PLoS Neglected Tropical Diseases (Apr 2023)

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

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

DOI
https://doi.org/10.1371/journal.pntd.0010401
Journal volume & issue
Vol. 17, no. 4
p. e0010401

Abstract

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BackgroundSoil 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 findingsPopulation-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 Conclusions/significanceThese 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 registrationNCT03014167.