title: Increasing teacher motivation and supervision is an important but not sufficient strategy for improving praziquantel uptake in Schistosoma mansoni control programs: serial cross sectional surveys in Uganda.
abstract: BACKGROUND
  Realization of the public health benefits of mass drug administration (MDA) for the control of schistosomiasis depends on achieving and maintaining high annual treatment coverage. In Uganda, the uptake of preventive treatment for schistosomiasis among school-age children in 2011 was only 28%. Strategies are needed to increase uptake.
  
  
  METHODS
  Serial cross-sectional surveys were conducted at baseline (after MDA in 2011) and at follow-up MDA in 2012 where teacher motivation was provided and supervision strengthened in Jinja district of Uganda. Uptake of praziquantel was assessed in 1,010 randomly selected children from 12 primary schools during the baseline survey and in another set of 1,020 randomly selected children from the same primary schools during the follow-up survey.
  
  
  RESULTS
  Self-reported uptake of praziquantel increased from 28.2% (95% CI 25.4%-30.9%) at baseline to 48.9% (95% CI 45.8%-52.0%) (p < 0.001) at follow-up. Prevalence and intensity of Schistosoma mansoni infection were unchanged and moderate on both occasions; 35.0% (95% CI: 25.4%-37.9%) and 32.6% (95% CI: 29.6%-35.5%) (p = 0.25) and 156.7 eggs per gram of stool (epg) (95% CI: 116.9-196.5) and 133.1 epg (95% CI: 99.0-167.2) (p = 0.38), respectively. There was no change in the proportion of children reporting side effects attributable to praziquantel at baseline (49.8%, 95% CI 43.8%-55.8%) and at follow-up (46.6%, 95% CI 42%.1-51.2%) (p = 0.50) as well as in the proportion of children with correct knowledge of schistosomiasis transmission and control between the baseline (45.9%, 95% CI 42.7%-73.7%) and follow-up (44.1%, 95% CI 41.0%- 47.2%) (p = 0.42).
  
  
  CONCLUSIONS
  Although teacher motivation and supervision to distribute treatment increased the uptake of praziquantel among school-age children, the realized uptake is still lower than is recommended by the World Health Organization (WHO) and apparently too low to affect the prevalence and intensity of schistosomiasis among the children. Additional measures are needed to increase uptake of praziquantel if school-based MDA is to achieve the objective of preventive chemotherapy.
authors: School of Medicine, Child Health and Development Center, Makerere University, Kampala, Uganda. simonmhmz@yahoo.com.
authors: Simon
authors: S
authors: Muhumuza
authors: Anne
authors: A
authors: Katahoire
authors: Fred
authors: F
authors: Nuwaha
authors: Annette
authors: A
authors: Olsen
mesh_terms: D000293:Adolescent; D000818:Animals; D000871:Anthelmintics / Q000008:administration & dosage*; D002648:Child; D003430:Cross-Sectional Studies; D005178:Faculty; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D055118:Medication Adherence; D009042:Motivation; D011223:Praziquantel / Q000008:administration & dosage*; D015995:Prevalence; D012550:Schistosoma mansoni / Q000187:drug effects / Q000302:isolation & purification / Q000502:physiology; D012555:Schistosomiasis mansoni / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology*; D012574:Schools; D013334:Students / Q000523:psychology; D014454:Uganda / Q000453:epidemiology
chemical_list: D000871:Anthelmintics; D011223:Praziquantel