Exploring factors associated with infection in school children in a high-transmission setting in Kenya.

Objectives: Kenya has implemented a national school-based deworming program, which has led to substantial decline in the prevalence of soil-transmitted helminths (STHs), although some pockets of infections remain. To effectively design an STH control program that leads to significant reductions of there is a need to understand the drivers of persistent infection despite ongoing treatment programs.

Methods: This study was conducted between July and September 2019 at the south coast of Kenya, using a two-stage sampling design. First, a school-based cross-sectional survey was conducted in 2265 randomly selected school children from selected schools in areas known to be endemic for . After this, we conducted a nested case-control study wherein all children positive for (142) were matched to 148 negative controls based on age and village. A household survey was then conducted with all household members of cases and controls. In addition, a subsample of 116 children found to be infected with were followed up to assess the efficacy of albendazole at day 21 post-treatment. The predictors of presence of were investigated through multilevel logistic regression, considering clustering of infection.

Results: Overall, 34.4% of the children were infected with at least one STH species; was the most common (28.3%), 89.1% of those with had light-intensity infections. The prevalence of was significantly higher in male children and was positively associated with younger age and number of people infected with in a household. The parasitological cure rate and egg reduction rate of were 35% and 51%, respectively. Other STHs identified were hookworm (9.6%) and (5.7%).

Conclusions: remains a significant public health challenge in the study area with albendazole treatment efficacy against the parasite, remaining lower than the World Health Organization-recommended thresholds. Because of the observed focal transmission of in the current area, control efforts tailored to local conditions and targeting lower implementation units should be used to achieve optimal results on transmission.