An integrated mass drug administration against hymenolepiasis and schistosomiasis in Sudan

Hymenolepis nana, commonly known as the dwarf tapeworm, affects 50 to 75 million people worldwide. To date, no studies have explored the disease burden of H. nana infection in Sudan. This study aimed to determine the national prevalence of H. nana across 189 districts and 18 states in Sudan and the number of individuals infected with H. nana who did not receive treatment during the mass drug administration (MDA) campaign targeting schistosomiasis. In addition, the study sought to evaluate the extent of co-infection of H. nana with schistosomiasis and soil-transmitted helminthiasis. This involved a secondary analysis of a nationwide survey conducted in 2017 in Sudan. Binomial family generalized linear models with a logarithmic link function were used to estimate the prevalence ratio of potential risk factors, including sex and water and sanitation conditions in schools and households. For the nationwide survey, a 2-stage sampling method was used, in which 105,167 students were selected from 1,772 schools. A total of 96,679 stool samples were collected, of which 4,706 (4.9%) tested positive for H. nana. Of these, fewer than 1% were co-infected with schistosomiasis (either Schistosoma haematobium or Schistosoma mansoni), and a mere 0.1% had co-infections with soil-transmitted helminths. At an 8% threshold for village-based MDA, approximately 1.1 million infected adults are ineligible to receive praziquantel from the village-based MDA. Children residing in households with improved latrines had a lower odds of H. nana infection than those without improved latrines did (adjusted odds ratio=0.87, 95% confidence interval=0.80-0.94, p=0.001). In countries where H. nana is endemic, such as Sudan, providers making MDA decisions should consider the prevalence of either H. nana or schistosomiasis, rather than focusing solely on the latter.