Efficacy of targeted pulse-dosing praziquantel regimens against persistent Schistosoma mansoni infections in commercial sand-mining cohorts along the Shire River, Malawi

African Journal of Parasitology Research | Vol. 14, No. 9, August 2026 | pp. 693–700

DOI: 10.46882/AJPR/140693

Article Type: Full Length Research Paper

Title: Efficacy of targeted pulse-dosing praziquantel regimens against persistent Schistosoma mansoni infections in commercial sand-mining cohorts along the Shire River, Malawi

Names of Authors: Chisomo M. Banda¹, Limbani D. Phiri¹, Tiwonge K. Manda²

Authors’ Affiliations: ¹Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi. ²College of Medicine, University of Malawi, Blantyre, Malawi.

Abstract: Occupational exposure to high-velocity riverine systems exposes sand-mining laborers to intense, repeated cercarial penetration, frequently resulting in high parasitic burdens that display poor clearance under standard chemotherapy. This open-label randomized trial evaluated the cure rate and egg reduction efficiency of a dual-dose pulse praziquantel regimen (40 milligrams per kilogram administered on days 0 and 14) compared to standard single-dose therapy among 420 male sand miners along the Shire River, Malawi. Stool specimens were processed using duplicate Kato-Katz smears at baseline and 28 days post-intervention. Baseline intestinal schistosomiasis prevalence was 58.3 percent (n = 245), with 34.2 percent of positive subjects presenting heavy intensity burdens (greater than 400 eggs per gram of faeces). The pulse-dosing cohort achieved a significantly higher cure rate of 86.4 percent (n = 108/125) compared to 61.6 percent (n = 74/120) in the single-dose control group (P < 0.001). The geometric mean egg reduction rate reached 96.8 percent in the pulse-dosing arm versus 78.4 percent in the reference arm. Mild, transient abdominal discomfort (12.4 percent) and dizziness (8.6 percent) were the primary reported adverse effects, which resolved within 36 hours. These results show that standard single-dose regimens are insufficient under conditions of extreme occupational exposure, demonstrating that a two-dose pulse strategy provides a highly effective curative alternative for high-risk demographic groups.

Keywords: Schistosoma mansoni, Praziquantel, Pulse-dosing, Occupational health, Sand miners, Malawi

Manuscript Timeline: Received: 05 July 2026; Revised: 02 August 2026; Accepted: 22 August 2026; Published: 05 September 2026

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