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Unprogrammed deworming in the Kibera slum, Nairobi: implications for control of soil-transmitted helminthiases.
PLoS Negl Trop Dis. 2015 Mar; 9(3):e0003590.PN

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.

Authors+Show Affiliations

Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.Kenya Medical Research Institute, Centre for Global Health Research, Nairobi, Kenya.Kenya Medical Research Institute, Centre for Global Health Research, Nairobi, Kenya.Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.Public Health Department, School Health Program, Nairobi County, Nairobi, Kenya.Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya.Kenya Medical Research Institute, Centre for Global Health Research, Nairobi, Kenya; Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya.Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.Children Without Worms, Task Force for Global Health, Decatur, Georgia, United States of America.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25763577

Citation

Harris, Julie R., et al. "Unprogrammed Deworming in the Kibera Slum, Nairobi: Implications for Control of Soil-transmitted Helminthiases." PLoS Neglected Tropical Diseases, vol. 9, no. 3, 2015, pp. e0003590.
Harris JR, Worrell CM, Davis SM, et al. Unprogrammed deworming in the Kibera slum, Nairobi: implications for control of soil-transmitted helminthiases. PLoS Negl Trop Dis. 2015;9(3):e0003590.
Harris, J. R., Worrell, C. M., Davis, S. M., Odero, K., Mogeni, O. D., Deming, M. S., Mohammed, A., Montgomery, J. M., Njenga, S. M., Fox, L. M., & Addiss, D. G. (2015). Unprogrammed deworming in the Kibera slum, Nairobi: implications for control of soil-transmitted helminthiases. PLoS Neglected Tropical Diseases, 9(3), e0003590. https://doi.org/10.1371/journal.pntd.0003590
Harris JR, et al. Unprogrammed Deworming in the Kibera Slum, Nairobi: Implications for Control of Soil-transmitted Helminthiases. PLoS Negl Trop Dis. 2015;9(3):e0003590. PubMed PMID: 25763577.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Unprogrammed deworming in the Kibera slum, Nairobi: implications for control of soil-transmitted helminthiases. AU - Harris,Julie R, AU - Worrell,Caitlin M, AU - Davis,Stephanie M, AU - Odero,Kennedy, AU - Mogeni,Ondari D, AU - Deming,Michael S, AU - Mohammed,Aden, AU - Montgomery,Joel M, AU - Njenga,Sammy M, AU - Fox,LeAnne M, AU - Addiss,David G, Y1 - 2015/03/12/ PY - 2014/10/02/received PY - 2015/02/04/accepted PY - 2015/3/13/entrez PY - 2015/3/13/pubmed PY - 2015/10/2/medline SP - e0003590 EP - e0003590 JF - PLoS neglected tropical diseases JO - PLoS Negl Trop Dis VL - 9 IS - 3 N2 - 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. SN - 1935-2735 UR - https://www.unboundmedicine.com/medline/citation/25763577/Unprogrammed_deworming_in_the_Kibera_slum_Nairobi:_implications_for_control_of_soil_transmitted_helminthiases_ L2 - http://dx.plos.org/10.1371/journal.pntd.0003590 DB - PRIME DP - Unbound Medicine ER -