A four-year follow-up of school children after mass treatment for schistosomiasis and soil-transmitted helminths in Mwea, Central Kenya

Abstract

Poly-parasitism infections are common in school children in tropical regions, especially in Africa. In a school based schistosomiasis and soil-transmitted helminths de-worming model project in Mwea, Kenya, approximately 40,000 school age children from 86 schools were treated annually with a standard dose of praziquantel (40mg/kg body weight) and albendazole (400mg). A cohort of approximately 2,300 children from 5 sentinel schools were followed up at multiple time points each year for four years and examined for intestinal helminths (Schistosoma mansoni, Trichuris trichiura, Hookworm (Necator americanus) and Ascaris lumbricoides). The overall prevalence of infection in the five schools before treatment was 47.4% for S. mansoni, 16.7% for N. americanus, 0.8% for T. trichiura and 1.7% for A. lumbricoides. The mean intensity of infection, as measured by eggs per gram of faeces (epg) was 146.2 for S. mansoni, 36.3 for N. americanus 1.0 for T. trichiura and 35.8 for A. lumbricoides. After 4 rounds of treatment, prevalence of S. mansoni reduced significantly by 88.7% to 5.4% (3.6% – 7.1%), a 97.1% reduction. The prevalence and intensity of S. mansoni infection varied by school according to its proximity to irrigated area, with those schools closest to the irrigated areas presenting higher infection prevalence and intensity. Re-infection with schistosomiasis following treatment was observed and is likely to reflect continued environmental transmission due to non-treatment of the adult population. Soil-transmitted helminths are less prevalent in the cohort, with corresponding lower intensity. This may allow albendazole treatment to be reduced to every 2 or 3 years. This study has shown that periodic administration of anthelminthic drugs reduces the prevalence and intensity (which is likely to be a close proxy of morbidity) of intestinal parasitic infections in school-age children. Adults in the community could also be targeted where resources allow in order to further increasing the effectiveness of de-worming programmes.