Improving public health control of schistosomiasis with a modified WHO strategy: a model-based comparison study

Publication date: October 2019Source: The Lancet Global Health, Volume 7, Issue 10Author(s): Emily Y Li, David Gurarie, Nathan C Lo, Xuewei Zhu, Charles H KingSummaryBackgroundSchistosomiasis is endemic in many low-income and middle-income countries. To reduce infection-associated morbidity, WHO has published guidelines for control of schistosomiasis based on targeted mass drug administration (MDA) and, in 2017, on supplemental snail control. We compared the current WHO guideline-based strategies from 2012 to an alternative, adaptive decision making framework for control in heterogeneous environments, to estimate their predicted relative effectiveness and time to achievement of defined public health goals.MethodsIn this model-based comparison study, we adapted an established transmission model for Schistosoma infection that couples local human and snail populations and includes aspects of snail ecology and parasite biology. We calibrated the model using data from high-risk, moderate-risk, and lower-risk rural villages in Kenya, and then simulated control via MDA. We compared 2012 WHO guidelines with a modified adaptive strategy that tested a lower-prevalence threshold for MDA and shorter intervals between implementation, evaluation, and modification. We also explored the addition of snail control to this modified strategy. The primary outcomes were the proportion of simulations that achieved the WHO targets in children aged 5–14 years of less than 5% (2020 morbidity control...
Source: The Lancet Global Health - Category: International Medicine & Public Health Source Type: research