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Researchers identify untreated populations for schistosomiasis, hookworm
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Researchers successfully identified individuals from Uganda who were untreated for schistosomiasis and hookworm infections during mass drug administrations based on their socioeconomic status and minority group affiliation, according to recent findings.
“Existing WHO guidelines prioritize individuals for treatment based on age, gender and high-risk occupations for Schistosoma mansoni or hookworm infections, but these infection risk factors were unable to identify nonrecipients of [mass drug administration (MDA)],” David W. Dunne, PhD, of the department of pathology at the University of Cambridge, and colleagues wrote.
In the study, researchers evaluated coverage of community-targeted MDA of Biltricide (praziquantel; Bayer Healthcare) and Albenza (albendazole, Amedra Pharmaceuticals) administered in 17 villages in Mayuge District, Uganda during October 2013 to identify factors predictive of not receiving MDA.
Community medical distributors (CMDs) recruited 1,034 participants from 517 households who each provided one stool sample for baseline parasitology testing. Parasitology and sociodemographic data, including social status and income, were collected from 935 participants through household questionnaires. Follow-up stool samples were collected from 860 patients.
The researchers found that 37.86% patients in the drug receipt model received both praziquantel and albendazole, 14.76% received praziquantel but not albendazole, and 3.21% received albendazole but not praziquantel. This indicated that 44.17% of study participants received neither drug.
Reasons for not receiving either drug were available for 86.29% of the heads of household who reported on the lack of treatment. The most commonly cited reasons were no drug availability (70.53%), lack of health education (12.25%) and ineligibility (11.26%).
The researchers identified four household-level factors associated with praziquantel receipt. Patients belonging to households headed by a Muslim had a 51.63% lower likelihood of praziquantel treatment vs. those living in households with Christian heads, a difference which bordered on significance. Other factors included being a member of the village majority tribe, which was associated with a 2.11 times greater likelihood of praziquantel treatment vs. minority tribe status (P = .023). Household wealth was associated with a 17.97% greater likelihood of praziquantel receipt for each point increase in home quality score (P = .002). Households with purified drinking water had a 2.12 times greater likelihood of receiving praziquantel vs. households that did not treat, filter or boil drinking water (P = .036).
In a related editorial, Charles H. King, MD, of Case Western Reserve University School of Medicine, wrote the study represents valuable “implementation science” evaluating the barriers to MDA.
“It is clear that quality implementation of public health programs must take into account patient knowledge and fears, as well as the context of patient social standing, nutrition, and his or her personal interactions with friends, family and drug distributors,” King wrote. “The next step for MDA programs is to use this new-found knowledge about specific social drivers in redesigning and reinforcing the training of drug delivery personnel, and in the development and refocusing of informational and motivational messaging to encourage public awareness and inclusion before, during and after MDA campaigns.” – by Jen Byrne
Disclosure: Dunne reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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