Unprogrammed Deworming in the Kibera Slum, Nairobi: Implications for Control of Soil-Transmitted Helminthiases

Details

• Alternative Title:
  PLoS Negl Trop Dis
• Personal Author:
  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.
• Description:
  Background
  
  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.
  
  Methods
  
  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.
  
  Results
  
  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).
  
  Conclusion
  
  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.
  
  
• Subjects:
  Adolescent Animals Child Child, Preschool Cross-Sectional Studies Female Helminthiasis Humans Infant Male Soil

  More +
• Source:
  PLoS Negl Trop Dis. 9(3).
• Document Type:
  Journal Article
• Place as Subject:
  Kenya
• Volume:
  9
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:9956e7954ee982b211d08eaa70ab72e3428064e0fbc2a76fecafd71495682a0e
• Download URL:
  https://stacks.cdc.gov/view/cdc/29008/cdc_29008_DS1.pdf
• File Type:
  [PDF - 192.61 KB ]