Multi-intervention integrated deworming strategy for sustained control of soil-transmitted helminths infections: a case study in Jiangsu Province, China

Background:Soil-transmitted helminths(STH)infections still present a global health problem.Mass drug adminis‑tration(MDA)is a widely applied strategy to reduce morbidity and mortality caused by STH.Yet,this approach has some shortcomings.In this study,we analyzed the impact of a multi-intervention integrated deworming approach including MDA,health education(HE),and environmental sanitation improvements(ESI)for sustained STH control in Jiangsu Province of China that was applied from 1989 to 2019.Methods:Data,including infection rate of STH,medications used,coverage of the medication,non-hazardous lavatory rate,and household piped-water access rate in rural areas,and actions related to HE and ESI were collected(from archives)and analyzed in this retrospective descriptive study.Pearson’s correlation analysis was applied to test correlations.Results:There was a dramatic decline in the infection rate of STH from 1989(59.32%)to 2019(0.12%).From 1995 to 1999,MDA and HE were recommended in rural areas.A negative correlation was observed between infection rate and medication from 1994 to 1998(r=-0.882,P=0.048).From 2000 to 2005,targeted MDA was given to high-risk populations with HE continuously promoting good sanitation behaviors.From 2006 to 2014,targeted MDA+HE and ESI were used to consolidate the control efect.ESI was strengthened from 2006,and a negative correlation was observed between the coverage rate of the non-hazardous lavatory and the infection rate from 2006 to 2019(r=-0.95,P<0.001).The targeted MDA was interrupted in 2015,while continuous eforts like HE and ESI contributed in sustaining STH control.Conclusions:Multi-intervention integrated deworming strategy contributes to the reduction of STH infections.This approach is a valuable example of how diferent interventions can be integrated to promote durable STH control.