Effectiveness of a Pre-treatment Snack on the Uptake of Mass Treatment for Schistosomiasis in Uganda: A Cluster Randomized Trial

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Date
2014-05Author
Muhumuza, Simon
Olsen, Annette
Katahoire, Anne
Kiragga, Agnes N.
Nuwaha, Fred
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Background: School-based mass treatment with praziquantel is the cornerstone for schistosomiasis control in school-aged
children. However, uptake of treatment among school-age children in Uganda is low in some areas. The objective of the
study was to examine the effectiveness of a pre-treatment snack on uptake of mass treatment.
Methods and Findings: In a cluster randomized trial carried out in Jinja district, Uganda, 12 primary schools were
randomized into two groups; one received education messages for schistosomiasis prevention for two months prior to mass
treatment, while the other, in addition to the education messages, received a pre-treatment snack shortly before mass
treatment. Four weeks after mass treatment, uptake of praziquantel was assessed among a random sample of 595 children
in the snack schools and 689 children in the non-snack schools as the primary outcome. The occurrence of side effects and
the prevalence and mean intensity of Schistosoma mansoni infection were determined as the secondary outcomes. Uptake
of praziquantel was higher in the snack schools, 93.9% (95% CI 91.7%–95.7%), compared to that in the non-snack schools,
78.7% (95% CI 75.4%–81.7%) (p = 0.002). The occurrence of side effects was lower in the snack schools, 34.4% (95% CI
31.5%–39.8%), compared to that in the non-snack schools, 46.9% (95% CI 42.2%–50.7%) (p = 0.041). Prevalence and mean
intensity of S. mansoni infection was lower in the snack schools, 1.3% (95% CI 0.6%–2.6%) and 38.3 eggs per gram of stool
(epg) (95% CI 21.8–67.2), compared to that in the non-snack schools, 14.1% (95% CI 11.6%–16.9%) (p = 0.001) and 78.4 epg
(95% CI 60.6–101.5) (p = 0.001), respectively.
Conclusions: Our results suggest that provision of a pre-treatment snack combined with education messages achieves a
higher uptake compared to the education messages alone. The use a pre-treatment snack was associated with reduced side
effects as well as decreased prevalence and intensity of S. mansoni infection.
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