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

Author:

Sheahan WilliamORCID,Anderson Roy,Aruldas Kumudha,Avokpaho Euripide,Galagan Sean,Goodman Jeanne,Houngbegnon Parfait,Israel Gideon John,Janagaraj Venkateshprabhu,Kaliappan Saravanakumar Puthupalayam,Means Arianna Rubin,Morozoff Chloe,Pearman Emily,Ramesh Rohan Michael,Roll Amy,Schaefer Alexandra,Simwanza James,Witek-McManus Stefan,Ajjampur Sitara S. R.,Bailey Robin,Ibikounlé Moudachirou,Kalua Khumbo,Luty Adrian J. F.,Pullan Rachel,Walson Judd L.,Ásbjörnsdóttir Kristjana Hrönn

Abstract

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.

Funder

Bill and Melinda Gates Foundation

Publisher

Public Library of Science (PLoS)

Subject

Infectious Diseases,Public Health, Environmental and Occupational Health

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