title: Impact of a national helminth control programme on infection and morbidity in Ugandan schoolchildren.
abstract: OBJECTIVE
  We aimed to assess the health impact of a national control programme targeting schistosomiasis and intestinal nematodes in Uganda, which has provided population-based anthelmintic chemotherapy since 2003.
  
  
  METHODS
  We conducted longitudinal surveys on infection status, haemoglobin concentration and clinical morbidity in 1871 randomly selected schoolchildren from 37 schools in eight districts across Uganda at three time points - before chemotherapy and after one year and two years of annual mass chemotherapy.
  
  
  RESULTS
  Mass treatment with praziquantel and albendazole led to a significant decrease in the intensity of Schistosoma mansoni - 70% (95% confidence interval (CI): 66-73%) after one year and 82% (95% CI: 80-85%) after two years of treatment. Intensity of hookworm infection also decreased (75% and 93%; unadjusted). There was a significant increase in haemoglobin concentration after one (0.135 g/dL (95% CI: 0.126-0.144)) and two years (0.303 g/dL (95% CI: 0.293-0.312)) of treatment, and a significant decrease in signs of early clinical morbidity. The impact of intervention on S. mansoni prevalence and intensity was similar to that predicted by mathematical models of the impact of chemotherapy on human schistosomiasis. Improvements in haemoglobin concentration were greatest among children who were anaemic or harbouring heavy S. mansoni infection at baseline.
  
  
  CONCLUSIONS
  Anthelmintic treatment delivered as part of a national helminth control programme can decrease infection and morbidity among schoolchildren and improve haemoglobin concentration.
authors.affiliation: Vector Control Division, Ministry of Health, Kampala, Uganda. vcd_sci@utlonline.co.ug
authors.forename: Narcis B
authors.initials: NB
authors.lastname: Kabatereine
authors.forename: Simon
authors.initials: S
authors.lastname: Brooker
authors.forename: Artemis
authors.initials: A
authors.lastname: Koukounari
authors.forename: Francis
authors.initials: F
authors.lastname: Kazibwe
authors.forename: Edridah M
authors.initials: EM
authors.lastname: Tukahebwa
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Fleming
authors.forename: Yaobi
authors.initials: Y
authors.lastname: Zhang
authors.forename: Joanne P
authors.initials: JP
authors.lastname: Webster
authors.forename: J Russell
authors.initials: JR
authors.lastname: Stothard
authors.forename: Alan
authors.initials: A
authors.lastname: Fenwick
mesh_terms: D000293:Adolescent; D015766:Albendazole / Q000008:administration & dosage* / Q000600:supply & distribution; D000722:Ancylostoma / Q000187:drug effects / Q000302:isolation & purification; D000818:Animals; D000871:Anthelmintics / Q000008:administration & dosage* / Q000600:supply & distribution; D002648:Child; D005260:Female; D006293:Health Promotion; D006373:Helminthiasis / Q000188:drug therapy* / Q000469:parasitology / Q000517:prevention & control; D006725:Hookworm Infections / Q000188:drug therapy / Q000469:parasitology / Q000517:prevention & control; D006801:Humans; D008297:Male; D009313:National Health Programs; D011223:Praziquantel / Q000008:administration & dosage* / Q000600:supply & distribution; D015397:Program Evaluation; D011446:Prospective Studies; D012550:Schistosoma mansoni / Q000187:drug effects / Q000302:isolation & purification; D012552:Schistosomiasis / Q000188:drug therapy / Q000517:prevention & control; D012572:School Health Services; D014454:Uganda
chemical_list: D000871:Anthelmintics; D011223:Praziquantel; D015766:Albendazole