aAjjampur SSR1 aBailey R1 aIbikounlé M1 aKalua K1 aLuty AJF1 aPullan R1 aWalson JL1 aÁsbjörnsdóttir KH1 aZhou X00aOverestimation of school-based deworming coverage resulting from school-based reporting  uhttps://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0010401&type=printable  a1-200 v173 a<p><strong>Background:</strong> Soil Transmitted Helminths (STH) infect over 1.5 billion people globally and are associated with anemia and stunting, resulting in an annual toll of 1.9 million Disability-Adjusted Life Years (DALYs). School-based deworming (SBD), via mass drug administration (MDA) campaigns with albendazole or mebendazole, has been recommended by the World Health Organization to reduce levels of morbidity due to STH in endemic areas. DeWorm3 is a cluster-randomized trial, conducted in three study sites in Benin, India, and Malawi, designed to assess the feasibility of interrupting STH transmission with community-wide MDA as a potential strategy to replace SBD. This analysis examines data from the DeWorm3 trial to quantify discrepancies between school-level reporting of SBD and gold standard individual-level survey reporting of SBD.</p>

<p><strong>Methodology/Principal findings:</strong> Population-weighted averages of school-level SBD calculated at the cluster level were compared to aggregated individual-level SBD estimates to produce a Mean Squared Error (MSE) estimate for each study site. In order to estimate individual-level SBD coverage, these MSE values were applied to SBD estimates from the control arm of the DeWorm3 trial, where only school-level reporting of SBD coverage had been collected. In each study site, SBD coverage in the school-level datasets was substantially higher than that obtained from individual-level datasets, indicating possible overestimation of school-level SBD coverage. When applying observed MSE to project expected coverages in the control arm, SBD coverage dropped from 89.1% to 70.5% (p-value &lt; 0.001) in Benin, from 97.7% to 84.5% (p-value &lt; 0.001) in India, and from 41.5% to 37.5% (p-value &lt; 0.001) in Malawi.</p>

<p><strong>Conclusions/Significance:</strong> These estimates indicate that school-level SBD reporting is likely to significantly overestimate program coverage. These findings suggest that current SBD coverage estimates derived from school-based program data may substantially overestimate true pediatric deworming coverage within targeted communities. Trial registration NCT03014167.</p>
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