Objective: To examine occurrence of Acute Respiratory tract Infections (ARIs) and determine facto... more Objective: To examine occurrence of Acute Respiratory tract Infections (ARIs) and determine factors associated with ARIs among children under five years attending Kinango Sub-County Hospital. Methods: A cross-sectional survey was conducted among mother-child aged between 0-59 month’s pairs attending outpatient care. Participants were recruited using systematic sampling method. Data was collected using an interviewer-administered structured questionnaire. Descriptive statistics were used to summarize child, parental and environmental characteristics. Factors associated with ARIs were established using binary logistic regression analysis. Odds Ratio (OR), at 95% Confidence Interval (CI) and p <0.05 significant level was used to describe an association between covariates and the outcome variable. Independent factors associated with occurrence of ARIS were determined by stepwise logistic regression. Results: 385 children participated in this study. 228 children (59.2%) presented with...
The Kenyan Ministry of Health and its partners through the Division of Vector-Borne and Neglected... more The Kenyan Ministry of Health and its partners through the Division of Vector-Borne and Neglected Tropical Diseases, is in charge of the Lymphatic Filariasis Mass Drug Administration programme. This is implemented through the national, county, and sub-county neglected tropical diseases coordinators. The current study sought to understand the roles, challenges faced and suggestions of how program performance can be improved by the community health extension workers, county and sub-county neglected tropical diseases coordinators. Two wards of the Kaloleni sub-county; Kilifi County were purposively selected. In 2015, Kaloleni and Kayafungo wards had a treatment coverage of 58% and 54% respectively; 62% and 39% respectively in 2016, all below the recommended minimum treatment coverage of 65%. Qualitative data was collected through sixteen in-depth interviews with community health extension workers and two semi-structured interviews with the county and sub-county neglected tropical dise...
Background: Drug and substance abuse has adverse health effects and a substantial economic burden... more Background: Drug and substance abuse has adverse health effects and a substantial economic burden to the global economies and at the household level. There is, however, limited data on socio-economic disparities in drugs and substance abuse in low-to-middle income countries such as Kenya. This study aimed to assess the socio-economic disparities in Murang’a county of central Kenya.Method: The study design was cross-sectional, and data collection was conducted between November and December 2017. A total of 449 households with at least one person who uses any drug or substance of abuse were randomly sampled from 4 purposively selected sub-locations of Murang’ a County. Structured questionnaires were used to collect data on types of drugs used, economic burden, and gender roles at the household level. Household socio-economic status (SES) was established (low, middle, and high SES ) using principal component analysis f(PCA) from a set of household assets and characteristics. Multivaria...
Background Malaria prevention in Africa is mainly through the use of long-lasting insecticide tre... more Background Malaria prevention in Africa is mainly through the use of long-lasting insecticide treated nets (LLINs). The objective of the study was to assess the effect of supplementing LLINs with either larviciding with Bacillus thuringiensis israelensis (Bti) or community education and mobilization (CEM), or with both interventions in the context of integrated vector management (IVM). Methods The study involved a factorial, cluster-randomized, controlled trial conducted in Malindi and Nyabondo sites in Kenya and Tolay site in Ethiopia, to assess the impact of the following four intervention options on mosquitoes and malaria prevalence: LLINs only (arm 1); LLINs and Bti (arm 2); LLINs and CEM (arm 3); and, LLINs combined with Bti and CEM (arm 4). Between January 2013 and December 2015, CDC light traps were used to sample adult mosquitoes during the second, third and fourth quarter of each year in 10 houses in each of 16 villages at each of the three study sites. Larvae were sampled ...
Background: Mosquito-proofing of houses using wire mesh screens is gaining greater recognition as... more Background: Mosquito-proofing of houses using wire mesh screens is gaining greater recognition as a practical intervention for reducing exposure to malaria transmitting mosquitoes. Screening potentially protects all persons sleeping inside the house against transmission of mosquito-borne diseases indoors. The study assessed the effectiveness of house eaves screening in reducing indoor vector densities and malaria prevalence in Nyabondo, western Kenya. Methods: 160 houses were selected for the study, with half of them randomly chosen for eaves screening with fibre-glass coated wire mesh (experimental group) and the other half left without screening (control group). Randomization was carried out by use of computer-generated list in permuted blocks of ten houses and 16 village blocks, with half of them allocated treatment in a ratio of 1:1. Cross-sectional baseline entomological and parasitological data were collected before eave screening. After baseline data collection, series of sam...
Lymphatic filariasis (LF) is a debilitating disease associated with extensive disfigurement and i... more Lymphatic filariasis (LF) is a debilitating disease associated with extensive disfigurement and is one of a diverse group of diseases referred to as neglected tropical diseases (NTDs) which mainly occur among the poorest populations. In line with global recommendations to eliminate LF, Kenya launched its LF elimination programme in 2002 with the aim to implement annual mass drug administration (MDA) in order to interrupt LF transmission. However, the programme faced financial and administrative challenges over the years such that sustained annual MDA was not possible. Recently, there has been renewed interest to eliminate LF and the Kenyan Ministry of Health, through support from World Health Organization (WHO), restarted annual MDA in 2015. The objective of this study was to evaluate the current status of LF infection in the endemic coastal region of Kenya before MDA campaigns were restarted. Ten sentinel sites in Kwale, Kilifi, Tana River, Lamu, and Taita-Taveta counties in coasta...
The American journal of tropical medicine and hygiene, May 22, 2016
Water, sanitation, and hygiene (WaSH) technologies and behaviors can prevent infection by soil-tr... more Water, sanitation, and hygiene (WaSH) technologies and behaviors can prevent infection by soil-transmitted helminth species independently, but may also interact in complex ways. However, these interactions are poorly understood. The purpose of this study was to characterize how school and home WaSH exposures were associated with Ascaris lumbricoides infection and to identify relevant interactions between separate WaSH technologies and behaviors. A study was conducted among 4,404 children attending 51 primary schools in western Kenya. We used multivariable mixed effects logistic regression to characterize how various WaSH exposures were associated with A. lumbricoides infection after annual school-based deworming. Few WaSH behaviors and technologies were independently associated with A. lumbricoides infection. However, by considering relevant interdependencies between variables, important associations were elucidated. The association between handwashing and A. lumbricoides depended l...
Under trial conditions insecticide-treated nets have been shown to provide significant clinical a... more Under trial conditions insecticide-treated nets have been shown to provide significant clinical and mortality protection under a range of malaria transmission intensity conditions. There are, however, few operational impact data, notably in very intense transmission conditions. This study, reports on malaria infection among Kenyan schoolchildren living in areas of intense malaria transmission and their reported use of insecticide-treated bed nets. 5188 children in 54 schools were randomly sampled from seven counties surrounding Lake Victoria between May and June 2014. A questionnaire was administered to schoolchildren in classes 2-6 on the use of a long-lasting, insecticide-treated net (LLIN) the night before the survey and provided a single blood sample for a rapid diagnostic test for malaria infection. Analysis of the impact of insecticide-treated net use on malaria prevalence was undertaken using a multivariable, mixed effects, logistic regression at 95 % confidence interval (CI)...
The implementation of soil-transmitted helminth (STH) treatment programmes occurs in varied envir... more The implementation of soil-transmitted helminth (STH) treatment programmes occurs in varied environmental, social and economic contexts. Programme impact will be influenced by factors that affect the reduction in the prevalence and intensity of infections following treatment, as well as the subsequent rate of reinfection. To better understand the heterogeneity of programme impact and its underlying reasons, we investigated the influence of contextual factors on reduction in STH infection as part of the national school based deworming (SBD) programme in Kenya. Data on the prevalence and intensity of infection were collected within the monitoring and evaluation component of the SBD programme at baseline and after delivery of two annual treatment rounds in 153 schools in western Kenya. Using a framework that considers STH epidemiology and transmission dynamics, capacity to deliver treatment, operational feasibility and financial capacity, data were assembled at both school and district (county) levels. Geographic heterogeneity of programme impact was assessed by descriptive and spatial analyses. Factors associated with absolute reductions of Ascaris lumbricoides and hookworm infection prevalence and intensity were identified using mixed effects linear regression modelling adjusting for baseline infection levels. The reduction in prevalence and intensity of A. lumbricoides and hookworms varied significantly by county and within counties by school. Multivariable analysis of factors associated with programme impact showed that absolute A. lumbricoides reductions varied by environmental conditions and access to improved sanitation at schools or within the community. Larger reduction in prevalence and intensity of hookworms were found in schools located within areas with higher community level access to improved sanitation and within counties with higher economic and health service delivery indicator scores. The study identifies factors associated with the impact of school-based deworming and in particular highlights how access to water, sanitation and hygiene and environmental conditions influence the impact of deworming programmes.
Background:Soil-transmitted helminths, a class of parasitic intestinal worms, are pervasive in ma... more Background:Soil-transmitted helminths, a class of parasitic intestinal worms, are pervasive in many low-income settings. Infection among children can lead to poor nutritional outcomes, anaemia, and reduced cognition. Mass treatment, typically administered through schools, with yearly or biannual drugs is inexpensive and can reduce worm burden, but reinfection can occur rapidly. Access to and use of sanitation facilities and proper hygiene can reduce infection, but rigorous data are scarce. Among school-age children, infection can occur at home or at school, but little is known about the relative importance of WASH in transmission in these two settings. Methods:We explored the relationships between school and household water, sanitation, and hygiene conditions and behaviours during the baseline of a large-scale mass drug administration programme in Kenya. We assessed several WASH measures to quantify the exposure of school children, and developed theory and empirically-based parsimonious models. Results:Results suggest mixed impacts of household and school WASH on prevalence and intensity of infection. WASH risk factors differed across individual worm species, which is expected given the different mechanisms of infection. Conclusions:No trend of the relative importance of school versus household-level WASH emerged, though some factors, like water supply were more strongly related to lower infection, which suggests it is important in supporting other school practices, such as hand-washing and keeping school toilets clean
Background:Schistosomiasis is a major public health problem in Kenya as well as in many other tro... more Background:Schistosomiasis is a major public health problem in Kenya as well as in many other tropical countries and is considered one of the most prevalentdiseases in the rural population. Between 2004 and 2009, primaryschoolchildreninMweairrigationschemeweretreatedforSchistosoma mansoni.Inthefouryear control programme, there was occurrence of light re-infection withS. mansoni. Therefore, the aim of this study was to assess the current prevalence ofS. mansoni, infection two years after the withdrawal of mass drug administration (MDA) programme. Methods:We carried out a cross-sectional study on a population of 387 children attending 3 primary schools located in Mwea irrigation scheme. Children, aged 8–16 years were interviewed and screened forS. mansoniusing duplicate Kato-Katz thick smears. Comparisonsof prevalence by age group and gender were tested for significance on the basis of the Wald test. Best prediction factors for infection withS. mansoniwere selected using forward–stepwise variable selection method. Results:The overall prevalence ofS. mansoniwas 53.7 %, (95%CI: 49.0–59.0, p-value = 0.000). Male children had higher prevalence of infection, 66.1 % (95%CI: 59.8–73.2, p-value = 0.000) compared to females. The gender (sex) of a child was the only factor reported to be significantly associated withS. mansoniinfection, (OR = 1.9, p-value = 0.015, 95%CI: 1.13–3.21). Conclusions:There was high prevalence ofS. mansoniinfections in the study area, two years after the withdrawal of MDA programme. We suggest that treatment should be continued in the school children at regular intervals, monitoring and surveillance intensified to ensure interruption of transmission areas
Objective: To examine occurrence of Acute Respiratory tract Infections (ARIs) and determine facto... more Objective: To examine occurrence of Acute Respiratory tract Infections (ARIs) and determine factors associated with ARIs among children under five years attending Kinango Sub-County Hospital. Methods: A cross-sectional survey was conducted among mother-child aged between 0-59 month’s pairs attending outpatient care. Participants were recruited using systematic sampling method. Data was collected using an interviewer-administered structured questionnaire. Descriptive statistics were used to summarize child, parental and environmental characteristics. Factors associated with ARIs were established using binary logistic regression analysis. Odds Ratio (OR), at 95% Confidence Interval (CI) and p <0.05 significant level was used to describe an association between covariates and the outcome variable. Independent factors associated with occurrence of ARIS were determined by stepwise logistic regression. Results: 385 children participated in this study. 228 children (59.2%) presented with...
The Kenyan Ministry of Health and its partners through the Division of Vector-Borne and Neglected... more The Kenyan Ministry of Health and its partners through the Division of Vector-Borne and Neglected Tropical Diseases, is in charge of the Lymphatic Filariasis Mass Drug Administration programme. This is implemented through the national, county, and sub-county neglected tropical diseases coordinators. The current study sought to understand the roles, challenges faced and suggestions of how program performance can be improved by the community health extension workers, county and sub-county neglected tropical diseases coordinators. Two wards of the Kaloleni sub-county; Kilifi County were purposively selected. In 2015, Kaloleni and Kayafungo wards had a treatment coverage of 58% and 54% respectively; 62% and 39% respectively in 2016, all below the recommended minimum treatment coverage of 65%. Qualitative data was collected through sixteen in-depth interviews with community health extension workers and two semi-structured interviews with the county and sub-county neglected tropical dise...
Background: Drug and substance abuse has adverse health effects and a substantial economic burden... more Background: Drug and substance abuse has adverse health effects and a substantial economic burden to the global economies and at the household level. There is, however, limited data on socio-economic disparities in drugs and substance abuse in low-to-middle income countries such as Kenya. This study aimed to assess the socio-economic disparities in Murang’a county of central Kenya.Method: The study design was cross-sectional, and data collection was conducted between November and December 2017. A total of 449 households with at least one person who uses any drug or substance of abuse were randomly sampled from 4 purposively selected sub-locations of Murang’ a County. Structured questionnaires were used to collect data on types of drugs used, economic burden, and gender roles at the household level. Household socio-economic status (SES) was established (low, middle, and high SES ) using principal component analysis f(PCA) from a set of household assets and characteristics. Multivaria...
Background Malaria prevention in Africa is mainly through the use of long-lasting insecticide tre... more Background Malaria prevention in Africa is mainly through the use of long-lasting insecticide treated nets (LLINs). The objective of the study was to assess the effect of supplementing LLINs with either larviciding with Bacillus thuringiensis israelensis (Bti) or community education and mobilization (CEM), or with both interventions in the context of integrated vector management (IVM). Methods The study involved a factorial, cluster-randomized, controlled trial conducted in Malindi and Nyabondo sites in Kenya and Tolay site in Ethiopia, to assess the impact of the following four intervention options on mosquitoes and malaria prevalence: LLINs only (arm 1); LLINs and Bti (arm 2); LLINs and CEM (arm 3); and, LLINs combined with Bti and CEM (arm 4). Between January 2013 and December 2015, CDC light traps were used to sample adult mosquitoes during the second, third and fourth quarter of each year in 10 houses in each of 16 villages at each of the three study sites. Larvae were sampled ...
Background: Mosquito-proofing of houses using wire mesh screens is gaining greater recognition as... more Background: Mosquito-proofing of houses using wire mesh screens is gaining greater recognition as a practical intervention for reducing exposure to malaria transmitting mosquitoes. Screening potentially protects all persons sleeping inside the house against transmission of mosquito-borne diseases indoors. The study assessed the effectiveness of house eaves screening in reducing indoor vector densities and malaria prevalence in Nyabondo, western Kenya. Methods: 160 houses were selected for the study, with half of them randomly chosen for eaves screening with fibre-glass coated wire mesh (experimental group) and the other half left without screening (control group). Randomization was carried out by use of computer-generated list in permuted blocks of ten houses and 16 village blocks, with half of them allocated treatment in a ratio of 1:1. Cross-sectional baseline entomological and parasitological data were collected before eave screening. After baseline data collection, series of sam...
Lymphatic filariasis (LF) is a debilitating disease associated with extensive disfigurement and i... more Lymphatic filariasis (LF) is a debilitating disease associated with extensive disfigurement and is one of a diverse group of diseases referred to as neglected tropical diseases (NTDs) which mainly occur among the poorest populations. In line with global recommendations to eliminate LF, Kenya launched its LF elimination programme in 2002 with the aim to implement annual mass drug administration (MDA) in order to interrupt LF transmission. However, the programme faced financial and administrative challenges over the years such that sustained annual MDA was not possible. Recently, there has been renewed interest to eliminate LF and the Kenyan Ministry of Health, through support from World Health Organization (WHO), restarted annual MDA in 2015. The objective of this study was to evaluate the current status of LF infection in the endemic coastal region of Kenya before MDA campaigns were restarted. Ten sentinel sites in Kwale, Kilifi, Tana River, Lamu, and Taita-Taveta counties in coasta...
The American journal of tropical medicine and hygiene, May 22, 2016
Water, sanitation, and hygiene (WaSH) technologies and behaviors can prevent infection by soil-tr... more Water, sanitation, and hygiene (WaSH) technologies and behaviors can prevent infection by soil-transmitted helminth species independently, but may also interact in complex ways. However, these interactions are poorly understood. The purpose of this study was to characterize how school and home WaSH exposures were associated with Ascaris lumbricoides infection and to identify relevant interactions between separate WaSH technologies and behaviors. A study was conducted among 4,404 children attending 51 primary schools in western Kenya. We used multivariable mixed effects logistic regression to characterize how various WaSH exposures were associated with A. lumbricoides infection after annual school-based deworming. Few WaSH behaviors and technologies were independently associated with A. lumbricoides infection. However, by considering relevant interdependencies between variables, important associations were elucidated. The association between handwashing and A. lumbricoides depended l...
Under trial conditions insecticide-treated nets have been shown to provide significant clinical a... more Under trial conditions insecticide-treated nets have been shown to provide significant clinical and mortality protection under a range of malaria transmission intensity conditions. There are, however, few operational impact data, notably in very intense transmission conditions. This study, reports on malaria infection among Kenyan schoolchildren living in areas of intense malaria transmission and their reported use of insecticide-treated bed nets. 5188 children in 54 schools were randomly sampled from seven counties surrounding Lake Victoria between May and June 2014. A questionnaire was administered to schoolchildren in classes 2-6 on the use of a long-lasting, insecticide-treated net (LLIN) the night before the survey and provided a single blood sample for a rapid diagnostic test for malaria infection. Analysis of the impact of insecticide-treated net use on malaria prevalence was undertaken using a multivariable, mixed effects, logistic regression at 95 % confidence interval (CI)...
The implementation of soil-transmitted helminth (STH) treatment programmes occurs in varied envir... more The implementation of soil-transmitted helminth (STH) treatment programmes occurs in varied environmental, social and economic contexts. Programme impact will be influenced by factors that affect the reduction in the prevalence and intensity of infections following treatment, as well as the subsequent rate of reinfection. To better understand the heterogeneity of programme impact and its underlying reasons, we investigated the influence of contextual factors on reduction in STH infection as part of the national school based deworming (SBD) programme in Kenya. Data on the prevalence and intensity of infection were collected within the monitoring and evaluation component of the SBD programme at baseline and after delivery of two annual treatment rounds in 153 schools in western Kenya. Using a framework that considers STH epidemiology and transmission dynamics, capacity to deliver treatment, operational feasibility and financial capacity, data were assembled at both school and district (county) levels. Geographic heterogeneity of programme impact was assessed by descriptive and spatial analyses. Factors associated with absolute reductions of Ascaris lumbricoides and hookworm infection prevalence and intensity were identified using mixed effects linear regression modelling adjusting for baseline infection levels. The reduction in prevalence and intensity of A. lumbricoides and hookworms varied significantly by county and within counties by school. Multivariable analysis of factors associated with programme impact showed that absolute A. lumbricoides reductions varied by environmental conditions and access to improved sanitation at schools or within the community. Larger reduction in prevalence and intensity of hookworms were found in schools located within areas with higher community level access to improved sanitation and within counties with higher economic and health service delivery indicator scores. The study identifies factors associated with the impact of school-based deworming and in particular highlights how access to water, sanitation and hygiene and environmental conditions influence the impact of deworming programmes.
Background:Soil-transmitted helminths, a class of parasitic intestinal worms, are pervasive in ma... more Background:Soil-transmitted helminths, a class of parasitic intestinal worms, are pervasive in many low-income settings. Infection among children can lead to poor nutritional outcomes, anaemia, and reduced cognition. Mass treatment, typically administered through schools, with yearly or biannual drugs is inexpensive and can reduce worm burden, but reinfection can occur rapidly. Access to and use of sanitation facilities and proper hygiene can reduce infection, but rigorous data are scarce. Among school-age children, infection can occur at home or at school, but little is known about the relative importance of WASH in transmission in these two settings. Methods:We explored the relationships between school and household water, sanitation, and hygiene conditions and behaviours during the baseline of a large-scale mass drug administration programme in Kenya. We assessed several WASH measures to quantify the exposure of school children, and developed theory and empirically-based parsimonious models. Results:Results suggest mixed impacts of household and school WASH on prevalence and intensity of infection. WASH risk factors differed across individual worm species, which is expected given the different mechanisms of infection. Conclusions:No trend of the relative importance of school versus household-level WASH emerged, though some factors, like water supply were more strongly related to lower infection, which suggests it is important in supporting other school practices, such as hand-washing and keeping school toilets clean
Background:Schistosomiasis is a major public health problem in Kenya as well as in many other tro... more Background:Schistosomiasis is a major public health problem in Kenya as well as in many other tropical countries and is considered one of the most prevalentdiseases in the rural population. Between 2004 and 2009, primaryschoolchildreninMweairrigationschemeweretreatedforSchistosoma mansoni.Inthefouryear control programme, there was occurrence of light re-infection withS. mansoni. Therefore, the aim of this study was to assess the current prevalence ofS. mansoni, infection two years after the withdrawal of mass drug administration (MDA) programme. Methods:We carried out a cross-sectional study on a population of 387 children attending 3 primary schools located in Mwea irrigation scheme. Children, aged 8–16 years were interviewed and screened forS. mansoniusing duplicate Kato-Katz thick smears. Comparisonsof prevalence by age group and gender were tested for significance on the basis of the Wald test. Best prediction factors for infection withS. mansoniwere selected using forward–stepwise variable selection method. Results:The overall prevalence ofS. mansoniwas 53.7 %, (95%CI: 49.0–59.0, p-value = 0.000). Male children had higher prevalence of infection, 66.1 % (95%CI: 59.8–73.2, p-value = 0.000) compared to females. The gender (sex) of a child was the only factor reported to be significantly associated withS. mansoniinfection, (OR = 1.9, p-value = 0.015, 95%CI: 1.13–3.21). Conclusions:There was high prevalence ofS. mansoniinfections in the study area, two years after the withdrawal of MDA programme. We suggest that treatment should be continued in the school children at regular intervals, monitoring and surveillance intensified to ensure interruption of transmission areas
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Papers by Collins Okoyo
settings. Infection among children can lead to poor nutritional outcomes, anaemia, and reduced cognition. Mass
treatment, typically administered through schools, with yearly or biannual drugs is inexpensive and can reduce
worm burden, but reinfection can occur rapidly. Access to and use of sanitation facilities and proper hygiene can
reduce infection, but rigorous data are scarce. Among school-age children, infection can occur at home or at
school, but little is known about the relative importance of WASH in transmission in these two settings.
Methods:We explored the relationships between school and household water, sanitation, and hygiene conditions
and behaviours during the baseline of a large-scale mass drug administration programme in Kenya. We assessed
several WASH measures to quantify the exposure of school children, and developed theory and empirically-based
parsimonious models.
Results:Results suggest mixed impacts of household and school WASH on prevalence and intensity of infection.
WASH risk factors differed across individual worm species, which is expected given the different mechanisms of
infection.
Conclusions:No trend of the relative importance of school versus household-level WASH emerged, though some
factors, like water supply were more strongly related to lower infection, which suggests it is important in supporting
other school practices, such as hand-washing and keeping school toilets clean
countries and is considered one of the most prevalentdiseases in the rural population. Between 2004 and 2009,
primaryschoolchildreninMweairrigationschemeweretreatedforSchistosoma mansoni.Inthefouryear
control programme, there was occurrence of light re-infection withS. mansoni. Therefore, the aim of this study was
to assess the current prevalence ofS. mansoni, infection two years after the withdrawal of mass drug administration
(MDA) programme.
Methods:We carried out a cross-sectional study on a population of 387 children attending 3 primary schools located in
Mwea irrigation scheme. Children, aged 8–16 years were interviewed and screened forS. mansoniusing duplicate
Kato-Katz thick smears. Comparisonsof prevalence by age group and gender were tested for significance on the
basis of the Wald test. Best prediction factors for infection withS. mansoniwere selected using forward–stepwise
variable selection method.
Results:The overall prevalence ofS. mansoniwas 53.7 %, (95%CI: 49.0–59.0, p-value = 0.000). Male children had
higher prevalence of infection, 66.1 % (95%CI: 59.8–73.2, p-value = 0.000) compared to females. The gender (sex) of a
child was the only factor reported to be significantly associated withS. mansoniinfection, (OR = 1.9, p-value = 0.015,
95%CI: 1.13–3.21).
Conclusions:There was high prevalence ofS. mansoniinfections in the study area, two years after the withdrawal
of MDA programme. We suggest that treatment should be continued in the school children at regular intervals,
monitoring and surveillance intensified to ensure interruption of transmission areas
settings. Infection among children can lead to poor nutritional outcomes, anaemia, and reduced cognition. Mass
treatment, typically administered through schools, with yearly or biannual drugs is inexpensive and can reduce
worm burden, but reinfection can occur rapidly. Access to and use of sanitation facilities and proper hygiene can
reduce infection, but rigorous data are scarce. Among school-age children, infection can occur at home or at
school, but little is known about the relative importance of WASH in transmission in these two settings.
Methods:We explored the relationships between school and household water, sanitation, and hygiene conditions
and behaviours during the baseline of a large-scale mass drug administration programme in Kenya. We assessed
several WASH measures to quantify the exposure of school children, and developed theory and empirically-based
parsimonious models.
Results:Results suggest mixed impacts of household and school WASH on prevalence and intensity of infection.
WASH risk factors differed across individual worm species, which is expected given the different mechanisms of
infection.
Conclusions:No trend of the relative importance of school versus household-level WASH emerged, though some
factors, like water supply were more strongly related to lower infection, which suggests it is important in supporting
other school practices, such as hand-washing and keeping school toilets clean
countries and is considered one of the most prevalentdiseases in the rural population. Between 2004 and 2009,
primaryschoolchildreninMweairrigationschemeweretreatedforSchistosoma mansoni.Inthefouryear
control programme, there was occurrence of light re-infection withS. mansoni. Therefore, the aim of this study was
to assess the current prevalence ofS. mansoni, infection two years after the withdrawal of mass drug administration
(MDA) programme.
Methods:We carried out a cross-sectional study on a population of 387 children attending 3 primary schools located in
Mwea irrigation scheme. Children, aged 8–16 years were interviewed and screened forS. mansoniusing duplicate
Kato-Katz thick smears. Comparisonsof prevalence by age group and gender were tested for significance on the
basis of the Wald test. Best prediction factors for infection withS. mansoniwere selected using forward–stepwise
variable selection method.
Results:The overall prevalence ofS. mansoniwas 53.7 %, (95%CI: 49.0–59.0, p-value = 0.000). Male children had
higher prevalence of infection, 66.1 % (95%CI: 59.8–73.2, p-value = 0.000) compared to females. The gender (sex) of a
child was the only factor reported to be significantly associated withS. mansoniinfection, (OR = 1.9, p-value = 0.015,
95%CI: 1.13–3.21).
Conclusions:There was high prevalence ofS. mansoniinfections in the study area, two years after the withdrawal
of MDA programme. We suggest that treatment should be continued in the school children at regular intervals,
monitoring and surveillance intensified to ensure interruption of transmission areas