Increasing teacher motivation and supervision is an important but not sufficient strategy for improving praziquantel uptake in Schistosoma mansoni control programs: serial cross sectional surveys in Uganda
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Date
2013-12-13
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
Abstract
Background: Realization of the public health benefits of mass drug administration (MDA) for the control of schistosomiasis depends on achieving and maintaining high annual treatment coverage. In Uganda, the uptake of
preventive treatment for schistosomiasis among school-age children in 2011 was only 28%. Strategies are needed
to increase uptake.
Methods: Serial cross-sectional surveys were conducted at baseline (after MDA in 2011) and at follow-up MDA in 2012 where teacher motivation was provided and supervision strengthened in Jinja district of Uganda. Uptake of
praziquantel was assessed in 1,010 randomly selected children from 12 primary schools during the baseline survey and in another set of 1,020 randomly selected children from the same primary schools during the follow-up survey.
Results: Self-reported uptake of praziquantel increased from 28.2% (95% CI 25.4%-30.9%) at baseline to 48.9%
(95% CI 45.8%-52.0%) (p < 0.001) at follow-up. Prevalence and intensity of Schistosoma mansoni infection were unchanged and moderate on both occasions; 35.0% (95% CI: 25.4%-37.9%) and 32.6% (95% CI: 29.6%-35.5%)
(p = 0.25) and 156.7 eggs per gram of stool (epg) (95% CI: 116.9-196.5) and 133.1 epg (95% CI: 99.0-167.2) (p = 0.38), respectively. There was no change in the proportion of children reporting side effects attributable to praziquantel at baseline (49.8%, 95% CI 43.8%-55.8%) and at follow-up (46.6%, 95% CI 42%.1-51.2%) (p = 0.50) as well as in the proportion of children with correct knowledge of schistosomiasis transmission and control between the baseline (45.9%, 95% CI 42.7%-73.7%) and follow-up (44.1%, 95% CI 41.0%- 47.2%) (p = 0.42).
Conclusion: Although teacher motivation and supervision to distribute treatment increased the uptake of praziquantel among school-age children, the realized uptake is still lower than is recommended by the World
Health Organization (WHO) and apparently too low to affect the prevalence and intensity of schistosomiasis among the children. Additional measures are needed to increase uptake of praziquantel if school-based MDA is to achieve
the objective of preventive chemotherapy.
Description
This paper reports the effects of the new strategy implemented in 2012 on levels of uptake, children’s knowledge on schistosomiasis prevention and prevalence and intensity of schistosomiasis before and after implementation.
Keywords
Schistosomiasis, Uptake of praziquantel, School children, Uganda
Citation
Muhumuza, Simon, Katahoire, Anne, Nuwaha, Fred and Olsen, Annette, 2013. ncreasing teacher motivation and supervision is an important but not sufficient strategy for improving praziquantel uptake in Schistosoma mansoni control programs: serial cross sectional surveys in Uganda.