03063nas a2200337   4500000000100000008004100001653005600042653003900098653002000137653003000157653000900187100001400196700001600210700001100226700001500237700001300252700001400265700001100279700001300290700001200303700001400315700001400329700001100343700001500354245013500369856009900504300001300603490000700616520208800623022001402711       2018                            d10aCommunity-based integrated mass drug administration10aNeglected tropical diseases (NTDs)10aschistosomiasis10aSoil-transmitted helminth10aTogo1 aBronzan R1 aDorkenoo AM1 aAgbo Y1 aHalatoko W1 aLayibo Y1 aAdjeloh P1 aTeko M1 aSossou E1 aYakpa K1 aTchalim M1 aDatagni G1 aSeim A1 aSognikin K00aImpact of community-based integrated mass drug administration on schistosomiasis and soil-transmitted helminth prevalence in Togo.  uhttps://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0006551&type=printable  ae00065510 v123 a<p><strong>BACKGROUND: </strong>Togo has conducted annual, integrated, community-based mass drug administration (MDA) for soil-transmitted helminths (STH) and schistosomiasis since 2010. Treatment frequency and target populations are determined by disease prevalence, as measured by baseline surveys in 2007 and 2009, and WHO guidelines. Reported programmatic treatment coverage has averaged over 94%. Togo conducted a cross-sectional survey in 2015 to assess the impact of four to five years of MDA on these diseases.</p>

<p><strong>METHODOLOGY/PRINCIPAL FINDINGS: </strong>In every sub-district in the country outside the capital, the same schools were visited as at baseline and a sample of fifteen children age 6 to 9 years old was drawn. Each child submitted urine and a stool sample. Urine samples were tested by dipstick for the presence of blood as a proxy measure of Schistosoma haematobium infection. Stool samples were analyzed by the Kato-Katz method for STH and Schistosoma mansoni. At baseline, 17,100 children were enrolled at 1,129 schools in 562 sub-districts; in 2015, 16,890 children were enrolled at the same schools. The overall prevalence of both STH and schistosomiasis declined significantly, from 31.5% to 11.6% for STH and from 23.5% to 5.0% for schistosomiasis (p&lt;0.001 in both instances). Egg counts from both years were available only for hookworm and S. mansoni; intensity of infection decreased significantly for both infections from 2009 to 2015 (p&lt;0.001 for both infections). In areas with high baseline prevalence, rebound of hookworm infection was noted in children who had not received albendazole in the past 6 months.</p>

<p><strong>CONCLUSIONS/SIGNIFICANCE: </strong>After four to five years of MDA in Togo, the prevalence and intensity of STH and schistosomiasis infection were significantly reduced compared to baseline. Data on STH indicate that stopping MDA in areas with high baseline prevalence may result in significant rebound of infection. Togo's findings may help refine treatment recommendations for these diseases.</p>
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