Impact of a national helminth control programme on infection and morbidity in Ugandan schoolchildren.
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.
Kabatereine
Narcis B
NB
Vector Control Division, Ministry of Health, Kampala, Uganda. vcd_sci@utlonline.co.ug
Brooker
Simon
S
Koukounari
Artemis
A
Kazibwe
Francis
F
Tukahebwa
Edridah M
EM
Fleming
Fiona M
FM
Zhang
Yaobi
Y
Webster
Joanne P
JP
Stothard
J Russell
JR
Fenwick
Alan
A
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
D000871:Anthelmintics; D011223:Praziquantel; D015766:Albendazole