WASH

How do villages which do not show substantial decreases in the prevalence of schistosomiasis despite repeated, high coverage mass drug administration (persistent hot-spot villages) differ from villages which show substantial decrease in prevalence across various factors (declining prevalence villages)?

Does community-based treatment of podoconiosis lymphoedema reduce the frequency of attacks of acute dermatolymphangioadenitis?

Study the impact of WASH on Trachoma by adding an STH intervention and post-treatment evaluation. WASH intervention and control communities will be treated with albendazole and STH burden will be assessed pre-treatment and at annual intervals thereafter.

Monitor recrudescence of STH after TAS to improve planning of STH programs and more effective use of STH drugs.

Monitor recrudescence of STH after TAS to improve planning of STH programs and more effective use of STH drugs.

Develop a program evaluation tool to permit program managers to effectively assess coverage and compliance. This study will focus on assessing MDA coverage for lymphatic filariasis by comparing the cost, time and feasibility of the EPI approach (n=480), LQAS design (n=95) and probability sampling alternatives (n=480).

Preliminary study findings:

• All three survey methods were feasible for the teams to implement and cost <$5,000.
• Preschool deworming coverage, provided through the community-based MDA, was <60%.
• The main reason for refusing the medication was that the child had recently been dewormed.
• Approximately 80% of preschool children surveyed received at least one dose of unprogrammed deworming in the past 12 months.
• The main sources of unprogrammed deworming were health centers, local pharmacies, and bodegas.

(1) Is it possible to eliminate schistosomiasis as a public health problem on Unguja in three years and to interrupt transmission in five years? (2) Is it possible to control schistosomiasis throughout Pemba (prevalence <10%) in three years and to eliminate it as a public health problem in five years? (3) What are the costs, successful strategies, barriers, etc. associated with three different interventions (MDA, vector control, and behavior change)?