A general framework to support cost-efficient survey design choices for the control of soil-transmitted helminths when deploying Kato-Katz thick smear

Adama Kazienga*, Bruno Levecke, Gemechu Tadesse Leta, Sake J. de Vlas, Luc E. Coffeng

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background To monitor and evaluate soil-transmitted helminth (STH) control programs, the World Health Organization (WHO) recommends screening stools from 250 children, deploying Kato-Katz thick smear (KK). However, it remains unclear whether these recommendations are suffi-cient to make adequate decisions about stopping preventive chemotherapy (PC) (preva-lence of infection <2%) or declaring elimination of STHs as a public health problem (prevalence of moderate-to-heavy intensity (MHI) infections <2%). Methodology We developed a simulation framework to determine the effectiveness and cost of survey designs for decision-making in STH control programs, capturing the operational resources to perform surveys, the variation in egg counts across STH species, across schools, between and within individuals, and between repeated smears. Using this framework and a lot quality assurance sampling approach, we determined the most cost-efficient survey designs (number of schools, subjects, stool samples per subject, and smears per stool sam-ple) for decision-making. Principal findings For all species, employing duplicate KK (sampling 4 to 6 schools and 64 to 70 subjects per school) was the most cost-efficient survey design to assess whether prevalence of any infection intensity was above or under 2%. For prevalence of MHI infections, single KK was the most cost-efficient (sampling 11 to 25 schools and 52 to 84 children per school). Conclusions/Significance KK is valuable for monitoring and evaluation of STH control programs, though we recom-mend deploying a duplicate KK on a single stool sample to stop PC, and a single KK to declare the elimination of STHs as a public health problem.

Original languageEnglish
Article numbere0011160
JournalPLoS Neglected Tropical Diseases
Volume17
Issue number6 June
DOIs
Publication statusPublished - 22 Jun 2023

Bibliographical note

Funding Information: BL acknowledges funding from Ghent University starting grant (www.ugent.be) and LEC from the Dutch Research Council (NWO, grant 016.Veni.178.023). In addition, the financial support for the dataset used in this study was provided by Schistosomiasis Control Initiative, the Partnership for Child Development, the Children’s Investment Fund Foundation, the End Neglected Tropical Diseases Fund, and UKAID-DFID.

Publisher Copyright: © 2023 Kazienga et al.

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