Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
Lancet. 2019 May 18;393(10185):2039-2050. doi: 10.1016/S0140-6736(18)32591-1. Epub 2019 Apr 18.
School-based deworming programmes can reduce morbidity attributable to soil-transmitted helminths in children but do not interrupt transmission in the wider community. We assessed the effects of alternative mass treatment strategies on community soil-transmitted helminth infection.
In this cluster-randomised controlled trial, 120 community units (clusters) serving 150 000 households in Kenya were randomly assigned (1:1:1) to receive albendazole through annual school-based treatment targeting 2-14 year olds or annual or biannual community-wide treatment targeting all ages. The primary outcome was community hookworm prevalence, assessed at 12 and 24 months through repeat cross-sectional surveys. Secondary outcomes were Ascaris lumbricoides and Trichuris trichiura prevalence, infection intensity of each soil-transmitted helminth species, and treatment coverage and costs. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT02397772.
After 24 months, prevalence of hookworm changed from 18·6% (95% CI 13·9-23·2) to 13·8% (10·5-17·0) in the annual school-based treatment group, 17·9% (13·7-22·1) to 8·0% (6·0-10·1) in the annual community-wide treatment group, and 20·6% (15·8-25·5) to 6·2% (4·9-7·5) in the biannual community-wide treatment group. Relative to annual school-based treatment, the risk ratio for annual community-wide treatment was 0·59 (95% CI 0·42-0·83; p<0·001) and for biannual community-wide treatment was 0·46 (0·33-0·63; p<0·001). More modest reductions in risk were observed after 12 months. Risk ratios were similar across demographic and socioeconomic subgroups after 24 months. No adverse events related to albendazole were reported.
Community-wide treatment was more effective in reducing hookworm prevalence and intensity than school-based treatment, with little additional benefit of treating every 6 months, and was shown to be remarkably equitable in coverage and effects.
Bill & Melinda Gates Foundation, the Joint Global Health Trials Scheme of the Medical Research Council, the UK Department for International Development, the Wellcome Trust, and the Children's Investment Fund Foundation.
学校驱虫方案可降低儿童感染土源性蠕虫病的发病率，但无法阻断社区内的传播。我们评估了替代大规模治疗策略对社区土源性蠕虫感染的影响。
本项集群随机对照试验将肯尼亚的 120 个社区单位（集群）（服务 150000 户家庭）以 1:1:1 的比例随机分配，分别接受阿苯达唑治疗：每年针对 2-14 岁儿童的学校基础驱虫治疗，或每年或每半年针对所有年龄段的社区范围驱虫治疗。主要结局是通过重复横断面调查，在 12 个月和 24 个月时评估社区钩虫流行率。次要结局包括蛔虫和鞭虫的流行率、每种土源性蠕虫的感染强度、治疗覆盖率和成本。分析采用意向治疗。本试验在 ClinicalTrials.gov 注册，编号为 NCT02397772。
24 个月后，在每年学校基础驱虫治疗组中，钩虫的流行率从 18.6%（95%CI，13.9-23.2）降至 13.8%（10.5-17.0），在每年社区范围驱虫治疗组中，从 17.9%（13.7-22.1）降至 8.0%（6.0-10.1），在每半年社区范围驱虫治疗组中，从 20.6%（15.8-25.5）降至 6.2%（4.9-7.5）。与每年学校基础驱虫治疗相比，每年社区范围驱虫治疗的风险比为 0.59（95%CI，0.42-0.83；p<0.001），每半年社区范围驱虫治疗的风险比为 0.46（0.33-0.63；p<0.001）。12 个月后观察到的风险降低幅度较小。24 个月后，各人口统计学和社会经济亚组的风险比相似。未报告与阿苯达唑相关的不良事件。
与学校基础驱虫治疗相比，社区范围驱虫治疗在降低钩虫流行率和感染强度方面更有效，每 6 个月治疗一次的效果增加不大，但在覆盖率和效果方面具有显著的公平性。
比尔及梅琳达·盖茨基金会、医学研究理事会联合全球卫生试验计划、英国国际发展部、惠康信托基金会和儿童投资基金基金会。
