PROJECT SUMMARY

PROJECT DESCRIPTION

Background

Ethiopia has made significant progress in reducing the burden of Schistosomiasis (SCH) and Soil-Transmitted Helminthiasis (STH) through repeated rounds of high-coverage mass drug administration (MDA), improved water, sanitation, and hygiene (WASH) interventions, and community-based behavior change initiatives. National mapping conducted between 2013 and 2020 enabled targeted implementation in endemic districts, contributing to substantial reductions in infection prevalence and intensity. Building on these achievements, Ethiopia’s Third National NTD Strategic Plan (2021–2025) has shifted its focus from morbidity control toward interruption of transmission and elimination.

As the country moves toward elimination, Stop-MDA surveys are essential to determine whether transmission has declined to levels where community-wide preventive chemotherapy can be safely discontinued and replaced with surveillance and targeted test-and-treat approaches. However, persistent transmission risks remain in remote, hard-to-reach, and underserved communities with limited access to routine health services. This project therefore aims to generate robust district-level evidence to guide decisions on stopping MDA and sustaining elimination gains in eight interruption-of-transmission (IoT) districts in South Ethiopia, Central Ethiopia, and Southwest Ethiopia regions.

Methods

A community-based cross-sectional cluster survey will be conducted in eight IoT districts targeted for SCH and STH elimination. The study will use a multistage sampling design. A total of 161 kebeles will first be stratified according to transmission risk, ecological characteristics, and accessibility, and grouped into approximately 62 evaluation units (EUs). From these, 20 EUs will be selected using proportional allocation and a combination of random and purposive sampling to ensure representation of high-risk and hard-to-reach communities.

Within each selected EU, eight villages will be surveyed, resulting in 160 villages overall. Systematic household sampling will be employed to enroll participants across three age categories: pre-school-aged children (2–5 years), school-aged children (6–<18 years), and adults (≥18 years), with balanced representation by sex. Approximately 11,520 individuals will participate in the survey. Stool and urine specimens will be collected and analyzed using duplicate Kato–Katz thick smears for detection of S. mansoni and soil-transmitted helminths, alongside point-of-care circulating cathodic antigen (POC-CCA) testing to improve sensitivity for S. mansoni detection in low-transmission settings.

Expected Outcomes

Evidence to support safe cessation of MDA for SCH and STH
Identification of residual transmission hotspots requiring targeted interventions
Recommendations for transition to surveillance and test-and-treat strategies
Strengthened evidence base for interruption-of-transmission verification
Contribution to Ethiopia’s SCH and STH elimination goals

Keywords

Stop-MDA survey; Schistosomiasis; Soil-Transmitted Helminthiasis; interruption of transmission; elimination; preventive chemotherapy; POC-CCA; Kato–Katz; surveillance; Ethiopia.