Discussion
infection
INFECTION, HOOKWORM, HOOKWORM INFECTION
To our knowledge, this is the first clinical trial in Uganda to compare the efficacy of dual-dose versus single-dose albendazole, and the first randomised trial globally to assess the clinical efficacy of albendazole when given with a fatty food against hookworm infection. Our study shows that dual-dose albendazole is more effective in treating hookworm than single-dose albendazole treatment. However, there is no difference in albendazole efficacy when it was co-administered with avocado (a fatty food) compared to without co-administration.Our findings are consistent with other data which suggest that the cure rate for hookworm is improved with multiple dosing. For instance, the cure rate for hookworm with single-dose albendazole was 54% (95% CI:27–81) in a study in Gabon, versus 92% (95% CI:78–100) with dual-dose [Previous laboratory studies have shown that an active albendazole metabolite (albendazole sulphoxide) plasma concentration is four to six times higher when a fatty food is given with albendazole than when albendazole is taken with water [Drug effectiveness studies comparing different brands of albendazole for treating hookworm in Nepal [Preventive chemotherapy is still an essential component for reducing the burden of STHs even though multisectoral and comprehensive interventions, including water, sanitation and hygiene (WASH) improvement, are required to eliminate STHs from a long-term perspective [There are some limitations of this study. First, the trial was not powered to show the combined effect of dual-dose albendazole with avocado use, which may have high drug efficacy since we use a factorial design in our study. A larger sample size would be required to secure sufficient power to precisely estimate drug efficacy separately among the four treatment groups.Second, the authors arbitrarily estimated the cure rate of albendazole with the avocado treatment group as 95% since there was no previous similar clinical trial. Therefore, we may not have had sufficient statistical power to detect smaller differences in albendazole efficacy between the without and the with-avocado group.Third, as described earlier, the amount of fat in 200 grams of avocado might not be enough to increase albendazole efficacy. For example, Nagy Fourth, the authors cannot explore dual-dose albendazole efficacy and avocado use against moderate- and heavy intensity hookworm infection since 97% of the participants had light intensity infection. Bezie 