Peer-reviewed article
Feasibility of paediatric schistosomiasis prevention with praziquantel, Madagascar.
Marchese V, Andrianarimanana DK, Ratefiarisoa S, Guth A, Lassmann M et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study tested whether young children aged 9 to 24 months in rural Madagascar could safely and acceptably receive praziquantel, a medication to prevent schistosomiasis. Over 5,100 child-caregiver pairs were offered crushed half-tablet doses mixed with water and sugar, with 86% uptake. Most caregivers found repeated treatment acceptable, though concerns about side effects deterred some. No serious adverse events occurred, and the approach was found feasible for scaling up in schistosomiasis-endemic areas.
Key points
- Praziquantel uptake rate was 86.2% among children aged 9-24 months in rural Madagascar
- 80.2% of caregivers found repeated preventive chemotherapy acceptable
- Caregiver anxiety and uncertainty about adverse events were the main factors associated with treatment refusal
- No children experienced serious adverse events or choking; 3.4% swallowed a partial dose
- The crushed half-tablet formulation mixed with water and sugar was found feasible and potentially sustainable
Limitations
The study was conducted over a 13-month period and does not provide long-term follow-up data on sustained treatment adherence or real-world implementation challenges at scale. The study assessed acceptability through cross-sectional survey methods rather than tracking the same children over repeated treatment cycles.
Abstract
Objective To assess the feasibility of fixed-dose, praziquantel preventive chemotherapy against schistosomiasis in young children in rural Madagascar, focusing on treatment uptake and sustainability. Methods We used the Consolidated Framework for Implementation Research to guide the study. Between November 2022 and December 2023, children aged 9 to 24 months at various venues were offered 300 mg of praziquantel as a crushed half tablet mixed with water and sugar. We conducted a cross-sectional survey among caregivers to assess treatment uptake and acceptability, children's compliance with drug administration, anxiety about adverse events, and praziquantel's tolerability and safety. Factors associated with uptake and acceptability were identified using Poisson regression. Findings The study analysis included 5142 child-caregiver pairs. The praziquantel uptake rate was 86.2% (95% confidence interval, CI: 85.3-87.1) and 80.2% (95% CI: 79.1-81.3) of caregivers regarded repeated preventive chemotherapy acceptable. Clear anxiety, and uncertainty, about adverse events were the most significant factors associated with refusal of both initial and repeated treatment. No children experienced serious adverse events or choking. Of the 4434 children who received praziquantel, 152 (3.4%) swallowed a partial dose, whereas 2467 (55.6%) cried and 1833 (41.3%) initially resisted treatment, but ultimately received it. Conclusion Fixed-dose praziquantel preventive chemotherapy using a crushed half tablet with water and sugar was feasible in preschool-aged children and was potentially sustainable. This approach has a strong potential for scaling up in areas where schistosomiasis is highly endemic.