Assessment of albendazole efficacy against Ascaris lumbricoides at three sites of Andhra Pradesh, Odisha, and Kerala in India

Abstract

Objective: To assess efficacy of albendazole against Ascaris (A.) lumbrìcoides among school-children at three sites of Rajahmundry, Sundergarh and Wayanad. Methods: Sites were selected based on soil-transmitted helminths prevalence, different sociocultural-geographical characteristics and operational feasibility. 9-12 Years old children from 14 schools were included. The study was conducted in two rounds: baseline & follow up survey. All eligible children found positive for A. lumbricoides at baseline were administered supervised single tablet albendazole 400 mg under the National Deworming Day Initiative. During post-treatment follow-up survey, eligible children who provided second stool sample were included in the final analysis. Stool samples were examined using WHO recommended Kato-Katz technique. Efficacy was estimated based on cure rate (CR) and Fecal Egg Count Reduction Rate (FECRR) among children found positive in baseline and follow-up surveys. Results: 328 Out of 625 (52.5%) were found positive for A. lumbricoides in the baseline survey and 85 out of 178 samples (47.8%) during post-treatment follow-up survey. Overall, the estimated CR was 52.2%. FECRR (95% CI) for albendazole was 72.6% (79.2%-66.0%). The FECRR was highest in East Godaveri [89.7% (96.8%-82.6%)], followed by Sundergarh [86.4% (95.3%-77.5%)] and Wayanad [69% (81.7%-56.4%)]. Conclusions: Our study confirmed overall reduction in FEC although with varying albendazole efficacy for A. lumbricoides infection at three different locations in India. However, these finding may be assessed in context of ongoing MDA under Filaria control program and further studies by in vivo as well as in vitro methods are required to reach to a conclusion on possible resistance if any.