Article Category:
Research Article

Sensitivity of Three Impact Assessment Methodologies in Adjusting Preventive Chemotherapy Treatment Decisions for Schistosomiasis Elimination in Ondo State, Nigeria

Uwem F. Ekpo Federal University of Agriculture, Abeokuta, Nigeria;
Akwa Ibom State University, Ikot Akpaden, Nigeria;

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Francisca O. Olamiju Mission to Safe the Helpless, Lagos, Nigeria;

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Hammed O. Mogaji Mission to Safe the Helpless, Lagos, Nigeria;
Marian University, Indianapolis, Indiana;

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Samuel N. Ovia Mission to Safe the Helpless, Lagos, Nigeria;

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Olanike O. Oladipupo Neglected Tropical Diseases Program Unit, Department of Public Health, Ondo State Ministry of Health, Akure, Nigeria;

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Alice Y. Kehinde Neglected Tropical Diseases Program Unit, Department of Public Health, Federal Ministry of Health, Akure, Nigeria;

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Fatai O. Oyediran Neglected Tropical Diseases Program Unit, Department of Public Health, Federal Ministry of Health, Abuja, Nigeria;

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Moses Aderogba Ending Neglected Diseases Fund, New York, New York

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Louise K. Makau-Barasa Ending Neglected Diseases Fund, New York, New York

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DOI:
https://doi.org/10.4269/ajtmh.24-0352
Volume/Issue:
Ahead of Print
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Efforts to eliminate schistosomiasis in Africa have advanced, with most countries evaluating the impact of preventive chemotherapy (PC) on disease burden. WHO has recommended eight distinct methodologies for such assessment. We, therefore, investigated the sensitivity of three prominent methodologies—sentinel, cluster, and practical, each varying in site selection, sampling approach, and data interpretation. We conducted a cross-sectional study among 2,093 children across 45 schools in Ese-Odo, Ile-Oluiji, and Irele local government areas (LGAs) of Ondo, Nigeria. Fresh stool and urine samples were processed using Kato–Katz and urine filtration techniques to estimate prevalence, which was compared with 2014 baseline estimates. Findings showed significant prevalence reductions in Ese-Odo from 1.3% (95% CI: 0.5–3.3) at baseline to 0.1% (95% CI: 0.01–0.95) at impact (d = −92.3%, P = 0.03) and in Ile-Oluiji from 58.0% (95% CI: 53.9–62.1) to 1.8% (95% CI: 0.9–3.3; d = −97%, P = 0.00). However, it increased from 3.0% (95% CI: 1.6–5.6) to 5.3% (95% CI: 3.8–7.3) in Irele (d = 66%, P = 0.13). Higher prevalence estimates were observed with the practical method compared with cluster and sentinel across the three LGAs: 0.3% versus 0.1% versus 0.0% in Ese-Odo, 5.8% versus 5.3% versus 5.4% in Irele, and 2.2% versus 1.8% versus 1.5% in Ile-Oluiji (all P >0.05). Sentinel and cluster methodologies suggest stopping PC, whereas the practical method suggests continued PC in Irele. Our findings demonstrate that practical assessment is a sensitive method for refining PC decisions.

Author Notes

Financial support: This study was funded by the Ending Neglected Diseases Fund. The funder has no specific role in the conceptualization, design, data collection, analysis, decision to publish, or preparation of the manuscript.

Disclosures: Ethical approval was obtained from the Ondo State Health Research Ethics Committee (Approval no. NHREC/18/08/2016). Additional approval was obtained from the Neglected Tropical Diseases Unit of the Federal Ministry of Health (Reference no. NSCP/6/7/IV/23). An extensive advocacy plan was initiated with key stakeholders in district Ministries of Health and Education to garner support and assurance for this study. Subsequently, decentralized sensitization and planning meetings were conducted with Neglected Tropical Diseases Unit contact personnel and education secretaries across the study area. This was followed by community engagement with representatives from study communities and schools. Sensitization of the study objectives, procedures, and target population was explained to community leaders, teachers, parents, and children. Participation in the study was voluntary and contingent upon the receipt of consent from participating minors between the ages 5 and 14 years old and a legal guardian. Minors who expressed willingness to participate in the study completed written assent forms and provided thumbprints on preprinted informed consent forms on the day of sample collection. Only children whose parents initially consented and for whom additional consent was provided by either the parent or the teacher on the day of sample collection were enrolled in the study.

Authors’ contributions: U. F. Ekpo, F. O. Olamiju, and H. O. Mogaji conceptualized the study. H. O. Mogaji prepared the protocol, whereas U. F. Ekpo, F. O. Olamiju, A. Y. Kehinde, and F. O. Oyediran improved the protocol. U. F. Ekpo, F. O. Olamiju, H. O. Mogaji, S. N. Ovia, and O. O. Oladipupo participated in supervised field surveys and data collection. H. O. Mogaji performed all statistical analyses. H. O. Mogaji prepared the first draft of the manuscript. U. F. Ekpo, F. O. Olamiju, H. O. Mogaji, A. Y. Kehinde, F. O. Oyediran, M. Aderogba, and L. K. Makau-Barasa contributed to the development of the final manuscript and approved its submission.

Data and availability: The datasets used and/or analyzed during the current study are available at https://zenodo.org/records/11080490.

Current contact information: Uwem F. Ekpo, Federal University of Agriculture, Abeokuta, Nigeria, and Akwa Ibom State University, Ikot Akpaden, Nigeria, E-mails: ufekpo@hotmail.com or uwemekpo@aksu.edu.ng. Francisca O. Olamiju and Samuel N. Ovia, Mission to Safe the Helpless, Lagos, Nigeria, E-mails: olamijufo@mitosath.org and oviasn@mitosath.org. Hammed O. Mogaji, Mission to Safe the Helpless, Lagos, Nigeria, and Marian University, Indianapolis, IN, E-mail: mogajihammed@gmail.com. Olanike O. Oladipupo, Neglected Tropical Diseases Program Unit, Department of Public Health, Ondo State Ministry of Health, Akure, Nigeria, E-mail: olanikeoladipupo1@gmail.com. Alice Y. Kehinde and Fatai O. Oyediran, Neglected Tropical Diseases Program Unit, Department of Public Health, Federal Ministry of Health Zonal Office, Akure, Nigeria, E-mails: kehindealice70@gmail.com and fatai_oyediran@yahoo.com. Moses Aderogba and Louise K. Makau-Barasa, Ending Neglected Diseases Fund, New York, NY, E-mails: maderogba@end.org and lmakau-barasa@endfund.org.

Address correspondence to Uwem F. Ekpo, Federal University of Agriculture, Alabata Rd., Abeokuta 110001, Nigeria. E-mail: ufekpo@hotmail.com
Copyright:
© The author(s) 2025
Received:
25 May 2024
|
Accepted:
09 Oct 2024
|
Published Online:
18 Feb 2025
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645

Expert Committee on Hepatitis

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by Harry Most, M.D., Editor. Symposium No. 4 of the Section on Microbiology, New York Academy of Medicine. 220 pp., cloth. New York, Columbia University Press, 1951. $4.50

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G. F. Otto

Immunology

by Noble Pierce Sherwood. Ph.D., M.D., Professor of Bacteriology, University of Kansas—3rd Edition, 731 pp., illustrated, cloth. St. Louis: The C. V. Mosby Co., 1951. $8.00

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