A general framework to support cost-efficient survey design choices for the control of soil-transmitted helminths when deploying Kato-Katz thick smear

Author:

Kazienga AdamaORCID,Levecke Bruno,Leta Gemechu Tadesse,de Vlas Sake J.,Coffeng Luc E.

Abstract

Background To monitor and evaluate soil-transmitted helminth (STH) control programs, the World Health Organization (WHO) recommends screening stools from 250 children, deploying Kato-Katz thick smear (KK). However, it remains unclear whether these recommendations are sufficient to make adequate decisions about stopping preventive chemotherapy (PC) (prevalence of infection <2%) or declaring elimination of STHs as a public health problem (prevalence of moderate-to-heavy intensity (MHI) infections <2%). Methodology We developed a simulation framework to determine the effectiveness and cost of survey designs for decision-making in STH control programs, capturing the operational resources to perform surveys, the variation in egg counts across STH species, across schools, between and within individuals, and between repeated smears. Using this framework and a lot quality assurance sampling approach, we determined the most cost-efficient survey designs (number of schools, subjects, stool samples per subject, and smears per stool sample) for decision-making. Principal findings For all species, employing duplicate KK (sampling 4 to 6 schools and 64 to 70 subjects per school) was the most cost-efficient survey design to assess whether prevalence of any infection intensity was above or under 2%. For prevalence of MHI infections, single KK was the most cost-efficient (sampling 11 to 25 schools and 52 to 84 children per school). Conclusions/Significance KK is valuable for monitoring and evaluation of STH control programs, though we recommend deploying a duplicate KK on a single stool sample to stop PC, and a single KK to declare the elimination of STHs as a public health problem.

Funder

Ghent University

Dutch Research Council

Schistosomiasis Control Initiative

Partnership for Child Development

Children's Investment Fund Foundation

End Neglected Tropical Diseases Fund

UKAID-DFI

Publisher

Public Library of Science (PLoS)

Subject

Infectious Diseases,Public Health, Environmental and Occupational Health

Reference30 articles.

1. World Health Organization. Helminth control in school-age children: a guide for managers of control programmes / A. Montresor… [et al.]. 2002 [cited 26 Apr 2023]. Available: https://apps.who.int/iris/handle/10665/42473

2. World Health Organization. Preventive chemotherapy in human helminthiasis: coordinated use of anthelminthic drugs in control interventions: a manual for health professionals and programme managers. 2006 [cited 26 Apr 2023]. Available: https://apps.who.int/iris/handle/10665/43545

3. World Health Organization. Helminth control in school-age children: a guide for managers of control programmes. 2011 [cited 26 Apr 2023]. Available: https://apps.who.int/iris/handle/10665/44671

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