# Program: Mass Drug Administration to Control Schistosomiasis

The content that appears below was created several years ago. This content is likely to be no longer fully accurate, both with respect to the research it presents and with respect to what it implies about our views and positions.

# In a nutshell

• The Problem: Schistosomiasis infection can cause anemia (and other chronic conditions) and in serious cases, death. More information on schistosomiasis available here.
• The Program: Mass administration of praziquantel (PZQ). (This program is often combined with administration of drugs targeting soil-transmitted helminths - more on the combination program here.)
• Track record: There's strong evidence from repeated trials that praziquantel effectively reduces prevalence of schistosomiasis infection.
• Cost-effectiveness: Estimates place this intervention among the most cost-effective.
• Bottom line: This is a proven, inexpensive method for improving lives in the developing world.

## Basics of the program

### What is the program? What problem does it target?

Schistosomiasis is a parasite infection that can cause chronic malnutrition, pain, anemia, and in some cases, death. It is further discussed here. The World Health Organization recommends treatment with praziquantel at least three times during childhood to cure non-severe morbidity and prevent the development of severe symptoms later in life.1

### What are the components required to implement this program - how does it work?

This program requires praziquantel and a means of administering the drug as efficiently as possible.
• Drugs: Praziquantel is donated by Merck to high disease burdened areas and thus freely available.2
• Distribution mechanism: The Disease Control Priorities Report states that schools provide a strong infrastructure for administration and that teachers can be trained to deliver drugs safely.3 In the absence of training, mobile teams can come in to implement drug administration, but this method can cost significantly more.4

## Program track record

### Micro evidence: Has this program been rigorously evaluated and shown to work?

A Cochrane review of 24 randomized and quasi-randomized controlled trials included 6,315 participants in interventions to treat urinary schistosomiasis. The review concluded that "praziquantel and metrifonate are effective treatments for urinary schistosomiasis and have few adverse events. Metrifonate requires multiple administrations and is therefore operationally less convenient in community-based control programmes."5 A Cochrane review of 13 randomized or pseudo-randomized trials treating intestinal schistosomiasis concluded that "oxamniquine and praziquantel both appear to be effective for treatment of S. mansoni, although lower doses of oxamniquine (less than 30 mg/kg) may not be as effective in some areas."6

### Macro evidence: Has this program played a role in large-scale success stories?

We have identified no such success stories. More on the general idea of "macro evidence" here.

## Recommendations and concerns

### Do expert reviews of the comparative merits of interventions endorse this one?

See this page for sources consulted. Experts endorse this intervention as part of the deworming intervention, which includes albendazole for soil-transmitted helminths (more on this combination program here).
• The Copenhagen Consensus ranks deworming and other nutrition programs at school as its 6th most promising program.7
• Jamison 2008 does not endorse this program8
• The Disease Control Priorities report states, "Until new technologies become available, anthelmintic chemotherapy for school-age children remains the most practical and substantive means to control ... schistosome infections in the developing world."9

### What versions of the intervention are best?

Three versions of this intervention are (1) population intervention, where everyone in a region is treated; (2) targeted intervention, where certain demographic subgroups are treated; and (3) selective intervention, where individuals selected by diagnosis or suspicion of infection are treated.10 Population deworming (treatment for all people in an area of high infection) is recommended by the World Health Organization as its first choice.11 However, treating school-aged children as a targeted population group is the version that has been most closely evaluated.12 It also may be the most cost-effective because school-aged children typically have the highest rate of helminth infection and reinfection, and schools offer an infrastructure for delivery.13