Effectiveness of a pre-treatment snack on the uptake of mass treatment for schistosomiasis in Uganda: a cluster randomized trial.
BACKGROUND
School-based mass treatment with praziquantel is the cornerstone for schistosomiasis control in school-aged children. However, uptake of treatment among school-age children in Uganda is low in some areas. The objective of the study was to examine the effectiveness of a pre-treatment snack on uptake of mass treatment.


RESULTS
In a cluster randomized trial carried out in Jinja district, Uganda, 12 primary schools were randomized into two groups; one received education messages for schistosomiasis prevention for two months prior to mass treatment, while the other, in addition to the education messages, received a pre-treatment snack shortly before mass treatment. Four weeks after mass treatment, uptake of praziquantel was assessed among a random sample of 595 children in the snack schools and 689 children in the non-snack schools as the primary outcome. The occurrence of side effects and the prevalence and mean intensity of Schistosoma mansoni infection were determined as the secondary outcomes. Uptake of praziquantel was higher in the snack schools, 93.9% (95% CI 91.7%-95.7%), compared to that in the non-snack schools, 78.7% (95% CI 75.4%-81.7%) (p = 0.002). The occurrence of side effects was lower in the snack schools, 34.4% (95% CI 31.5%-39.8%), compared to that in the non-snack schools, 46.9% (95% CI 42.2%-50.7%) (p = 0.041). Prevalence and mean intensity of S. mansoni infection was lower in the snack schools, 1.3% (95% CI 0.6%-2.6%) and 38.3 eggs per gram of stool (epg) (95% CI 21.8-67.2), compared to that in the non-snack schools, 14.1% (95% CI 11.6%-16.9%) (p = 0.001) and 78.4 epg (95% CI 60.6-101.5) (p = 0.001), respectively.


CONCLUSIONS
Our results suggest that provision of a pre-treatment snack combined with education messages achieves a higher uptake compared to the education messages alone. The use a pre-treatment snack was associated with reduced side effects as well as decreased prevalence and intensity of S. mansoni infection.


BACKGROUND
www.ClinicalTrials.gov NCT01869465
Makerere University, School of Medicine, Child Health and Development Center, Kampala, Uganda.
Simon
S
Muhumuza
University of Copenhagen, Faculty of Health and Medical Sciences, Section for Parasitology, Health and Development, Copenhagen, Denmark.
Annette
A
Olsen
Makerere University, School of Medicine, Child Health and Development Center, Kampala, Uganda.
Anne
A
Katahoire
Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
Agnes N
AN
Kiragga
Makerere University, School of Public Health, Kampala, Uganda.
Fred
F
Nuwaha
D000293:Adolescent; D002648:Child; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011223:Praziquantel / Q000627:therapeutic use; D015995:Prevalence; D012552:Schistosomiasis / Q000188:drug therapy* / Q000453:epidemiology*; D062410:Snacks; D016896:Treatment Outcome; D014454:Uganda / Q000453:epidemiology
D011223:Praziquantel