Does supervised administration based on routine soil-transmitted helminth surveillance reduce hookworm infection in villagers in Eastern China? A pragmatic trial

Abstract Background: Despite significant progress has been made in China through decades to reduce the prevalence of hookworm, including deworming and surveillance, the burden of this disease is still heavy in mountainous regions. We conducted a community-based intervention trial in Ninghai, a mountainous coastal county in Southeastern China, to explore a more efficient method of tackling hookworm infection in economically developed but geographically isolated areas. Methods: Six villages were selected for this trial. Considering of their historical prevalence and demographic similarity. three villages assigned to the intervention group and three to the control group. Control methods of intervention groups involved deworming medicine and health education, which was deliberately provided by well-trained healthcare staffs. In control sites, only health education was provided while parasitic survey, the result of parasitic survey was informed if the result was positive, but medicine needed to be purchased by the patient. Our primary metrics was hookworm prevalence in residents, determined by modified Kato-Katz method. The infection intensity was also presented by eggs per gram of faeces (EPG). Results: The analysis included 1330 participants in control sites and 1270 participants in intervention sites. The relative reduction in hookworm prevalence was significant in the intervention sites (81.99%, 95% CI: 60.15-91.86) comparing to the control sites (51.84%, 3.34-76.01). The relative reduction in hookworm infection intensity was not significantly different between the intervention sites and control sites (64.83%, 95% CI：-237.18-96.33 vs. 77.23%, 95% CI:-94.33-97.33). However, the prevalence of light and moderate intensity group, the relative reduction in intervention groups were greater than that in control groups (light infection group: 83.34%, 95% CI:60.87-92.91 vs. 45.8%, 95%CI: -14.21-74.28; moderate infection group: 100% vs. 62.06%, 95%CI: -263.82-96.04). Conclusions: Notable for its ease of implementation, cost-effectiveness, and high participant compliance, the program leverages the established rural STHs surveillance system in China to promptly administer medication among infected individuals. Its potential of replicating over the nationwide and referring as an attempt for global efforts underscores its significance in combatting hookworm infection efficiently and economically.