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
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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DOI：
10.1186/1471-2334-13-590
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发表时间：
2013-12-13
影响因子：
3.7
通讯作者：
Olsen, Annette
中科院分区：
文献类型：
--
作者：
Muhumuza, Simon;Katahoire, Anne;Olsen, Annette
背景资料：实现大规模药物管理（MDA）控制血吸虫病的公共卫生效益取决于实现和保持高的年度治疗覆盖率。在乌干达，2011年学龄儿童接受血吸虫病预防性治疗的比例仅为28%。战略需要增加uptake.Methods：一系列横断面调查进行基线（MDA后，在2011年），并在后续MDA在2012年，教师的动机，并在乌干达金贾区加强监督。在基线调查期间，从12所小学随机选择了1，010名儿童，在后续调查期间，从同一所小学随机选择了1，020名儿童，对吡喹酮的摄入情况进行了评估。自我报告的吡喹酮摄入率从基线时的28.2%（95% CI 25.4%-30.9%）增加到随访时的48.9%（95% CI 45.8%-52.0%）（p < 0.001）。曼氏血吸虫感染的患病率和强度在两种情况下均保持不变，为中度; 35.0%（95% CI：25.4%-37.9%）和32.6%（95% CI：29.6%-35.5%）（p = 0.25）和156.7个卵/克粪便（epg）（95% CI：116.9-196.5）和133.1 epg（95% CI：99.0-167.2）（p = 0.38）。基线（49.8%，95% CI 43.8%-55.8%）和随访（46.6%，95% CI 42%）时报告吡喹酮副作用的儿童比例无变化。1-51.2%）（p = 0.50）以及基线和基线之间具有正确血吸虫病传播和控制知识的儿童比例（45.9%，95% CI 42.7%-73.7%）和随访（44.1%，95% CI 41.0%-47.2%）（p = 0.42）。虽然教师的激励和监督分发治疗增加了学龄儿童对吡喹酮的吸收，实际摄入量仍低于世界卫生组织（WHO）的建议，显然太低，不足以影响儿童血吸虫病的流行和严重程度。如果以学校为基础的MDA要实现预防性化疗的目标，就需要采取额外的措施来增加吡喹酮的摄入。
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.