Fighting intestinal worm infections with better data
National deworming programs need high-quality data to scale-up interventions, streamline intervention delivery, and direct resources where they are most needed. According to Alex Jones, the Deputy Director of Children Without Worms (CWW), “a national STH program cannot succeed without a clear understanding of current disease epidemiology. If we want to achieve the goal of elimination as a public health problem, we must support countries to get there with innovative tools such as the ICSPM”. The Integrated Community-based Survey for Program Monitoring or ICSPM is part of a suite of tools developed by CWW that help Soil-Transmitted Helminthiasis (STH or deworming) programs improve the evidence that they collect and use for program decisions. ICSPM is a population-based cluster survey that improves monitoring by estimating STH prevalence and intensity of infection, as well as assessing drug treatment coverage, sanitation access, and hygiene behaviors.
For a disease that affects approximately 1.5 billion people globally, robust data on prevalence and intensity of infection has not been readily available to help countries determine when to start and stop treatment. In 2016, CWW and the STH Advisory Committee, a scientific and technical body of experts, sought to address this gap in the global STH program. With the help of expert Dr. Michael Deming, CWW acted on the Advisory Committee’s recommendation to develop the ICSPM. Deming contends, “it has become increasingly important to monitor the impact of deworming medicines on the prevalence and intensity of STH infection. Such monitoring enables STH programs to follow WHO guidelines on the frequency of infection and to track progress toward the goal of lowering the prevalence of moderate-to-heavy STH infection among school-age children to less than 1%”.
The ICSPM is designed to address the needs of national STH control programs to make evidence-based decisions on intervention delivery, and detect areas of persistent infection. Deming explains, “the ICSPM is community-based rather than school-based, includes all three STH risk groups (pre-school age children, school-age children and women of reproductive age), and uses probability sampling, meaning that the selection of risk-group members is unbiased”. This means that the results from the sample will be reflective of the total population of the district. Dr. Jahirul Karim, deputy program manager for lymphatic filariasis and STH in Bangladesh, adds that the ICSPM “will help countries implement WHO guidelines while also having the evidence to back it up.”
The ICSPM was piloted in two districts of Bangladesh in 2017. Since then, CWW and the Bangladesh Ministry of Health & Family Welfare have surveyed seven districts, with three more planned for 2019. Similarly, CWW supported partners in Sierra Leone, including the Ministry of Health and Sanitation, to survey two districts in 2018. The goal is to get more countries to adopt and adapt the ICSPM once the whole toolkit is available, expected in 2019.
CWW is also working to create a number of complementary tools that can be customized by countries to suit their specific needs. Along with the survey manual, which can be tailored by the country into a country-specific protocol, upcoming tools include a site-selection tool, an automated sampling tool, survey questionnaires, and an easy-to-use training manual for field staff.
By creating resources such as the ICSPM, CWW hopes to provide ready-to-use program monitoring tools that help countries make data-driven decisions for their program. Additionally, CWW offers national programs technical assistance in implementing their surveys, as they have in Bangladesh and Sierra Leone. According to Dr. Deming, pilot projects using the ICSPM have gone a long way in “demonstrating that it is practical and useful in the ways intended.”
 World Health Organization. “Soil-Transmitted Helminth Infections”.
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