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Effectiveness of Albendazole for Hookworm Varies Widely by Community and Correlates with Nutritional Factors: A Cross-Sectional Study of School-Age Children in Ghana
Debbie Humphries
Debbie Humphries
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut.
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Sara Nguyen
Sara Nguyen
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut.
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Sunny Kumar
Sunny Kumar
Yale Partnerships for Global Health, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut.
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Josephine E. Quagraine
Josephine E. Quagraine
Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana.
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Joseph Otchere
Joseph Otchere
Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana.
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Lisa M. Harrison
Lisa M. Harrison
Yale Partnerships for Global Health, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut.
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Michael Wilson
Michael Wilson
Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana.
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Michael Cappello
Michael Cappello
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut.
Yale Partnerships for Global Health, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut.
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Mass drug administration (MDA) targeting school-age children is recommended by the World Health Organization for the global control of soil-transmitted helminth (STH) infections. Although considered safe and cost-effective to deliver, benzimidazole anthelminthics are variably effective against the three most common STHs, and widespread use has raised concern about the potential for emerging resistance. To identify factors mediating response to albendazole, we conducted a cross-sectional study of hookworm infection in the Kintampo North Municipality of Ghana in 2011. Among 140 school-age children residing in five contiguous communities, the hookworm prevalence was 59% (82/140). The overall cure rate following administration of single-dose albendazole (400 mg) was 35% (27/76), with a community-wide fecal egg reduction rate (ERR) of 61% (95% confidence interval: 51.8–71.1). Significant disparities were observed in albendazole effectiveness by community, with a cure rate as low as 0% (N = 24) in Jato Akuraa and ERRs ranging from 53% to 95% across the five study sites. Individual host factors associated with response to deworming treatment included time since last meal, pretreatment blood hemoglobin level, and mid-upper arm circumference. These data demonstrate significant community-level variation in the effectiveness of albendazole, even among populations living in close proximity. Identification of host factors that influence response to albendazole, most notably the timing of drug administration and nutritional factors, creates an opportunity to enhance the effectiveness of deworming through targeted interventions. These findings also demonstrate the importance of measuring anthelminthic response as part of the monitoring and evaluation of community-based deworming programs.
Author Notes
Financial support: This work was supported by National Institutes of Health grant 1R01AI099623, a Wilbur Downs International Health Research Fellowship, and the Yale College Dean's Research Fellowship.
Authors' addresses: Debbie Humphries and Sara Nguyen, Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, E-mails: debbie.humphries@yale.edu and sara.ann.nguyen@gmail.com. Sunny Kumar, Lisa M. Harrison, and Michael Cappello, Department of Pediatrics, Yale School of Medicine, New Haven, CT, E-mails: sunnykumar.yale@gmail.com, lisa.harrison@yale.edu, and michael.cappello@yale.edu. Josephine E. Quagraine, Joseph Otchere, and Michael Wilson, Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana, E-mails: jquagraine2@gmail.com, jotchere@noguchi.ug.edu.gh, and mwilson@noguchi.ug.edu.gh.
ProCite
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Reference Manager
BibTeX
Zotero
EndNote
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1.
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2.
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17.
Davey C, Aiken AM, Hayes RJ, Hargreaves JR, 2015. Re-analysis of health and educational impacts of a school-based deworming programme in western Kenya: a statistical replication of a cluster quasi-randomized stepped-wedge trial. Int J Epidemiol 44: 1581–1592.
-
18.
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-
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Humphries D, Nguyen S, Boakye D, Wilson M, Cappello M, 2012. The promise and pitfalls of mass drug administration to control intestinal helminth infections. Curr Opin Infect Dis 25: 584–589.
-
21.
Truscott J, Turner H, Anderson R, 2015. What impact will the achievement of the current World Health Organisation targets for anthelmintic treatment coverage in children have on the intensity of soil transmitted helminth infections? Parasit Vectors 8: 1–12.
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