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Area of Science:

  • Tropical Medicine
  • Infectious Diseases
  • Public Health

Background:

  • Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) studies in Africa demonstrated mass drug administration (MDA) reduces Schistosoma infection.
  • However, persistent hotspots (PHS) with minimal or no decline in infection were observed in up to 30% of villages.

Purpose of the Study:

  • To analyze factors contributing to persistent hotspots (PHS) in schistosomiasis control.
  • To identify potential strategies for addressing PHS to achieve schistosomiasis elimination.

Main Methods:

  • Analysis of SCORE field studies in low-, moderate-, and high-prevalence areas across Africa.
  • Comparison of PHS with villages that responded effectively to repeated MDA.

Main Results:

  • No consistent relationship found between PHS and intervention type, MDA coverage, or baseline infection levels.
  • Differences in water sources, sanitation, and hygiene were noted between PHS and responsive villages in smaller studies.

Conclusions:

  • Persistent hotspots (PHS) pose a significant challenge to schistosomiasis elimination efforts.
  • Identifying PHS after a few years of MDA is possible, but generalizable approaches require further research across diverse social-ecological settings.