03186nas a2200349   4500000000100000008004100001260001200042653002000054653001500074653002200089100001100111700001400122700001900136700001300155700001300168700001400181700001600195700001100211700001500222700001600237700001400253700001800267700001300285700001600298700001300314700001400327245008000341300001400421490000800435520237900443022001402822       2019                            d  c01/201910aschistosomiasis10a2020 goals10a2025 global goals1 aDeol A1 aFleming F1 aCalvo-Urbano B1 aWalker M1 aBucumi V1 aGnandou I1 aTukahebwa E1 aJemu S1 aMwingira U1 aAlkohlani A1 aTraoré M1 aRuberanziza E1 aTouré S1 aBasáñez M1 aFrench M1 aWebster J00aSchistosomiasis - Assessing Progress toward the 2020 and 2025 Global Goals.  a2519-25280 v3813 a<p><b>BACKGROUND: </b>With the vision of "a world free of schistosomiasis," the World Health Organization (WHO) set ambitious goals of control of this debilitating disease and its elimination as a public health problem by 2020 and 2025, respectively. As these milestones become imminent, and if programs are to succeed, it is important to evaluate the WHO programmatic guidelines empirically.</p><p><b>METHODS: </b>We collated and analyzed multiyear cross-sectional data from nine national schistosomiasis control programs (in eight countries in sub-Saharan Africa and in Yemen). Data were analyzed according to schistosome species ( or ), number of treatment rounds, overall prevalence, and prevalence of heavy-intensity infection. Disease control was defined as a prevalence of heavy-intensity infection of less than 5% aggregated across sentinel sites, and the elimination target was defined as a prevalence of heavy-intensity infection of less than 1% in all sentinel sites. Heavy-intensity infection was defined as at least 400 eggs per gram of feces for  infection or as more than 50 eggs per 10 ml of urine for  infection.</p><p><b>RESULTS: </b>All but one country program (Niger) reached the disease-control target by two treatment rounds or less, which is earlier than projected by current WHO guidelines (5 to 10 years). Programs in areas with low endemicity levels at baseline were more likely to reach both the control and elimination targets than were programs in areas with moderate and high endemicity levels at baseline, although the elimination target was reached only for  infection (in Burkina Faso, Burundi, and Rwanda within three treatment rounds). Intracountry variation was evident in the relationships between overall prevalence and heavy-intensity infection (stratified according to treatment rounds), a finding that highlights the challenges of using one metric to define control or elimination across all epidemiologic settings.</p><p><b>CONCLUSIONS: </b>These data suggest the need to reevaluate progress and treatment strategies in national schistosomiasis control programs more frequently, with local epidemiologic data taken into consideration, in order to determine the treatment effect and appropriate resource allocations and move closer to achieving the global goals. (Funded by the Children's Investment Fund Foundation and others.).</p>  a1533-4406