title: Improved mapping strategy to better inform policy on the control of schistosomiasis and soil-transmitted helminthiasis in Sierra Leone.
abstract: BACKGROUND
  Schistosomiasis and soil-transmitted helminthiasis (STH) are endemic in Sierra Leone confirmed by national mapping in 2008. To better inform planning of preventive chemotherapy strategy, another survey was conducted before mass drug administration (MDA) in seven districts according to the mapping results or local knowledge. Fifty-nine chiefdoms and one school in every chiefdom were selected. Thirty school children aged 9-14 years from each school (total: 1760) were examined by parasitological methods for infection with Schistosoma mansoni and STHs.
  
  
  RESULTS
  The overall prevalence of S. mansoni was 40.2% (95% confidence interval (CI): 37.9-42.5%), particularly in Kailahun (63.3%), Kenema (46.7%), Koinadugu (41.9%) and Kono (71.7%). The results demonstrated the focal distribution of S. mansoni in Bo, Tonkolili and Bombali districts with prevalence ranging from 0.0-63.3%, 3.3-90.0% and 0.0-67.9% respectively. The arithmetic mean intensity of S. mansoni infection was 95.4 epg (95% CI: 61.4-129.5 epg), Heavy mean intensity of infection was found in Kailahun (120.2 epg), Kenema (104.5 epg), Koinadugu (112.3 epg) and Kono (250.3 epg). Heavy or moderate infection with S. mansoni occurred in 20.7% of children examined. Hookworm prevalence was moderate: 31.2% (95% CI: 29.1-33.4%), but high in Bo (50.0%) and Tonkolili (56.7%). Hookworm intensity of infection was light with a mean epg of 53.0 (95% CI: 38.4-67.7 epg). Prevalence and intensity of Ascaris lumbricoides (1.5%, 17.8 epg) and Trichuris trichiura (2.5%, 20.3 epg) was low.
  
  
  CONCLUSIONS
  The prediction by previous spatial analysis that S. mansoni was highly endemic across north-eastern Sierra Leone was confirmed with a significant proportion of children heavily or moderately infected. The distribution of S. mansoni in Bo, Tonkolili and Bombali districts ranged widely, highlighting the importance of considering the nature of focal transmission in national mapping exercises. These results were used to refine the MDA for schistosomiasis control to chiefdom implementation units rather than the entire district in these 3 districts. The survey demonstrated that sufficient number of survey sites for schistosomiasis mapping in each district should be used to provide a better national planning of MDA activities, and that it is affordable with the contributions from all parties involved and national resources mobilized.
authors.affiliation: Helen Keller International, Freetown, Sierra Leone. mhodges@hki.org
authors.forename: Mary
authors.initials: M
authors.lastname: Hodges
authors.forename: Nsa
authors.initials: N
authors.lastname: Dada
authors.forename: Anna
authors.initials: A
authors.lastname: Wamsley
authors.forename: Jusufu
authors.initials: J
authors.lastname: Paye
authors.forename: Emanuel
authors.initials: E
authors.lastname: Nyorkor
authors.forename: Mustapha
authors.initials: M
authors.lastname: Sonnie
authors.forename: Guy
authors.initials: G
authors.lastname: Barnish
authors.forename: Moses
authors.initials: M
authors.lastname: Bockarie
authors.forename: Yaobi
authors.initials: Y
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000818:Animals; D000871:Anthelmintics / Q000008:administration & dosage; D002648:Child; D003140:Communicable Disease Control / Q000379:methods; D005260:Female; D006291:Health Policy; D006373:Helminthiasis / Q000453:epidemiology* / Q000517:prevention & control; D006376:Helminths / Q000145:classification / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D015995:Prevalence; D012807:Sierra Leone / Q000453:epidemiology
chemical_list: D000871:Anthelmintics