03413nas a2200349   4500000000100000008004100001653003600042653002500078653003000103653002400133100001300157700001500170700001300185700001300198700001500211700001200226700002000238700001400258700001200272700001200284700001100296700001900307700001800326700001500344700001300359700001400372700001700386245016600403856007200569520240800641022001403049       2019                            d10aSoil-transmitted helminth (STH)10aTreatment strategies10aTransmission interruption10aCommunity treatment1 aPullan R1 aHalliday K1 aOswald W1 aMcharo C1 aBeaumont E1 aKepha S1 aWitek-McManus S1 aGichuki P1 aAllen E1 aDrake T1 aPitt C1 aMatendechero S1 aGwayi-Chore M1 aAnderson R1 aNjenga S1 aBrooker S1 aMwandawiro C00aEffects, equity, and cost of school-based and community-wide treatment strategies for soil-transmitted helminths in Kenya: a cluster-randomised controlled trial.  uhttps://www.sciencedirect.com/science/article/pii/S01406736183259113 a<p><strong>BACKGROUND: </strong>School-based deworming programmes can reduce morbidity attributable to soil-transmitted helminths in children but do not interrupt transmission in the wider community. We assessed the effects of alternative mass treatment strategies on community soil-transmitted helminth infection.</p>

<p><strong>METHODS: </strong>In this cluster-randomised controlled trial, 120 community units (clusters) serving 150 000 households in Kenya were randomly assigned (1:1:1) to receive albendazole through annual school-based treatment targeting 2-14 year olds or annual or biannual community-wide treatment targeting all ages. The primary outcome was community hookworm prevalence, assessed at 12 and 24 months through repeat cross-sectional surveys. Secondary outcomes were Ascaris lumbricoides and Trichuris trichiura prevalence, infection intensity of each soil-transmitted helminth species, and treatment coverage and costs. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT02397772.</p>

<p><strong>FINDINGS: </strong>After 24 months, prevalence of hookworm changed from 18·6% (95% CI 13·9-23·2) to 13·8% (10·5-17·0) in the annual school-based treatment group, 17·9% (13·7-22·1) to 8·0% (6·0-10·1) in the annual community-wide treatment group, and 20·6% (15·8-25·5) to 6·2% (4·9-7·5) in the biannual community-wide treatment group. Relative to annual school-based treatment, the risk ratio for annual community-wide treatment was 0·59 (95% CI 0·42-0·83; p&lt;0·001) and for biannual community-wide treatment was 0·46 (0·33-0·63; p&lt;0·001). More modest reductions in risk were observed after 12 months. Risk ratios were similar across demographic and socioeconomic subgroups after 24 months. No adverse events related to albendazole were reported.</p>

<p><strong>INTERPRETATION: </strong>Community-wide treatment was more effective in reducing hookworm prevalence and intensity than school-based treatment, with little additional benefit of treating every 6 months, and was shown to be remarkably equitable in coverage and effects.</p>

<p><strong>FUNDING: </strong>Bill &amp; Melinda Gates Foundation, the Joint Global Health Trials Scheme of the Medical Research Council, the UK Department for International Development, the Wellcome Trust, and the Children's Investment Fund Foundation.</p>
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