title: Sustaining control of schistosomiasis mansoni in moderate endemicity areas in western Côte d'Ivoire: a SCORE study protocol.
abstract: BACKGROUND
  Schistosomiasis is a parasitic disease that occurs in the tropics and subtropics. The mainstay of control is preventive chemotherapy with praziquantel. In Africa, an estimated 230 million people require preventive chemotherapy. In western Côte d'Ivoire, infections with Schistosoma mansoni are widespread. To provide an evidence-base for programme decisions about preventive chemotherapy to sustain control of schistosomiasis, a 5-year multi-country study with different treatment arms has been designed by the Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) and is currently being implemented in various African settings, including Côte d'Ivoire.
  
  
  METHODS
  We report the study protocol, including ethics statement and insight from a large-scale eligibility survey carried out in four provinces in western Côte d'Ivoire. The study protocol has been approved by the ethics committees of Basel and Côte d'Ivoire. A total of 12,110 children, aged 13-14 years, from 264 villages were screened for S. mansoni using duplicate Kato-Katz thick smears from single stool samples. Among the schools with a S. mansoni prevalence of 10-24%, 75 schools were selected and randomly assigned to one of three treatment arms. In each school, three stool samples are being collected from 100 children aged 9-12 years annually and one stool sample from 100 first-year students at baseline and in the final year and subjected to duplicate Kato-Katz thick smears. Cost and coverage data for the different intervention arms, along with environmental, political and other characteristics that might impact on the infection prevalence and intensity will be recorded in each study year, using a pretested village inventory form.
  
  
  CONCLUSIONS
  The study will document changes in S. mansoni infection prevalence and intensity according to different treatment schemes. Moreover, factors that determine the effectiveness of preventive chemotherapy will be identified. These factors will help to develop reasonable measures of force of transmission that can be used to make decisions about the most cost-effective means of lowering prevalence, intensity and transmission in a given setting. The gathered information and results will inform how to effectively sustain control of schistosomiasis at a low level in different social-ecological contexts.
  
  
  BACKGROUND
  ISRCTN99401114 (date assigned: 12 November 2014).
authors.forename: Rufin K
authors.initials: RK
authors.lastname: Assaré
authors.forename: Stefanie
authors.initials: S
authors.lastname: Knopp
authors.forename: Nicaise A
authors.initials: NA
authors.lastname: N'Guessan
authors.forename: Ahoua
authors.initials: A
authors.lastname: Yapi
authors.forename: Yves-Nathan T
authors.initials: YN
authors.lastname: Tian-Bi
authors.forename: Patrick K
authors.initials: PK
authors.lastname: Yao
authors.forename: Jean T
authors.initials: JT
authors.lastname: Coulibaly
authors.forename: Mamadou
authors.initials: M
authors.lastname: Ouattara
authors.forename: Aboulaye
authors.initials: A
authors.lastname: Meïté
authors.forename: Alan
authors.initials: A
authors.lastname: Fenwick
authors.forename: Eliézer K
authors.initials: EK
authors.lastname: N'Goran
authors.affiliation: Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P,O, Box, Basel, CH-4002, Switzerland. juerg.utzinger@unibas.ch.
authors.forename: Jürg
authors.initials: J
authors.lastname: Utzinger
mesh_terms: D000871:Anthelmintics / Q000627:therapeutic use*; D002648:Child; D007560:Cote d'Ivoire / Q000453:epidemiology; D019353:Endemic Diseases / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D011223:Praziquantel / Q000627:therapeutic use*; D015995:Prevalence; D012555:Schistosomiasis mansoni / Q000188:drug therapy* / Q000453:epidemiology; D012574:Schools; D013334:Students
chemical_list: D000871:Anthelmintics; D011223:Praziquantel