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Unprogrammed deworming in the Kibera slum, Nairobi: implications for control of soil-transmitted helminthiases.


ABSTRACT:

Background

Programs for control of soil-transmitted helminth (STH) infections are increasingly evaluating national mass drug administration (MDA) interventions. However, "unprogrammed deworming" (receipt of deworming drugs outside of nationally-run STH control programs) occurs frequently. Failure to account for these activities may compromise evaluations of MDA effectiveness.

Methods

We used a cross-sectional study design to evaluate STH infection and unprogrammed deworming among infants (aged 6-11 months), preschool-aged children (PSAC, aged 1-4 years), and school-aged children (SAC, aged 5-14 years) in Kibera, Kenya, an informal settlement not currently receiving nationally-run MDA for STH. STH infection was assessed by triplicate Kato-Katz. We asked heads of households with randomly-selected children about past-year receipt and source(s) of deworming drugs. Local non-governmental organizations (NGOs) and school staff participating in school-based deworming were interviewed to collect information on drug coverage.

Results

Of 679 children (18 infants, 184 PSAC, and 477 SAC) evaluated, 377 (55%) reported receiving at least one unprogrammed deworming treatment during the past year. PSAC primarily received treatments from chemists (48.3%) or healthcare centers (37.7%); SAC most commonly received treatments at school (55.0%). Four NGOs reported past-year deworming activities at 47 of >150 schools attended by children in our study area. Past-year deworming was negatively associated with any-STH infection (34.8% vs 45.4%, p = 0.005). SAC whose most recent deworming medication was sourced from a chemist were more often infected with Trichuris (38.0%) than those who received their most recent treatment from a health center (17.3%) or school (23.1%) (p = 0.05).

Conclusion

Unprogrammed deworming was received by more than half of children in our study area, from multiple sources. Both individual-level treatment and unprogrammed preventive chemotherapy may serve an important public health function, particularly in the absence of programmed deworming; however, they may also lead to an overestimation of programmed MDA effectiveness. A standardized, validated tool is needed to assess unprogrammed deworming.

SUBMITTER: Harris JR 

PROVIDER: S-EPMC4357447 | biostudies-literature | 2015 Mar

REPOSITORIES: biostudies-literature

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Publications

Unprogrammed deworming in the Kibera slum, Nairobi: implications for control of soil-transmitted helminthiases.

Harris Julie R JR   Worrell Caitlin M CM   Davis Stephanie M SM   Odero Kennedy K   Mogeni Ondari D OD   Deming Michael S MS   Mohammed Aden A   Montgomery Joel M JM   Njenga Sammy M SM   Fox LeAnne M LM   Addiss David G DG  

PLoS neglected tropical diseases 20150312 3


<h4>Background</h4>Programs for control of soil-transmitted helminth (STH) infections are increasingly evaluating national mass drug administration (MDA) interventions. However, "unprogrammed deworming" (receipt of deworming drugs outside of nationally-run STH control programs) occurs frequently. Failure to account for these activities may compromise evaluations of MDA effectiveness.<h4>Methods</h4>We used a cross-sectional study design to evaluate STH infection and unprogrammed deworming among  ...[more]

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