Background

The mainstay of current schistosomiasis control programs is mass preventive chemotherapy of school-aged children with praziquantel. This treatment is delivered through school-based, community-based, or combined school- and community-based systems. Attaining very high coverage rates for children is essential in mass schistosomiasis treatment programs, as is ensuring that there are no persistently untreated subpopulations, a potential challenge for school-based programs in areas with low school enrollment. This review sought to compare the different treatment delivery methods based both on their coverage of school-aged children overall and on their coverage specifically of non-enrolled children. In addition, qualitative community or programmatic factors associated with high or low coverage rates were identified, with suggestions for overall coverage improvement.

Methodology/Principal findings

This review was registered prospectively with PROSPERO (CRD 42015017656). Five hundred forty-nine publication of potential relevance were identified through database searches, reference lists, and personal communications. Eligible studies included those published before October 2015, written in English or French, containing quantitative or qualitative data about coverage rates for MDA of school-aged children with praziquantel. Among the 22 selected studies, combined community- and school-based programs achieved the highest median coverage rates (89%), followed by community-based programs (72%). School-based programs had both the lowest median coverage of children overall (49%) and the lowest coverage of the non-enrolled subpopulation of children. Qualitatively, major factors affecting program success included fear of side effects, inadequate education about schistosomiasis, lack of incentives for drug distributors, and inequitable distribution to minority groups.

Conclusions/Significance

This review provides an evidence-based framework for the development of future schistosomiasis control programs. Based on our results, a combined community and school-based delivery system should maximize coverage for both in- and out-of-school children, especially when combined with interventions such as snacks for treated children, educational campaigns, incentives for drug distributors, and active inclusion of marginalized groups.

Trial registration

ClinicalTrials.gov CRD42015017656

中文翻译：

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对血吸虫病大规模药物管理计划中针对学龄儿童的社区，学校和联合分娩方式的系统评价

背景

当前的血吸虫病控制计划的主要内容是对吡喹酮的学龄儿童进行预防性化疗。通过基于学校，基于社区或基于学校和社区的组合系统来提供这种处理。在大规模的血吸虫病治疗计划中，必须确保儿童获得很高的覆盖率，这是确保没有持续未经治疗的亚人群的必要条件，这是入学率低地区学校计划的潜在挑战。这篇综述试图根据他们对学龄儿童的总体覆盖率，特别是对未入学儿童的覆盖率，来比较不同的治疗方法。此外，还确定了与高或低覆盖率相关的定性社区或计划因素，

方法/主要发现

该评价已在PROSPERO（CRD 42015017656）上进行了前瞻性注册。通过数据库搜索，参考文献列表和个人通讯，确定了549篇潜在的相关性出版物。符合条件的研究包括2015年10月之前以英文或法文出版的研究，其中包含有关吡喹酮学龄儿童MDA覆盖率的定量或定性数据。在22项选定的研究中，以社区和学校为基础的综合计划的中位覆盖率最高（89％），其次是以社区为基础的计划（72％）。校本课程的总体中位数覆盖率最低（49％），而未入学儿童群体的覆盖率最低。在质量上，影响程序成功的主要因素包括对副作用的恐惧，

结论/意义

这项审查为未来的血吸虫病控制计划的发展提供了一个基于证据的框架。根据我们的结果，结合社区和学校为基础的分发系统应该最大程度地覆盖在校儿童和失学儿童，尤其是在与干预措施结合使用时，例如为受治疗儿童提供零食，开展教育活动，鼓励药物分销商以及积极纳入边缘群体。

试用注册

ClinicalTrials.gov CRD42015017656