Feasibility of paediatric schistosomiasis prevention with praziquantel, Madagascar.

Objective: To assess the feasibility of fixed-dose, praziquantel preventive chemotherapy against schistosomiasis in young children in rural Madagascar, focusing on treatment uptake and sustainability. Methods: We used the Consolidated Framework for Implementation Research to guide the study. Between November 2022 and December 2023, children aged 9 to 24 months at various venues were offered 300 mg of praziquantel as a crushed half tablet mixed with water and sugar. We conducted a cross-sectional survey among caregivers to assess treatment uptake and acceptability, children's compliance with drug administration, anxiety about adverse events, and praziquantel's tolerability and safety. Factors associated with uptake and acceptability were identified using Poisson regression. Findings: The study analysis included 5142 child-caregiver pairs. The praziquantel uptake rate was 86.2% (95% confidence interval, CI: 85.3-87.1) and 80.2% (95% CI: 79.1-81.3) of caregivers regarded repeated preventive chemotherapy acceptable. Clear anxiety, and uncertainty, about adverse events were the most significant factors associated with refusal of both initial and repeated treatment. No children experienced serious adverse events or choking. Of the 4434 children who received praziquantel, 152 (3.4%) swallowed a partial dose, whereas 2467 (55.6%) cried and 1833 (41.3%) initially resisted treatment, but ultimately received it. Conclusion: Fixed-dose praziquantel preventive chemotherapy using a crushed half tablet with water and sugar was feasible in preschool-aged children and was potentially sustainable. This approach has a strong potential for scaling up in areas where schistosomiasis is highly endemic.