title: Governance, organization, accountability and sustainability of a region-wide school-based deworming program in Loreto, Peru.
abstract: Chau Cuica was the name given by the regional government of Loreto in Peru for its school-based deworming program which was initiated in 2012 with a donation of mebendazole from an international non-governmental organization. Embedded in the program from the start was a sentinel surveillance component which consisted of 16 sentinel schools representing Loreto's seven provinces. Coverage rates varied between 35% and 61% over the first two years of the program (and seven deworming cycles). Initial prevalences of soil-transmitted helminth infections were high, with 82.4% of schoolchildren having at least one infection and prevalences of both Ascaris lumbricoides and Trichuris trichiura infections both exceeding 60%. After two years, these prevalences had dropped to 56% for any STH infection, 38% for A. lumbricoides and 34% for T. trichiura. Importantly, the proportions of children with moderate and heavy infections also dropped. Both the regional Ministry of Health and the Ministry of Education were jointly charged to implement this deworming program. The program's costs were estimated to be approximately 22 cents (USD) per child per deworming cycle. The responsibility for the surveillance component was initially undertaken by research partners from a local NGO and a Canadian university, which transferred gradually over the course of the deworming program to being entirely the responsibility of the Ministry of Health. This regional deworming program may serve as a model for other jurisdictions that are planning a school-based deworming program with an integrated surveillance component to monitor impact.
authors.affiliation: Dirección Regional de Salud Loreto, Iquitos, Peru.
authors.forename: Hugo Rodriguez
authors.initials: HR
authors.lastname: Ferruci
authors.affiliation: Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: H
authors.initials: H
authors.lastname: Razuri
authors.affiliation: Asociación Civil Selva Amazónica, Iquitos, Peru.
authors.forename: M
authors.initials: M
authors.lastname: Casapia
authors.affiliation: Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Rahme
authors.affiliation: Dirección Regional de Salud Loreto, Iquitos, Peru.
authors.forename: H
authors.initials: H
authors.lastname: Silva
authors.affiliation: Independent consultant, Washington DC, USA.
authors.forename: S
authors.initials: S
authors.lastname: Ault
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
authors.forename: B
authors.initials: B
authors.lastname: Blouin
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
authors.forename: L S
authors.initials: LS
authors.lastname: Mofid
authors.affiliation: Department of the Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Montresor
authors.affiliation: Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada. Electronic address: theresa.gyorkos@mcgill.ca.
authors.forename: T W
authors.initials: TW
authors.lastname: Gyorkos
mesh_terms: D000818:Animals; D000969:Antinematodal Agents / Q000627:therapeutic use*; D017164:Ascaris lumbricoides / Q000187:drug effects*; D002170:Canada; D002648:Child; D005260:Female; D006373:Helminthiasis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D032541:Mass Vaccination / Q000706:statistics & numerical data*; D008463:Mebendazole / Q000627:therapeutic use*; D010568:Peru; D015995:Prevalence; D012307:Risk Factors; D012574:Schools; D014257:Trichuriasis / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D000969:Antinematodal Agents; D008463:Mebendazole
keywords: Deworming; Monitoring; Peru; School-age children; Soil-transmitted helminth infections