Discussion
diarrhoea, fever, abdominal pain, malaria, vomiting, vomiting-induced, skin rash, Vomiting
MALARIA, ADVERSE EVENTS, DISEASE, SCHISTOSOMIASIS, ADVERSE EVENT
This randomized controlled trial demonstrated that the integration of MDA for schistosomiasis and STH with SMC drugs is feasible logistically, with a high retention of study participants 5 months after the administration of the drugs to study children. This is the first study proving the feasibility of delivering MDA for schistosomiasis and STH through an SMC platform. This finding has provided evidence to boost the public health recommendations for combined malaria and helminth control and reinforces the empirical evidence that the future direction of health care systems in developing countries should be comprehensive health management rather than vertical management of a single disease. The delivery method adopted for the integrated strategy, involving house-to-house visits, contributed to the logistical feasibility and high retention. Similarly, using local health workers who understood the study communities and their cultures made the combined approach to gain the trust and acceptance of the parents of the study children. More importantly, the collaborative support provided by the Senegal national malaria and NTD control programmes made the implementation of the integrated strategy logistically feasible. These factors have been documented to be effective strategies in the vertical implementation of MDA and SMC in most African settings [The administration of the anthelminthic drugs (PZQ and ALB) and SMC drugs (SPAQ) on separate days (24 h apart) provided an opportunity to objectively assess the tolerability of the different drug regimen. Vomiting was the most common adverse events reported among children in the treatment groups 2 and 3 who were randomized to receive praziquantel with SMC drugs. This adverse event was transient, mild to moderate in intensity and did not prevent the children from taking SMC drugs in the subsequent days. Nevertheless, the high incidence of vomiting among the children in these treatment groups may pose a major challenge to the uptake and acceptability of the integrated malaria-helminth preventive treatment approach by the children and their parents. This finding resonated with the feedback obtained through qualitative interviews conducted among the parents/caregivers of the children enrolled in this trial, during which they expressed concerns about the bitter taste, smell, and vomiting-induced effect of praziquantel [Other adverse events such as fever, abdominal pain, skin rash, refusal of food/poor appetite and diarrhoea were similar in frequency across the three groups and were generally mild and transient. Although the prevalence of This study had some limitations. Given that SMC is a standard preventive treatment for malaria in the study area, a control group for SMC could not be included. However, historical data showed that a much higher prevalence of malaria and lower Hb concentration would have been reported at the end of the transmission season without SMC in the study area [Consistent with the findings of the preceding surveys [