Children Without Worms, The Task Force for Global Health, Atlanta, Georgia, United States of America.
Communicable Disease Control, Ministry of Health & Family Welfare, Dhaka, Bangladesh.
PLoS Negl Trop Dis. 2020 Dec 7;14(12):e0008597. doi: 10.1371/journal.pntd.0008597. eCollection 2020 Dec.
In 2008, Bangladesh initiated Preventive Chemotherapy (PCT) for school-age children (SAC) through bi-annual school-based mass drug administration (MDA) to control Soil-Transmitted Helminth (STH) infections. In 2016, the Ministry of Health and Family Welfare's Program on Lymphatic Filariasis Elimination and STH (ELFSTH) initiated district-level community impact assessments with Children Without Worms (CWW) using standardized, population-based sampling to measure the post-intervention STH burden across all ages (≥ 1 yr) for the three STH species. The Integrated Community-based Survey for Program Monitoring (ICSPM) was developed by CWW and was used to survey 12 districts in Bangladesh from 2017-2020. We excluded the first two district data as piloting caused some sampling errors and combined the individual demographic and parasite-specific characteristics from the subsequent 10 districts, linking them with the laboratory data for collective analysis. Our analysis identified district-specific epidemiologic findings, important for program decisions. Of the 17,874 enrolled individuals, our results are based on 10,824 (61.0%) stool samples. Overall, the prevalence of any STH species was substantially reduced to 14% from 79.8% in 2005. The impact was similar across all ages. STH prevalence was 14% in 10 districts collectively, but remained high in four districts, despite their high reported PCT coverage in previous years. Among all, Bhola district was unique because it was the only district with high T.trichuris prevalence. Bangladesh successfully lowered STH prevalence across all ages despite targeting SAC only. Data from the survey indicate a significant number of adults and pre-school age children (PSAC) were self-deworming with purchased pills. This may account for the flat impact curve across all ages. Overall prevalence varied across surveyed districts, with persistent high transmission in the northeastern districts and a district in the central flood zone, indicating possible service and ecological factors. Discrepancies in the impact between districts highlight the need for district-level data to evaluate program implementation after consistent high PCT coverage.
2008 年，孟加拉国通过在学校开展两年一次的大规模药物治疗（MDA）为学龄儿童（SAC）提供预防性化疗（PCT），以控制土壤传播性蠕虫（STH）感染。2016 年，卫生和家庭福利部的淋巴丝虫病和 STH 消除规划（ELFSTH）启动了区级社区影响评估，使用标准化的基于人群的抽样方法来衡量所有年龄段（≥1 岁）的三种 STH 感染后负担。儿童无蠕虫（CWW）制定了综合社区规划监测调查（ICSPM），并于 2017-2020 年在孟加拉国的 12 个区进行了调查。我们排除了前两个区的数据，因为试点工作造成了一些抽样误差，并将随后 10 个区的个人人口统计学和寄生虫特异性特征合并在一起，将其与实验室数据联系起来进行综合分析。我们的分析确定了具有规划决策意义的特定地区的流行病学发现。在 17874 名入组的个体中，我们的结果基于 10824 名（61.0%）粪便样本。总体而言，从 2005 年的 79.8%，所有 STH 物种的流行率都大幅降低到 14%。所有年龄段的影响都相似。在所有年龄段中，10 个区的 STH 流行率为 14%，但在过去几年报告的 PCT 覆盖率较高的四个区仍居高不下。其中，博洛区是独特的，因为它是唯一一个 T.trichuris 流行率较高的区。尽管仅针对 SAC，但孟加拉国成功降低了所有年龄段的 STH 流行率。调查数据表明，相当数量的成年人和学龄前儿童（PSAC）正在用购买的药丸进行自我驱虫。这可能是所有年龄段的影响曲线呈平坦的原因。总体流行率在调查区之间有所不同，东北部和中部洪水区的传播持续较高，表明可能存在服务和生态因素。区之间的影响差异突出表明，在持续高覆盖率的情况下，需要进行区级数据评估以评估方案的实施情况。
