Effectiveness of a pre-treatment snack on the uptake of mass treatment for schistosomiasis in Uganda: a cluster randomized trial

Simon Muhumuza; Annette Olsen; Anne Katahoire; Agnes N Kiragga; Fred Nuwaha

doi:10.1371/journal.pmed.1001640

Effectiveness of a pre-treatment snack on the uptake of mass treatment for schistosomiasis in Uganda: a cluster randomized trial

PLoS Med. 2014 May 13;11(5):e1001640. doi: 10.1371/journal.pmed.1001640. eCollection 2014 May.

Authors

Simon Muhumuza¹, Annette Olsen², Anne Katahoire¹, Agnes N Kiragga³, Fred Nuwaha⁴

Affiliations

¹ Makerere University, School of Medicine, Child Health and Development Center, Kampala, Uganda.
² University of Copenhagen, Faculty of Health and Medical Sciences, Section for Parasitology, Health and Development, Copenhagen, Denmark.
³ Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
⁴ Makerere University, School of Public Health, Kampala, Uganda.

Abstract

Background: School-based mass treatment with praziquantel is the cornerstone for schistosomiasis control in school-aged children. However, uptake of treatment among school-age children in Uganda is low in some areas. The objective of the study was to examine the effectiveness of a pre-treatment snack on uptake of mass treatment.

Methods and findings: In a cluster randomized trial carried out in Jinja district, Uganda, 12 primary schools were randomized into two groups; one received education messages for schistosomiasis prevention for two months prior to mass treatment, while the other, in addition to the education messages, received a pre-treatment snack shortly before mass treatment. Four weeks after mass treatment, uptake of praziquantel was assessed among a random sample of 595 children in the snack schools and 689 children in the non-snack schools as the primary outcome. The occurrence of side effects and the prevalence and mean intensity of Schistosoma mansoni infection were determined as the secondary outcomes. Uptake of praziquantel was higher in the snack schools, 93.9% (95% CI 91.7%-95.7%), compared to that in the non-snack schools, 78.7% (95% CI 75.4%-81.7%) (p = 0.002). The occurrence of side effects was lower in the snack schools, 34.4% (95% CI 31.5%-39.8%), compared to that in the non-snack schools, 46.9% (95% CI 42.2%-50.7%) (p = 0.041). Prevalence and mean intensity of S. mansoni infection was lower in the snack schools, 1.3% (95% CI 0.6%-2.6%) and 38.3 eggs per gram of stool (epg) (95% CI 21.8-67.2), compared to that in the non-snack schools, 14.1% (95% CI 11.6%-16.9%) (p = 0.001) and 78.4 epg (95% CI 60.6-101.5) (p = 0.001), respectively.

Conclusions: Our results suggest that provision of a pre-treatment snack combined with education messages achieves a higher uptake compared to the education messages alone. The use a pre-treatment snack was associated with reduced side effects as well as decreased prevalence and intensity of S. mansoni infection.

Trial registration: www.ClinicalTrials.gov NCT01869465

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Child
Confidence Intervals
Female
Humans
Logistic Models
Male
Odds Ratio
Praziquantel / therapeutic use
Prevalence
Schistosomiasis / drug therapy*
Schistosomiasis / epidemiology*
Snacks*
Treatment Outcome
Uganda / epidemiology

Substances

Praziquantel

Associated data

ClinicalTrials.gov/NCT01869465

Grants and funding

This study received financial support from the Danish Ministry of Foreign Affairs (DANIDA). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.