***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: OBJECTIVE We aim ed to assess the health impact of a national control programme targeting schistosomiasis and intestinal nematodes in Ug and a , which has provided population -based anthelmintic chemotherapy since 2003 . METHODS We conducted longitudinal surveys on infection status , haemoglobin concentration and clinical morbidity in 1871 r and omly selected schoolchildren from 37 schools in eight districts across Ug and a at three time points - before chemotherapy and after one year and two years of annual mass chemotherapy . FINDINGS Mass treatment with praziquantel and albendazole led to a significant decrease in the intensity of Schistosoma mansoni - 70 % ( 95 % confidence interval ( CI ) : 66 - 73 % ) after one year and 82 % ( 95 % CI : 80 - 85 % ) after two years of treatment . Intensity of hookworm infection also decreased ( 75 % and 93 % ; unadjusted ) . There was a significant increase in haemoglobin concentration after one ( 0.135 g/dL ( 95 % CI : 0.126 - 0.144 ) ) and two years ( 0.303 g/dL ( 95 % CI : 0.293 - 0.312 ) ) of treatment , and a significant decrease in signs of early clinical morbidity . The impact of intervention on S. mansoni prevalence and intensity was similar to that predicted by mathematical models of the impact of chemotherapy on human schistosomiasis . Improvements in haemoglobin concentration were greatest among children who were anaemic or harbouring heavy S. mansoni infection at baseline . CONCLUSION Anthelmintic treatment delivered as part of a national helminth control programme can decrease infection and morbidity among schoolchildren and improve haemoglobin concentration OBJECTIVE To study the role of health education and community participation for the provision of facilities necessary for the control of urinary schistosomiasis in southern Ghana . HYPOTHESIS Health education facilitates community participation in the provision of facilities for the control of bilharzia . STUDY AREA Three rural communities drained by the Densu river in southern Ghana . PARTICIPANTS Individuals aged 14 years and above formed groups of 10 - 12 persons by age , sex , ethnic and educational background ; 15 - 16 groups were formed . INTERVENTIONS Based on existing structures , one community received active , another passive health education and the third had no education . All three communities received chemotherapy . DESIGN Study was carried out in three phases : pre-intervention phase -- during which baseline data on residents ' knowledge , attitude , beliefs and perception about bilharzia were collected using focus group discussion s ( FGD ) prior to the second phase , intervention . Another FGD was held after 18 months to evaluate the intervention -- third phase . RESULTS This study suggests that most community members were aware of schistosomiasis but not as a disease . Before the health education , some residents believed bilharzia was a sign of manhood while others attributed the red colour of the urine to the red colour of a variety of sugar cane eaten in the area . After the health education , residents in the three areas constructed h and -dug wells . In addition , those who received active health education constructed two toilets for the schools and weeded the banks of the rivers . Residents also associated the disease with the water snail . CONCLUSION Health education was useful in changing community perception on bilharzia The aim of the study was to assess the efficacy and side effects following single and repeated ( 6 weeks apart ) praziquantel treatment ( 40 mg/kg ) in a Schistosoma mansoni-endemic focus with long-st and ing transmission at Lake Albert in Ug and a between December 1996 and January 1997 . The results were based on 482 individuals , r and omly representing all age and both gender groups . The cure rate following the first and second treatments was 41.9 % and 69.1 % , respectively . The cure rate was higher in adults than in children , irrespective of intensity of infection . In addition , the cure rate declined markedly with increasing intensity of infection . The reduction in intensity of infection was marked , being 97.7 % and 99.6 % after the first and second treatments , respectively . A pre- and post-treatment symptom question naire revealed a broad range of side effects , including abdominal pain and diarrhoea . However , no serious or long-lasting complications affecting compliance were observed . The marked reductions in faecal egg excretion and the acceptable level of side effects point to a single praziquantel treatment ( 40mg/kg ) as the strategy of choice in such a highly endemic S. mansoni focus To determine the effect of targeted field administration of oral chemotherapeutic agents on the prevalence , intensity , and morbidity of Schistosoma haematobium infections , we initiated a long-term school-based program in the Msambweni area of Kwale District , Coast Province , Kenya . Prior to treatment , 69 % of the children examined ( ages 4 - 21 , n = 2,628 ) were infected ; 34 % had moderate or heavy infections ( greater than 100 eggs/10 ml urine ) . Infected individuals were r and omized to receive , during one year , either metrifonate ( 10 mg/kg x 3 doses ) or praziquantel , ( 40 mg/kg x 1 dose ) . At the end of the first year , prevalence of infection fell to 19 % ; only 2 % of the pupils remained in the moderately and heavily infected groups . Corresponding decreases in the prevalence of hematuria ( 54 % in 1984 vs. 16 % in 1985 ) and proteinuria ( 56 % in 1984 vs. 26 % in 1985 ) were noted . These were associated with significant declines in bladder thickening and irregularities noted during ultrasound examinations , but not with decreases in hydronephrosis . There was no significant difference in the post-treatment prevalence or intensity of infection after treatment with metrifonate as compared with praziquantel . These results demonstrate that field-applied chemotherapy with either agent offers a practical strategy for the control of S. haematobium infection and its associated morbidity 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 To determine the effect of repeated , annual , age-targeted therapy on prevalence and intensity of Schistosoma haematobium infection in an endemic area , we treated all available , infected , school-age children ( n = 2 , 493 ) in the Msambweni area of Coast Province , Kenya with a r and omized protocol of oral metrifonate ( 10 mg/kg for three doses each year ) or praziquantel therapy ( 40 mg/kg as a single dose each year ) for a period of one to three years . During 1984 - 1987 , 1 , 101 children completed three years of therapy , 550 received two years , and 842 received a single year . Annual followup revealed significant long-term suppression of S. haematobium infection in the targeted school-age population . Both cross-sectional analysis and study of individual outcomes suggested maximal suppression of infection after two years of therapy . Suppression lasted more than two years after cessation of treatment , and was associated with reduced community transmission ( gauged by decreased prevalence among new study entrants and decreasing negative-to-positive conversion on annual parasitologic examinations ) . Comparison of metrifonate and praziquantel outcomes indicated greater suppression of infection and longer infection-free intervals for some subgroups given praziquantel . We conclude that annual population -based therapy targeted to schoolchildren has direct and indirect beneficial effects for endemic communities . In some specific situations , repeat therapy may not suppress transmission , and reduced drug efficacy may be observed after one to three years , suggesting the need for additional non-drug control measures in highly endemic villages Severity of  urinary tract morbidity increases with intensity and duration of Schistosoma haematobium infection . We assessed the ability of yearly drug therapy to control infection intensity and reduce S. haematobium-associated disease in children 5 - 21 years old in an endemic area of Kenya . In year 1 , therapy result ed in reduced prevalence ( 66 % to 22 % , P < 0.001 ) and intensity of S. haematobium infection ( 20 to 2 eggs/10 mL urine ) , with corresponding reductions in the prevalence of hematuria ( 52 % to 19 % , P < 0.001 ) . There was not , however , a significant first-year effect on prevalence of urinary tract abnormalities detected by ultrasound . Repeat therapy in years 2 and 3 result ed in significant regression of hydronephrosis and bladder abnormalities ( 41 % to 6 % prevalence , P < 0.01 ) , and further reductions in proteinuria . Repeat age-targeted therapy was associated with decreased prevalence of infection among young children ( < 5 yr ) entering into the targeted age group . Two years after discontinuation of therapy , intensity of S. haematobium infection and ultrasound abnormalities remained suppressed , but hematuria prevalence began to increase ( to 33 % in 1989 ) . Reinstitution of annual therapy in 1989 and 1990 reversed this trend . We conclude that annual oral therapy provides an effective strategy for control of morbidity due to S. haematobium on a population basis , both through regression of disease in treated individuals , and prevention of infection in untreated subjects Chemotherapy with praziquantel is the cornerstone of schistosomiasis control . In view of recent concern about tolerance or resistance to praziquantel , monitoring its efficacy in different epidemiological setting s is required . We report a study among 253 schoolchildren in an area highly endemic for Schistosoma mansoni in western Côte d'Ivoire . After examining four consecutive stool specimens from each child , the first praziquantel treatment at 60 mg/kg divided into two doses was administered . Four weeks later , stool specimens were again screened over 4 consecutive days and revealed a cure rate of 71.6 % and an egg reduction rate of 79.9 % . There was a significant association between cure rate and intensity of infection prior to treatment with highest cure rates observed in light infections ( P < 0.01 ) . Praziquantel , at a single dose of 40 mg/kg , was again administered 35 days after the first treatment . The overall cure and egg reduction rates increased considerably . The association between cure rate and intensity of infection prior to the second treatment was significant but less pronounced . Twenty-two children remained S. mansoni positive after the two chemotherapy campaigns , and interestingly , many of these were only identified after repeated stool examinations . We argue that pre-patent infections may account for some of these ' treatment failures ' . However , further studies in other endemic setting s are needed , with parasitological diagnoses having a high sensitivity The aim of this study was to assess the effect of two doses of 40 mg/kg praziquantel with 2 weeks interval versus a st and ard single dose of 40 mg/kg on cure rates , egg reduction , intensity of infection , and micro-haematuria in Schistosoma haematobium infections . A r and omised controlled intervention study was carried out among school-aged children in two different endemic setting s with follow-up at 3 , 6 and 18 months following drug administration . Differences in cure rates between the two treatment regimens were not significant . However , in high transmission areas , the double treatment regimen was more effective in egg reduction than single treatment regimen and the difference in egg reduction between the two treatments was significant at 3 months ( P<0.005 ) , 6 months ( P<0.0001 ) and 18 months ( P<0.003 ) after treatment . There was a significant difference in the effect of the two treatments on prevalence of micro-haematuria at 18-month follow-up in both Koulikoro ( P<0.001 ) and Selingue ( P<0.003 ) . The study shows that although no significant difference could be observed in the overall cure-rates between the two treatment regimens , the effect of double treatment was a significant reduction in infection intensity as well as micro-haematuria which may have a great impact in reducing subtle morbidity A study was performed to determine the efficacy of praziquantel ( PZQ ) against Schistosoma haematobium . Children ( n = 592 ) infected with S. haematobium received either a single treatment with PZQ ( 40 mg/kg ) or two or three treatments with PZQ at three- 
    Output:
    
In 10 reports meeting study criteria , improvements in parasitological treatment outcomes after two doses of praziquantel were greater for S. mansoni infection than for S. haematobium infection .
/ SIGNIFICANCE Although schedules for repeated treatment with praziquantel require greater inputs in terms of direct costs and community participation , there are incremental benefits to this approach at an estimated cost of $ 153 ( S. mansoni)-$211 ( S. haematobium ) per additional lifetime QALY gained by double treatment in school-based programs .
More rapid reduction of infection-related disease may improve program adherence , and if , as an externality of the program , transmission can be reduced through more effective coverage , significant additional benefits are expected to accrue in the targeted communities