Re-evaluating Albendazole-Based Preventive Chemotherapy for Soil-Transmitted Helminths in Indonesia: A Narrative Review on Efficacy, Challenges, and Future Strategies

Lala Gunasari; Dian Nurmansyah; Dessy Triana

doi:10.47134/scpr.v3i1.5601

Authors

Lala Foresta Valentine Gunasari Universitas Bengkulu
Dian Nurmansyah Universita Gajah Mada
Dessy Triana Universitas Bengkulu

DOI:

https://doi.org/10.47134/scpr.v3i1.5601

Keywords:

Albendazole, Efficacy, Soil-Transmitted Helminth, Mass Drug Administration

Abstract

This narrative review seeks to critically analyze the efficacy of albendazole, the cornerstone anthelmintic of the program. Relevant literature (2020-2025) was identified through a systematic search of the ScienceDirect and Google Scholar databases. While evidence confirms albendazole's effectiveness, with cure rates up to 93%, its performance is inconsistent and influenced by a confluence of factors. A critical constraint identified is the absence of robust, large-scale national surveillance data on STH prevalence and drug efficacy, hindering a comprehensive assessment of albendazole's performance within the program. The persistent burden of STH underscores a gap between program implementation and its intended public health impact. While albendazole remains essential, its variable efficacy and operational barriers necessitate a critical reassessment of the current strategy.

References

Adrizain, R., Setiabudi, D., Faridah, L., Fauziah, N., & Setiabudiawan, B. (2020). Challenges for national deworming policy in Indonesia: Experience from Bandung district West Java province. https://doi.org/10.21203/rs.3.rs-25514/v1

Ajjampur, S. S. R., Aruldas, K., Ásbjörnsdóttir, K. H., Avokpaho, E., Bailey, R., Cottrell, G., Galagan, S. R., Halliday, K. E., Houngbégnon, P., Ibikounlé, M., Israel, G. J., Kaliappan, S. P., Kalua, K., Legge, H., Littlewood, D. T. J., Luty, A. J. F., Manuel, M., Massougbodji, A., Means, A. R., & Walson, J. L. (2025). Feasibility of interrupting the transmission of soil-transmitted helminths: The DeWorm3 community cluster-randomised controlled trial in Benin, India, and Malawi. The Lancet, 406(10502), 475–488. https://doi.org/10.1016/S0140-6736(25)00766-4

Algorta, J., Krolewiecki, A., Pinto, F., Gold, S., & Muñoz, J. (2022). Pharmacokinetic characterization and comparative bioavailability of an innovative orodispersible fixed-dose combination of ivermectin and albendazole: A single dose, open label, sequence randomized, crossover clinical trial in healthy volunteers. Frontiers in Pharmacology, 13. https://doi.org/10.3389/fphar.2022.914886

Alheety, N. F., Awad, S. A., Alheety, M. A., Darwesh, M. Y., Abbas, J. A., & Besbes, R. (2025). Benzimidazole derivatives: A review of advances in synthesis, biological potential, computational modelling, and specialized material functions. Chemistry, 8(1), 1. https://doi.org/10.3390/chemistry8010001

Ali, S., Anggraini, F., Kurniawan, F., Kristin, H., Hengestu, A., Lede, Y. K., Kerans, G., Jerawu, A. A. L., Joprang, F. S., & Kaisar, M. M. M. (2025). High burden of soil-transmitted helminth infections among preschool and school aged-children in North Kodi, Southwest Sumba, Indonesia: A cross-sectional study. Tropical Biomedicine, 42(3), 344–355. https://doi.org/10.47665/tb.42.3.014

Ameen, E., Zhu, S. N., Guzman, C. M., Taub, E., Siles, C., Sanchez, G. M., Vilcarromero, S., Ramal, C., Tangoa, N., & Marcos, L. A. (2023). Feasibility of training community health workers to use smartphone-attached microscopy for point-of-care visualization of soil-transmitted helminths in the Peruvian Amazon. American Journal of Tropical Medicine and Hygiene, 108(6), 1175–1182. https://doi.org/10.4269/ajtmh.22-0210

Coffeng, L. E., Vlaminck, J., Cools, P., Denwood, M., Albonico, M., Ame, S. M., Ayana, M., Dana, D., Cringoli, G., de Vlas, S. J., Fenwick, A., French, M., Kazienga, A., Keiser, J., Knopp, S., Leta, G., Matoso, L. F., Maurelli, M. P., Montresor, A., & Levecke, B. (2023). A general framework to support cost-efficient fecal egg count methods and study design choices for large-scale STH deworming programs—Monitoring of therapeutic drug efficacy as a case study. PLoS Neglected Tropical Diseases, 17(5). https://doi.org/10.1371/journal.pntd.0011071

Curico, G., Garcia Bardales, P. F., Pinedo Vasquez, T. N., Lopez, W. V. S., Olortegui, M. P., Schiaffino, F., Yori, P. P., Colston, J. M., Flynn, T. G., Sanchez, G. M., Delgado, H. S., Oberhelman, R. A., & Kosek, M. N. (2024). Efficacy of single-dose albendazole and albendazole plus ivermectin for soil-transmitted helminth infection in children in the Peruvian Amazon. American Journal of Tropical Medicine and Hygiene, 111(1), 80–88. https://doi.org/10.4269/ajtmh.23-0497

Darlan, D. M., Rozi, M. F., Yulfi, H., Panggabean, M., Andriyani, Y., Siregar, I., Hutagalung, V. S., & Mastari, E. S. (2025). Identifying risk factors for soil-transmitted helminths among indigenous communities in Simalungun, North Sumatra. Tropical Biomedicine, 42(2), 85–89. https://doi.org/10.47665/tb.42.2.001

delos Trinos, J. P. C., Coffeng, L. E., Garcia, F., Belizario, V., Wiseman, V., Watts, C., & Vaz Nery, S. (2024). Cost and budget impact of mass drug administration compared to expanded school-based targeted preventive chemotherapy for soil-transmitted helminth control in Zamboanga Peninsula, the Philippines. The Lancet Regional Health – Western Pacific, 50. https://doi.org/10.1016/j.lanwpc.2024.101162

Djuardi, Y., Lazarus, G., Stefanie, D., Fahmida, U., Ariawan, I., & Supali, T. (2021). Soil-transmitted helminth infection, anemia, and malnutrition among preschool-age children in Nangapanda subdistrict, Indonesia. PLoS Neglected Tropical Diseases, 15(6). https://doi.org/10.1371/journal.pntd.0009506

Djune-Yemeli, L., Nana-Djeunga, H. C., Lenou-Nanga, C. G., Donfo-Azafack, C., Domche, A., Fossuo-Thotchum, F., Niamsi-Emalio, Y., Ntoumi, F., & Kamgno, J. (2020). Serious limitations of the current strategy to control soil-transmitted helminths and added value of ivermectin/albendazole mass administration: A population-based observational study in Cameroon. PLoS Neglected Tropical Diseases, 14(11), e0008794. https://doi.org/10.1371/journal.pntd.0008794

Dyer, C. E. F., Clarke, N. E., Nguyen, D. N., Dilrukshi Herath, H. M. P., Hii, S. F., Pickford, R., Traub, R. J., & Nery, S. V. (2022). Assessing the efficacy of albendazole against hookworm in Vietnam using quantitative PCR and sodium nitrate flotation. PLoS Neglected Tropical Diseases, 16(10). https://doi.org/10.1371/journal.pntd.0010767

Eneanya, O. A., Gankpala, L., Goss, C. W., Momolu, A. T., Nyan, E. S., Gray, E. B., Fischer, K., Curtis, K., Bolay, F. K., Weil, G. J., & Fischer, P. U. (2022). Community-based trial assessing the impact of annual versus semiannual mass drug administration with ivermectin plus albendazole and praziquantel on helminth infections in northwestern Liberia. Acta Tropica, 231. https://doi.org/10.1016/j.actatropica.2022.106437

Fauziah, N., Ar-Rizqi, M. A., Hana, S., Patahuddin, N. M., & Diptyanusa, A. (2022). Stunting as a risk factor of soil-transmitted helminthiasis in children: A literature review. Interdisciplinary Perspectives on Infectious Diseases, 2022. https://doi.org/10.1155/2022/8929025

Febriyanti, H., & Idris, H. (2020). Evaluation of program for overcoming intestinal worm infections among children. Kesmas, 15(1), 24–31. https://doi.org/10.21109/kesmas.v15i1.2737

Gandasegui, J., Grau-Pujol, B., Novela, V., Muchisse, O., Cambra-Pellejà, M., Cossa, A., Jamine, J. C., Sacoor, C., Brienen, E. A. T., Catala-Moll, F., van Lieshout, L., Martínez-Valladares, M., Paredes, R., Muñoz, J., & Doyle, S. R. (2024). Deep-amplicon sequencing of the complete beta-tubulin gene in Trichuris trichiura before and after albendazole treatment. International Journal for Parasitology: Drugs and Drug Resistance, 26. https://doi.org/10.1016/j.ijpddr.2024.100570

Gomez, S. R., Maddren, R., Liyew, E. F., Chernet, M., Anjulo, U., Tamiru, A., Mengitsu, B., Forbes, K., Collyer, B., Salasibew, M., & Anderson, R. (2023). Predisposition to soil-transmitted helminth reinfection after four rounds of mass drug administration: Results from a longitudinal cohort in the Geshiyaro project, a transmission elimination feasibility study in the Wolaita zone of southern Ethiopia. Transactions of the Royal Society of Tropical Medicine and Hygiene, 117(7), 514–521. https://doi.org/10.1093/trstmh/trad007

Gray, D. J., Du, Z., Mationg, M. L., Li, Y., Yang, H., Wang, D., Aung, E., Bieri, F. A., O’Connor, S., Yan, X., Wu, F., Steinmann, P., Halton, K., Stewart, D. E., Clements, A. C. A., McManus, D. P., & Williams, G. M. (2026). Efficacy of two rounds of albendazole treatment on soil-transmitted helminths in schoolchildren, Yunnan Province, China. Nature Communications, 17(1). https://doi.org/10.1038/s41467-025-64883-0

Gultom, D. E., Ali, M., Pasaribu, A. P., & Pasaribu, S. (2020). Two or three consecutive days albendazole treatment has better efficacy than single-dose albendazole treatment for trichuriasis. Indonesian Biomedical Journal, 12(1), 45–50. https://doi.org/10.18585/INABJ.V12I1.920

Hardwick, R. J., Truscott, J. E., Oswald, W. E., Werkman, M., Halliday, K. E., Pullan, R. L., & Anderson, R. M. (2021). Individual adherence to mass drug administration in neglected tropical disease control: A probability model conditional on past behaviour. PLoS Neglected Tropical Diseases, 15(1), 1–15. https://doi.org/10.1371/journal.pntd.0009112

Hardy, M., Samuela, J., Kama, M., Tuicakau, M., Romani, L., Whitfeld, M. J., King, C. L., Weil, G. J., Grobler, A. C., Robinson, L. J., Kaldor, J. M., & Steer, A. C. (2020). The safety of combined triple drug therapy with ivermectin, diethylcarbamazine and albendazole in the neglected tropical diseases co-endemic setting of Fiji: A cluster randomised trial. PLoS Neglected Tropical Diseases, 14(3). https://doi.org/10.1371/journal.pntd.0008106

Ipa, M., Isnani, T., Girsang, V. I., Amila, Harianja, E. S., Purba, Y., Wandra, T., Budke, C. M., & Purba, I. E. (2024). Soil-transmitted helminth infections and anemia in children attending government run schools on Samosir Island, Indonesia. Parasite Epidemiology and Control, 25. https://doi.org/10.1016/j.parepi.2024.e00344

Khir, N., Nisha, M., Yenn, T. W., & Davamani, F. (2023). Determining the efficacy of albendazole against STH infection among Orang Asli. Malaysian Journal of Medicine and Health Sciences, 19(Supplement 9), 191–196. https://doi.org/10.47836/mjmhs.19.s9.28

Krolewiecki, A., Enbiale, W., Gandasegui, J., van Lieshout, L., Kepha, S., Messa Junior, A., Bengtson, M., Gelaye, W., Escola, V., Martinez-Valladares, M., Cambra-Pellejà, M., Algorta, J., Martí-Soler, H., Fleitas, P., Ballester, M. R., Doyle, S. R., Williams, N. A., Legarda, A., Mandomando, I., & Muñoz, J. (2022). An adaptive phase II/III safety and efficacy randomized controlled trial of single day or three-day fixed-dose albendazole-ivermectin co-formulation versus albendazole for the treatment of Trichuris trichiura and other STH infections: ALIVE trial protocol. Gates Open Research, 6. https://doi.org/10.12688/gatesopenres.13615.1

Le, B., Clarke, N. E., Legrand, N., & Nery, S. V. (2024). Effectiveness of ivermectin mass drug administration in the control of soil-transmitted helminth infections in endemic populations: A systematic review and meta-analysis. Infectious Diseases of Poverty, 13(1). https://doi.org/10.1186/s40249-024-01185-5

McPherson, S., Tafese, G., Tafese, T., Behaksra, S. W., Solomon, H., Oljira, B., Miecha, H., Debebe, K. A., Kebede, B., Gebre, T., Kebede, F., Seife, F., Tadesse, F., Mammo, B., Aseffa, A., Solomon, A. W., Mabey, D. C. W., Marks, M., & Gadisa, E. (2023). Safety of integrated mass drug administration of azithromycin, albendazole and ivermectin versus standard treatment regimens: A cluster-randomised trial in Ethiopia. EClinicalMedicine, 59. https://doi.org/10.1016/j.eclinm.2023.101984

Means, A. R., Ajjampur, S. S. R., Bailey, R., Galactionova, K., Gwayi-Chore, M. C., Halliday, K., Ibikounle, M., Juvekar, S., Kalua, K., Kang, G., Lele, P., Luty, A. J. F., Pullan, R., Sarkar, R., Schär, F., Tediosi, F., Weiner, B. J., Yard, E., & Walson, J. (2018). Evaluating the sustainability, scalability, and replicability of an STH transmission interruption intervention: The DeWorm3 implementation science protocol. PLoS Neglected Tropical Diseases, 12(1), 1–13. https://doi.org/10.1371/journal.pntd.0005988

Mitchell, E., Kelly-Hanku, A., Krentel, A., Romani, L., Robinson, L. J., Nery, S. V., Kaldor, J., Steer, A. C., & Bell, S. (2022). Community perceptions and acceptability of mass drug administration for the control of neglected tropical diseases in Asia-Pacific countries: A systematic scoping review of qualitative research. PLoS Neglected Tropical Diseases, 16(3). https://doi.org/10.1371/journal.pntd.0010215

Murhandarwati, E. H., Probandari, A., Kusumasari, R. A., Ferdiana, A., Kustanti, C. Y., Dewi, K., Tarmizi, S. N., Wulandari, L. P. L., Schierhout, G., Romani, L., Kaldor, J., & Nery, S. V. (2024). Effect of preventive chemotherapy for neglected tropical diseases in Indonesia from 1992 to 2022: A systematic review and meta-analysis. Tropical Medicine and International Health, 29(12), 995–1005. https://doi.org/10.1111/tmi.14057

Nachaiwieng, W., Sanit, S., Kongta, N., Saingamsook, J., Duangmano, S., Pornprasert, S., Somboon, P., & Yanola, J. (2024). The impact of an integrated intervention program combining drug therapy with water, sanitation, and hygiene (WASH) education on reinfection with intestinal parasitic infections among the Karen hill tribe in northern Thailand. Parasites & Vectors, 17(1). https://doi.org/10.1186/s13071-024-06611-z

Nisha, M., Faqiha, N., Shafiqah, N., Nurhidayah, S., & Davamani, F. (2021). Research note: Efficacy of single dose albendazole treatment of soil-transmitted helminths among indigenous children in Malaysia. Taman Kajang Sentral, 52(1).

Palmeirim, M. S., Hürlimann, E., Beinamaryo, P., Kyarisiima, H., Nabatte, B., Hattendorf, J., Steinmann, P., & Keiser, J. (2024). Efficacy and safety of albendazole alone versus albendazole in combination with ivermectin for the treatment of Trichuris trichiura infections: An open-label, randomized controlled superiority trial in south-western Uganda. PLoS Neglected Tropical Diseases. https://doi.org/10.1371/journal.pntd.0012687

Rahayu, N., Ferdina, A. R., Hidayat, S., Kusumaningtyas, H., Suryatinah, Y., Ridha, M. R., & Pangaribuan, H. U. (2023). Status of soil-transmitted helminth after implementation of school-based deworming programmes in five districts, South Kalimantan Province, Indonesia. Journal of Communicable Diseases, 55(4), 1–13. https://doi.org/10.24321/0019.5138.202347

Sindhu, K. N., Aruldas, K., Kaliappan, S. P., Mahendran, E., Walson, J. L., Means, A. R., & Ajjampur, S. S. R. (2023). Perceptions associated with noncompliance to community-wide mass drug administration for soil-transmitted helminths. American Journal of Tropical Medicine and Hygiene, 109(4), 830–834. https://doi.org/10.4269/ajtmh.23-0176

Sukmana, D. J., Kridaningsih, T. N., Mufidah, H., Kenangalem, E., Burdam, F. H., Susilawati, T. N., Poespoprodjo, J. R., & Murhandarwati, E. E. H. (2025). Molecular diagnosis of Trichuris trichiura: Prevalence and associated risk factors in children under five living in a malaria-endemic area in Papua, Indonesia. PLOS ONE, 20(11). https://doi.org/10.1371/journal.pone.0335643

Sungkar, S., Sukartini, N., Wirastuti, A., & Tanjungsari, D. W. (2024). Erythrocyte and iron profiles in soil-transmitted helminth-infected children in a rural area in Banten, Indonesia. Medical Journal of Indonesia, 33(1), 13–16. https://doi.org/10.13181/mji.oa.247154

Surja, S. S., Ali, S., Ajisuksmo, C., Pramono, H., Iustitiani, N. S. D., Celine, & Cindy. (2021). Hookworm infection still prevalent in the less developed urban area in Jakarta, Indonesia. Clinical Epidemiology and Global Health, 9, 137–140. https://doi.org/10.1016/j.cegh.2020.08.003

Suryawati, Putra, T. R. I., Liansyah, T. M., Maulina, N., Maulidina, R. Y., & Al-Muchtari, T. A. Z. (2024). Description of mothers’ knowledge, attitudes, and behavior regarding deworming the children against soil-transmitted helminthiasis at the Lampaseh Health Center in Banda Aceh City. Indonesian Journal of Tropical and Infectious Disease, 12(3), 226–236. https://doi.org/10.20473/ijtid.v12i3.54434

Tee, M. Z., Lee, S. C., Er, Y. X., Yap, N. J., Ngui, R., Easton, A. V., Siow, V. W. Y., Ng, K. S., Boey, C. C. M., Chua, K. H., Cadwell, K., Loke, P., & Lim, Y. A. L. (2022). Efficacy of triple dose albendazole treatment for soil-transmitted helminth infections. PLoS ONE, 17(8). https://doi.org/10.1371/journal.pone.0272821

Vlaminck, J., Levecke, B., Cools, P., Albonico, M., Ame, S., Chanthapaseuth, T., Viengxay, V., Do Trung, D., Osei-Atweneboana, M. Y., Asuming-Brempong, E., Jahirul Karim, M., Al Kawsar, A., Keiser, J., Khieu, V., Faye, B., Turate, I., Mbonigaba, J. B., Ruijeni, N., Shema, E., & Vercruysse, J. (2020). Piloting a surveillance system to monitor the global patterns of drug efficacy and the emergence of anthelmintic resistance in soil-transmitted helminth control programs: A Starworms study protocol. Gates Open Research, 4. https://doi.org/10.12688/gatesopenres.13115.1

Witek-McManus, S., Simwanza, J., Chisambi, A. B., Kepha, S., Kamwendo, Z., Mbwinja, A., Samikwa, L., Oswald, W. E., Kennedy, D. S., Timothy, J. W. S., Legge, H., Galagan, S. R., Emmanuel-Fabula, M., Schaer, F., Ásbjörnsdóttir, K., Halliday, K. E., Walson, J. L., Juziwelo, L., Bailey, R. L., & Pullan, R. L. (2021). Epidemiology of soil-transmitted helminths following sustained implementation of routine preventive chemotherapy: Demographics and baseline results of a cluster randomised trial in southern Malawi. PLoS Neglected Tropical Diseases, 15(5). https://doi.org/10.1371/journal.pntd.0009292

World Health Organization. (2023). Soil-transmitted helminth infections. https://www.who.int/news-room/fact-sheets/detail/soil-transmitted-helminth-infections