Progress in controlling the transmission of schistosome parasites in Southern Ethiopia – the Geshiyaro project in the Wolaita Zone

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Abstract Background This paper describes changes in the prevalence and intensity of schistosome parasite infections in a project integrating mass drug administration (MDA), water, sanitation and hygiene (WaSH), and behavioral change interventions. Method The Geshiyaro project has three intervention arms. Arm 1 is divided into two subgroups: “Arm 1 pilot” with one district, and Arm 1 with four other districts. Both groups received integrated community-wide MDA, WaSH and behavioral change interventions. Arm 2 includes 17 districts with community-wide MDA, while Arm 3, which was used as a control has implemented school-based MDA in three districts. The participants were randomly assigned to five age groups (0–4, 5–14, 15–19, 20–35, and 35 + years) with equal sizes. The number of individuals in each arm was 584 for Arm 1 pilot, 1636 for Arm 1, 2203 for Arm 2, 2238 for Arm 3. The prevalence and intensity of infection were compared across different arms using statistical tests. Result The prevalence of schistosome parasite infection ranged from 0–2.6%, and 1.7–25.7%, across districts respectively employing the Kato Katz (KK) and Point-of-care circulating cathodic antigen (POC-CCA) diagnostics. The mean infection intensity level employing both diagnostics did not show any marked difference at baseline and follow-up surveys when measured by (KK) except in Arm 2 (t = 6.89, p < 0.0001). Infection prevalence reduced significantly in Arm 1 (t = 8.62, p < 0.0001), Arm 2 (t = 6.94, p < 0.0001) and Arm 3 (t = 8.83, p < 0.0001) but not in Arm 1 pilot (t = 1.69, p = 0.09) by POC-CCA, when trace was considered positive. The decrease was significant only in Arm 1 (t = 3.28, p = 0.0001) and Arm 2 (t = 7.62, p < 0.0001) when the trace was considered negative in POC-CCA. Arm 2 demonstrated significant difference in difference (DID) compared to the control group, Arm 3, regardless of whether trace in POC-CCA was considered positive (DID = 3.9%, df = 8780, p = 0.025) or negative (DID=-5.2, df = 8780, p-value = 0.0004). Conclusion The prevalence of schistosomiasis was low by KK but moderate in some locations by POC-CCA diagnostics. The infection level has decreased across all arms of the Geshiyaro study at mid-term of the seven-year project but more needs to be done to reduce the rate of parasite transmission based on the POC-CCA diagnostic scores.

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