Precision mapping of schistosomiasis and soil-transmitted helminthiasis among school-age children: Targeting interventions in western Kenya

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BACKGROUND: Mapping of schistosomiasis (SCH) and soil-transmitted helminthiasis (STH) is a critical step in understanding where at-risk populations live in order to effectively plan and target available resources and to achieve maximum impact on disease burden. A precision mapping protocol was developed and implemented in Kakamega, Bungoma, Trans Nzoia and Vihiga Counties in western Kenya by applying the current World Health Organization (WHO) mapping guideline at a lower administrative level (Ward). METHODS: Cross-sectional surveys were conducted among school-age children (SAC) in 5 primary schools purposefully selected in each mapping unit (Ward). In each school, stool and urine samples were collected from 60 randomly selected children (ages 8-14 years). The prevalence and intensity of infection of Schistosoma mansoni and STH were determined using the Kato-Katz technique and urine filtration for S. haematobium. Water Sanitation and Hygiene (WASH) status were also recorded. RESULTS: Of the 46,464 children sampled, 3.2% (95% CI: 3.0-3.3) were infected with at least one Schistosoma species, with S. mansoni being the most predominant at 3.2% (95% CI: 2.9 - 3.3). 7.6% (95% CI: 7.3 - 7.8) of children were infected with at least one STH species, with A. lumbricoides being the most common (6.5%), and hookworm the least common (0.7%). The prevalence of S. mansoni was highest in Bungoma County (4.5%) and lowest in Trans Nzoia county (0.5%); STH prevalence was highest in Vihiga County (10.7%) and lowest in Trans Nzoia County (4.8%). SCH and STH infections were mainly of light intensity (2.2% and 5.6%, respectively). Based on sub-County-level data and prevalence threshold of ≥2% for MDA, 49 and 144 Wards required treatment for SCH and STH, respectively, whereas based on the Ward-level data, only 40 and 138 Wards required treatment for SCH and STH, respectively. CONCLUSIONS: Use of Ward relative to sub-county prevalence revealed considerable spatial heterogeneity for SCH and STH and resulted in 14.5% and 0.8% reduction in the number of people treated for SCH and STH, respectively, underscoring the critical role of precision mapping in improved targeting of interventions.

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