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Impact of Schistosomiasis Mass Drug Administration on Schistosomiasis Prevalence among School Children in Nigeria

Abstract

Schistosomiasis is a neglected tropical disease that remains an important public health concern in several endemic areas of Nigeria, particularly among school-age children who may have frequent contact with freshwater sources where transmission occurs. Repeated infection can result in anaemia, malnutrition, impaired physical development, reduced school attendance, poor educational performance, and other chronic health complications. Schistosomiasis is transmitted when individuals come into contact with freshwater containing infective stages of the parasite, making children in communities with limited access to safe water and adequate sanitation particularly vulnerable. Mass Drug Administration (MDA) is a major public health intervention for schistosomiasis control and involves the periodic administration of recommended medicines, particularly praziquantel, to eligible populations in endemic communities. The objective of MDA is to reduce the burden of infection, prevent complications, and reduce transmission within affected populations. Schistosomiasis prevalence refers to the proportion of individuals within a defined population who have evidence of schistosomiasis infection at a particular time. In Nigeria, sustained and adequately implemented MDA programmes are important for reducing the burden of schistosomiasis among school children and supporting national neglected tropical disease control and elimination efforts. Against this background, this study investigates the impact of schistosomiasis mass drug administration on schistosomiasis prevalence among school children in Nigeria. The study will be anchored on the Health Belief Model, the Health Systems Framework, and the Social Ecological Model. The Health Belief Model explains preventive health behaviour through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action and provides a framework for understanding children's and caregivers' participation in schistosomiasis MDA. The Health Systems Framework emphasizes service delivery, health workforce, health information, essential medicines, financing, and accessibility as important components of effective disease-control programmes. The Social Ecological Model recognizes that infection risk and preventive behaviour are influenced by interacting individual, household, school, community, environmental, and health-system factors. Collectively, these theoretical perspectives provide a suitable framework for explaining how schistosomiasis MDA may influence schistosomiasis prevalence among school children in Nigeria. The study will adopt a quantitative quasi-experimental, cohort, or repeated cross-sectional research design, depending on the availability of programme and surveillance data. Data will be collected from school-age children attending selected primary schools in communities identified as endemic for schistosomiasis in Nigeria. A multistage sampling technique will be used to select states, local government areas, endemic communities, schools, and eligible pupils. Schistosomiasis MDA will be assessed using indicators such as MDA coverage, number of treatment rounds received, frequency of treatment, proportion of eligible children treated, availability of praziquantel, treatment adherence, availability of trained drug distributors, school-based distribution coverage, community and school mobilization, caregiver awareness, supervision, and programme continuity. Schistosomiasis prevalence will be assessed using appropriate parasitological diagnostic methods and relevant programme surveillance procedures to determine the proportion of children with evidence of infection. Data will be obtained from structured questionnaires, school MDA registers, drug-distribution records, laboratory results, school health records, community health-worker records, and programme reports where available. Descriptive statistics will be used to summarize participants' characteristics, MDA coverage, and schistosomiasis prevalence patterns. Inferential statistical techniques, including chi-square tests, prevalence comparisons, correlation analysis, and regression analysis, will be used to determine the impact of MDA on schistosomiasis prevalence. Where baseline and follow-up data are available, changes in prevalence before and after MDA implementation will be examined. Diagnostic tests will also be conducted to assess the reliability and robustness of the findings. The study is expected to find that effective schistosomiasis MDA has a significant negative impact on schistosomiasis prevalence among school children in Nigeria. Schools and communities with high and sustained MDA coverage are expected to demonstrate lower levels of schistosomiasis infection than those with inadequate or inconsistent treatment coverage. Periodic administration of recommended praziquantel treatment may reduce the burden of infection among school children and prevent the development of severe complications associated with repeated infection. School-based distribution may also improve access to treatment by reaching large numbers of eligible children through established educational structures. Community mobilization, caregiver education, and health education may further improve participation in MDA and increase awareness of schistosomiasis prevention. Conversely, low treatment coverage, medicine shortages, inadequate drug-distributor training, refusal or non-acceptance of treatment, poor programme supervision, and difficulties reaching children in remote communities may reduce the effectiveness of MDA. However, MDA alone may not completely determine schistosomiasis prevalence because freshwater exposure, sanitation conditions, availability of safe water, hygiene practices, environmental factors, and repeated contact with contaminated water may also influence infection levels. The study is expected to contribute to the literature on schistosomiasis MDA, schistosomiasis prevalence, school health, neglected tropical diseases, infectious disease control, community health, epidemiology, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, neglected tropical disease programme authorities, state ministries of health, state ministries of education, local government health authorities, school health programme managers, healthcare workers, development partners, and policymakers regarding strategies for strengthening schistosomiasis control among school children. The study will also provide evidence-based recommendations for improving MDA coverage, ensuring adequate availability of praziquantel, strengthening school-based drug distribution, improving teacher and community health-worker training, increasing caregiver and pupil awareness, strengthening programme monitoring and supervision, identifying children missed during MDA, and integrating schistosomiasis MDA with water, sanitation and hygiene interventions and other school-based neglected tropical disease control programmes across endemic communities in Nigeria.

Keywords: Schistosomiasis mass drug administration, schistosomiasis prevalence, school children, Nigeria, praziquantel, neglected tropical diseases, school health, MDA coverage, infectious disease control, community health, epidemiology, public health.