scholarly journals Longitudinal changes in the prevalence and intensity of soil-transmitted helminth infection following expanded community-wide mass drug administration in the delta region of Myanmar

2018 ◽  
Author(s):  
Julia C Dunn ◽  
Alison A Bettis ◽  
Nay Yee Wyine ◽  
Aye Moe Moe Lwin ◽  
Aung Tun ◽  
...  
Keyword(s):  
Drug Administration ◽  
Mass Drug Administration ◽  
Neglected Tropical Diseases ◽  
Age Groups ◽  
World Health ◽  
Delta Region ◽  
Social Settings ◽  
Before And After ◽  
Target Disease ◽  
Health Organization

AbstractMass drug administration (MDA), targeted at school-aged children is the method recommended by the World Health Organization for the control of morbidity induced by soil-transmitted helminth (STH) infection in endemic countries. However, MDA does not prevent reinfection between treatment rounds. In countries with endemic infection, such as Myanmar, the MDA coverage, who is targeted, and rates of reinfection in given environmental and social settings will determine how effective mass drug treatment is in suppressing transmission in the long-term. In this paper, data from an epidemiology study on STH, conducted between June 2015 and June 2016 in the delta region of Myanmar, are analysed to determine the risks of STH infection in the whole community over a year which included two MDA rounds. Risk ratios (RRs) for the four-month reinfection period were below one, whereas RRs for the six-month reinfection period were above one, indicating that more people were infected after six months of exposure post-MDA. Evidence of predisposition, as measured by the Kendall Tau-b statistic, was found for all STH species and across all age groups. This study demonstrates that a six-month gap between MDA in these communities is enough time for STH infection to return to pre-MDA levels and that the same individuals are being consistently infected between MDA rounds.Author summaryMass drug administration (MDA), treating either whole communities or targeted groups without a prior diagnosis, is used as a control strategy for many neglected tropical diseases, including soil-transmitted helminth (STH) infection. MDA takes place at set intervals, aiming to reduce morbidity caused by the target disease and potentially interrupt transmission. In this study we measure STH infection in two villages in the delta region of Myanmar over the course of a year, both before and after MDA rounds, to quantify the effect of treatment on infection and to identify groups with persistent infections. We found that whilst overall prevalence of STH infection decreased over the year, intensity of infection, measured by eggs per gram of faeces, did not significantly decrease. We also found evidence to suggest that particular people are predisposed to STH infection. This is possibly due to non-compliance to MDA, or behavioural and social factors. The findings presented here will provide evidence to support continuing Myanmar’s MDA programme for STH control and using accurate diagnostics to identify and target “predisposed” people for sustained treatment.

scholarly journals Modelling the ability of mass drug administration to interrupt soil-transmitted helminth transmission: Community-based deworming in Kenya as a case study

2021 ◽  
Vol 15 (8) ◽  
pp. e0009625
Author(s):  
Nyuk Sian Chong ◽  
Stacey R. Smith? ◽  
Marleen Werkman ◽  
Roy M. Anderson
Keyword(s):  
Drug Administration ◽  
Mass Drug Administration ◽  
Neglected Tropical Diseases ◽  
Initial Conditions ◽  
Drug Efficacy ◽  
World Health ◽  
High Prevalence ◽  
Lower Drug ◽  
Health Organization ◽  
The Impact

The World Health Organization has recommended the application of mass drug administration (MDA) in treating high prevalence neglected tropical diseases such as soil-transmitted helminths (STHs), schistosomiasis, lymphatic filariasis, onchocerciasis and trachoma. MDA—which is safe, effective and inexpensive—has been widely applied to eliminate or interrupt the transmission of STHs in particular and has been offered to people in endemic regions without requiring individual diagnosis. We propose two mathematical models to investigate the impact of MDA on the mean number of worms in both treated and untreated human subpopulations. By varying the efficay of drugs, initial conditions of the models, coverage and frequency of MDA (both annual and biannual), we examine the dynamic behaviour of both models and the possibility of interruption of transmission. Both models predict that the interruption of transmission is possible if the drug efficacy is sufficiently high, but STH infection remains endemic if the drug efficacy is sufficiently low. In between these two critical values, the two models produce different predictions. By applying an additional round of biannual and annual MDA, we find that interruption of transmission is likely to happen in both cases with lower drug efficacy. In order to interrupt the transmission of STH or eliminate the infection efficiently and effectively, it is crucial to identify the appropriate efficacy of drug, coverage, frequency, timing and number of rounds of MDA.

scholarly journals Implementation of mass drug administration for neglected tropical diseases in Guinea during the COVID-19 pandemic

2021 ◽  
Vol 15 (9) ◽  
pp. e0009807
Author(s):  
Fatoumata Sakho ◽  
Christelly Flore Badila ◽  
Benoit Dembele ◽  
Aissatou Diaby ◽  
Abdoul Karim Camara ◽  
...  
Keyword(s):  
Drug Administration ◽  
Mass Drug Administration ◽  
Neglected Tropical Diseases ◽  
Risk Mitigation ◽  
World Health ◽  
Mitigation Measures ◽  
Tropical Diseases ◽  
First Case ◽  
Household Members ◽  
Health Organization

Background Guinea reported its first case of COVID-19 on March 12, 2020. Soon thereafter, a national state of emergency was declared, all land borders were closed, schools were shut down, and public gatherings were limited. Many health activities, including field-based activities targeting neglected tropical diseases (NTDs), were paused. The World Health Organization (WHO) issued updated guidance on the resumption of NTD field-based activities on July 27, 2020. In response, the Guinea Ministry of Health (MoH) and its partners planned and resumed mass drug administration (MDA) in mid-August to September 2020 in 19 health districts. Methodology/principal findings A risk-benefit assessment was conducted to identify potential risks associated with the MDA in the COVID-19 context. Following this assessment, a risk mitigation plan with barrier measures was developed to guide MDA implementation. These measures included COVID-19 testing for all national staff leaving Conakry, mask wearing, social distancing of two meters, and hand washing/sanitizing. A checklist was developed and used to monitor compliance to risk mitigation measures. Data on adherence to risk mitigation measures were collected electronically during the MDA. A total of 120 checklists, representing 120 community drug distributor (CDD) teams (two CDDs per team) and 120 households, were completed. Results indicated that washing or disinfecting hands was practiced by 68.3% of CDD teams, compared to 45.0% among households. Face masks to cover the mouth and nose were worn by 79.2% of CDD teams, while this was low among households (23.3%). In 87.5% of households, participants did not touch the dose pole and in 88.3% of CDD teams, CDDs did not touch the hands of the participants while giving the drugs. A large majority of CDD teams (94.2%) and household members (94.2%) were willing to participate in the MDA despite the pandemic. The epidemiological coverage was ≥65% for lymphatic filariasis, onchocerciasis and soil-transmitted helminths in 10 out of 19 HDs and ≥75% for schistosomiasis for school-aged children in 7 out of 11 HDs. Conclusions/significance Guinea was one of the first countries in Africa to resume MDA activities during the COVID-19 pandemic without causing an observed increase of transmission. The development of a risk mitigation plan and a method to monitor adherence to barrier measures was critical to this unprecedented effort. The rapid incorporation of COVID-19 barrier measures and their acceptance by CDDs and household members demonstrated both the adaptability of the National NTD Program to respond to emerging issues and the commitment of the MoH to implement NTD programs.

scholarly journals Predictive Value of Ov16 Antibody Prevalence in Different Subpopulations for Elimination of African Onchocerciasis

2019 ◽  
Vol 188 (9) ◽  
pp. 1723-1732 ◽  
Author(s):  
Luc E Coffeng ◽  
Wilma A Stolk ◽  
Allison Golden ◽  
Tala de los Santos ◽  
Gonzalo J Domingo ◽  
...  
Keyword(s):  
Drug Administration ◽  
Mass Drug Administration ◽  
Predictive Value ◽  
Age Groups ◽  
World Health ◽  
Age Group ◽  
Threshold Values ◽  
Antibody Prevalence ◽  
Endemic Areas ◽  
Health Organization

Abstract The World Health Organization currently recommends assessing elimination of onchocerciasis by testing whether Ov16 antibody prevalence in children aged 0–9 years is below 0.1%. However, the certainty of evidence for this recommendation is considered to be low. We used the established ONCHOSIM model to investigate the predictive value of different Ov16-antibody prevalence thresholds in various age groups for elimination of onchocerciasis in a variety of endemic settings and for various mass drug administration scenarios. According to our simulations, the predictive value of Ov16 antibody prevalence for elimination depends highly on the precontrol epidemiologic situation, history of mass drug administration, the age group that is sampled, and the chosen Ov16-antibody prevalence threshold. The Ov16 antibody prevalence in children aged 5–14 years performs best in predicting elimination. Appropriate threshold values for this age group start at 2.0% for very highly endemic areas; for lower-endemic areas, even higher threshold values are safe to use. Guidelines can be improved by sampling school-aged children, which also is operationally more feasible than targeting children under age 10 years. The use of higher threshold values allows sampling of substantially fewer children. Further improvement can be achieved by taking a differentiated sampling approach based on precontrol endemicity.

scholarly journals The contribution of mass drug administration to global health: past, present and future

2014 ◽  
Vol 369 (1645) ◽  
pp. 20130434 ◽  
Author(s):  
Joanne P. Webster ◽  
David H. Molyneux ◽  
Peter J. Hotez ◽  
Alan Fenwick
Keyword(s):  
Global Health ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Neglected Tropical Diseases ◽  
World Health Organisation ◽  
Essential Medicines ◽  
World Health ◽  
Diagnostic Tools ◽  
Preventive Chemotherapy ◽  
High Coverage

Mass drug administration (MDA) is a means of delivering safe and inexpensive essential medicines based on the principles of preventive chemotherapy, where populations or sub-populations are offered treatment without individual diagnosis. High-coverage MDA in endemic areas aims to prevent and alleviate symptoms and morbidity on the one hand and can reduce transmission on the other, together improving global health. MDA is the recommended strategy of the World Health Organisation to control or eliminate several neglected tropical diseases (NTDs). More than 700 million people now receive these essential NTD medicines annually. The combined cost of integrated NTD MDA has been calculated to be in the order of $0.50 per person per year. Activities have recently been expanded due, in part, to the proposed attempt to eliminate certain NTDs in the coming two decades. More than 1.9 billion people need to receive MDA annually across several years if these targets are to be met. Such extensive coverage will require additional avenues of financial support, expanded monitoring and evaluation focusing on impact and drug efficacy, as well as new diagnostic tools and social science strategies to encourage adherence. MDA is a means to help reduce the burden of disease, and hence poverty, among the poorest sector of populations. It has already made significant improvements to global health and productivity and has the potential for further successes, particularly where incorporated into sanitation and education programmes. However logistical, financial and biological challenges remain.

scholarly journals A community survey of coverage and adverse events following country-wide triple-drug mass drug administration for lymphatic filariasis elimination, Samoa 2018

2020 ◽  
Vol 14 (11) ◽  
pp. e0008854
Author(s):  
Gabriela A. Willis ◽  
Helen J. Mayfield ◽  
Therese Kearns ◽  
Take Naseri ◽  
Robert Thomsen ◽  
...  
Keyword(s):  
Adverse Events ◽  
Lymphatic Filariasis ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Total Population ◽  
Community Survey ◽  
World Health ◽  
Cross Sectional ◽  
Eligible Population ◽  
Health Organization

The Global Programme to Eliminate Lymphatic Filariasis has made considerable progress but is experiencing challenges in meeting targets in some countries. Recent World Health Organization guidelines have recommended two rounds of triple-drug therapy with ivermectin, diethylcarbamazine (DEC), and albendazole (IDA), in areas where mass drug administration (MDA) results with two drugs (DEC and albendazole) have been suboptimal, as is the case in Samoa. In August 2018, Samoa was the first country in the world to implement countrywide triple-drug MDA. This paper aims to describe Samoa’s experience with program coverage and adverse events (AEs) in the first round of triple-drug MDA. We conducted a large cross-sectional community survey to assess MDA awareness, reach, compliance, coverage and AEs in September/October 2018, 7–11 weeks after the first round of triple-drug MDA. In our sample of 4420 people aged ≥2 years (2.2% of the population), age-adjusted estimates indicated that 89.0% of the eligible population were offered MDA, 83.9% of the eligible population took MDA (program coverage), and 80.2% of the total population took MDA (epidemiological coverage). Overall, 83.8% (2986/3563) reported that they did not feel unwell at all after taking MDA. Mild AEs (feeling unwell but able to do normal everyday things) were reported by 13.3% (476/3563) and moderate or severe AEs (feeling unwell and being unable to do normal everyday activities such as going to work or school) by 2.9% (103/3563) of participants. This study following the 2018 triple-drug MDA in Samoa demonstrated a high reported program awareness and reach of 90.8% and 89.0%, respectively. Age-adjusted program coverage of 83.9% of the total population showed that MDA was well accepted and well tolerated by the community.

scholarly journals The promise, problems and pitfalls of mass drug administration for malaria elimination: a qualitative study with scientists and policymakers

2018 ◽  
Vol 11 (3) ◽  
pp. 166-176 ◽  
Author(s):  
Nils Kaehler ◽  
Bipin Adhikari ◽  
Phaik Yeong Cheah ◽  
Nicholas P J Day ◽  
Daniel H Paris ◽  
...  
Keyword(s):  
Drug Administration ◽  
Mass Drug Administration ◽  
Malaria Elimination ◽  
Artemisinin Resistance ◽  
Malaria Prevention ◽  
Evidence Base ◽  
World Health ◽  
Pilot Studies ◽  
Target Populations ◽  
Health Organization

Abstract Background The emergence of artemisinin resistance in the Greater Mekong Subregion (GMS) has prompted urgent containment measures. One possible approach is mass drug administration (MDA). This article explores attitudes towards and perceptions of MDA for malaria elimination among policymakers and leading malariologists. Methods Thirty-two semistructured interviews (SSI) were conducted with policymakers (n=17) and principal investigators (n=15) selected based on their involvement in malaria prevention, control and elimination in the GMS. Interviews were audio recorded and transcribed for qualitative content (thematic) analysis using NVivo (QSR International, Doncaster, Victoria, Australia). Results Researchers and policymakers described reluctance and consequently delays to pilot MDA for malaria elimination. Most policymakers and some researchers reported concerns around the evidence base, citing a lack of data on its effectiveness and appropriate target populations. There were also worries about promoting resistance. Other issues included a previous lack of support from the World Health Organization, past MDAs, the remoteness of target populations and challenges explaining the rationale for MDA. Conclusions The complex rationale for MDA for malaria elimination, mistaking pilot studies for implementation, past experiences with MDA, difficulties in selecting appropriate sites and the WHO’s lack of clear backing undermined the support for MDA for malaria elimination.

scholarly journals The Added Value of Water, Sanitation, and Hygiene Interventions to Mass Drug Administration for Reducing the Prevalence of Trachoma: A Systematic Review Examining

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
Anyess Travers ◽  
Sheryl Strasser ◽  
Stephanie L. Palmer ◽  
Christine Stauber
Keyword(s):  
Systematic Review ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Added Value ◽  
World Health ◽  
Sanitation And Hygiene ◽  
Pubmed Database ◽  
Health Organization ◽  
Hygiene Education ◽  
The Impact

Trachoma is the leading cause of infectious blindness worldwide. The SAFE strategy, the World Health Organization-recommended method to eliminate blinding trachoma, combines developments in water, sanitation, surgery, and antibiotic treatment. Current literature does not focus on the comprehensive effect these components have on one another. The present systematic review analyzes the added benefit of water, sanitation, and hygiene education interventions to preventive mass drug administration of azithromycin for trachoma. Trials were identified from the PubMed database using a series of search terms. Three studies met the complete criteria for inclusion. Though all studies found a significant change in reduction of active trachoma prevalence, the research is still too limited to suggest the impact of the “F” and “E” components on trachoma prevalence and ultimately its effects on blindness.

scholarly journals Potential use of antibodies to provide an earlier indication of lymphatic filariasis resurgence in post-mass drug administration surveillance, American Samoa

2021 ◽  
Author(s):  
Angela M. Cadavid Restrepo ◽  
Katherine Gass ◽  
Kimberly Y. Won ◽  
Meru Sheel ◽  
Keri Robinson ◽  
...  
Keyword(s):  
Lymphatic Filariasis ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
American Samoa ◽  
School Level ◽  
World Health ◽  
Chi Squared ◽  
Health Organization ◽  
Potential Use

AbstractObjectivesUnder the Global Programme to Eliminate Lymphatic Filariasis (LF), American Samoa conducted seven rounds of mass drug administration between 2000 and 2006. The territory passed transmission assessment surveys (TAS) in 2011 (TAS-1) and 2015 (TAS-2) based on World Health Organization guidelines. In 2016, the territory failed TAS-3, indicating resurgence. This study aims to determine if antibodies (Ab) may have provided a timelier indication of LF resurgence in American Samoa.MethodsWe examined school-level Ag and Ab status (presence/absence of Ag- and Ab- positive children) and prevalence of single and combined Ab responses to Wb123, Bm14, Bm33 Ags at each TAS. Pearson’s chi-squared tests and logistic regression were used to examine associations between school-level Ab prevalence in TAS-1 and TAS-2 and school-level Ag status in TAS-3.ResultsSchools with higher prevalence of Wb123 Ab in TAS-2 had higher odds of being Ag-positive in TAS-3 (odds ratio [OR] 24.5, 95% CI:1.2-512.7). Schools that were Ab-positive for WB123 plus Bm14, Bm33 or both Bm14 and Bm33 in TAS-2 had higher odds of being Ag-positive in TAS-3 (OR 16.0-24.5).ConclusionAnti-filarial Abs could provide earlier signals of resurgence and enable a timelier response. The promising role of Abs in post-MDA surveillance and decision making should be further investigated in other settings.

scholarly journals Individual adherence to mass drug administration in neglected tropical disease control: A probability model conditional on past behaviour

2021 ◽  
Vol 15 (1) ◽  
pp. e0009112
Author(s):  
Robert J. Hardwick ◽  
James E. Truscott ◽  
William E. Oswald ◽  
Marleen Werkman ◽  
Katherine E. Halliday ◽  
...  
Keyword(s):  
Drug Administration ◽  
Mass Drug Administration ◽  
Neglected Tropical Diseases ◽  
Probability Model ◽  
Randomised Trial ◽  
Age Groups ◽  
Substantial Reduction ◽  
Probability Models ◽  
Considerable Impact ◽  
The Impact

We present a general framework which describes the systematic (binary) scenario of individuals either taking treatment or not for any reason, over the course of mass drug administration (MDA)—which we refer to as ‘adherence’ and ‘non-adherence’. The probability models developed can be informed by observed adherence behaviour as well as employed to explore how different patterns influence the impact of MDA programmes, by the use of mathematical models of transmission and control. We demonstrate the interpretative value of the developed probability model employing a dataset collected in the TUMIKIA project, a randomised trial of deworming strategies to control soil-transmitted helminths (STH) by MDA conducted in coastal Kenya. We stratify our analysis by age and sex, although the framework which we introduce here may be readily adapted to accommodate other stratifications. Our findings include the detection of specific patterns of non-adherence in all age groups to varying extents. This is particularly apparent in men of ages 30+. We then demonstrate the use of the probability model in stochastic individual-based simulations by running two example forecasts for the elimination of STH transmission employing MDA within the TUMIKIA trial setting with different adherence patterns. This suggested a substantial reduction in the probability of elimination (between 23-43%) when comparing observed adherence patterns with an assumption of independence, with important implications for programmes. The results here demonstrate the considerable impact and utility of considering non-adherence on the success of MDA programmes to control neglected tropical diseases (NTDs).

scholarly journals Population Pharmacokinetics and Pharmacodynamics of Praziquantel in Ugandan Children with Intestinal Schistosomiasis: Higher Dosages Are Required for Maximal Efficacy

mBio ◽  
2016 ◽  
Vol 7 (4) ◽  
Author(s):  
Amaya L. Bustinduy ◽  
David Waterhouse ◽  
Jose C. de Sousa-Figueiredo ◽  
Stephen A. Roberts ◽  
Aaron Atuhaire ◽  
...  
Keyword(s):  
Young Children ◽  
Schistosoma Mansoni ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Drug Exposure ◽  
World Health ◽  
Preventive Chemotherapy ◽  
Time Curve ◽  
Dosing Regimens ◽  
Health Organization

ABSTRACT Each year, millions of African children receive praziquantel (PZQ) by mass drug administration (MDA) to treat schistosomiasis at a standard single dose of 40 mg/kg of body weight, a direct extrapolation from studies of adults. A higher dose of 60 mg/kg is also acceptable for refractory cases. We conducted the first PZQ pharmacokinetic (PK) and pharmacodynamic (PD) study in young children comparing dosing. Sixty Ugandan children aged 3 to 8 years old with egg patent Schistosoma mansoni received PZQ at either 40 mg/kg or 60 mg/kg. PK parameters of PZQ racemate and enantiomers ( R and S ) were quantified. PD outcomes were assessed by standard fecal egg counts and novel schistosome-specific serum (circulating anodic antigen [CAA]) and urine (circulating cathodic antigen [CCA]) antigen assays. Population PK and PD analyses were performed to estimate drug exposure in individual children, and the relationship between drug exposure and parasitological cure was estimated using logistic regression. Monte Carlo simulations were performed to identify better, future dosing regimens. There was marked PK variability between children, but the area under the concentration-time curve (AUC) of PZQ was strongly predictive of the parasitological cure rate (CR). Although no child achieved antigenic cure, which is suggestive of an important residual adult worm burden, higher AUC was associated with greater CAA antigenic decline at 24 days. To optimize the performance of PZQ, analysis of our simulations suggest that higher doses (>60 mg/kg) are needed, particularly in smaller children. IMPORTANCE Schistosomiasis is a neglected tropical disease, typically associated with chronic morbidity, and its control is a global health priority. Praziquantel (PZQ) is the only available antiparasitic drug and is often given out, as a single oral dose (40 mg/kg), to school-aged children by mass drug administration (MDA) schemes operating within preventive chemotherapy campaigns as endorsed by the World Health Organization (WHO). This current strategy has several limitations. (i) It excludes preschool children who can be patently infected. (ii) It delivers PZQ at a dose directly extrapolated from adult pharmacological studies. To address these problems, we conducted the first pharmacokinetic and pharmacodynamic study of young children within an area of Uganda where Schistosoma mansoni is hyperendemic. Our results demonstrate that a higher dose (>60 mg/kg) is required, especially in smaller children, and draw attention to the need for further optimization of PZQ treatment based on schistosome antigenic assays, which are more sensitive to pharmacodynamic markers.

Sign in / Sign up

Export Citation Format

Share Document