부산대학교 도서관

Background: Soil Transmitted Helminths (STH) infect over 1.5 billion people globally and are associated with anemia and stunting, resulting in an annual toll of 1.9 million Disability-Adjusted Life Years (DALYs). School-based deworming (SBD), via mass drug administration (MDA) campaigns with albendazole or mebendazole, has been recommended by the World Health Organization to reduce levels of morbidity due to STH in endemic areas. DeWorm3 is a cluster-randomized trial, conducted in three study sites in Benin, India, and Malawi, designed to assess the feasibility of interrupting STH transmission with community-wide MDA as a potential strategy to replace SBD. This analysis examines data from the DeWorm3 trial to quantify discrepancies between school-level reporting of SBD and gold standard individual-level survey reporting of SBD. Methodology/Principal findings: Population-weighted averages of school-level SBD calculated at the cluster level were compared to aggregated individual-level SBD estimates to produce a Mean Squared Error (MSE) estimate for each study site. In order to estimate individual-level SBD coverage, these MSE values were applied to SBD estimates from the control arm of the DeWorm3 trial, where only school-level reporting of SBD coverage had been collected. In each study site, SBD coverage in the school-level datasets was substantially higher than that obtained from individual-level datasets, indicating possible overestimation of school-level SBD coverage. When applying observed MSE to project expected coverages in the control arm, SBD coverage dropped from 89.1% to 70.5% (p-value < 0.001) in Benin, from 97.7% to 84.5% (p-value < 0.001) in India, and from 41.5% to 37.5% (p-value < 0.001) in Malawi. Conclusions/Significance: These estimates indicate that school-level SBD reporting is likely to significantly overestimate program coverage. These findings suggest that current SBD coverage estimates derived from school-based program data may substantially overestimate true pediatric deworming coverage within targeted communities. Trial registration: NCT03014167. Author summary: Soil Transmitted Helminths (STH) infect over 1.5 billion people globally and are associated with anemia and stunting. School-based deworming (SBD) via mass drug administration has been recommended by the World Health Organization to reduce levels of morbidity due to STH in endemic areas. This study examines discrepancies between school-level reporting of SBD and individual-level survey reporting of SBD from the DeWorm3 trial in Benin, India, and Malawi. Study cluster coverages were calculated for both school-level and individual-level data in the intervention arm and the differences between them were used to produce a mean squared error (MSE) statistic for each cluster. These values were then applied to the control arm, where only school-level data had been collected, to estimate individual-level data. In each study site, SBD coverage in the school-level data was substantially higher than in the individual-level data. When applying observed MSE to project individual-level data in the control arm, SBD coverage dropped from 89.1% to 70.5% in Benin, from 97.7% to 84.5% in India, and from 41.5% to 37.5% in Malawi. These estimates indicate that current SBD coverage estimates derived from school-level data may substantially overestimate true pediatric deworming coverage within targeted communities. [ABSTRACT FROM AUTHOR]