Harris Julie R, Worrell Caitlin M, Davis Stephanie M, Odero Kennedy, Mogeni Ondari D, Deming Michael S, Mohammed Aden, Montgomery Joel M, Njenga Sammy M, Fox LeAnne M, Addiss David G
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.
PLoS Negl Trop Dis. 2015 Mar 12;9(3):e0003590. doi: 10.1371/journal.pntd.0003590. eCollection 2015 Mar.
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.
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.
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).
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.
土壤传播性蠕虫（STH）感染控制项目越来越多地对全国性群体药物驱虫（MDA）干预措施进行评估。然而，“非计划性驱虫”（即在国家开展的STH控制项目之外接受驱虫药物）的情况频繁发生。未能将这些活动纳入考量可能会影响对MDA效果的评估。
我们采用横断面研究设计，对肯尼亚基贝拉的婴儿（6至11个月大）、学龄前儿童（PSAC，1至4岁）和学龄儿童（SAC，5至14岁）中的STH感染和非计划性驱虫情况进行评估。基贝拉是一个非正式定居点，目前未接受国家开展的针对STH的MDA。通过三次重复的加藤-厚涂片法评估STH感染情况。我们向随机选取儿童的户主询问过去一年接受驱虫药物的情况及药物来源。对参与学校驱虫工作的当地非政府组织（NGO）和学校工作人员进行访谈，以收集药物覆盖范围的信息。
在评估的679名儿童（18名婴儿、184名PSAC和477名SAC）中，377名（55%）报告在过去一年中至少接受过一次非计划性驱虫治疗。PSAC主要从药剂师处（48.3%）或医疗保健中心（37.7%）接受治疗；SAC最常在学校接受治疗（55.0%）。四个NGO报告了在我们研究区域内150多所学校中的47所学校开展的过去一年驱虫活动。过去一年的驱虫与任何STH感染呈负相关（34.8%对45.4%，p = 0.005）。最近一次驱虫药物来自药剂师的SAC感染鞭虫的比例（38.0%）高于那些最近一次治疗来自医疗保健中心（17.3%）或学校（23.1%）的SAC（p = 0.05）。
在我们的研究区域，超过一半的儿童接受了来自多种来源的非计划性驱虫。个体层面的治疗和非计划性预防性化疗可能都发挥着重要的公共卫生作用，特别是在没有计划性驱虫的情况下；然而，它们也可能导致对计划性MDA效果的高估。需要一种标准化、经过验证的工具来评估非计划性驱虫情况。
