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Community-based interventions for the prevention and control of helmintic neglected tropical diseases.

Salam RA, Maredia H, Das JK, Lassi ZS, Bhutta ZA - Infect Dis Poverty (2014)

Bottom Line: They are also effective in improving mean hemoglobin (SMD: 0.34, 95% CI: 0.20, 0.47) and reducing anemia prevalence (RR: 0.90, 95% CI: 0.85, 0.96).We did not find any conclusive evidence from the quantitative synthesis on the relative effectiveness of integrated and non-integrated delivery strategies due to the limited data available for each subgroup.However, the qualitative synthesis from the included studies supports community-based delivery strategies and suggests that integrated prevention and control measures are more effective in achieving greater coverage compared to the routine vertical delivery, albeit it requires an existing strong healthcare infrastructure.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Women and Child Health, The Aga Khan University, Karachi 74800, Pakistan.

ABSTRACT
In this paper, we aim to systematically analyze the effectiveness of community-based interventions (CBIs) for the prevention and control of helminthiasis including soil-transmitted helminthiasis (STH) (ascariasis, hookworms, and trichuriasis), lymphatic filariasis, onchocerciasis, dracunculiasis, and schistosomiasis. We systematically reviewed literature published before May 2013 and included 32 studies in this review. Findings from the meta-analysis suggest that CBIs are effective in reducing the prevalence of STH (RR: 0.45, 95% CI: 0.38, 0.54), schistosomiasis (RR: 0.40, 95% CI: 0.33, 0.50), and STH intensity (SMD: -3.16, 95 CI: -4.28, -2.04). They are also effective in improving mean hemoglobin (SMD: 0.34, 95% CI: 0.20, 0.47) and reducing anemia prevalence (RR: 0.90, 95% CI: 0.85, 0.96). However, it did not have any impact on ferritin, height, weight, low birth weight (LBW), or stillbirths. School-based delivery significantly reduced STH (RR: 0.49, 95% CI: 0.39, 0.63) and schistosomiasis prevalence (RR: 0.50, 95% CI: 0.33, 0.75), STH intensity (SMD: -0.22, 95% CI: -0.26, -0.17), and anemia prevalence (RR: 0.87, 95% CI: 0.81, 0.94). It also improved mean hemoglobin (SMD: 0.24, 95% CI: 0.16, 0.32). We did not find any conclusive evidence from the quantitative synthesis on the relative effectiveness of integrated and non-integrated delivery strategies due to the limited data available for each subgroup. However, the qualitative synthesis from the included studies supports community-based delivery strategies and suggests that integrated prevention and control measures are more effective in achieving greater coverage compared to the routine vertical delivery, albeit it requires an existing strong healthcare infrastructure. Current evidence suggests that effective community-based strategies exist and deliver a range of preventive, promotive, and therapeutic interventions to combat helminthic neglected tropical diseases (NTDs). However, there is a need to implement and evaluate efficient integrated programs with the existing disease control programs on a larger scale throughout resource-limited regions especially to reach the unreachable.

No MeSH data available.


Related in: MedlinePlus

Forest plot for the impact of CBIs on anemia.
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Figure 5: Forest plot for the impact of CBIs on anemia.

Mentions: Twelve studies reported STH prevalence, showing a significant 53% reduction in the overall STH prevalence (RR: 0.47, 95% CI: 0.41, 0.54) rate, 60% reduction in hookworm prevalence (RR: 0.40, 95% CI: 0.31, 0.52), 68% in ascariasis (RR: 0.32, 95% CI: 0.20, 0.51), and 34% (RR: 0.66, 95% CI: 0.55, 0.80) in trichuriasis prevalence (see Figure 2). Twenty-five studies pooled for schistosomiasis prevalence also showed a significant 59% overall reduction (RR: 0.41, 95% CI: 0.34, 0.50), with 59% (RR: 0.41, 95% CI: 0.30, 0.57), 76% (RR: 0.24, 95% CI: 0.07, 0.80) and 52% (RR: 0.48, 95% CI: 0.36, 0.64) reductions in the prevalence of Schistosoma haematobium, Schistosoma japonicum, and Schistosoma mansoni, respectively (see Figure 3). CBIs also significantly reduced the mean STH intensity (SMD: −3.16, 95 CI: −4.28, −2.04).Twelve studies reported on the hemoglobin (Hb) levels and showed significantly improved mean Hb in the intervention group (SMD: 0.34, 95% CI: 0.20, 0.47), while anemia significantly reduced by 10% (RR: 0.90, 95% CI: 0.85, 0.96) (see Figures 4 and 5). Impacts on serum ferritin, weight, height and delivery outcomes of stillbirth, low birth weight (LBW), and very LBW remained non-significant in the overall, as well as the subgroup, analyses.


Community-based interventions for the prevention and control of helmintic neglected tropical diseases.

Salam RA, Maredia H, Das JK, Lassi ZS, Bhutta ZA - Infect Dis Poverty (2014)

Forest plot for the impact of CBIs on anemia.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4128617&req=5

Figure 5: Forest plot for the impact of CBIs on anemia.
Mentions: Twelve studies reported STH prevalence, showing a significant 53% reduction in the overall STH prevalence (RR: 0.47, 95% CI: 0.41, 0.54) rate, 60% reduction in hookworm prevalence (RR: 0.40, 95% CI: 0.31, 0.52), 68% in ascariasis (RR: 0.32, 95% CI: 0.20, 0.51), and 34% (RR: 0.66, 95% CI: 0.55, 0.80) in trichuriasis prevalence (see Figure 2). Twenty-five studies pooled for schistosomiasis prevalence also showed a significant 59% overall reduction (RR: 0.41, 95% CI: 0.34, 0.50), with 59% (RR: 0.41, 95% CI: 0.30, 0.57), 76% (RR: 0.24, 95% CI: 0.07, 0.80) and 52% (RR: 0.48, 95% CI: 0.36, 0.64) reductions in the prevalence of Schistosoma haematobium, Schistosoma japonicum, and Schistosoma mansoni, respectively (see Figure 3). CBIs also significantly reduced the mean STH intensity (SMD: −3.16, 95 CI: −4.28, −2.04).Twelve studies reported on the hemoglobin (Hb) levels and showed significantly improved mean Hb in the intervention group (SMD: 0.34, 95% CI: 0.20, 0.47), while anemia significantly reduced by 10% (RR: 0.90, 95% CI: 0.85, 0.96) (see Figures 4 and 5). Impacts on serum ferritin, weight, height and delivery outcomes of stillbirth, low birth weight (LBW), and very LBW remained non-significant in the overall, as well as the subgroup, analyses.

Bottom Line: They are also effective in improving mean hemoglobin (SMD: 0.34, 95% CI: 0.20, 0.47) and reducing anemia prevalence (RR: 0.90, 95% CI: 0.85, 0.96).We did not find any conclusive evidence from the quantitative synthesis on the relative effectiveness of integrated and non-integrated delivery strategies due to the limited data available for each subgroup.However, the qualitative synthesis from the included studies supports community-based delivery strategies and suggests that integrated prevention and control measures are more effective in achieving greater coverage compared to the routine vertical delivery, albeit it requires an existing strong healthcare infrastructure.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Women and Child Health, The Aga Khan University, Karachi 74800, Pakistan.

ABSTRACT
In this paper, we aim to systematically analyze the effectiveness of community-based interventions (CBIs) for the prevention and control of helminthiasis including soil-transmitted helminthiasis (STH) (ascariasis, hookworms, and trichuriasis), lymphatic filariasis, onchocerciasis, dracunculiasis, and schistosomiasis. We systematically reviewed literature published before May 2013 and included 32 studies in this review. Findings from the meta-analysis suggest that CBIs are effective in reducing the prevalence of STH (RR: 0.45, 95% CI: 0.38, 0.54), schistosomiasis (RR: 0.40, 95% CI: 0.33, 0.50), and STH intensity (SMD: -3.16, 95 CI: -4.28, -2.04). They are also effective in improving mean hemoglobin (SMD: 0.34, 95% CI: 0.20, 0.47) and reducing anemia prevalence (RR: 0.90, 95% CI: 0.85, 0.96). However, it did not have any impact on ferritin, height, weight, low birth weight (LBW), or stillbirths. School-based delivery significantly reduced STH (RR: 0.49, 95% CI: 0.39, 0.63) and schistosomiasis prevalence (RR: 0.50, 95% CI: 0.33, 0.75), STH intensity (SMD: -0.22, 95% CI: -0.26, -0.17), and anemia prevalence (RR: 0.87, 95% CI: 0.81, 0.94). It also improved mean hemoglobin (SMD: 0.24, 95% CI: 0.16, 0.32). We did not find any conclusive evidence from the quantitative synthesis on the relative effectiveness of integrated and non-integrated delivery strategies due to the limited data available for each subgroup. However, the qualitative synthesis from the included studies supports community-based delivery strategies and suggests that integrated prevention and control measures are more effective in achieving greater coverage compared to the routine vertical delivery, albeit it requires an existing strong healthcare infrastructure. Current evidence suggests that effective community-based strategies exist and deliver a range of preventive, promotive, and therapeutic interventions to combat helminthic neglected tropical diseases (NTDs). However, there is a need to implement and evaluate efficient integrated programs with the existing disease control programs on a larger scale throughout resource-limited regions especially to reach the unreachable.

No MeSH data available.


Related in: MedlinePlus