Evidence map›Paper›PMID 31006575›Full record

Trial reportLancet (London, England)2019

Effects, equity, and cost of school-based and community-wide treatment strategies for soil-transmitted helminths in Kenya: a cluster-randomised controlled trial.

Rachel L Pullan, Katherine E Halliday, William E Oswald, Carlos Mcharo, Emma Beaumont, Stella Kepha, Stefan Witek-McManus, Paul M Gichuki, Elizabeth Allen, Tom Drake and 7 more

Registry-linked trialOpen access · hybridAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Lancet (London, England), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02397772 (The Impact of Different Treatment Strategies on the Transmission Dynamics of Soil-transmitted Helminths), which is not on this map. Cited by 80 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
80citing papers in PubMed, 3 pooled it
10.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02397772 phase4completednot on this map

The Impact of Different Treatment Strategies on the Transmission Dynamics of Soil-transmitted Helminths: a Cluster Randomised Trial in Kenya

TypeinterventionalSponsorLondon School of Hygiene and Tropical MedicineRan2015 to 2017Enrolled21,761ConditionsHelminthiasis, Nematode Infection, Disease Transmission, InfectiousArmsalbendazole
3 · Its place in the literature

Who cites it

80 citing papers in PubMed, 3 syntheses or guidelines pooled it, 110 citations in OpenAlex.

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  3. Anthelmintic drugs for treating ascariasis.The Cochrane database of systematic reviews · 2020
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20 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

17 authors at 7 institutions in 2 countries.

Rachel L PullanFaculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK. Electronic address: rachel.pullan@lshtm.ac.uk.
Katherine E HallidayFaculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
William E OswaldFaculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
Carlos McharoEastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya.
Emma BeaumontFaculty of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London, UK.
Stella KephaFaculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya; Pwani University Bioscience Research Centre, Pwani University, Kilifi, Kenya.
Stefan Witek-McManusFaculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
Paul M GichukiEastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya.
Elizabeth AllenFaculty of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London, UK.
Tom DrakeFaculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
Catherine PittFaculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
Sultani H MatendecheroNeglected Tropical Diseases Unit, Division of Communicable Disease Prevention and Control, Ministry of Health, Nairobi, Kenya.
Marie-Claire Gwayi-ChoreDeworm the World Initiative, Evidence Action, Nairobi, Kenya.
Roy M AndersonFaculty of Medicine, Department of Infectious Disease Epidemiology, London Centre for Neglected Tropical Disease Research, School of Public Health, St Mary's Campus, Imperial College London, London, UK.
Sammy M NjengaEastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya.
Simon J BrookerFaculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
Charles S MwandawiroEastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya.
London School of Hygiene & Tropical Medicine · GBKenya Medical Research Institute · KEFaculty of Public Health · GBImperial College London · GBMinistry of Health · KEPractical Action · KEPwani University · KE

Funding

Medical Research Council MR/N00597X/1Medical Research Council MR/R015600/1Wellcome Trust
6 · The paper itself

Abstract

backgroundSchool-based deworming programmes can reduce morbidity attributable to soil-transmitted helminths in children but do not interrupt transmission in the wider community. We assessed the effects of alternative mass treatment strategies on community soil-transmitted helminth infection.

methodsIn this cluster-randomised controlled trial, 120 community units (clusters) serving 150 000 households in Kenya were randomly assigned (1:1:1) to receive albendazole through annual school-based treatment targeting 2-14 year olds or annual or biannual community-wide treatment targeting all ages. The primary outcome was community hookworm prevalence, assessed at 12 and 24 months through repeat cross-sectional surveys. Secondary outcomes were Ascaris lumbricoides and Trichuris trichiura prevalence, infection intensity of each soil-transmitted helminth species, and treatment coverage and costs. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT02397772.

findingsAfter 24 months, prevalence of hookworm changed from 18·6% (95% CI 13·9-23·2) to 13·8% (10·5-17·0) in the annual school-based treatment group, 17·9% (13·7-22·1) to 8·0% (6·0-10·1) in the annual community-wide treatment group, and 20·6% (15·8-25·5) to 6·2% (4·9-7·5) in the biannual community-wide treatment group. Relative to annual school-based treatment, the risk ratio for annual community-wide treatment was 0·59 (95% CI 0·42-0·83; p<0·001) and for biannual community-wide treatment was 0·46 (0·33-0·63; p<0·001). More modest reductions in risk were observed after 12 months. Risk ratios were similar across demographic and socioeconomic subgroups after 24 months. No adverse events related to albendazole were reported.

interpretationCommunity-wide treatment was more effective in reducing hookworm prevalence and intensity than school-based treatment, with little additional benefit of treating every 6 months, and was shown to be remarkably equitable in coverage and effects.

fundingBill & Melinda Gates Foundation, the Joint Global Health Trials Scheme of the Medical Research Council, the UK Department for International Development, the Wellcome Trust, and the Children's Investment Fund Foundation.

Indexed as

AdolescentAdultAlbendazoleAnimalsAnthelminticsAscariasisAscaris lumbricoidesChildChild, PreschoolCross-Sectional StudiesFemaleHookworm InfectionsHumansIntention to Treat AnalysisKenyaMaleAlbendazoleAnthelminticsSoil

Identifiers

PMID31006575
PMCPMC6525786
OpenAlexW2937488800

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.