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Overestimation of school-based deworming coverage resulting from school-based reporting

Overestimation of school-based deworming coverage resulting from school-based reporting

Title: Overestimation of school-based deworming coverage resulting from school-based reporting
Author: Sheahan, William
Anderson, Roy
Aruldas, Kumudha
Avokpaho, Euripide
Galagan, Sean
Goodman, Jeanne
Houngbegnon, Parfait
Israel, Gideon John
Janagaraj, Venkateshprabhu
Kaliappan, Saravanakumar Puthupalayam
... 16 more authors Show all authors
Date: 2023-04-10
Language: English
Scope: e0010401
Department: Faculty of Medicine
Series: PLoS Neglected Tropical Diseases; 17(4)
ISSN: 1935-2727
DOI: https://doi.org/10.1371/journal.pntd.0010401
Subject: Animals; Child; Humans; Helminthiasis/drug therapy; Anthelmintics/therapeutic use; Albendazole/therapeutic use; Helminths; Mass Drug Administration; Soil/parasitology; Prevalence; Public Health, Environmental and Occupational Health; Infectious Diseases
URI: https://hdl.handle.net/20.500.11815/4338

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Sheahan , W , Anderson , R , Aruldas , K , Avokpaho , E , Galagan , S , Goodman , J , Houngbegnon , P , Israel , G J , Janagaraj , V , Kaliappan , S P , Means , A R , Morozoff , C , Pearman , E , Ramesh , R M , Roll , A , Schaefer , A , Simwanza , J , Witek-Mcmanus , S , Ajjampur , S S R , Bailey , R , Ibikounlé , M , Kalua , K , Luty , A J F , Pullan , R , Walson , J L & Ásbjörnsdóttir , K H 2023 , ' Overestimation of school-based deworming coverage resulting from school-based reporting ' , PLoS Neglected Tropical Diseases , vol. 17 , no. 4 , e0010401 , pp. e0010401 . https://doi.org/10.1371/journal.pntd.0010401


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.


Copyright: © 2023 Sheahan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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