在乌干达，治疗前小吃对大规模血吸虫病治疗吸收率的影响：一项群组随机试验。
Effectiveness of a pre-treatment snack on the uptake of mass treatment for schistosomiasis in Uganda: a cluster randomized trial.
机构信息
Makerere University, School of Medicine, Child Health and Development Center, Kampala, Uganda.
University of Copenhagen, Faculty of Health and Medical Sciences, Section for Parasitology, Health and Development, Copenhagen, Denmark.
出版信息
PLoS Med. 2014 May 13;11(5):e1001640. doi: 10.1371/journal.pmed.1001640. eCollection 2014 May.
BACKGROUND
School-based mass treatment with praziquantel is the cornerstone for schistosomiasis control in school-aged children. However, uptake of treatment among school-age children in Uganda is low in some areas. The objective of the study was to examine the effectiveness of a pre-treatment snack on uptake of mass treatment.
METHODS AND FINDINGS
In a cluster randomized trial carried out in Jinja district, Uganda, 12 primary schools were randomized into two groups; one received education messages for schistosomiasis prevention for two months prior to mass treatment, while the other, in addition to the education messages, received a pre-treatment snack shortly before mass treatment. Four weeks after mass treatment, uptake of praziquantel was assessed among a random sample of 595 children in the snack schools and 689 children in the non-snack schools as the primary outcome. The occurrence of side effects and the prevalence and mean intensity of Schistosoma mansoni infection were determined as the secondary outcomes. Uptake of praziquantel was higher in the snack schools, 93.9% (95% CI 91.7%-95.7%), compared to that in the non-snack schools, 78.7% (95% CI 75.4%-81.7%) (p = 0.002). The occurrence of side effects was lower in the snack schools, 34.4% (95% CI 31.5%-39.8%), compared to that in the non-snack schools, 46.9% (95% CI 42.2%-50.7%) (p = 0.041). Prevalence and mean intensity of S. mansoni infection was lower in the snack schools, 1.3% (95% CI 0.6%-2.6%) and 38.3 eggs per gram of stool (epg) (95% CI 21.8-67.2), compared to that in the non-snack schools, 14.1% (95% CI 11.6%-16.9%) (p = 0.001) and 78.4 epg (95% CI 60.6-101.5) (p = 0.001), respectively.
CONCLUSIONS
Our results suggest that provision of a pre-treatment snack combined with education messages achieves a higher uptake compared to the education messages alone. The use a pre-treatment snack was associated with reduced side effects as well as decreased prevalence and intensity of S. mansoni infection.
TRIAL REGISTRATION
www.ClinicalTrials.gov NCT01869465
背景
在学龄儿童中，以学校为基础的群体用吡喹酮治疗是血吸虫病控制的基石。然而，在乌干达的一些地区，学龄儿童接受治疗的比例较低。本研究的目的是检验治疗前小吃对群体治疗参与度的影响。
方法和发现
在乌干达 Jinja 区进行的一项集群随机试验中，将 12 所小学随机分为两组；一组在群体治疗前两个月接受血吸虫病预防教育信息，另一组除了教育信息外，还在群体治疗前接受治疗前小吃。群体治疗后四周，评估小吃学校的 595 名儿童和非小吃学校的 689 名儿童中随机样本的吡喹酮摄入量，作为主要结局。副作用的发生情况以及曼氏血吸虫感染的流行率和平均强度则作为次要结局。小吃学校的吡喹酮摄入量更高，为 93.9%（95%CI 91.7%-95.7%），而非小吃学校的吡喹酮摄入量为 78.7%（95%CI 75.4%-81.7%）（p=0.002）。小吃学校的副作用发生率较低，为 34.4%（95%CI 31.5%-39.8%），而非小吃学校的副作用发生率为 46.9%（95%CI 42.2%-50.7%）（p=0.041）。小吃学校的曼氏血吸虫感染流行率和平均强度更低，分别为 1.3%（95%CI 0.6%-2.6%）和 38.3 每克粪便虫卵数（epg）（95%CI 21.8-67.2），而非小吃学校的流行率和平均强度分别为 14.1%（95%CI 11.6%-16.9%）（p=0.001）和 78.4 epg（95%CI 60.6-101.5）（p=0.001）。
结论
我们的研究结果表明，与单纯的教育信息相比，提供治疗前小吃并结合教育信息可提高参与度。治疗前小吃的使用与副作用减少以及曼氏血吸虫感染的流行率和强度降低有关。
试验注册
www.ClinicalTrials.gov NCT01869465
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