Pragmatic weight estimation for dosing of a new paediatric treatment for schistosomiasis prevention and control in preschool-aged children: a feasibility study in Uganda and Côte d’Ivoire

Abstract Background Schistosomiasis remains a major public health concern in endemic settings. The Pediatric Praziquantel Consortium has developed a new paediatric treatment, arpraziquantel, for preschool-aged children. Because the treatment is dosed according to body weight, dose determination by scales poses operational challenges in community-based mass treatment campaigns. This study assessed the performance of the Pediatric Advanced Weight Prediction in the Emergency Room Extra-Long Mid-Arm Circumference (PAWPER XL-MAC) tape for weight estimation during mass drug administration in Uganda and Côte d’Ivoire. Methods A mixed-methods study evaluated feasibility in terms of accuracy, reliability and acceptability of the PAWPER XL-MAC tape across delivery platforms and users between March 2025 and March 2026. Accuracy metrics comprised (1) the mean relative difference and mean absolute relative difference between predicted (tape) and observed (scale) weight and (2) the proportion of estimates within 10% (PW10) and 20% (PW20) of observed weight. Reliability was evaluated by calculating the intraclass-correlation coefficient (ICC). User experiences were collected through observations, questionnaires, focus group discussions and in-depth interviews. Results In Uganda ( n = 3369), mean absolute differences were 11.0–11.1%; PW10 60.2–61.0%. In Côte d’Ivoire ( n = 1249), accuracy was higher (6.8–7.7%; PW10 72.4–78.2%). Reliability was high between users and countries (ICCs ≥ 0.84). Sufficient time for practical training was essential to achieve solid performance. With continued use, an increase in confidence, efficiency, and accuracy was observed. Qualitative results indicated strong acceptability and practical advantages amongst users. Conclusions This is the first study to demonstrate that the PAWPER XL-MAC tape offers reliable, accurate, and acceptable weight estimation for community-based interventions, supporting its use in routine child healthcare and public health programmes. Trial registration ClinicalTrials.gov ID NCT06698510, date of registration: 21.11.2024.