Systematic review of community-based, school-based, and combined delivery modes for reaching school-aged children in mass drug administration programs for schistosomiasis.
Systematic review of community-based, school-based, and combined delivery modes for reaching school-aged children in mass drug administration programs for schistosomiasis.
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DOI：
10.1371/journal.pntd.0006043
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发表时间：
2017-10
影响因子：
3.8
通讯作者：
King CH
中科院分区：
文献类型：
--
作者：
Burnim M;Ivy JA;King CH
目前血吸虫病控制方案的主要内容是对学龄儿童使用吡喹酮进行集体预防性化疗。这种治疗是通过基于学校、基于社区或基于学校和社区相结合的系统来提供的。在大规模血吸虫病治疗项目中，实现非常高的儿童覆盖率至关重要，同样重要的是确保没有长期得不到治疗的亚群，这对入学率较低地区的学校项目来说是一个潜在的挑战。这项审查力求根据对学龄儿童的总体覆盖率和特别是对未入学儿童的覆盖率，比较不同的治疗提供方法。此外，还确定了与覆盖率高或低有关的定性社区或方案因素，并提出了全面改善覆盖率的建议。这项综述已在PROSPERO(CRD 42015017656)上进行了前瞻性注册。通过数据库搜索、参考文献清单和个人通信确定了549种可能相关的出版物。符合条件的研究包括那些在2015年10月之前以英语或法语发表的研究，其中包含关于服用吡喹酮的学龄儿童丙二醛覆盖率的定量或定性数据。在22项选定的研究中，社区和学校项目的综合覆盖率中位数最高(89%)，其次是社区项目(72%)。以学校为基础的方案的儿童覆盖率中位数最低(49%)，未入学儿童亚群的覆盖率最低。在质量上，影响项目成功的主要因素包括对副作用的恐惧、关于血吸虫病的教育不足、缺乏对药品分销商的激励以及对少数群体的不公平分配。这篇综述为未来血吸虫病控制计划的发展提供了一个循证的框架。根据我们的结果，社区和学校相结合的提供系统应最大限度地扩大对在校和失学儿童的覆盖面，特别是在与干预措施相结合时，例如为接受治疗的儿童提供零食、开展教育运动、奖励药品分销商以及积极接纳边缘化群体。临床试验网站CRD42015017656血吸虫病是一种慢性炎症性疾病，由寄生虫引起，影响全球超过2.9亿人。感染的后果包括贫血、发育迟缓、肝脏异常和不育。目前，血吸虫病控制的主要途径是对流行区的学龄儿童进行集体预防性治疗。这种名为吡喹酮的疗法可以通过学校、社区或学校和社区相结合的系统进行分发。这项系统审查的第一部分比较了三种分娩模式，发现联合分娩对学龄儿童的总体覆盖率最高，仅社区分娩次之。仅限学校提供的服务不仅总体覆盖率最低，而且在针对未入学儿童方面尤其落后。总体而言，这些成果支持更频繁地使用综合办法，以实现最高的覆盖率，并确保失学儿童不会长期得不到治疗。在本综述的第二部分中，我们考察了影响项目成功的定性因素。结果表明，可以通过小的干预措施提高总体治疗覆盖率，例如为参与活动的儿童提供零食以减少药物副作用、关于血吸虫病的教育运动、对药品分销商的奖励以及积极纳入边缘群体。
The mainstay of current schistosomiasis control programs is mass preventive chemotherapy of school-aged children with praziquantel. This treatment is delivered through school-based, community-based, or combined school- and community-based systems. Attaining very high coverage rates for children is essential in mass schistosomiasis treatment programs, as is ensuring that there are no persistently untreated subpopulations, a potential challenge for school-based programs in areas with low school enrollment. This review sought to compare the different treatment delivery methods based both on their coverage of school-aged children overall and on their coverage specifically of non-enrolled children. In addition, qualitative community or programmatic factors associated with high or low coverage rates were identified, with suggestions for overall coverage improvement. This review was registered prospectively with PROSPERO (CRD 42015017656). Five hundred forty-nine publication of potential relevance were identified through database searches, reference lists, and personal communications. Eligible studies included those published before October 2015, written in English or French, containing quantitative or qualitative data about coverage rates for MDA of school-aged children with praziquantel. Among the 22 selected studies, combined community- and school-based programs achieved the highest median coverage rates (89%), followed by community-based programs (72%). School-based programs had both the lowest median coverage of children overall (49%) and the lowest coverage of the non-enrolled subpopulation of children. Qualitatively, major factors affecting program success included fear of side effects, inadequate education about schistosomiasis, lack of incentives for drug distributors, and inequitable distribution to minority groups. This review provides an evidence-based framework for the development of future schistosomiasis control programs. Based on our results, a combined community and school-based delivery system should maximize coverage for both in- and out-of-school children, especially when combined with interventions such as snacks for treated children, educational campaigns, incentives for drug distributors, and active inclusion of marginalized groups. ClinicalTrials.gov CRD42015017656 Schistosomiasis is a chronic inflammatory condition, caused by parasitic flukes, that affects over 290 million people worldwide. Consequences of infection include anemia, stunted growth, liver abnormalities, and subfertility. Currently, the main approach to schistosomiasis control involves mass preventive treatment of school-aged children in endemic areas. The treatment, praziquantel, can be distributed through school-based, community-based, or combined school- and community-based systems. The first part of this systematic review compared the three delivery modes and found that combined delivery resulted in the best overall coverage of school-aged children, with community-only delivery the next-best approach. School-only delivery not only had the lowest overall coverage, but especially fell behind in targeting children not enrolled in school. As a whole, these results support the more frequent use of a combined approach to delivery in order to achieve the highest coverage rates and ensure that out-of-school children are not left persistently untreated. In the second part of this review the qualitative factors affecting program success were examined. The results indicate that overall treatment coverage can be improved via small interventions, such as snacks for participating children to reduce drug side effects, educational campaigns about schistosomiasis, incentives for drug distributors, and active inclusion of marginalized groups.
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影响因子：
8.1
作者：
Dabo A;Bary B;Kouriba B;Sankaré O;Doumbo O
通讯作者：
Doumbo O
影响因子：
3.7
作者：
Muhumuza, Simon;Katahoire, Anne;Olsen, Annette
通讯作者：
Olsen, Annette
影响因子：
1.5
作者：
Muhumuza, Simon;Olsen, Annette;Katahoire, Anne
通讯作者：
Katahoire, Anne
影响因子：
3.8
作者：
Grimes JE;Croll D;Harrison WE;Utzinger J;Freeman MC;Templeton MR
通讯作者：
Templeton MR
DOI：
10.1016/j.trstmh.2005.03.015
发表时间：
2006-03-01
影响因子：
2.2
作者：
Kabatereine, NB;Tukahebwa, E;Fenwick, A
通讯作者：
Fenwick, A