scholarly journals Evaluating the Impact of Biannual School-Based and Community-Wide Treatment on Urogenital Schistosomiasis in Niger

2020 ◽  
Author(s):  
Anna Elizabeth Phillips ◽  
Zilahatou Tohon ◽  
Neerav A. Dhanani ◽  
Boubacar Sofo ◽  
Issa Gnandou ◽  
...  
Keyword(s):  
Randomised Trial ◽  
Evidence Base ◽  
Cluster Randomised Trial ◽  
Relative Reduction ◽  
Preventive Chemotherapy ◽  
Urogenital Schistosomiasis ◽  
Schistosomiasis Control ◽  
School Based ◽  
Significant Difference ◽  
The Impact

Abstract Background The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) coordinated a five-year study implemented in several countries, including Niger, to provide an evidence-base for programmatic decisions regarding cost-effective approaches to preventive chemotherapy for schistosomiasis control. Methods This was a cluster-randomised trial investigating six possible combinations of annual or biannual community-wide treatment (CWT), school-based treatment (SBT), and holidays from mass treatment over four years. The most intense arm involved two years of annual CWT followed by two years of biannual CWT, while the least intensive arm involved one year of annual SBT followed by a year without treatment and two more years of annual SBT. The primary outcome of interest was prevalence and intensity of S. haematobium among 100 children aged 9-to-12-years sampled each year. In addition, 100 children aged 5-to-8 years in their first year of school and 50 adults (aged 20-to-55 years) were tested in the first and final fifth year of the study. Results In total, data was collected from 167,500 individuals across 225 villages in nine districts within the Niger River valley, Western Niger. Overall, prevalence of S. haematobium decreased from baseline to Year 5 across all study arms. The relative reduction of prevalence was greater in biannual compared with annual treatment across all arms, however, the only significant difference was seen in areas with a high starting prevalence. Although adults were not targeted for treatment in SBT arms, a statistically significant decrease in prevalence among adults was seen in moderate prevalence areas receiving biannual (10.7% to 4.8%) SBT (p<0.001). Adults tested in the annual SBT group also showed a decrease in prevalence between Year 1 and Year 5 (12.2% to 11.0%), but this difference was not significant.Conclusions These findings are an important consideration for schistosomiasis control programs that are considering elimination and support the idea that scaling up the frequency of treatment rounds, particularly in areas of low prevalence, will not eliminate schistosomiasis. Interestingly, the finding that prevalence decreased among adults in SBT arms suggests that transmission in the community can be reduced, even where only school children are being treated, which could have logistical and cost-saving implications for the national control programmes.

scholarly journals Evaluating the impact of biannual school-based and community-wide treatment on urogenital schistosomiasis in Niger

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Anna E. Phillips ◽  
Zilahatou Tohon ◽  
Neerav A. Dhanani ◽  
Boubacar Sofo ◽  
Issa Gnandou ◽  
...  
Keyword(s):  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Relative Reduction ◽  
Preventive Chemotherapy ◽  
Urogenital Schistosomiasis ◽  
Schistosomiasis Control ◽  
School Based ◽  
Significant Difference ◽  
Control Programmes ◽  
The Impact

Abstract Background The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) coordinated a five-year study implemented in several countries, including Niger, to provide an evidence-base for programmatic decisions regarding cost-effective approaches to preventive chemotherapy for schistosomiasis control. Methods This was a cluster-randomised trial investigating six possible combinations of annual or biannual community-wide treatment (CWT), school-based treatment (SBT), and holidays from mass treatment over four years. The most intense arm involved two years of annual CWT followed by 2 years of biannual CWT, while the least intensive arm involved one year of annual SBT followed by a year without treatment and two more years of annual SBT. The primary outcome of interest was prevalence and intensity of Schistosoma haematobium among 100 children aged 9–12 years sampled each year. In addition, 100 children aged 5–8 years in their first year of school and 50 adults (aged 20–55 years) were tested in the first and final fifth year of the study. Results In total, data were collected from 167,500 individuals across 225 villages in nine districts within the Niger River valley, Western Niger. Overall, the prevalence of S. haematobium decreased from baseline to Year 5 across all study arms. The relative reduction of prevalence was greater in biannual compared with annual treatment across all arms; however, the only significant difference was seen in areas with a high starting prevalence. Although adults were not targeted for treatment in SBT arms, a statistically significant decrease in prevalence among adults was seen in moderate prevalence areas receiving biannual (10.7% to 4.8%) SBT (P < 0.001). Adults tested in the annual SBT group also showed a decrease in prevalence between Year 1 and Year 5 (12.2% to 11.0%), but this difference was not significant. Conclusions These findings are an important consideration for schistosomiasis control programmes that are considering elimination and support the idea that scaling up the frequency of treatment rounds, particularly in areas of low prevalence, will not eliminate schistosomiasis. Interestingly, the finding that prevalence decreased among adults in SBT arms suggests that transmission in the community can be reduced, even where only school children are being treated, which could have logistical and cost-saving implications for the national control programmes.

scholarly journals Effectiveness of a school-based intervention for adolescents and teachers to promote mental health among refugee and migrant adolescents

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
F Osman ◽  
A Sarkadi ◽  
I Feldman ◽  
A Tökés ◽  
A Perez-Aronsson ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Problems ◽  
Randomised Trial ◽  
Significant Risk ◽  
Cluster Randomised Trial ◽  
Post Traumatic Stress ◽  
Refugee Youth ◽  
School Based Intervention ◽  
School Based ◽  
The Impact

Abstract Refugee youth have often experienced trauma during relocation and continue to face adversity in their host country in the form of acculturation stress, residence insecurity, social isolation, and experiences of discrimination. These experiences are associated with a significant risk of developing mental health problems such as post-traumatic stress disorder (PTSD). This cluster randomised trial aims to evaluate the effectiveness of a school-based intervention that provides a manualized, trauma-focussed programme called Teaching Recovery Techniques (TRT) to target refugee and migrant youth and an In-Service Teacher Training (INSETT) programme to teachers. The study will consider the impact of the intervention on the mental health of adolescent refugees and their guardians who participate in the TRT programme. It will also consider the intervention's impact on the interrelationships between teachers and parents and teachers' cultural competence, as well as the social support and school belonging experienced by adolescents who do not participate in TRT but whose teachers receive INSETT training. Further details on TRT and INSETT, trial design and preliminary findings will be presented at the workshop.

scholarly journals Cluster-randomised trial of the impact of school-based deworming and iron supplementation on the cognitive abilities of schoolchildren in Sri Lanka's plantation sector

2013 ◽  
Vol 18 (8) ◽  
pp. 942-951 ◽  
Author(s):  
Roshini Ebenezer ◽  
Kithsiri Gunawardena ◽  
Balachandran Kumarendran ◽  
Arunasalam Pathmeswaran ◽  
Matthew C. H. Jukes ◽  
...  
Keyword(s):  
Cognitive Abilities ◽  
Iron Supplementation ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
School Based ◽  
Cluster Randomised ◽  
The Impact

scholarly journals Factors perceived to facilitate or hinder handwashing among primary students: a qualitative assessment of the Mikono Safi intervention schools in NW Tanzania

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e030947
Author(s):  
Elialilia Okello ◽  
Saidi Kapiga ◽  
Heiner Grosskurth ◽  
Kenneth Makata ◽  
Onike Mcharo ◽  
...  
Keyword(s):  
Data Collection ◽  
Primary Schools ◽  
Randomised Trial ◽  
Primary Students ◽  
Qualitative Assessment ◽  
Cluster Randomised Trial ◽  
School Based ◽  
Helminth Infections ◽  
Teachers And Students ◽  
The Impact

ObjectiveTo qualitatively assess the effects of a multi-modal school-based water, sanitation and hygiene (WASH) intervention on handwashing behaviour among primary students in North Western (NW) Tanzania.DesignThe study was a qualitative assessment of barriers and facilitators to handwashing among students attending primary schools participating in the Mikono Safi Trial (Kiswahili for ‘Clean Hands), a cluster-randomised trial assessing the impact of a school-based WASH intervention on selected soil transmitted helminth infections. Data collection methods included in-depth interviews with teachers, focus group discussions and friendship pair interviews with students collected between April and October 2018. The Capability-Opportunity-Motivation and Behaviour model was used to inform data collection and analysis.SettingThe study was conducted in four purposively selected intervention schools in three districts of Kagera region, NW Tanzania (Bukoba urban, Bukoba rural and Muleba districts).ParticipantsParticipants comprised 16 purposively selected teachers aged between 23 and 52 years and 100 students aged 7–15 yearsResultsThe Mikono Safi intervention increased students’ reported capability and motivation to wash their hands with soap at key times, particularly after visiting the toilet. Improvements in students’ handwashing knowledge and skills were reported by both teachers and students, and motivation for handwashing was enhanced by emotional drivers such as disgust, fear and nurture. Newly established handwashing stations improved the physical opportunity to wash hands, although the availability of water and the provision of soap was not always consistent (eg, due to internal organisational shortcomings or during the dry season). Students and teachers were actively engaged in intervention implementation which created a school community that valued and supported improved hand hygiene.ConclusionThe intervention was successful in improving capability and motivation for handwashing. Handwashing opportunity was also greatly improved, although the supply with water and soap was sometimes interrupted, calling for much stronger multi-sectoral collaboration to improve access to water at schools.Trial registration numberISRCTN45013173; Pre-results.

scholarly journals A cluster randomised trial of the impact of a policy of daily testing for contacts of COVID-19 cases on attendance and COVID-19 transmission in English secondary schools and colleges

2021 ◽  
Author(s):  
Bernadette C Young ◽  
David W Eyre ◽  
Saroj Kendrick ◽  
Chris White ◽  
Sylvester Smith ◽  
...  
Keyword(s):  
At Risk ◽  
Secondary Schools ◽  
Randomised Trial ◽  
Further Education ◽  
School Intervention ◽  
Cluster Randomised Trial ◽  
School Based ◽  
Cluster Randomised ◽  
Daily Contact ◽  
The Impact

Background School-based COVID-19 contacts in England are asked to self-isolate at home. However, this has led to large numbers of missed school days. Therefore, we trialled daily testing of contacts as an alternative, to investigate if it would affect transmission in schools. Methods We performed an open-label cluster randomised controlled trial in students and staff from secondary schools and further education colleges in England (ISRCTN18100261). Schools were randomised to self-isolation of COVID-19 contacts for 10 days (control) or to voluntary daily lateral flow device (LFD) testing for school contacts with LFD-negative contacts remaining at school (intervention). Household contacts were excluded from participation. Co-primary outcomes in all students and staff were symptomatic COVID-19, adjusted for community case rates, to estimate within-school transmission (non-inferiority margin: <50% relative increase), and COVID-19-related school absence. Analyses were performed on an intention to treat (ITT) basis using quasi-Poisson regression, also estimating complier average causal effects (CACE). Secondary outcomes included participation rates, PCR results in contacts and performance characteristics of LFDs vs. PCR. Findings Of 99 control and 102 intervention schools, 76 and 86 actively participated (19-April-2021 to 27-June-2021); additional national data allowed most non-participating schools to be included in the co-primary outcomes. 2432/5763 (42.4%) intervention arm contacts participated. There were 657 symptomatic PCR-confirmed infections during 7,782,537 days-at-risk (59.1/100k/week) and 740 during 8,379,749 days-at-risk (61.8/100k/week) in the control and intervention arms respectively (ITT adjusted incidence rate ratio, aIRR=0.96 [95%CI 0.75-1.22;p=0.72]) (CACE-aIRR=0.86 [0.55-1.34]). There were 55,718 COVID-related absences during 3,092,515 person-school-days (1.8%) and 48,609 during 3,305,403 person-school-days (1.5%) in the control and intervention arms (ITT-aIRR=0.80 [95%CI 0.53-1.21;p=0.29]) (CACE-aIRR 0.61 [0.30-1.23]). 14/886(1.6%) control contacts providing an asymptomatic PCR sample tested positive compared to 44/2981(1.5%) intervention contacts (adjusted odds ratio, aOR=0.73 [95%CI 0.33-1.61;p=0.44]). Rates of symptomatic infection in contacts were 44/4665 (0.9%) and 79/5955 (1.3%), respectively (aOR=1.21 [0.82-1.79;p=0.34]). Interpretation Daily contact testing of school-based contacts was non-inferior to self-isolation for control of COVID-19 transmission. COVID-19 rates in school-based contacts in both intervention and control groups were <2%. Daily contact testing is a safe alternative to home isolation following school-based exposures.

scholarly journals The RATIONS (Reducing Activation of Tuberculosis by Improvement of Nutritional Status) study: a cluster randomised trial of nutritional support (food rations) to reduce TB incidence in household contacts of patients with microbiologically confirmed pulmonary tuberculosis in communities with a high prevalence of undernutrition, Jharkhand, India

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e047210
Author(s):  
Anurag Bhargava ◽  
Madhavi Bhargava ◽  
Banurekha Velayutham ◽  
Kannan Thiruvengadam ◽  
Basilea Watson ◽  
...  
Keyword(s):  
Risk Factor ◽  
Nutritional Status ◽  
G Proteins ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Household Contacts ◽  
Cluster Randomised ◽  
High Prevalence ◽  
Secondary Outcomes ◽  
The Impact

IntroductionIndia has the largest burden of cases and deaths related to tuberculosis (TB). Undernutrition is the leading risk factor accounting for TB incidence, while severe undernutrition is a common risk factor for mortality in patients with TB in India. The impact of nutritional supplementation on TB incidence is unknown, while few underpowered studies have assessed its impact on TB mortality. We designed an open-label, field-based cluster randomised trial to assess the impact of nutritional supplementation (with food rations) on TB incidence in a group at higher risk of TB infection and disease, viz household contacts (HHC) of patients with microbiologically confirmed pulmonary TB (PTB) in Jharkhand, a state with a high prevalence of undernutrition.Methods and analysisWe shall enrol 2800 adult patients with PTB of the national TB programme, across 28 treatment units in 4 districts, and their approximately 11 200 eligible contacts. The sample size has 80% power to detect the primary outcome of 50% reduction in incidence of active TB in HHC over 2 years of follow-up. Patients and HHC in both the arms will undergo nutritional assessment and counselling. Patients will receive monthly food rations (supplying 1200 kcal and 52 g proteins/day) and multivitamins along with antitubercular treatment. The HHC in the intervention arm will receive food rations (supplying 750 kcal and 23 g proteins/day) and multivitamins while HHC in control arm will be on usual diet. The secondary outcomes in HHC will include effects on nutritional status, non-TB infections. Secondary outcomes in patients are effects on TB mortality, adherence, adverse effects, nutritional and performance status. Substudies will examine micronutrient status and effects on dietary intake, body composition, muscle strength and immune function.Ethics and disseminationThe institutional ethics committee of ICMR-NIRT, Chennai, approved the study (289/NIRT-IEC/2018). The results will be disseminated in publications and presentations.Trial registration numberClinical Trial Registry of India: CTRI/2019/08/020490.

Cluster randomised trial of the impact of biosecurity measures on poultry health in backyard flocks

2013 ◽  
Vol 198 (3) ◽  
pp. 649-655 ◽  
Author(s):  
Anne Conan ◽  
Flavie Luce Goutard ◽  
Davun Holl ◽  
Sok Ra ◽  
Aurélia Ponsich ◽  
...  
Keyword(s):  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Cluster Randomised ◽  
Backyard Flocks ◽  
The Impact

scholarly journals Effectiveness of expanding annual mass azithromycin distribution treatment coverage for trachoma in Niger: a cluster randomised trial

2017 ◽  
Vol 102 (5) ◽  
pp. 680-686 ◽  
Author(s):  
Abdou Amza ◽  
Boubacar Kadri ◽  
Beido Nassirou ◽  
Sun Y Cotter ◽  
Nicole E Stoller ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Randomised Trial ◽  
Chlamydia Infection ◽  
Cluster Randomised Trial ◽  
Active Trachoma ◽  
Treatment Coverage ◽  
Significant Difference ◽  
Registration Number ◽  
Rate Of Decline ◽  
Antibiotic Coverage

Background/aimsThe WHO recommends 3–5 years of annual mass azithromycin distribution with at least 80% treatment coverage to districts with active trachoma prevalence over 10% among children. Here, we assess the efficacy of expanding the coverage target to at least 90% for trachoma control in a mesoendemic region of Niger.MethodsTwenty-four communities were randomised to a single day of azithromycin distribution with a coverage target of 80% of the community or up to 4 days of treatment, aiming for greater than 90% coverage. Distributions were annual and individuals above 6 months of age were treated. Children under 5 years of age were monitored for ocular chlamydia infection and active trachoma.ResultsAt baseline, ocular chlamydia prevalence was 20.5% (95% CI 9.8% to 31.2%) in the standard coverage arm and 21.9% (95% CI 11.3% to 32.5%) in the enhanced coverage arm, which reduced to 4.6% (95% CI 0% to 9.5%, p=0.008) and 7.1% (95% CI 2.7% to 11.4%, p<0.001) at 36 months, respectively. There was no significant difference in 36-month ocular chlamydia prevalence between the two arms (p=0.21). There was no difference in the rate of decline in ocular chlamydia between the two arms in a repeated measures model (p=0.80).ConclusionsFor annual mass azithromycin distribution programme to an entire community, there may be no additional benefit of increasing antibiotic coverage above the WHO’s 80% target.Trial registration numberNCT00792922, post-results.

scholarly journals Young Adults in Endemic Areas: An Untreated Group in Need of School-Based Preventive Chemotherapy for Schistosomiasis Control and Elimination

2018 ◽  
Vol 3 (3) ◽  
pp. 100 ◽  
Author(s):  
Harrison Korir ◽  
Diana Riner ◽  
Emmy Kavere ◽  
Amos Omondi ◽  
Jasmine Landry ◽  
...  
Keyword(s):  
Young Adults ◽  
Point Of Care ◽  
Intensity Of Infection ◽  
Preventive Chemotherapy ◽  
Schistosomiasis Control ◽  
Soil Transmitted Helminths ◽  
College And University ◽  
School Based ◽  
College Setting ◽  
University Settings

Parasitologic surveys of young adults in college and university settings are not commonly done, even in areas known to be endemic for schistosomiasis and soil-transmitted helminths. We have done a survey of 291 students and staff at the Kisumu National Polytechnic in Kisumu, Kenya, using the stool microscopy Kato-Katz (KK) method and the urine point-of-care circulating cathodic antigen (POC-CCA) test. Based on three stools/two KK slides each, in the 208 participants for whom three consecutive stools were obtained, Schistosoma mansoni prevalence was 17.8%. When all 291 individuals were analyzed based on the first stool, as done by the national neglected tropical disease (NTD) program, and one urine POC-CCA assay (n = 276), the prevalence was 13.7% by KK and 23.2% by POC-CCA. Based on three stools, 2.5% of 208 participants had heavy S. mansoni infections (≥400 eggs/gram feces), with heavy S. mansoni infections making up 13.5% of the S. mansoni cases. The prevalence of the soil-transmitted helminths (STH: Ascaris lumbricoides, Trichuris trichiura and hookworm) by three stools was 1.4%, 3.1%, and 4.1%, respectively, and by the first stool was 1.4%, 2.4% and 1.4%, respectively. This prevalence and intensity of infection with S. mansoni in a college setting warrants mass drug administration with praziquantel. This population of young adults is ‘in school’ and is both approachable and worthy of inclusion in national schistosomiasis control and elimination programs.

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