title: Assessing the effect of an integrated control strategy for schistosomiasis japonica emphasizing bovines in a marshland area of Hubei Province, China: a cluster randomized trial.
abstract: BACKGROUND
  More than 80% of schistosomiasis patients in China live in the lake and marshland regions. The purpose of our study is to assess the effect of a comprehensive strategy to control transmission of Schistosoma japonicum in marshland regions.
  
  
  RESULTS
  In a cluster randomized controlled trial, we implemented an integrated control strategy in twelve villages from 2009 through 2011 in Gong'an County, Hubei Province. The routine interventions included praziquantel chemotherapy and controlling snails, and were implemented in all villages. New interventions, mainly consisting of building fences to limit the grazing area for bovines, building safe pastures for grazing, improving the residents' health conditions and facilities, were only implemented in six intervention villages. Results showed that the rate of S. japonicum infection in humans, bovines, snails, cow dung and mice in the intervention group decreased from 3.41% in 2008 to 0.81% in 2011, 3.3% to none, 11 of 6,219 to none, 3.9% to none and 31.7% to 1.7%, respectively (P<0.001 for all comparisons). In contrast, there were no statistically significant reductions of S. japonicum infection in humans, bovines and snails from 2008 to 2011 in the control group (P>0.05 for all comparisons). Moreover, a generalized linear model showed that there was a higher infection risk in humans in the control group than in the intervention group (OR = 1.250, P = 0.001) and an overall significant downward trend in infection risk during the study period.
  
  
  CONCLUSIONS
  The integrated control strategy, designed to reduce the role of bovines and humans as sources of S. japonicum infection, was highly effective in controlling the transmission of S. japonicum in marshland regions in China.
  
  
  BACKGROUND
  Chinese Clinical Trial Registry ChiCTR-PRC-12002405.
authors.affiliation: School of Public Health & Global Health Institute, Wuhan University, Wuhan, Hubei, PR China.
authors.forename: Xi-Cheng
authors.initials: XC
authors.lastname: Hong
authors.forename: Xing-Jian
authors.initials: XJ
authors.lastname: Xu
authors.forename: Xi
authors.initials: X
authors.lastname: Chen
authors.forename: Yue-Sheng
authors.initials: YS
authors.lastname: Li
authors.forename: Chuan-Hua
authors.initials: CH
authors.lastname: Yu
authors.forename: Yi
authors.initials: Y
authors.lastname: Yuan
authors.forename: Yan-Yan
authors.initials: YY
authors.lastname: Chen
authors.forename: Ren-Dong
authors.initials: RD
authors.lastname: Li
authors.forename: Juan
authors.initials: J
authors.lastname: Qiu
authors.forename: Zong-Chuan
authors.initials: ZC
authors.lastname: Liu
authors.forename: Ping
authors.initials: P
authors.lastname: Yi
authors.forename: Guang-Hui
authors.initials: GH
authors.lastname: Ren
authors.forename: Hong-Bin
authors.initials: HB
authors.lastname: He
mesh_terms: D000328:Adult; D000818:Animals; D000871:Anthelmintics / Q000627:therapeutic use; D002417:Cattle; D002418:Cattle Diseases / Q000188:drug therapy* / Q000469:parasitology / Q000517:prevention & control / Q000635:transmission*; D002681:China; D005243:Feces / Q000469:parasitology; D005260:Female; D006801:Humans; D008297:Male; D051379:Mice; D008875:Middle Aged; D011223:Praziquantel / Q000627:therapeutic use; D015995:Prevalence; D012377:Rodentia / Q000469:parasitology; D012424:Rural Population; D012549:Schistosoma japonicum / Q000302:isolation & purification; D012554:Schistosomiasis japonica / Q000188:drug therapy / Q000517:prevention & control / Q000635:transmission* / Q000662:veterinary*; D012908:Snails / Q000469:parasitology; D015047:Zoonoses / Q000453:epidemiology* / Q000469:parasitology / Q000635:transmission*
chemical_list: D000871:Anthelmintics; D011223:Praziquantel