{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T14:06:45Z","timestamp":1790777205424,"version":"4.1.0"},"update-to":[{"DOI":"10.1371\/journal.pntd.0008771","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2020,11,18]],"date-time":"2020-11-18T00:00:00Z","timestamp":1605657600000}}],"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2020,11,2]],"date-time":"2020-11-02T00:00:00Z","timestamp":1604275200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1129535"],"award-info":[{"award-number":["OPP1129535"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:p>\n                    Global efforts to control morbidity associated with soil-transmitted helminth infections (STH) have focused largely on the targeted treatment of high-risk groups, including children and pregnant women. However, it is not clear when such programs can be discontinued and there are concerns about the sustainability of current STH control programs. The DeWorm3 project is a large multi-country community cluster randomized trial in Benin, India and Malawi designed to determine the feasibility of interrupting the transmission of STH using community-wide delivery of mass drug administration (MDA) with anthelmintics over multiple rounds. Here, we present baseline data and estimate key epidemiological parameters important in determining the likelihood of transmission interruption in the DeWorm3 trial. A baseline census was conducted in October-December 2017 in India, November-December 2017 in Malawi and in January-February 2018 in Benin. The baseline census enumerated all members of each household and collected demographic data and information on occupation, assets, and access to water, sanitation and hygiene (WASH). Each study site was divided into 40 clusters of at least 1,650 individuals per cluster. Clusters were randomized to receive twice yearly community-wide MDA with albendazole (GSK) targeting eligible individuals of all ages (20 clusters), or to receive the standard-of-care deworming program targeting children provided in each country. In each site, a randomly selected group of 150 individuals per cluster (6,000 total per site) was selected from the baseline census using stratified random sampling, and each individual provided a single stool sample for analysis of STH infection using the Kato-Katz technique. Study site, household and individual characteristics were summarized as appropriate. We estimated key epidemiological parameters including the force of infection and the degree of parasite aggregation within the population. The DeWorm3 sites range in population from 94,969 to 140,932. The population age distribution varied significantly by site, with the highest proportion of infants and young children in Malawi and the highest proportion of adults in India. The baseline age- and cluster-weighted prevalence, as measured by Kato-Katz, varied across sites and by species, Baseline hookworm prevalence in India was 21.4% (95% CI: 20.4\u201322.4%), while prevalence of\n                    <jats:italic>Ascaris<\/jats:italic>\n                    and\n                    <jats:italic>Trichuris<\/jats:italic>\n                    by Kato-Katz was low (0.1% and 0.3% overall). In Malawi, the overall age- and cluster-weighted STH prevalence was 7.7% (95% CI: 7.1\u20138.4%) predominantly driven by hookworm infections (7.4%) while\n                    <jats:italic>Ascaris<\/jats:italic>\n                    (0.1%) and\n                    <jats:italic>Trichuris<\/jats:italic>\n                    (0.3%) infections were rare. In Benin, the overall age- and cluster-weighted prevalence was significantly lower (5.6%, 95% CI: 5.1\u20136.2%) and\n                    <jats:italic>Ascaris<\/jats:italic>\n                    (2.0%, 95% CI: 1.6\u20132.3%) was more common than in other sites.\n                    <jats:italic>Ascaris<\/jats:italic>\n                    infections were more likely to be moderate- or heavy-intensity (43.7%, unweighted) compared to hookworm (5.0%). The force of infection for hookworm was highest in adults in India and Malawi but appeared relatively stable across age groups in Benin. These data demonstrate the significant variability between the sites in terms of demography, socio-economic status and environmental characteristics. In addition, the baseline prevalence and intensity data from DeWorm3 suggest that each site has unique epidemiologic characteristics that will be critical in determining correlates of achieving STH transmission interruption in the DeWorm3 trial.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Trial registration:<\/jats:bold>\n                    The trial was registered at ClinicalTrials.gov (\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT03014167\" xlink:type=\"simple\">NCT03014167<\/jats:ext-link>\n                    ).\n                  <\/jats:p>","DOI":"10.1371\/journal.pntd.0008771","type":"journal-article","created":{"date-parts":[[2020,11,2]],"date-time":"2020-11-02T13:47:48Z","timestamp":1604324868000},"page":"e0008771","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":21,"title":["Baseline patterns of infection in regions of Benin, Malawi and India seeking to interrupt transmission of soil transmitted helminths (STH) in the DeWorm3 trial"],"prefix":"10.1371","volume":"14","author":[{"name":"The DeWorm3 Trials Team","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2020,11,2]]},"reference":[{"issue":"10117","key":"pntd.0008771.ref001","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/S0140-6736(17)31930-X","article-title":"Soil-transmitted helminth infections","volume":"391","author":"PM Jourdan","year":"2018","journal-title":"The Lancet"},{"key":"pntd.0008771.ref002","unstructured":"Guideline: Preventive Chemotherapy to Control Soil-Transmitted Helminth Infections in At-Risk Population Groups. In: 2017. WHO, editor. Geneva."},{"issue":"86","key":"pntd.0008771.ref003","first-page":"257","article-title":"Soil-transmitted helminthiases: estimates of the number of children needing preventive chemotherapy and number treated","volume":"25","year":"2011","journal-title":"Weekly Epidemiological Record"},{"issue":"4","key":"pntd.0008771.ref004","doi-asserted-by":"crossref","first-page":"e0005497","DOI":"10.1371\/journal.pntd.0005497","article-title":"Building on the success of soil-transmitted helminth control\u2014The future of deworming","volume":"11","author":"PM Jourdan","year":"2017","journal-title":"PLOS Neglected Tropical Diseases"},{"issue":"suppl_4","key":"pntd.0008771.ref005","doi-asserted-by":"crossref","first-page":"S253","DOI":"10.1093\/cid\/ciy002","article-title":"Investigating the Effectiveness of Current and Modified World Health Organization Guidelines for the Control of Soil-Transmitted Helminth Infections","volume":"66","author":"SH Farrell","year":"2018","journal-title":"Clinical Infectious Diseases"},{"issue":"10","key":"pntd.0008771.ref006","doi-asserted-by":"crossref","first-page":"e0006864","DOI":"10.1371\/journal.pntd.0006864","article-title":"Defining stopping criteria for ending randomized clinical trials that investigate the interruption of transmission of soil-transmitted helminths employing mass drug administration","volume":"12","author":"M Werkman","year":"2018","journal-title":"PLOS Neglected Tropical Diseases"},{"issue":"5","key":"pntd.0008771.ref007","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1097\/QCO.0000000000000395","article-title":"Prospects for elimination of soil-transmitted helminths","volume":"30","author":"KH \u00c1sbj\u00f6rnsd\u00f3ttir","year":"2017","journal-title":"Current Opinion in Infectious Diseases"},{"issue":"5","key":"pntd.0008771.ref008","article-title":"Effects of water, sanitation, handwashing and nutritional interventions on soil-transmitted helminth infections in young children: A cluster- randomized controlled trial in rural Bangladesh","volume":"13","author":"CJ Ercumen A B-","year":"2019","journal-title":"PLoS Negl Trop Dis"},{"issue":"10185","key":"pntd.0008771.ref009","doi-asserted-by":"crossref","first-page":"2039","DOI":"10.1016\/S0140-6736(18)32591-1","article-title":"Effects, equity, and cost of school-based and community-wide treatment strategies for soil-transmitted helminths in Kenya: a cluster-randomised controlled trial","volume":"393","author":"RL Pullan","year":"2019","journal-title":"The Lancet"},{"issue":"1","key":"pntd.0008771.ref010","doi-asserted-by":"crossref","first-page":"e0006166","DOI":"10.1371\/journal.pntd.0006166","article-title":"Assessing the feasibility of interrupting the transmission of soil-transmitted helminths through mass drug administration: The DeWorm3 cluster randomized trial protocol","volume":"12","author":"KH \u00c1sbj\u00f6rnsd\u00f3ttir","year":"2018","journal-title":"PLOS Neglected Tropical Diseases"},{"key":"pntd.0008771.ref011","unstructured":"Progress on drinking water, sanitation and hygiene: 2017 update and SDG baselines. 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helminths","volume":"369","author":"R Anderson","year":"2014","journal-title":"Philosophical Transactions of the Royal Society B: Biological Sciences"},{"key":"pntd.0008771.ref032","doi-asserted-by":"crossref","DOI":"10.1093\/oso\/9780198545996.001.0001","volume-title":"Infectious Diseases of Humans: Dynamics and Control","author":"RM MR Anderson","year":"1991"},{"issue":"1","key":"pntd.0008771.ref033","volume":"8","author":"J Truscott","year":"2015","journal-title":"What impact will the achievement of the current World Health Organisation targets for anthelmintic treatment coverage in children have on the intensity of soil transmitted helminth infections?"},{"issue":"3","key":"pntd.0008771.ref034","doi-asserted-by":"crossref","first-page":"e0007196","DOI":"10.1371\/journal.pntd.0007196","article-title":"Calculating the prevalence of soil-transmitted helminth infection through pooling of stool samples: Choosing and optimizing the pooling strategy","volume":"13","author":"JE Truscott","year":"2019","journal-title":"PLOS Neglected Tropical Diseases"}],"updated-by":[{"DOI":"10.1371\/journal.pntd.0008771","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2020,11,18]],"date-time":"2020-11-18T00:00:00Z","timestamp":1605657600000}}],"container-title":["PLOS Neglected Tropical 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