title: Treatment of human and livestock helminth infections in a mobile pastoralist setting at Lake Chad: Attitudes to health and analysis of active pharmaceutical ingredients of locally available anthelminthic drugs.
abstract: Mobile pastoralists face challenges in accessing quality health care and medication for managing human and animal diseases. We determined livestock disease priorities, health seeking behaviour of people bearing helminthiases and - placing particular emphasis on trematode infections - treatment strategies and outcome satisfaction among mobile pastoralists of four ethnic groups in the Lake Chad area using focus group discussions. People suffering from schistosomiasis were interviewed about symptoms, health seeking behaviour and their satisfaction with respect to the provided treatment. Anthelminthic drugs for human and veterinary use obtained from various health care structures were analysed for active pharmaceutical ingredients (API) and quantity, using high pressure liquid chromatography-UV and liquid chromatography combined with tandem mass spectrometry. Most people suffering from schistosomiasis sought treatment at health care centres. Yet, they also consulted informal providers without medical training. Regarding animal health, self-mediated therapy was common to manage suspected livestock fascioliasis. Self-reported treatment satisfaction for human schistosomiasis and trematodiasis treatment outcome in livestock were low. Mobile pastoralists perceived the purchased drugs to be of low quality. Among 33 products locally sold as anthelminthic drugs for human or veterinary use, 27 contained albendazole or mebendazole, varying between 91% and 159% of the labelled amount. Six products were sold loosely with incomplete information and their API could not be identified. No counterfeit anthelminthic drugs were detected. None of the samples contained praziquantel or triclabendazole, the drugs of choice against schistosomiasis and fascioliasis, respectively. The perceived unsatisfactory treatment outcomes in humans and animals infected with trematodes are most likely due to empiric diagnosis and the resulting use of inadequate therapy for human schistosomiasis and the lack of efficacious drugs against livestock fascioliasis.
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
authors.forename: Helena
authors.initials: H
authors.lastname: Greter
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
authors.forename: Noemi
authors.initials: N
authors.lastname: Cowan
authors.affiliation: Institut de Recherche en Elevage pour le Développement, N'Djamena, Chad.
authors.forename: Bongo N
authors.initials: BN
authors.lastname: Ngandolo
authors.affiliation: Centre de Support en Santé International, N'Djamena, Chad.
authors.forename: Hamit
authors.initials: H
authors.lastname: Kessely
authors.affiliation: Institut de Recherche en Elevage pour le Développement, N'Djamena, Chad.
authors.forename: Idriss O
authors.initials: IO
authors.lastname: Alfaroukh
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
authors.forename: Jürg
authors.initials: J
authors.lastname: Utzinger
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Keiser
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland. Electronic address: jakob.zinsstag@unibas.ch.
authors.forename: Jakob
authors.initials: J
authors.lastname: Zinsstag
mesh_terms: D000818:Animals; D000871:Anthelmintics / Q000008:administration & dosage / Q000627:therapeutic use*; D002596:Chad; D005211:Fascioliasis / Q000188:drug therapy; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006297:Health Services Accessibility; D006373:Helminthiasis / Q000188:drug therapy*; D006374:Helminthiasis, Animal / Q000188:drug therapy*; D006801:Humans; D060106:Lakes; D058751:Livestock; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D017060:Patient Satisfaction; D012552:Schistosomiasis / Q000188:drug therapy / Q000208:ethnology
chemical_list: D000871:Anthelmintics
keywords: Anthelminthic drugs; Chad; Fascioliasis; Focus group discussion; Mobile pastoralists; Schistosomiasis