Evaluating the reach and performance of treatment campaigns in Mauritania

We recently had the opportunity to assist in evaluating the success of a mass drug administration (MDA) campaign conducted by the Mauritanian Ministry of Health.

The MDA was conducted throughout January and February to provide praziquantel tablets for children affected by schistosomiasis, a parasitic disease transmitted to humans through contact with contaminated water.

Schistosomiasis can severely impact children’s growth and cognitive development and its effects may contribute to poor school attendance and long-term health problems.

The MDA specifically targeted school-aged children, those between 5 and 14 years old, a group the World Health Organization (WHO) identifies as heavily impacted by schistosomiasis. Regular treatment during childhood can decrease the intensity of infection over time, leading to a healthier population as these children grow into adults.

Funded by GiveWell, a charitable organisation committed to maximising the impact of donations, the MDA aimed to reach 75% (the threshold set by the WHO for effective MDA campaigns) of the school-age population in the target area in the south of Mauritania. Southern Mauritania, the most populous area of the country, borders Senegal, with the Senegal River forming the boundary. Here, schistosomiasis is a significant concern, as the proximity to the river basin, combined with the community’s reliance on fishing and agriculture, heightens exposure to infested water.

This is compounded by the risk of flooding which occurs in the area due to higher rainfall. Irrigation along the Senegal river has heavily impacted prevalence of schistosomiasis through increased water contact and related transmission.

We assisted the Ministry of Health (MoH) in conducting a coverage evaluation survey, a standard procedure following an MDA. This survey independently assesses the effectiveness of drug distribution by interviewing a representative sample of the targeted population and completing a questionnaire to determine if they received and took the required dose of praziquantel.

Three teams, made up of health workers and data specialists, visited selected towns and conducted house-to-house interviews. Using mobile devices and tablets, they collected data on socioeconomic status, school attendance, knowledge of schistosomiasis and its prevention and MDA participation. Heads of households provided initial information, followed by interviews with the children to confirm they had taken the praziquantel.

As numerous public health interventions can be taking place in a community, children may sometimes find it difficult to remember which treatments the MoH team is asking about. To mitigate this, the data collectors carry praziquantel tablets to show the children, along with a dose pole used during the MDA. The dose pole measures a child’s height, helping to estimate their weight and therefore the correct dosage of praziquantel. Reintroducing these items can jog a child’s memory and ensure the teams capture accurate information.

Conducting these surveys can be challenging due to difficult terrain, impassable roads, and limited internet access, all of which disrupt travel and hinder communication. However, these surveys are crucial for combating schistosomiasis and eliminating parasitic infections among children.

We are currently assisting with the analysis of the collected data, which is owned by the Mauritanian MoH, and will share the results with both the Ministry and the funder, GiveWell. In addition to presenting the results, we will also report on the MDA process, highlighting any lessons learned or challenges encountered during the treatment campaign. This report will help inform future MDAs and support the MoH with their schistosomiasis control programme.

WHO has set specific targets for the treatment of schistosomiasis to control and eventually eliminate the disease as a public health problem. WHO recommends that countries achieve a minimum of 75% treatment coverage of school-aged children (SAC) in endemic areas.

The key targets are:

• Morbidity Elimination: Reducing the prevalence of heavy-intensity infections among SAC in endemic areas.
• Transmission Interruption: In selected regions, particularly those with sustained low transmission, moving towards interrupting transmission entirely.

“Thanks to the continued support of Unlimit Health, our country will be able to significantly reduce the serious and disabling complications caused by schistosomiasis, and by 2030, with the support of Unlimit Health, our country will be able to eliminate schistosomiasis in accordance with the WHO roadmap.”

– Dr Barro Abass

Later this year, we will collaborate with the MoH in Mauritania to conduct a reassessment mapping survey (also called impact assessment surveys). Reassessment mapping for schistosomiasis involves evaluating the current epidemiological situation in endemic areas to update and refine control strategies. This process is crucial for adapting intervention measures such as MDA and for moving towards the elimination of the disease as a public health problem.

We eagerly anticipate the results and remain dedicated to supporting our colleagues at the Mauritanian MoH in their efforts to eliminate schistosomiasis.