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<h4>Background</h4>Driven by global targets to eliminate soil-transmitted helminths as a public health problem, governments have rapidly rolled out control programmes using school and community-based platforms. To justify and target ongoing investment, quantification of impact and identification of remaining high-risk areas are needed. We aimed to assess regional progress towards these targets.<h4>Methods</h4>We did a continental-scale ecological analysis using a Bayesian space-time hierarchical model to estimate the effects of known environmental, socioeconomic, and control-related factors on the prevalence of soil-transmitted helminths, and we mapped the probability that implementation units had achieved moderate-to-heavy intensity infection prevalence of less than 2% among children aged 5-14 years between Jan 1, 2000, and Dec 31, 2018.<h4>Findings</h4>We incorporated data from 26 304 georeferenced surveys, spanning 3096 (60%) of the 5183 programmatic implementation units. Our findings suggest a reduction in the prevalence of soil-transmitted helminths in children aged 5-14 years in sub-Saharan Africa, from 44% in 2000 to 13% in 2018, driven by sustained delivery of preventive chemotherapy, improved sanitation, and economic development. Nevertheless, 1301 (25%) of 5183 implementation units still had an estimated prevalence of moderate-to-heavy intensity infection exceeding the 2% target threshold in 2018, largely concentrated in nine countries (in 1026 [79%] of 1301 implementation units): Nigeria, Democratic Republic of the Congo, Ethiopia, Cameroon, Angola, Mozambique, Madagascar, Equatorial Guinea, and Gabon.<h4>Interpretation</h4>Our estimates highlight the areas to target and strengthen interventions, and the areas where data gaps remain. If elimination of soil-transmitted helminths as a public health problem is to be achieved in sub-Saharan Africa by 2030, continued investment in treatment and prevention activities are essential to ensure that no areas are left behind.<h4>Funding</h4>Bill & Melinda Gates Foundation.

Original publication

DOI

10.1016/s2214-109x(20)30398-3

Type

Journal

The Lancet. Global health

Publication Date

01/2021

Volume

9

Pages

e52 - e60

Addresses

Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA; Department of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa. Electronic address: benn.sartorius1@lshtm.ac.uk.

Keywords

Animals, Humans, Helminths, Helminthiasis, Soil, Severity of Illness Index, Prevalence, Adolescent, Child, Child, Preschool, Africa South of the Sahara, Female, Male, Spatial Analysis