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School-based deworming (SBD) reporting significantly overestimates actual coverage. This study found that reported SBD rates were much higher than individual-level surveys, highlighting potential overestimations in mass drug administration (MDA) program data.

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Area of Science:

  • Global Health
  • Infectious Diseases
  • Public Health Interventions

Background:

  • Soil-transmitted helminths (STH) affect over 1.5 billion people globally, causing anemia and stunting.
  • School-based deworming (SBD) through mass drug administration (MDA) is a WHO-recommended strategy to reduce STH morbidity.
  • The DeWorm3 trial assessed community-wide MDA as an alternative to SBD for interrupting STH transmission.

Purpose of the Study:

  • To quantify discrepancies between school-level and individual-level reporting of SBD coverage.
  • To evaluate the accuracy of SBD coverage estimates used in public health programs.
  • To assess the impact of overestimation on deworming program reach.

Main Methods:

  • Compared population-weighted school-level SBD averages with aggregated individual-level SBD estimates.
  • Calculated Mean Squared Error (MSE) at each study site (Benin, India, Malawi).
  • Applied MSE to control arm data to estimate true individual-level SBD coverage.

Main Results:

  • School-level SBD reporting consistently showed higher coverage than individual-level data across all sites.
  • Estimated SBD coverage in Benin dropped from 89.1% to 70.5% (p<0.001) after applying MSE.
  • Estimated SBD coverage in India decreased from 97.7% to 84.5% (p<0.001), and in Malawi from 41.5% to 37.5% (p<0.001).

Conclusions:

  • School-level reporting significantly overestimates actual deworming program coverage.
  • Current SBD coverage estimates may substantially inflate the true reach of pediatric deworming efforts.
  • Accurate coverage data is crucial for effective STH control strategies and resource allocation.