Persistent helminthiasis among reproductive-aged women in Bangladesh: Implementation gaps in long-standing mass drug administration programs
1
Zoology, Dhaka University, Dhaka, Bangladesh
2
Parasitology, Sylhet Agricultural University, Sylhet, Bangladesh
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Helminthiasis remains a public health concern in low-resource settings. Evidence on program performance among adult women, a population often excluded from routine deworming, is limited. This study assessed the burden of intestinal parasitic infections and examined implementation-related factors influencing control efforts among reproductive-aged women in northwestern Bangladesh.
METHODS:
A community-based mixed-methods cross-sectional study was conducted among women aged 15–49 years. Quantitative data were collected from 1852 participants using a structured questionnaire, and 1788 women provided stool samples for parasitological examination. To explore implementation fidelity and health-system barriers, 12 in-depth interviews, 8 focus group discussions, and 2 key-informant interviews were conducted with women, household decision-makers, frontline health workers, and community leaders.
RESULTS:
Overall, 18.8% [95% CI: 17.0–20.7] of women were infected with at least one intestinal parasite. Ascaris lumbricoides was the most prevalent infection (15.6% [95% CI: 14.0–17.4]), followed by hookworm (11.7% [95% CI: 10.3–13.3]) and Trichuris trichiura (4.9% [95% CI: 4.0–6.0]). Mixed infections were identified in 5.6% [95% CI: 4.6–6.8] of participants. Enterobius vermicularis infection was detected in 2.4% [95% CI: 1.8–3.2], while trematode species were observed in 0.5% [95% CI: 0.3–1.0] of stool samples. Persistent infections were associated with socioeconomic status, sanitation, health literacy, and hygiene practices. Evaluated MDA coverage among reproductive-aged women was lower than routine program reports. Key implementation barriers included restrictive drug distribution policies, limited access to distribution points, weak report of population dynamics, insufficient follow-up, misinformation about drug side effects, and inadequate motivation of drug distributors.
CONCLUSIONS:
Despite long-term MDA implementation, a substantial burden of helminthiasis persists among reproductive-aged women, highlighting critical implementation gaps. Policy responses should prioritize inclusive drug distribution strategies, strengthened monitoring systems, capacity building of frontline implementers, and context-specific community engagement. Integrating implementation science approaches into national helminth control programs is essential to improve coverage, equity, and long-term sustainability.
Helminthiasis remains a public health concern in low-resource settings. Evidence on program performance among adult women, a population often excluded from routine deworming, is limited. This study assessed the burden of intestinal parasitic infections and examined implementation-related factors influencing control efforts among reproductive-aged women in northwestern Bangladesh.
METHODS:
A community-based mixed-methods cross-sectional study was conducted among women aged 15–49 years. Quantitative data were collected from 1852 participants using a structured questionnaire, and 1788 women provided stool samples for parasitological examination. To explore implementation fidelity and health-system barriers, 12 in-depth interviews, 8 focus group discussions, and 2 key-informant interviews were conducted with women, household decision-makers, frontline health workers, and community leaders.
RESULTS:
Overall, 18.8% [95% CI: 17.0–20.7] of women were infected with at least one intestinal parasite. Ascaris lumbricoides was the most prevalent infection (15.6% [95% CI: 14.0–17.4]), followed by hookworm (11.7% [95% CI: 10.3–13.3]) and Trichuris trichiura (4.9% [95% CI: 4.0–6.0]). Mixed infections were identified in 5.6% [95% CI: 4.6–6.8] of participants. Enterobius vermicularis infection was detected in 2.4% [95% CI: 1.8–3.2], while trematode species were observed in 0.5% [95% CI: 0.3–1.0] of stool samples. Persistent infections were associated with socioeconomic status, sanitation, health literacy, and hygiene practices. Evaluated MDA coverage among reproductive-aged women was lower than routine program reports. Key implementation barriers included restrictive drug distribution policies, limited access to distribution points, weak report of population dynamics, insufficient follow-up, misinformation about drug side effects, and inadequate motivation of drug distributors.
CONCLUSIONS:
Despite long-term MDA implementation, a substantial burden of helminthiasis persists among reproductive-aged women, highlighting critical implementation gaps. Policy responses should prioritize inclusive drug distribution strategies, strengthened monitoring systems, capacity building of frontline implementers, and context-specific community engagement. Integrating implementation science approaches into national helminth control programs is essential to improve coverage, equity, and long-term sustainability.
| eISSN: | 2654-1459 |
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