Preventive chemotherapy coverage against Soil-transmitted helminthiases among school age children in vertical versus integrated treatment approaches: Implications from coverage validation survey in Ethiopia
Authors: Asfaw Mekuria , Zerdo Zerihun , Churko Chuchu , Seife Fikre , Yihune Manaye , Chisha Yilma , Teshome Abinet , Getachew Birhanu , Negussu Nebiyu 
Published: March 2020

Background

Soil-transmitted helminths (STH) are widely distributed in Ethiopia with highest prevalence and burden. Since 2015 the country launched national deworming programme to control STH associated morbidity using mass treatment with Albendazole/Mebendazole. Data on routine coverage of Preventive chemotherapy (PC) are available at different level of the health system, however in some circumstances these reports are unreliable and evidence is lacking on validated treatment coverage against STH.

Methodology

A community-based cross-sectional study was conducted in ten districts of Ethiopia; from January to April 2019. A total of 8154 SAC (4100 males and 4054 females) were participated from randomly selected households. Data were analysed using SPSS software (IBM, version 25); then di-aggregated by gender, age and school attendance and presented in tables and graphs.

Principal findings

Albendazole/Mebendazole mass treatment coverage against STH among school-age children was found to be 71%. In vertical (school-based) treatment approach, 4822(68.4%) were treated; whereas in integrated (community directed) approach, 963(86.9 %) were treated. The treatment coverage among males was 2948(71.9%), while among females it was 2837(70%). Based on age the treatment coverage in the age group 10-14 years was 77%; which is higher than the coverage in age group 5-9 years was 64.4%. In addition, the treatment coverage in school attendant was 81%; which is higher than coverage non-enrolled children (28%). The main deworming site was school, 5223(91%). Moreover, the main reported reasons for not swallowing drugs were not attending school, 422(19.75%) and drugs were not given, 397(18.6%).

Concussions/significance

Albendazole/Mebendazole mass treatment coverage against soil-transmitted helminths among school-age children was below the WHO recommendation (75%). Operational research is required to identify barriers for low coverage of ALB/MBD among children who are non-enrolled school-age children. Further, a call for action is required from different stakeholders to improve treatment coverage of ALB/MBD.

Author Summary

Neglected Tropical Diseases (NTDs) are a group of communicable diseases, which inequitably affect the world’s poorest, marginalized, voiceless and powerless people. It is prevalent in areas with unsafe water, poor sanitation and hygiene. STH (ascariasis, hookworm, and trichuriasis), intestinal worms, are one of the common NTDs which are transmitted through contact with soil contaminated with human feces.

Globally, more than 4 billion people are at risk for STH and with over 1 billion are already infected. In Ethiopia, about 81 million people are at risk for STH infection. School age children and pre-school age children are highly affected by the diseases, and it causes anemia, vitamin A deficiency, stunting, malnutrition, impaired development, and intestinal obstruction.

As one of NTDS, ending STH can contribute to Ethiopia be on track of attaining universal health coverage (UHC). STH can be controlled, possibly eliminated by combined interventions of preventive chemotherapy with improved water, sanitation and hygiene (WASH). In Ethiopia, though remarkable attainments are made so far on controlling STH morbidity through mapping and scaling-up mass drug administration, still more work is required to increase coverage of PC and integration of PC with WASH to meet the national objectives of elimination or control of STH.