Coverage of Mass Drug Administration and Outcomes for Schistosomiasis and Soil Transmitted Helminths, Uganda, 2013–2023

Abstract

Background Uganda has a high burden of Neglected Tropical Diseases (NTDs), particularly affecting the rural populations. Some NTDs are targeted for control/elimination using preventive chemotherapy administered annually or bi-annually to populations at risk through mass drug administration (MDA). Schistosomiasis and soil transmitted helminths (STHs) are among these. MDA for Schistosomiasis is given only to school-age children (SAC) and adults while that for STHs is given only to SAC and pre-school-age children (preSAC). The MDA coverage target for both these NTDs is 75%. Decline in size of population at risk (PAR) and number of cases are indicators of effective control/progress towards elimination. We describe the trends in coverage of MDA and outcomes for schistosomiasis and STHs. Methods We reviewed available data on MDA coverage, size of population at risk and disease occurrence (case counts) for schistosomiasis and STHs from 2013 to 2023. We analysed the trends using the Mann Kendal test. Results From 2014–2022, there was an apparent increase in MDA coverage for schistosomiasis for both SAC (from 21–82%, p = 0.5) and adults (from 34–36%, p = 0.1) but both trends were not significant. Similarly, for STHs, MDA coverage increased for both SAC (from 63–114%, p = 0.09) and preSAC (from 65–76%, p = 1.0), but these trends were not significant. The PAR for schistosomiasis increased by 25% for SAC (2014: 4,777,189 vs 2022: 5,979,311, p = 0.002) and by 60% for adults (2014: 4,436,444 vs 2022: 7,091,933, p = 0.03). For STHs, PAR increased by 19% for both SAC (2014:11,287,385 vs 2022:13,397,219, p = 0.03) and preSAC (2014: 5,279,025 vs 2022: 6,299,355, p = 0.047). From 2013–2023, there was a 62% reduction in reported cases of Schistosomiasis (2013: 6518 vs 2023: 2501, p = 0.7) and a 52% reduction in reported cases of STHs (2013: 2,457,021 vs 2023:1,176,463, p = 0.5) but both trends were not significant. Conclusions Current efforts to control Schistosomiasis and STHs are ineffectual. Efforts to improve and maintain MDA coverage for both NTDs to the target of 75% are crucial, while the rise in PAR and unabating case counts necessitates targeted interventions including improved sanitation, health education and vaccine development.