***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A field trial was conducted in the Gezira , Sudan , to evaluate the acceptability and efficacy of praziquantel , a new schistosomicide . In one Arab village 350 patients with Schistosoma mansoni were r and omly assigned to two treatment groups and given 1 X 40 mg kg-1 ( Group A ) or 2 X 20 mg kg-1 given four to six hours apart ( Group B ) . In two small settlements ( camps ) 2 km distant from the Arab village 38 patients with S. mansoni and 43 with concurrent S. mansoni and S. haematobium infections were given 1 X 40 mg kg-1 . Side effects were mild and limited to the first 24 hours after treatment . The main complaints were abdominal pain , diarrhoea , urticaria and /or vomiting and were most common in the camp residents ( 79 % ) with 60 % of Group A and 45 % of Group B having one or more side effects . One month after treatment ' cure ' rates were : Camps 63 % , Group A 84 % and Group B 96 % , and the reduction in egg output was over 95 % . After 12 months re-infection was greater in the camps . As there was no significant difference in the egg output reduction between the two treatment regimes , praziquantel is recommended for mass chemotherapy in Gezira at the logistically simpler regimen of 1 X 40 mg kg-1 Background The Schistosomiasis Consortium for Operational Research and Evaluation ( SCORE ) has launched several large-scale trials to determine the best strategies for gaining and sustaining control of schistosomiasis and transitioning toward elimination . In Côte d’Ivoire , a 5-year cluster-r and omized trial is being implemented in 75 schools to sustain the control of schistosomiasis mansoni . We report Schistosoma mansoni infection levels in children one year after the initial school-based treatment ( SBT ) with praziquantel  and compare with baseline results to determine the effect of the intervention . Methodology The baseline cross-sectional survey was conducted in late 2011/early 2012 and the first follow-up in May 2013 . Three consecutive stool sample s were collected from 9- to 12-year-old children in 75 schools at baseline and 50 schools at follow-up . Stool sample s were subjected to duplicate Kato-Katz thick smears . Directly observed treatment ( DOT ) coverage of the SBT was assessed and the prevalence and intensity of S. mansoni infection compared between baseline and follow-up . Principal Findings The S. mansoni prevalence in the 75 schools surveyed at baseline was 22.1 % ( 95 % confidence interval ( CI ) : 19.5–24.4 % ) . The DOT coverage was 84.2 % . In the 50 schools surveyed at baseline and one year after treatment , the overall prevalence of S. mansoni infection decreased significantly from 19.7 % ( 95 % CI : 18.5–20.8 % ) to 12.8 % ( 95 % CI : 11.9–13.8 % ) , while the arithmetic mean S. mansoni eggs per gram of stool ( EPG ) among infected children slightly increased from 92.2 EPG ( 95 % CI : 79.2–105.3 EPG ) to 109.3 EPG ( 95 % CI : 82.7–135.9 EPG ) . In two of the 50 schools , the prevalence increased significantly , despite a DOT coverage of > 75 % . Conclusions / Significance One year after the initial SBT , the S. mansoni prevalence had decreased . Despite this positive trend , an increase was observed in some schools . Moreover , the infection intensity among S. mansoni-infected children was slightly higher at the 1-year follow-up compared to the baseline situation . Our results emphasize the heterogeneity of transmission dynamics and provide a benchmark for the future yearly follow-up surveys of this multi-year SCORE intervention study Integrated control strategies are important for sustainable control of schistosomiasis and soil-transmitted helminthiasis , despite their challenges for their effective implementation . With the support of Good Neighbors International in collaboration with National Institute of Medical Research , Mwanza , Tanzania , integrated control applying mass drug administration ( MDA ) , health education using PHAST , and improved safe water supply has been implemented on Kome Isl and over 5 years for controlling schistosomiasis and soil-transmitted helminths ( STHs ) . Baseline surveys for schistosomiasis and STHs was conducted before implementation of any integrated control strategies , followed by 4 cross-sectional follow-up surveys on r and omly selected sample s of schoolchildren and adults in 10 primary schools and 8 villages , respectively , on Kome isl and s. Those follow-up surveys were conducted for impact evaluation after introduction of control strategies interventions in the study area . Five rounds of MDA have been implemented from 2009 along with PHAST and improved water supply with pumped wells as other control strategies for complementing MDA . A remarkable steady decline of schistosomiasis and STHs was observed from 2009 to 2012 with significant trends in their prevalence decline , and thereafter infection rate has remained at a low sustainable control . By the third follow-up survey in 2012 , Schistosoma mansoni infection prevalence was reduced by 90.5 % and hookworm by 93.3 % among schoolchildren while in adults the corresponding reduction was 83.2 % and 56.9 % , respectively . Integrated control strategies have successfully reduced S. mansoni and STH infection status to a lower level . This study further suggests that monitoring and evaluation is a crucial component of any large-scale STH and schistosomiasis intervention Background In Mozambique , schistosomiasis is highly endemic across the whole country . The Schistosomiasis Consortium for Operational Research and Evaluation ( SCORE ) coordinates a five-year study that has been implemented in various African countries , including Mozambique . The overall goal of SCORE was to better underst and how to best apply preventive chemotherapy with praziquantel ( PZQ ) for schistosomiasis control by evaluating the impact of alternative treatment approaches . Methods This was a cluster-r and omised trial that compared the impact of different treatment strategies in study areas with prevalence among school children of ≥21 % S. haematobium infection by urine dipstick . Each village was r and omly allocated to one of six possible combinations of community-wide treatment ( CWT ) , school-based treatment ( SBT ) , and /or drug holidays over a period of four years , followed by final data collection in the fifth year . The most intense intervention arm involved four years of CWT , while the least intensive arm involved two years of SBT followed by two consecutive years of PZQ holiday . Each study arm included 25 villages r and omly assigned to one of the six treatment arms . The primary outcome of interest was change in prevalence and intensity of S. haematobium among 100 children aged 9-to-12-years that were sample d each year in every village . In addition to children aged 9-to-12 years , 100 children aged 5–8 years in their first-year of school and 50 adults ( aged 20–55 years ) were tested in the first and final fifth year of the study . Prevalence and intensity of S. haematobium infection was evaluated by two filtrations , each of 10mL , from a single urine specimen . Principal findings In total , data was collected from 81,167 individuals across 149 villages in ten districts of Cabo Delgado province , Northern Mozambique . Overall PZQ treatment result ed in a significant reduction in the prevalence of S. haematobium infection from Year 1 to Year 5 , where the average prevalence went from 60.5 % to 38.8 % , across all age groups and treatment arms . The proportion of those heavily infected also reduced from 17.6 % to 11.9 % over five years . There was a significantly higher likelihood of males being infected than females at baseline , but no significant difference between the sexes in their response to treatment . The only significant response based on a study arm was seen in both the 9-to-12-year-old and first-year cross sections , where two consecutive treatment holidays result ed in a significantly higher final prevalence of S. haematobium than no treatment holidays . When the arms were grouped together , four rounds of treatment ( regardless of whether it was CWT or SBT ) , however , did result in a significantly greater reduction in S. haematobium prevalence than two rounds of treatment ( i.e. with two intermittent or consecutive holiday years ) over a five-year period . Conclusions Although PC was successful in reducing the burden of active infection , even among those heavily infected , annual CWT did not have a significantly greater impact on disease prevalence or intensity than less intense treatment arms . This may be due to extremely high starting prevalence and intensity in the study area , with frequent exposure to reinfection , or related to challenges in achieving high treatment coverage More frequent treatment had a greater impact on prevalence and intensity of infection when arms were grouped by number of treatments , however , cost efficiency was greater in arms only receiving two treatments . Finally , a significant reduction in prevalence of S. haematobium was seen in adults even in the SBT arms implying the rate of transmission in the community had been decreased , even where only school children have been treated , which has significant logistical and cost-saving implication s for a national control programme in justifying CWT A parasitological , clinical and ultrasonographic longitudinal study was undertaken in 1993 in a focus hyperendemic for Schistosoma mansoni infection in the central highl and s of Madagascar . All the inhabitants were systematic ally treated with praziquantel . A complete examination and treatment were repeated each year . Among the 289 villagers who underwent the complete 3 years ' follow up , 65.9 % excreted eggs at the initial survey and the mean egg count of infected individuals was 202 eggs/g . In 1996 , the prevalence of infection was 19.3 % with a mean egg count of 27 eggs/g and , among inhabitants aged > 44 years , only one was found to be infected . The proportion of individuals complaining of bloody stool decreased from 24.9 % in 1993 to 8.4 % in 1996 . Compared to the initial clinical examination , the age-adjusted prevalence of splenomegaly was significantly lower in 1996 , but remained high : 62 % in the 10 - 14 years age group and 59 % in individuals aged > 24 years . Ultrasonographic examination after 3 years of praziquantel therapy showed a marked decrease of the overall prevalence of schistosomal hepatic fibrosis , from 28 % in 1993 to 10.3 % in 1996 . This improvement had already been achieved during the second year of follow-up for most subjects . Usually , the reversal of morbidity affected individuals classified as stage 1 at the beginning of the study . Stage 3 was not observed in the last 2 surveys . One patient 's ascites disappeared during the follow-up , associated with a significant reversal of periportal fibrosis . Our results indicate that repeated praziquantel therapy can lead to improvement of liver morbidity and the prevention of the development of schistosomal hepatic fibrosis , even in an old-established hyperendemic focus OBJECTIVE In the course of performing systematic review s on the prevalence of low back and neck pain , we required a tool to assess the risk of study bias . Our objectives were to ( 1 ) modify an existing checklist and ( 2 ) test the final tool for interrater agreement . STUDY DESIGN AND SETTING The final tool consists of 10 items addressing four domains of bias plus a summary risk of bias assessment . Two research ers tested the interrater agreement of the tool by independently assessing 54 r and omly selected studies .  Interrater agreement overall and for each individual item was assessed using the proportion of agreement and Kappa statistic . RESULTS Raters found the tool easy to use , and there was high interrater agreement : overall agreement was 91 % and the Kappa statistic was 0.82 ( 95 % confidence interval : 0.76 , 0.86 ) . Agreement was almost perfect for the individual items on the tool and moderate for the summary assessment . CONCLUSION We have addressed a research gap by modifying and testing a tool to assess risk of study bias . Further research may be useful for assessing the applicability of the tool across different conditions BACKGROUND In sub-Saharan Africa , 112 million people are infected with Schistosoma haematobium , with the most intense infections in children 5 - 15 years old . METHODS We describe a longitudinal epidemiological study that evaluates the relationship between S. haematobium infection and associated morbidity in children before and after the large-scale administration of praziquantel for schistosomiasis and albendazole for soil-transmitted helminths .  RESULTS At baseline , higher intensities of S. haematobium infection were observed in children with anemia and /or severe microhematuria  , but there was no apparent association between the risk of undernutrition and intensity of S. haematobium infection . Significant reductions in the prevalence and intensity of S. haematobium infection 1 year after treatment were , however , observed . Children who benefited the most from anthelmintic treatment in terms of increased hemoglobin concentrations were those who had anemia at baseline and those with highly positive microhematuria scores at baseline . CONCLUSIONS This study suggests that even a single round of mass chemotherapy can have a substantial impact on S. haematobium infection and its associated morbidity in children Although it is established that the treatment by praziquantel reduces the 
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Box plots also showed no apparent differences in intensity reduction between the two treatment strategies .
/ SIGNIFICANCE The results of this meta- analysis do not support the hypothesis that community-wide treatment is more effective than targeted treatment at reducing schistosomiasis infections in children .