# Achieving elimination of soil-transmitted helminthiasis as a public health problem in Mali

## TL;DR

Mali successfully reduced soil-transmitted helminth infections through integrated mass drug administration, achieving near elimination as a public health problem.

## Contribution

Demonstrates Mali's progress in eliminating STH through integrated MDA and surveillance, making it one of the first African countries to do so.

## Key findings

- Baseline STH prevalence in 2004–2005 was 6.3%, with hookworm being the main species.
- By 2014–2019, STH prevalence dropped to 0.1%, with no moderate or heavy infections.
- Mali's integrated approach overcame security challenges and achieved national elimination goals.

## Abstract

Mali was endemic for soil-transmitted helminthiasis (STH), mainly hookworms in the southern regions. Following baseline mapping, mass drug administration (MDA) for STH was integrated with MDA for schistosomiasis for school-aged children (SAC) or lymphatic filariasis (LF) for populations aged five and older and vitamin A supplementation for preschool children. Epidemiological evaluations were conducted to assess progress towards eliminating STH as a public health problem.

Cross-sectional studies were conducted in schools in 2004–2005 at baseline and in 2014–2019 for integrated evaluation with either schistosomiasis assessments or LF transmission assessment surveys (TAS). Children aged 7–14 years (6–7 years in TAS-STH surveys) were selected through systematic random sampling, and stool samples from selected children were examined using the Kato–Katz method for the eggs of any species of STH. The prevalence of infection and the prevalence of moderate-intensity and heavy-intensity (MHI) infections were calculated.

A total of 13 769 SAC were examined at baseline in 2004–2005, with an overall STH prevalence of 6.3% (95% CI 5.9% to 6.7%). Overall STH prevalence was the highest in Sikasso (22.9%), followed by Segou (9.4%). The prevalence of MHI infections ranged from 0% to 9.0% among the survey sites, with high prevalences (2.9–9.0%) in some communities in the Sikasso region. The predominant species of STH infection was hookworm, with negligible infection by Ascaris lumbricoides and Trichuris trichiura. Integrated schistosomiasis/STH impact assessments from 2014 to 2017 sampled 5776 children, with an overall prevalence of 0.1% (95% CI 0.1% to 0.3%) and 0% MHI infections. The integrated TAS-STH surveys in 2018–2019 in 29 districts further confirmed an overall low STH prevalence of 0.1% (95% CI 0.0% to 0.3%). These results indicate the progress towards the national goal of eliminating STH as a public health problem in Mali and highlight the need for continued surveillance in certain regions.

Through over a decade of integrated treatment overcoming major security challenges, Mali may have successfully eliminated STH as a public health problem in all regions, one of the first countries in Africa to achieve this milestone.