Provision of a snack before mass treatment of schistosomiasis with praziquantel leads to increased uptake of treatment in school-aged children in Uganda, according to a study published in this week's PLOS Medicine. Simon Muhumuza and colleagues from Makerere University, Kampala, Uganda found that 93.9% of children reported taking praziquantel in schools that offered a snack before treatment compared with 78.7% of children in schools that did not offer a snack.
The researchers reached these conclusions by conducting a cluster randomized controlled trial in Jinja district, Uganda. Twelve primary schools were randomized to receive education messages for schistosomiasis prevention with or without a pre-treatment snack (mango juice and donuts) shortly before treatment with praziquantel, and four weeks later, the researchers interviewed a random sample of 1,284 children from the schools and collected stool samples to test for Schistosoma mansoni infection. In addition to the increased uptake of praziquantel in the children from the snack schools, they found these children were less likely to report side effects (34.4% vs. 46.7%) and had a lower prevalence (1.3% vs. 14.1%) and lower intensity (38.3 vs. 78.4 eggs per gram of stool) of S. mansoni infection, compared with those children from the non-snack schools.
The researchers acknowledge that it is possible that children could have provided socially desirable answers regarding uptake and the occurrence of side effects, however, the infection prevalence and intensity findings validated the self-reported uptake.
The authors say: "Our results suggest that provision of a pre-treatment snack combined with education messages achieves a higher uptake compared to the education messages alone. The use of a pre-treatment snack was associated with reduced side effects as well as decreased prevalence and intensity of S. mansoni infection."
Muhumuza S, Olsen A, Katahoire A, Kiragga AN, Nuwaha F (2014) Effectiveness of a Pre-treatment Snack on the Uptake of Mass Treatment for Schistosomiasis in Uganda: A Cluster Randomized Trial. PLoS Med 11(5): e1001640. DOI: 10.1371/journal.pmed.1001640