Evaluating School-Based Deworming Coverage of Soil-Transmitted Helminths Programs for Children Living in Benin, India, and Malawi

Abstract

Soil Transmitted Helminths (STH) are a group of intestinal parasitic worms infecting over 1.5 billion people, disproportionately affecting the health outcomes of women and children in marginalized communities. Most countries reduce STH-associated morbidities in children through school-based deworming (SBD) programs. Our objective was to calculate school-based STH deworming coverage and identify school-level correlates of coverage across areas participating in a cluster randomized trial in Benin, Malawi, and India. We conducted a secondary analysis of DeWorm3’s repeat cross-sectional longitudinal school survey over three years, including 308 observations of school-level deworming in Benin, 1,713 in India, and 164 in Malawi. SBD coverage was calculated and compared across time and sites using Kruskal-Wallis tests. A multivariate analysis using generalized linear mixed effects models with clustering by school and time determined correlates of coverage at the 0.05 significance level. SBD coverage was 100% in India (95% confidence interval [CI]: 97.2%, 140%), 87% in Benin (CI: 72.5%, 97.4%), and 46% in Malawi (CI: 33.6%, 62.7%). High attendance rates were significantly associated with increased (Benin) and decreased (Malawi) coverage. High student-to-faculty ratios (Benin, India) and a higher percentage of female teachers (India), were associated with reduced coverage. Exploring these correlates of coverage could assist in identifying schools unable to meet the WHO thresholds for preventing STH-associated morbidities in children.