title: Can mass drug administration lead to the sustainable control of schistosomiasis?
abstract: BACKGROUND
  In the Philippines, the current national control strategy for schistosomiasis is annual mass drug administration (MDA) with 40 mg/kg of praziquantel in all schistosomiasis-endemic villages with a prevalence ≥10%.
  
  
  METHODS
  A cross-sectional survey of schistosomiasis was conducted in 2012 on 18 221 individuals residing in 22 schistosomiasis-endemic villages in the province of Northern Samar. The prevalence of schistosomiasis, intensity of Schistosoma infection, and morbidity of disease were assessed.
  
  
  RESULTS
  Despite an active schistosomiasis-control program in Northern Samar for >30 years, which included a MDA campaign in the last 5 years, the mean prevalence of schistosomiasis among 10 435 evaluated subjects was 27.1% (95% confidence interval [CI], 26.3%-28.0%), and the geometric mean intensity of infection among 2832 evaluated subjects was 17.2 eggs per gram of feces (95% CI, 16.4-18.1). Ultrasonography revealed high levels of schistosomiasis-induced morbidity in the schistosomiasis-endemic communities. Left lobe liver enlargement (≥70 mm) was evident in 89.3% of subjects. Twenty-five percent of the study population had grade II/III liver parenchyma fibrosis, and 13.3% had splenomegaly (≥100 mm).
  
  
  CONCLUSIONS
  MDA on its own was insufficient to control the prevalence of schistosomiasis, intensity of Schistosoma infection, or morbidity of the disease. Alternative control measures will be needed to complement the existing national MDA program.
authors: Griffith Health Institute, Griffith University, Gold Coast Campus, Queensland, Australia.
authors: Allen G P
authors: AG
authors: Ross
authors: Department of Health, Research Institute for Tropical Medicine, Manila.
authors: Remigio M
authors: RM
authors: Olveda
authors: Municipal Medical Officer of Health, Palapag, The Philippines.
authors: Delia
authors: D
authors: Chy
authors: Griffith Health Institute, Griffith University, Gold Coast Campus, Queensland, Australia.
authors: David U
authors: DU
authors: Olveda
authors: QIMR Berghofer Medical Research Institute, Brisbane, Australia Hunan Institute of Parasitic Diseases, WHO Collaborating Center for Research and Control of Schistosomiasis in the Lake Region, Yueyang, China.
authors: Yuesheng
authors: Y
authors: Li
authors: Department of Infectious Diseases, College of Veterinary Medicine and Center for Tropical and Emerging Global Diseases, University of Georgia.
authors: Donald A
authors: DA
authors: Harn
authors: School of Population Health, University of Queensland, Brisbane.
authors: Darren J
authors: DJ
authors: Gray
authors: Municipal Medical Officer of Health, Palapag, The Philippines.
authors: Donald P
authors: DP
authors: McManus
authors: Department of Health, Research Institute for Tropical Medicine, Manila.
authors: Veronica
authors: V
authors: Tallo
authors: Discipline of Public Health, Flinders University, Adelaide, Australia.
authors: Thao N P
authors: TN
authors: Chau
authors: School of Population Health, University of Queensland, Brisbane.
authors: Gail M
authors: GM
authors: Williams
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000871:Anthelmintics / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004358:Drug Therapy / Q000379:methods; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D010679:Philippines / Q000453:epidemiology; D011223:Praziquantel / Q000008:administration & dosage*; D015995:Prevalence; D012424:Rural Population; D012552:Schistosomiasis / Q000188:drug therapy* / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000871:Anthelmintics; D011223:Praziquantel
keywords: control; elimination; mass drug administration (MDA); schistosomiasis