Control efficacy of annual community-wide treatment against Schistosoma japonicum in China: a meta-analysis.
BACKGROUND
Human schistosomiasis is caused by schistosome, with annual loss of over 70 million disability adjusted life years in the world. China is endemic with Schistosoma japonicum and large-scale chemotherapy with praziquantel has become the mainstay of control in China since 1990s. However, the control effects of mass treatment in the field have been uneven. Moreover, mass treatment has come into a wide use in other countries with limited health resources. Therefore, a better understanding of the control effect of mass treatment is in an urgent need.


METHODS
We performed a systematic search of the literature to investigate the control efficiency of annual community-wide treatment (ACWT, treatment to an entire community without any preliminary screening) with a single dose of PZQ (40 mg kg(-1) bodyweight) against schistosome in humans in China. Three Chinese literature databases, including China National Knowledge Infrastructure, WanFang and Chinese Scientific Journal Databases, and the PubMed were searched. Pooled prevalence ratios (prevalence after to before treatment) were used to assess effect. Our protocol is available on PROSPERO (No. CRD42013003628).


RESULTS
22 articles were included. Meta-analyses on data from 18 studies on one round of ACWT, 17 studies on two consecutive rounds and 6 studies on three consecutive rounds were performed. The results showed control effects of ACWT plus other measures were statistically significant, with prevalence ratios being 0.38 (0.31, 0.46) for one round, 0.28 (0.22, 0.35) for two rounds and 0.22 (0.10, 0.46) for three rounds. When ACWT was performed alone or with health education only, the values for one and two rounds were 0.389 (0.307, 0.492) and 0.348 (0.300, 0.403), respectively.


CONCLUSIONS
The control effect of ACWT alone or with other measures is significant and increases with the number of rounds. Such program is recommended in high endemic areas and the criteria yet merit further assessment.
Department of Epidemiology and Statistics, School of Public Health, Soochow University, Suzhou, China.
Jing
J
Su
Da-Bing
DB
Lu
Xia
X
Zhou
Su-Rong
SR
Wang
Hong-Xiang
HX
Zhuge
D000818:Animals; D002681:China / Q000453:epidemiology; D003140:Communicable Disease Control / Q000706:statistics & numerical data*; D016206:Databases, Bibliographic; D005260:Female; D006801:Humans; D008297:Male; D011223:Praziquantel / Q000627:therapeutic use*; D015995:Prevalence; D019057:Quality-Adjusted Life Years; D012549:Schistosoma japonicum / Q000187:drug effects / Q000502:physiology; D012554:Schistosomiasis japonica / Q000188:drug therapy* / Q000453:epidemiology; D012556:Schistosomicides / Q000627:therapeutic use*; D016896:Treatment Outcome
D012556:Schistosomicides; D011223:Praziquantel