Infectious Disease · Medical Literature
Beyond Coverage: A Systematic Review and Thematic Analysis of Delivery, Compliance, Equity and Impact in Mass Deworming for Soil-Transmitted Helminths.
Abstract
Soil-transmitted helminth (STH) infections affect approximately 1.5 billion people globally. Although the World Health Organization (WHO) aims for 75% mass drug administration (MDA) coverage by 2030, the long-term population benefit remains debated. This review aims to describe the characteristics of recent mass deworming studies, synthesize parasitologic and coverage outcomes, and identify programmatic themes. Search was conducted across Scopus, PubMed, and EBSCO CINAHL, restricted to studies reporting both parasitologic efficacy outcomes and MDA coverage. Following a risk of bias assessment in Review Manager 5.4, qualitative data were processed in Taguette 1.5.1 through a hierarchical thematic analysis to generate basic, organizing, and global themes and supplemented by VOSviewer 1.6.20 overlay visualization. Thirteen eligible studies primarily featured African countries and cross-sectional study designs. While overall risk of bias was low, lack of blinding revealed high performance bias. Thematic analysis, supported by bibliographic visualization, identified four global themes on delivery, compliance, equity and impact. Findings indicate that annual dosing is often insufficient and requires bi-annual schedules and WASH integration. Compliance is hindered by temporal inaccessibility and unreliable decentralized monitoring while equity gaps persist for out-of-school children and pregnant women. Although drug efficacy is confirmed, risks of resistance and diagnostic underreporting via the Kato-Katz method remain critical concerns. This review identifies four interrelated pillars of delivery, compliance, equity, and impact that shape the effectiveness of mass deworming programs and have direct implications for achieving WHO 2030 targets.
Clinical relevance
Among recent mass drug administration (MDA) programs targeting soil-transmitted helminths (STH), what programmatic characteristics, parasitologic efficacy outcomes, coverage rates, and implementation themes—specifically relating to delivery, compliance, equity, and impact—are present in the published literature? __SNAPSHOT__ {"studyDesign":"Systematic review with hierarchical qualitative thematic analysis (and bibliographic co-citation visualization via VOSviewer); risk of bias assessed using Review Manager 5.4; qualitative data coded in Taguette 1.5.1","setting":"Multi-country; eligible studies primarily from African countries; institutional setting of individual included studies not reported","sampleSize":"13 eligible studies included in the review; individual study-level sample sizes not reported in the abstract","population":"Populations residing in STH-endemic areas targeted by mass drug administration programs; specific age groups, sex distribution, and comorbidity profiles of included study populations not reported in the abstract","intervention":"Mass drug administration (MDA) for soil-transmitted helminths, with an emphasis on annual dosing schedules; specific anthelmintic agents (e.g., albendazole, mebendazole) not specified in the abstract","comparator":"Not applicable; review synthesizes observational and interventional MDA program data without a uniform comparator; study designs of included studies were primarily cross-sectional","primaryOutcome":"Parasitologic efficacy outcomes (e.g., prevalence or intensity of STH infection) and MDA coverage rates, as dual eligibility criteria; specific primary endpoint metrics and pooled effect sizes not reported in the abstract","followUp":"Not reported; duration of follow-up within included studies not specified in the abstract","fundingSource":"Not reported"}
Key findings
Thirteen studies met eligibility criteria requiring reporting of both parasitologic efficacy outcomes and MDA coverage; the majority were conducted in African countries and employed cross-sectional designs. Overall risk of bias across included studies was assessed as low; however, lack of blinding in MDA trials was identified as a source of high performance bias. Hierarchical thematic analysis generated four global themes: delivery, compliance, equity, and impact. A key programmatic conclusion emerging from the synthesis is that annual MDA dosing frequency is often insufficient—the abstract is truncated and does not specify under what conditions this insufficiency was observed, for which STH species, or at what transmission intensity thresholds. No pooled effect sizes, confidence intervals, p-values, absolute or relative risk reductions, or number-needed-to-treat values are reported in the available abstract. Coverage targets (WHO goal: ≥75% by 2030) are noted as context but whether included studies met this threshold on average is not stated. All quantitative values referenced above derive solely from the abstract as provided; none were independently calculated.
Practice implications
This systematic review with thematic analysis addresses an important programmatic gap: translating MDA coverage statistics into actionable implementation science. The four-theme framework (delivery, compliance, equity, impact) provides a useful organizing structure for program planners and public health practitioners managing STH control in endemic settings. The primary finding that annual dosing is often insufficient aligns with existing literature suggesting that high-transmission settings may require biannual or more frequent MDA rounds to achieve sustained reductions in STH prevalence and intensity. However, several important limitations temper the conclusions that can be drawn: (1) Only an abstract was available for this review; the full data synthesis, thematic content, quantitative results, and subgroup analyses cannot be evaluated. (2) The review included only 13 studies—a small corpus for a global disease affecting 1.5 billion people—raising concerns about comprehensiveness and the representativeness of conclusions. (3) The predominance of African countries limits generalizability to STH-endemic regions in Asia and Latin America, which have distinct STH species profiles, health system structures, and MDA delivery contexts. (4) The restriction to studies reporting both parasitologic and coverage outcomes may have introduced selection bias by excluding programmatic studies reporting only one of these domains. (5) Cross-sectional designs dominate the evidence base, precluding causal inference about MDA impact over time. (6) High performance bias due to non-blinding is inherent to open-label MDA programs and must be accounted for when interpreting reported efficacy. Clinicians and program managers should not alter MDA frequency or policy solely on the basis of this abstract; the full publication should be reviewed when available. __LIMITATIONS__ Only an abstract was available; full results, thematic content, quantitative syntheses, and methodological detail cannot be independently assessed.,Small number of eligible studies (n=13) limits statistical power for any quantitative synthesis and may reflect restrictive eligibility criteria (dual requirement for parasitologic and coverage outcomes) rather than a true paucity of evidence.,Geographic concentration in African countries limits generalizability to STH-endemic regions of Southeast Asia, South Asia, and Latin America, where species distribution, infrastructure, and health-seeking behavior differ substantially.,Predominance of cross-sectional designs precludes longitudinal causal inference about the sustained impact of MDA on STH transmission dynamics.,High performance bias identified due to lack of blinding, which is structurally unavoidable in open MDA programs but may inflate reported programmatic or compliance outcomes.,Restriction to studies reporting both parasitologic efficacy and coverage as dual eligibility criteria may systematically exclude large-scale operational MDA programs that report only programmatic coverage without parasitologic follow-up, potentially skewing findings toward more rigorous but less representative program evaluations.,Thematic analysis is inherently interpretive; reproducibility of theme generation across different research teams is not assessable from the abstract alone.,Funding source is not reported, limiting assessment of potential conflicts of interest.,The abstract is truncated; conclusions stated as 'findings indicate that annual dosing is often insufficient' cannot be fully contextualized without the complete manuscript specifying the evidence base, transmission intensity thresholds, or species-specific findings that support this claim. __BOTTOM_LINE_CATEGORY__ potentially_practice_informing __BOTTOM_LINE__ This systematic review of 13 predominantly African MDA studies identifies four programmatic themes—delivery, compliance, equity, and impact—and suggests that annual deworming dosing is frequently insufficient to achieve sustained STH control, though the evidence base is small, geographically concentrated, and dominated by cross-sectional designs. The findings are hypothesis-generating and programmatically informative rather than definitive, and should be used to guide MDA program design and advocacy for higher-frequency dosing in high-transmission settings pending review of the full publication. No change in individual clinical practice is warranted from this abstract alone; public health program planners should treat these thematic conclusions as supporting—but not replacing—existing WHO guidance.