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Ito EE, Babalola AS, Balogun JB, Eze CN, Nduka FO, Egwunyenga AO. Geospatial Mapping and Seasonal Profiling of Urinary Schistosomiasis in Ase-Niger River Settlements: A Data-Driven Population-Base Study in Delta State, Nigeria. Acta Parasitol 2024; 69:1562-1575. [PMID: 39164551 DOI: 10.1007/s11686-024-00906-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 08/05/2024] [Indexed: 08/22/2024]
Abstract
OBJECTIVES This study is aimed to determine the geospatial, seasonal, age and gender prevalence and intensity of UgS; and to establish disease maps in the Ase-Niger River communities for effective drug administration. STUDY DESIGN This study employed a 24 months longitudinal study design for parasitological investigations in 11 riparian communities of the Ase-Niger River basin, taking into cognizance their GPS locations imported into QGIS software for schistosomiasis mapping. METHODS A total of 7,219 urine samples with WHO structured questionnaires were retrieved and subjected to parasitological evaluation using swinnex urine filtration techniques. RESULTS An overall prevalence of 48.10% was established. Geospatially, prevalence ranges from 34.27% (Ivrogbo) to 52.29% (Ase) with seasonal significant difference (p < 0.05) accounting for 76.19% of the total variance. Ashaka had the highest prevalence for both males (55.73%) and females (53.32%) with significant difference in the study sites (p < 0.05) accounting for 96.47% of the total variance. Age-group 11-20 years consistently maintain a high prevalence at all sites. The peak geometric mean intensity of 105.69 was obtained in the dry season at Lagos Iyede. Ashaka, Igbuku, Iyede-Ame, and Onogboko had heavy-intensity levels in both seasons. Overall, the intensity was lower during the wet season than the dry season, with significant variations (p < 0.05) at Awah and Itobi-Ige. Geospatial prevalence and intensity have a robust and strong positive correlation (r = 0.7178; p = 0.0129), with 51.53% of intensity variability being influenced by prevalence (R2 = 0.5153). CONCLUSION UgS is a significant public health issue in the Ase-Niger River basin, with prevalences surpassing the national average of 29.0% which calls for MDA in these settlements.
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Affiliation(s)
- Edore Edwin Ito
- Department of Animal and Environmental Biology, Delta State University, Abraka, Nigeria.
- Department of Animal and Environmental Biology, University of Port Harcourt, Port Harcourt, Nigeria.
| | - Ayodele Samuel Babalola
- Department of Public Health and Epidemiology, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Joshua Babalola Balogun
- Department of Animal and Environmental Biology, Federal University Dutse, Dutse, Jigawa State, Nigeria
| | - Chinwe Nwadiuto Eze
- Department of Animal and Environmental Biology, University of Port Harcourt, Port Harcourt, Nigeria
| | - Florence Onyemachi Nduka
- Department of Animal and Environmental Biology, University of Port Harcourt, Port Harcourt, Nigeria
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Mertelsmann AM, Bowers SF, Wright D, Maganga JK, Mazigo HD, Ndhlovu LC, Changalucha JM, Downs JA. Effects of Schistosoma haematobium infection and treatment on the systemic and mucosal immune phenotype, gene expression and microbiome: A systematic review. PLoS Negl Trop Dis 2024; 18:e0012456. [PMID: 39250522 PMCID: PMC11412685 DOI: 10.1371/journal.pntd.0012456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 09/19/2024] [Accepted: 08/13/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Urogenital schistosomiasis caused by Schistosoma haematobium affects approximately 110 million people globally, with the majority of cases in low- and middle-income countries. Schistosome infections have been shown to impact the host immune system, gene expression, and microbiome composition. Studies have demonstrated variations in pathology between schistosome subspecies. In the case of S. haematobium, infection has been associated with HIV acquisition and bladder cancer. However, the underlying pathophysiology has been understudied compared to other schistosome species. This systematic review comprehensively investigates and assimilates the effects of S. haematobium infection on systemic and local host mucosal immunity, cellular gene expression and microbiome. METHODS We conducted a systematic review assessing the reported effects of S. haematobium infections and anthelmintic treatment on the immune system, gene expression and microbiome in humans and animal models. This review followed PRISMA guidelines and was registered prospectively in PROSPERO (CRD42022372607). Randomized clinical trials, cohort, cross-sectional, case-control, experimental ex vivo, and animal studies were included. Two reviewers performed screening independently. RESULTS We screened 3,177 studies and included 94. S. haematobium was reported to lead to: (i) a mixed immune response with a predominant type 2 immune phenotype, increased T and B regulatory cells, and select pro-inflammatory cytokines; (ii) distinct molecular alterations that would compromise epithelial integrity, such as increased metalloproteinase expression, and promote immunological changes and cellular transformation, specifically upregulation of genes p53 and Bcl-2; and (iii) microbiome dysbiosis in the urinary, intestinal, and genital tracts. CONCLUSION S. haematobium induces distinct alterations in the host's immune system, molecular profile, and microbiome. This leads to a diverse range of inflammatory and anti-inflammatory responses and impaired integrity of the local mucosal epithelial barrier, elevating the risks of secondary infections. Further, S. haematobium promotes cellular transformation with oncogenic potential and disrupts the microbiome, further influencing the immune system and genetic makeup. Understanding the pathophysiology of these interactions can improve outcomes for the sequelae of this devastating parasitic infection.
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Affiliation(s)
- Anna M Mertelsmann
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Sheridan F Bowers
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Drew Wright
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medical College, New York, New York, United States of America
| | - Jane K Maganga
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania
| | - Humphrey D Mazigo
- Department of Parasitology and Entomology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Lishomwa C Ndhlovu
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - John M Changalucha
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania
| | - Jennifer A Downs
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania
- Weill Bugando School of Medicine, Mwanza, Tanzania
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3
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Kayuni S, Cunningham L, Mainga B, Kumwenda D, Jnr DL, Chammudzi P, Kapira D, Namacha G, Chisale A, Nchembe T, Kinley L, Chibwana E, Ntaba B, Chapweteka G, Khumalo W, Chibowa H, Kumfunda V, Juhasz A, Jones S, Archer J, O'Ferrall AM, Rollason S, Chiphwanya J, Makaula P, LaCourse EJ, Musaya J, Stothard JR. Detection of male genital schistosomiasis (MGS) associated with human, zoonotic and hybrid schistosomes in Southern Malawi. BMC Infect Dis 2024; 24:839. [PMID: 39160482 PMCID: PMC11331596 DOI: 10.1186/s12879-024-09732-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 08/07/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Male Genital Schistosomiasis (MGS) remains an often-overlooked chronic sequela of urogenital schistosomiasis in endemic areas of sub-Saharan Africa. As part of a 2-year longitudinal study on Hybridization of UroGenital Schistosomiasis (HUGS) in Malawi, a MGS sub-study was conducted to assess whether hybrid schistosomes were incriminated. METHODS During recruitment, demographic, health and socio-economic data were collected through individual questionnaire interviews in Mthawira community from Nsanje District along Shire River and Samama community from Mangochi District along Lake Malawi shoreline. Urine and semen samples were collected and analysed to determine the identity of schistosome infection. Urine filtration and microscopy, direct microscopy of semen and its sediments (after centrifugation) were performed. Thereafter, the sediments were examined by molecular DNA analysis with a novel two-tube real-time PCR assay. The participants were also screened for Human papilloma virus (HPV) and other sexually transmitted infections (STIs). RESULTS Twenty-two men were recruited for the sub-study, 8 in Nsanje District and 14 in Mangochi District, with a median age of 22.0 years. By microscopy, ten (45.7%) participants had Schistosoma ova in their urine, 11 (50.0%) in semen while 16 (72.7%) were positive by real-time PCR. One participant had both S. haematobium and S. mattheei ova in his semen, three showed symptoms, and one had a mixed infection of S. mansoni and possible S. haematobium-S. mattheei hybrid. Twelve men had detectable high-risk HPV serotypes 16, 18 and others while six had Trichomonas vaginalis and other STIs. CONCLUSION Zoonotic and hybrid schistosomes can cause MGS similar to human schistosomes, which can be co-infected with HPV and STIs, thereby posing a new challenge in diagnosis, management and control measures in resource poor settings. Increased awareness of these infections among local communities and primary healthcare workers and improvement of disease management are needed and advocated.
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Affiliation(s)
- Sekeleghe Kayuni
- Malawi Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Queen Elizabeth Central Hospital, campus, 1 Chipatala Avenue, Private Bag 360, Blantyre 3, Chichiri, Malawi.
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, CTID Building, Pembroke Place, Liverpool, Merseyside, L3 5QA, UK.
- Pathology Department, School of Medicine and Oral Health, Mahatma Gandhi campus, Private Bag 360, Blantyre 3, Chichiri, Malawi.
| | - Lucas Cunningham
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, CTID Building, Pembroke Place, Liverpool, Merseyside, L3 5QA, UK
| | - Bright Mainga
- Malawi Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Queen Elizabeth Central Hospital, campus, 1 Chipatala Avenue, Private Bag 360, Blantyre 3, Chichiri, Malawi
- Laboratory Department, Mangochi District Hospital, P.O. Box 52, Mangochi, Malawi
| | - Dingase Kumwenda
- Malawi Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Queen Elizabeth Central Hospital, campus, 1 Chipatala Avenue, Private Bag 360, Blantyre 3, Chichiri, Malawi
- Obstetrics and Gynaecology Department, Queen Elizabeth Central Hospital, 1 Chipatala Avenue, P.O. Box 95, Blantyre, Malawi
| | - David Lally Jnr
- Malawi Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Queen Elizabeth Central Hospital, campus, 1 Chipatala Avenue, Private Bag 360, Blantyre 3, Chichiri, Malawi
| | - Priscilla Chammudzi
- Malawi Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Queen Elizabeth Central Hospital, campus, 1 Chipatala Avenue, Private Bag 360, Blantyre 3, Chichiri, Malawi
| | - Donales Kapira
- Malawi Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Queen Elizabeth Central Hospital, campus, 1 Chipatala Avenue, Private Bag 360, Blantyre 3, Chichiri, Malawi
| | - Gladys Namacha
- Malawi Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Queen Elizabeth Central Hospital, campus, 1 Chipatala Avenue, Private Bag 360, Blantyre 3, Chichiri, Malawi
| | - Alice Chisale
- Malawi Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Queen Elizabeth Central Hospital, campus, 1 Chipatala Avenue, Private Bag 360, Blantyre 3, Chichiri, Malawi
| | - Tereza Nchembe
- Malawi Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Queen Elizabeth Central Hospital, campus, 1 Chipatala Avenue, Private Bag 360, Blantyre 3, Chichiri, Malawi
| | - Louis Kinley
- Malawi Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Queen Elizabeth Central Hospital, campus, 1 Chipatala Avenue, Private Bag 360, Blantyre 3, Chichiri, Malawi
- Radiology Department, Queen Elizabeth Central Hospital, 1 Chipatala Avenue, P.O. Box 95, Blantyre, Malawi
| | - Ephraim Chibwana
- Malawi Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Queen Elizabeth Central Hospital, campus, 1 Chipatala Avenue, Private Bag 360, Blantyre 3, Chichiri, Malawi
- Radiology Department, Queen Elizabeth Central Hospital, 1 Chipatala Avenue, P.O. Box 95, Blantyre, Malawi
| | - Bessie Ntaba
- Malawi Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Queen Elizabeth Central Hospital, campus, 1 Chipatala Avenue, Private Bag 360, Blantyre 3, Chichiri, Malawi
| | | | - Waleke Khumalo
- Nsanje District Hospital, Ministry of Health, Nsanje, Malawi
| | - Henry Chibowa
- Mangochi District Hospital, Ministry of Health, Mangochi, Malawi
| | - Victor Kumfunda
- Mangochi District Hospital, Ministry of Health, Mangochi, Malawi
| | - Alexandra Juhasz
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, CTID Building, Pembroke Place, Liverpool, Merseyside, L3 5QA, UK
- Institute of Medical Microbiology, Semmelweis University, Budapest, H-1089, Hungary
| | - Sam Jones
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, CTID Building, Pembroke Place, Liverpool, Merseyside, L3 5QA, UK
| | - John Archer
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, CTID Building, Pembroke Place, Liverpool, Merseyside, L3 5QA, UK
| | - Angus M O'Ferrall
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, CTID Building, Pembroke Place, Liverpool, Merseyside, L3 5QA, UK
| | - Sarah Rollason
- School of Biosciences, The Sir Martin Evans Building, Cardiff University, Cardiff, CF10 3AX, UK
| | - John Chiphwanya
- Community Health Sciences Unit (CHSU), National Schistosomiasis and Soil-Transmitted Helminths Control Programme, Ministry of Health, Area 3, Off Mtunthama Drive, Private Bag 65, Lilongwe, Malawi
| | - Peter Makaula
- Malawi Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Queen Elizabeth Central Hospital, campus, 1 Chipatala Avenue, Private Bag 360, Blantyre 3, Chichiri, Malawi
| | - E James LaCourse
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, CTID Building, Pembroke Place, Liverpool, Merseyside, L3 5QA, UK
| | - Janelisa Musaya
- Malawi Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Queen Elizabeth Central Hospital, campus, 1 Chipatala Avenue, Private Bag 360, Blantyre 3, Chichiri, Malawi
- Pathology Department, School of Medicine and Oral Health, Mahatma Gandhi campus, Private Bag 360, Blantyre 3, Chichiri, Malawi
| | - J Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, CTID Building, Pembroke Place, Liverpool, Merseyside, L3 5QA, UK
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Donnelly O, Mesquita S, Archer J, Ali SM, Bartonicek Z, Lugli EB, Webster BL. Refining the Schistosoma haematobium recombinase polymerase amplification (Sh-RPA) assay: moving towards point-of-care use in endemic settings. Parasit Vectors 2024; 17:321. [PMID: 39068490 PMCID: PMC11283713 DOI: 10.1186/s13071-024-06380-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 06/26/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Urogenital schistosomiasis is caused by the parasitic trematode Schistosoma haematobium. Sensitive and specific point-of-care diagnostics are needed for elimination of this disease. Recombinase polymerase amplification (RPA) assays meet these criteria, and an assay to diagnose S. haematobium has been developed (Sh-RPA). However, false-positive results can occur, and optimisation of reaction conditions to mitigate these is needed. Ease of use and compatibility of DNA extraction methods must also be considered. METHODS Using synthetic DNA, S. haematobium genomic DNA (gDNA), and urine samples from clinical cases, Sh-RPA reactions incorporating different betaine concentrations (0 M, 1 M, 2.5 M, 12.5 M) and the sample-to-water ratios were tested to determine effects on assay specificity and sensitivity. In addition, five commercial DNA extraction kits suitable for use in resource-limited settings were used to obtain gDNA from single S. haematobium eggs and evaluated in terms of DNA quality, quantity, and compatibility with the Sh-RPA assay. All samples were also evaluated by quantitative polymerase chain reaction (qPCR) to confirm DNA acquisition. RESULTS The analytical sensitivity of the Sh-RPA with all betaine concentrations was ≥ 10 copies of the synthetic Dra1 standard and 0.1 pg of S. haematobium gDNA. The addition of betaine improved Sh-RPA assay specificity in all reaction conditions, and the addition of 2.5 M of betaine together with the maximal possible sample volume of 12.7 µl proved to be the optimum reaction conditions. DNA was successfully isolated from a single S. haematobium egg using all five commercial DNA extraction kits, but the Sh-RPA performance of these kits varied, with one proving to be incompatible with RPA reactions. CONCLUSIONS The addition of 2.5 M of betaine to Sh-RPA reactions improved reaction specificity whilst having no detrimental effect on sensitivity. This increases the robustness of the assay, advancing the feasibility of using the Sh-RPA assay in resource-limited settings. The testing of commercial extraction kits proved that crude, rapid, and simple methods are sufficient for obtaining DNA from single S. haematobium eggs, and that these extracts can be used with Sh-RPA in most cases. However, the observed incompatibility of specific kits with Sh-RPA highlights the need for each stage of a molecular diagnostic platform to be robustly tested prior to implementation.
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Affiliation(s)
- Owain Donnelly
- Wolfson Wellcome Biomedical Laboratories, Department of Science, Natural History Museum, Cromwell Road, London, SW7 5BD, UK
- Malaria Biochemistry Laboratory, The Francis Crick Institute, 1 Midland Road, London, NW1 1AT, UK
| | - Silvia Mesquita
- Wolfson Wellcome Biomedical Laboratories, Department of Science, Natural History Museum, Cromwell Road, London, SW7 5BD, UK
- René Rachou Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - John Archer
- Wolfson Wellcome Biomedical Laboratories, Department of Science, Natural History Museum, Cromwell Road, London, SW7 5BD, UK
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Said M Ali
- Public Health Laboratory-Ivo de Carneri, P.O. Box 122, Chake-Chake, Pemba, United Republic of Tanzania
| | - Zikmund Bartonicek
- Wolfson Wellcome Biomedical Laboratories, Department of Science, Natural History Museum, Cromwell Road, London, SW7 5BD, UK
- Department of Genetics, Evolution and Environment, University College London, London, UK
| | - Elena B Lugli
- Wolfson Wellcome Biomedical Laboratories, Department of Science, Natural History Museum, Cromwell Road, London, SW7 5BD, UK
| | - Bonnie L Webster
- Wolfson Wellcome Biomedical Laboratories, Department of Science, Natural History Museum, Cromwell Road, London, SW7 5BD, UK.
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Ndubani R, Lamberti O, Kildemoes A, Hoekstra P, Fitzpatrick J, Kelly H, Vwalika B, Randrianasolo B, Sturt A, Kayuni S, Choko A, Kasese N, Kjetland E, Nemungadi T, Mocumbi S, Samson A, Ntapara E, Thomson A, Danstan E, Chikwari CD, Martin K, Rabiu I, Terkie G, Chaima D, Kasoka M, Joeker K, Arenholt LTS, Leutscher P, Stothard R, Rabozakandria O, Gouvras A, Munthali T, Hameja G, Kanfwa P, Hikabasa H, Ayles H, Shanaube K, Bustinduy AL. The first BILGENSA Research Network workshop in Zambia: identifying research priorities, challenges and needs in genital bilharzia in Southern Africa. Wellcome Open Res 2024; 9:360. [PMID: 39170763 PMCID: PMC11336559 DOI: 10.12688/wellcomeopenres.22429.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2024] [Indexed: 08/23/2024] Open
Abstract
Female genital schistosomiasis (FGS) and male genital schistosomiasis (MGS) are gender-specific manifestations of urogenital schistosomiasis. Morbidity is a consequence of prolonged inflammation in the human genital tract caused by the entrapped eggs of the waterborne parasite, Schistosoma (S.) haematobium. Both diseases affect the sexual and reproductive health (SRH) of millions of people globally, especially in sub-Sahara Africa (SSA). Awareness and knowledge of these diseases is largely absent among affected communities and healthcare workers in endemic countries. Accurate burden of FGS and MGS disease estimates, single and combined, are absent, mostly due to the absence of standardized methods for individual or population-based screening and diagnosis. In addition, there are disparities in country-specific FGS and MGS knowledge, research and implementation approaches, and diagnosis and treatment. There are currently no WHO guidelines to inform practice. The BILGENSA (Genital Bilharzia in Southern Africa) Research Network aimed to create a collaborative multidisciplinary network to advance clinical research of FGS and MGS across Southern African endemic countries. The workshop was held in Lusaka, Zambia over two days in November 2022. Over 150 researchers and stakeholders from different schistosomiasis endemic settings attended. Attendees identified challenges and research priorities around FGS and MGS from their respective countries. Key research themes identified across settings included: 1) To increase the knowledge about the local burden of FGS and MGS; 2) To raise awareness among local communities and healthcare workers; 3) To develop effective and scalable guidelines for disease diagnosis and management; 4) To understand the effect of treatment interventions on disease progression, and 5) To integrate FGS and MGS within other existing sexual and reproductive health (SRH) services. In its first meeting, the BILGENSA Network set forth a common research agenda across S. haematobium endemic countries for the control of FGS and MGS.
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Affiliation(s)
| | - Olimpia Lamberti
- Department of Clinical Research, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Anna Kildemoes
- Section for Parasitology and Aquatic Pathobiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pytsje Hoekstra
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Helen Kelly
- Department of Clinical Research, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Bellington Vwalika
- Department of gynaecology, University of Zambia, Lusaka, Lusaka Province, Zambia
| | | | - Amy Sturt
- Infectious Diseases Section, Veterans Affairs Healthcare System, Palo Alto, USA
- 8. Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
| | - Seke Kayuni
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Augustine Choko
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Eyrun Kjetland
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences,, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- Department of Infectious Diseases, Norwegian Centre for Imported and Tropical Diseases, Oslo, Norway
| | - Takalani Nemungadi
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences,, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Sibone Mocumbi
- Manhiça Health Research Centre (CISM), Maputo Central Hospital, Maputo, Mozambique
| | - Anna Samson
- Department of Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Elizabeth Ntapara
- Mbeya Medical Research Centre (MMRC), National Institute of Medical Research, Mwanza, Tanzania
| | - Anifrid Thomson
- Mbeya Medical Research Centre (MMRC), National Institute of Medical Research, Mwanza, Tanzania
| | - Elizabeth Danstan
- Biomedical Research and Training Institute, Harare, Harare Province, Zimbabwe
| | - Chido Dziya Chikwari
- Biomedical Research and Training Institute, Harare, Harare Province, Zimbabwe
- The Centre for Sexual Health and HIV/AIDS Research Zimbabwe, Harare, Zimbabwe
| | - Kevin Martin
- Department of Clinical Research, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
- Biomedical Research and Training Institute, Harare, Harare Province, Zimbabwe
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Ibrahim Rabiu
- Department of Community Medicine, Gombe State University, Gombe, Gombe, Nigeria
| | - Gifty Terkie
- Department of Community Medicine, Gombe State University, Gombe, Gombe, Nigeria
| | - David Chaima
- Department of Pathology, School of Medicine and Oral Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Manuel Kasoka
- Department of gynaecology, University of Zambia, Lusaka, Lusaka Province, Zambia
| | - Karoline Joeker
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Louise Thomsen Schmidt Arenholt
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Centre for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark
- Department of Obstetrics and Gynecology, North Denmark Regional Hospital, Hjoerring, Denmark
| | - Peter Leutscher
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Obstetrics and Gynecology, North Denmark Regional Hospital, Hjoerring, Denmark
| | - Russel Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | | | - Tendai Munthali
- School of Public Health, University of Zambia, Lusaka, Lusaka Province, Zambia
- Department of Public Health, Ministry of Health, Lusaka, Zambia
| | - Grace Hameja
- Department of Neglected Tropical Diseases, Ministry of Health, Lusaka, Zambia
| | - Paul Kanfwa
- Department of gynaecology, University of Zambia, Lusaka, Lusaka Province, Zambia
| | - Halwindi Hikabasa
- School of Public Health, University of Zambia, Lusaka, Lusaka Province, Zambia
| | - Helen Ayles
- Zambart School of Medicine, Lusaka, Zambia
- Department of Clinical Research, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | | | - Amaya L. Bustinduy
- Department of Clinical Research, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
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Kayuni SA, Musaya J, Stothard JR. Highlighting male genital schistosomiasis in Malawi. Trends Parasitol 2024; 40:546-548. [PMID: 38821840 DOI: 10.1016/j.pt.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 06/02/2024]
Abstract
Highlighting recent literature, we review the epidemiological and clinical importance of male genital schistosomiasis (MGS) in Malawi. We then discuss why individual disease management is an unmet public health challenge and outline how future interventions should be better set within routine services of HIV and men's sexual and reproductive health clinics.
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Affiliation(s)
- Sekeleghe A Kayuni
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; Malawi-Liverpool-Wellcome Programme, Kamuzu University of Health Sciences, Queen Elizabeth Central Hospital Campus, Blantyre 3, Malawi
| | - Janelisa Musaya
- Malawi-Liverpool-Wellcome Programme, Kamuzu University of Health Sciences, Queen Elizabeth Central Hospital Campus, Blantyre 3, Malawi
| | - J Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK.
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Roure S, Vallès X, Pérez-Quílez O, López-Muñoz I, Chamorro A, Abad E, Valerio L, Soldevila L, España S, Hegazy AHA, Fernández-Rivas G, Gorriz E, Herena D, Oliveira M, Miralles MC, Conde C, Montero-Alia JJ, Fernández-Pedregal E, Miranda-Sánchez J, Llibre JM, Isnard M, Bonet JM, Estrada O, Prat N, Clotet B. Male genitourinary schistosomiasis-related symptoms among long-term Western African migrants in Spain: a prospective population-based screening study. Infect Dis Poverty 2024; 13:23. [PMID: 38449032 PMCID: PMC10919049 DOI: 10.1186/s40249-024-01190-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/29/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Schistosomiasis is highly endemic in sub-Saharan Africa and frequently imported to Europe. Male urogenital manifestations are often neglected. We aimed to ascertain the prevalence of genitourinary clinical signs and symptoms among long-term African migrants in a non-endemic European country using a serology test. METHODS We carried out a prospective, community-based cross-sectional study of adult male migrants from sub-Saharan Africa living in Spain. Schistosoma serology tests and microscopic urine examinations were carried out, and clinical data were obtained from an electronic medical record search and a structured questionnaire. RESULTS We included 388 adult males, mean age 43.5 years [Standard Deviation (SD) = 12.0, range: 18-76]. The median time since migration to the European Union was 17 [Interquartile range (IQR): 11-21] years. The most frequent country of origin was Senegal (N = 179, 46.1%). Of the 338, 147 (37.6%) tested positive for Schistosoma. Parasite eggs were present in the urine of only 1.3%. Nine genitourinary clinical items were significantly associated with positive Schistosoma serology results: pelvic pain (45.2%; OR = 1.57, 95% CI: 1.0-2.4), pain on ejaculation (14.5%; OR = 1.85, 95% CI: 1.0-3.5), dyspareunia (12.4%; OR = 2.45, 95% CI: 1.2-5.2), erectile dysfunction (9.5%; OR = 3.10, 95% CI: 1.3-7.6), self-reported episodes of infertility (32.1%; OR = 1.69, 95% CI: 1.0-2.8), haematuria (55.2%; OR = 2.37, 95% CI: 1.5-3.6), dysuria (52.1%; OR = 2.01, 95% CI: 1.3-3.1), undiagnosed syndromic STIs (5.4%), and orchitis (20.7%; OR = 1.81, 95% CI: 1.0-3.1). Clinical signs tended to cluster. CONCLUSIONS Urogenital clinical signs and symptoms are prevalent among male African long-term migrants with a positive Schistosoma serology results. Genital involvement can be frequent even among those with long periods of non-residence in their sub-Saharan African countries of origin. Further research is needed to develop diagnostic tools and validate therapeutic approaches to chronic schistosomiasis.
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Affiliation(s)
- Sílvia Roure
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Catalan Institute for Health, CAP La Salut, Passatge dels Encants S/N, 08916, Badalona, Spain.
- Fundació Lluita contra les Infeccions, c/ Can Ruti s/n, 08916, Badalona, Spain.
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, c/ Can Ruti s/n, 08916, Badalona, Spain.
| | - Xavier Vallès
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Catalan Institute for Health, CAP La Salut, Passatge dels Encants S/N, 08916, Badalona, Spain
- Fundació Lluita contra les Infeccions, c/ Can Ruti s/n, 08916, Badalona, Spain
- Germans Trias i Pujol Research Institute, c/ Can Ruti s/n, 08916, Badalona, Spain
| | - Olga Pérez-Quílez
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Catalan Institute for Health, CAP La Salut, Passatge dels Encants S/N, 08916, Badalona, Spain
| | - Israel López-Muñoz
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Catalan Institute for Health, CAP La Salut, Passatge dels Encants S/N, 08916, Badalona, Spain
| | - Anna Chamorro
- Fundació Lluita contra les Infeccions, c/ Can Ruti s/n, 08916, Badalona, Spain
| | - Elena Abad
- Fundació Lluita contra les Infeccions, c/ Can Ruti s/n, 08916, Badalona, Spain
| | - Lluís Valerio
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Catalan Institute for Health, CAP La Salut, Passatge dels Encants S/N, 08916, Badalona, Spain
- Fundació Lluita contra les Infeccions, c/ Can Ruti s/n, 08916, Badalona, Spain
| | - Laura Soldevila
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Catalan Institute for Health, CAP La Salut, Passatge dels Encants S/N, 08916, Badalona, Spain
- Fundació Lluita contra les Infeccions, c/ Can Ruti s/n, 08916, Badalona, Spain
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, c/ Can Ruti s/n, 08916, Badalona, Spain
| | - Sergio España
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Catalan Institute for Health, CAP La Salut, Passatge dels Encants S/N, 08916, Badalona, Spain
- Fundació Lluita contra les Infeccions, c/ Can Ruti s/n, 08916, Badalona, Spain
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, c/ Can Ruti s/n, 08916, Badalona, Spain
| | - Alaa H A Hegazy
- Microbiology Department, Germans Trias i Pujol University Hospital, c/ Can Ruti s/n, 08916, Badalona, Spain
- Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, c/ Can Ruti s/n, 08916, Badalona, Spain
- Faculty of Medicine, University of Asyut, El Fateh, Assiut Governorate, 71515, Egypt
| | - Gema Fernández-Rivas
- Microbiology Department, Germans Trias i Pujol University Hospital, c/ Can Ruti s/n, 08916, Badalona, Spain
- Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, c/ Can Ruti s/n, 08916, Badalona, Spain
| | - Ester Gorriz
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Catalan Institute for Health, CAP La Salut, Passatge dels Encants S/N, 08916, Badalona, Spain
| | - Dolores Herena
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Catalan Institute for Health, CAP La Salut, Passatge dels Encants S/N, 08916, Badalona, Spain
| | - Mário Oliveira
- Department of Urology, Germans Trias i Pujol University Hospital, c/ Can Ruti s/n, 08916, Badalona, Spain
| | - Maria Carme Miralles
- Canovelles Primary Health Care Unit, Barcelona North Metropolitan Health Directorate, Catalan Institute for Health, C/ Indústria 23, 08420, Canovelles, Spain
| | - Carmen Conde
- Canovelles Primary Health Care Unit, Barcelona North Metropolitan Health Directorate, Catalan Institute for Health, C/ Indústria 23, 08420, Canovelles, Spain
| | - Juan José Montero-Alia
- Primary Health Care Unit Mataró-3 (Rocafonda-Palau), Barcelona North Metropolitan Health Directorate, Catalan Institute for Health, Camí Ral el Ravalet 208, Mataró, 08302, Barcelona, Spain
| | - Elia Fernández-Pedregal
- International Health Program (PROSICS), Barcelona North Metropolitan Territorial Directorate for Infectious Diseases, Catalan Institute for Health, CAP La Salut, Passatge dels Encants S/N, 08916, Badalona, Spain
- Fundació Lluita contra les Infeccions, c/ Can Ruti s/n, 08916, Badalona, Spain
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, c/ Can Ruti s/n, 08916, Badalona, Spain
| | - Jose Miranda-Sánchez
- Barcelona North Metropolitan Primary Care Directorate, Catalan Institute for Health, Ctra. de Barcelona 473, Sabadell, 08204, Barcelona, Spain
| | - Josep M Llibre
- Fundació Lluita contra les Infeccions, c/ Can Ruti s/n, 08916, Badalona, Spain
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, c/ Can Ruti s/n, 08916, Badalona, Spain
| | - Mar Isnard
- Barcelona North Metropolitan Primary Care Directorate, Catalan Institute for Health, Ctra. de Barcelona 473, Sabadell, 08204, Barcelona, Spain
| | - Josep Maria Bonet
- Barcelona North Metropolitan Primary Care Directorate, Catalan Institute for Health, Ctra. de Barcelona 473, Sabadell, 08204, Barcelona, Spain
| | - Oriol Estrada
- Directorate for Innovation and Interdisciplinary Cooperation, Barcelona North Metropolitan Health Directorate, Catalan Institute for Health, C/ Can Ruti S/N, 08916, Badalona, Spain
| | - Núria Prat
- Barcelona North Metropolitan Primary Care Directorate, Catalan Institute for Health, Ctra. de Barcelona 473, Sabadell, 08204, Barcelona, Spain
| | - Bonaventura Clotet
- Fundació Lluita contra les Infeccions, c/ Can Ruti s/n, 08916, Badalona, Spain
- IrsiCaixa-AIDS Research Institute, Hospital Universitari Germans Trias i Pujol University Hospital, c/ Can Ruti s/n, 08916, Badalona, Spain
- Infectious Diseases Directorate, Barcelona North Metropolitan Health Directorate, Catalan Institute for Health, C/ Can Ruti S/N, 08916, Badalona, Spain
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8
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Lubanga AF, Bwanali AN, Munthali LE, Mphepo M, Chumbi GD, Kangoma M, Matola Y, Kaonga B, Moyo CS. Exploring the Role of Community Involvement in Reducing the Burden of Schistosomiasis and Other Neglected Tropical Diseases in Malawi: Where are We in the Fight Against Neglected Tropical Diseases? Res Rep Trop Med 2024; 15:51-58. [PMID: 38435085 PMCID: PMC10909323 DOI: 10.2147/rrtm.s448425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/24/2024] [Indexed: 03/05/2024] Open
Abstract
Schistosomiasis has been endemic in Malawi since 1947. Despite the longevity of endemicity of the disease, it still maintains a high burden in Malawi. This could be attributed to insufficient coverage of preventive and therapeutic mass drug administration (MDA) which mainly targets school-aged children, leaving out adults who also bear a high burden of the disease. Additionally, despite well documented impact of community involvement in boosting up the effectiveness of health programmes, there is minimal community involvement in schistosomiasis control and prevention programmes. Therefore, this perspective seeks to discuss the historical background of schistosomiasis in Malawi, gaps in community engagement and participation and suggest ways of enhancing the role of the community in prevention and control programmes. Amongst other challenges, the control programmes are centralised, leading to minimal input at the district and community level as well as low awareness of schistosomiasis control and prevention methods at the community level. It is of utmost significance therefore to provide comprehensive schistosomiasis health education to the communities and devise a thorough outline of the specific roles and responsibilities of all stakeholders including community members in the fight against schistosomiasis and other neglected tropical diseases.
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Affiliation(s)
- Adriano Focus Lubanga
- Education and Research, Clinical Research Education and Management Services Ltd (CREAMS), Lilongwe, Malawi
- Department of Clinical Services, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Akim Nelson Bwanali
- Education and Research, Clinical Research Education and Management Services Ltd (CREAMS), Lilongwe, Malawi
- Department of Clinical Services, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | | | - Mzati Mphepo
- Department of Clinical Services, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | | | - Melina Kangoma
- Department of Clinical Services, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Yankho Matola
- Department of Clinical Services, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Byenala Kaonga
- Department of Clinical Services, Kamuzu Central Hospital, Lilongwe, Malawi
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9
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Comelli A, Genovese C, Gobbi F, Brindicci G, Capone S, Corpolongo A, Crosato V, Mangano VD, Marrone R, Merelli M, Prato M, Santoro CR, Scarso S, Vanino E, Marchese V, Antinori S, Mastroianni C, Raglio A, Bruschi F, Minervini A, Donà D, Garazzino S, Galli L, Lo Vecchio A, Galli A, Dragoni G, Cricelli C, Colacurci N, Ferrazzi E, Pieralli A, Montresor A, Richter J, Calleri G, Bartoloni A, Zammarchi L. Schistosomiasis in non-endemic areas: Italian consensus recommendations for screening, diagnosis and management by the Italian Society of Tropical Medicine and Global Health (SIMET), endorsed by the Committee for the Study of Parasitology of the Italian Association of Clinical Microbiologists (CoSP-AMCLI), the Italian Society of Parasitology (SoIPa), the Italian Society of Gastroenterology and Digestive Endoscopy (SIGE), the Italian Society of Gynaecology and Obstetrics (SIGO), the Italian Society of Colposcopy and Cervico-Vaginal Pathology (SICPCV), the Italian Society of General Medicine and Primary Care (SIMG), the Italian Society of Infectious and Tropical Diseases (SIMIT), the Italian Society of Pediatrics (SIP), the Italian Society of Paediatric Infectious Diseases (SITIP), the Italian Society of Urology (SIU). Infection 2023; 51:1249-1271. [PMID: 37420083 PMCID: PMC10545632 DOI: 10.1007/s15010-023-02050-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/08/2023] [Indexed: 07/09/2023]
Affiliation(s)
- Agnese Comelli
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Camilla Genovese
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
- II Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Federico Gobbi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
- University of Brescia, Brescia, Italy
| | - Gaetano Brindicci
- AOU Consorziale Policlinico di Bari, Infectious Diseases Unit, Bari, Italy
| | - Susanna Capone
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
| | - Angela Corpolongo
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Verena Crosato
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
| | - Valentina Dianora Mangano
- Department of Translational Research, N.T.M.S, Università di Pisa, Pisa, Italy
- Programma Di Monitoraggio Delle Parassitosi e f.a.d, AOU Pisana, Pisa, Italy
| | - Rosalia Marrone
- National Institute for Health, Migration and Poverty, Rome, Italy
| | - Maria Merelli
- Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | - Marco Prato
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | | | - Salvatore Scarso
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Elisa Vanino
- Unit of Infectious Diseases, Ospedale "Santa Maria delle Croci", AUSL Romagna, Ravenna, Italy
| | - Valentina Marchese
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
| | - Spinello Antinori
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Claudio Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Annibale Raglio
- Committee for the Study of Parasitology of the Italian Association of Clinical Microbiologists (CoSP-AMCLI), Milan, Italy
| | - Fabrizio Bruschi
- Department of Translational Research, N.T.M.S, Università di Pisa, Pisa, Italy
- Programma Di Monitoraggio Delle Parassitosi e f.a.d, AOU Pisana, Pisa, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Department of Urology, University of Florence, Florence, Italy
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy
| | - Silvia Garazzino
- Paediatric Infectious Disease Unit, Regina Margherita Children's Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Luisa Galli
- Infectious Diseases Unit, Meyer Children's Hospital, IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Sciences, Paediatric Infectious Disease Unit, University of Naples Federico II, Naples, Italy
| | - Andrea Galli
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Gabriele Dragoni
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Claudio Cricelli
- Health Search-Istituto di Ricerca della SIMG (Italian Society of General Medicine and Primary Care), Florence, Italy
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Enrico Ferrazzi
- Department of Woman, New-Born and Child, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Annalisa Pieralli
- Ginecologia Chirurgica Oncologica, Careggi University and Hospital, Florence, Italy
| | - Antonio Montresor
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Joachim Richter
- Institute of International Health, Charité Universitätsmedizin, Corporate Member of Freie und Humboldt Universität Berlin and Berlin Institute of Health, Berlin, Germany
| | - Guido Calleri
- Amedeo Di Savoia Hospital, ASL Città di Torino, Turin, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.
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10
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Sánchez-Marqués R, Salvador F, Bocanegra C, Nindia A, Pintar Z, Martínez J, Aixut S, Pessela A, Ramírez-Arroyo S, Farrés A, Chopo M, Izquierdo S, Mas-Coma S, Bargues MD, Molina I. Schistosoma haematobium infection and morbidity risk factors for pre-school age children in western Angola: A knowledge, attitudes and practices survey. PLoS Negl Trop Dis 2023; 17:e0011650. [PMID: 37844022 PMCID: PMC10578572 DOI: 10.1371/journal.pntd.0011650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 09/05/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Urogenital schistosomiasis is one of the most prevalent parasitic diseases in sub-Saharan Africa. It is a poverty-related disease conditioned by behavioural practices. METHODS Our objective is to evaluate the awareness, mindset and habits about urogenital schistosomiasis in the community of Cubal (Angola), as well as its association with infection and urinary tract morbidity in pre-school age children. A cross-sectional study of knowledge, attitudes and practices at home was conducted between February and May 2022 with 250 participants. RESULTS Overall, 93.6% of those surveyed had some prior knowledge about schistosomiasis and, among all the symptoms associated with this disease, blood in the urine was the best known (54.4%). Nevertheless, 57.6% obtained a medium knowledge score. Regarding attitude, the majority of respondents had a high attitude score (79.2%) with 96.0% willing to participate in mass drug administration campaigns. Laundry in the river was the most common risk practice (61.2%) and 55.2% out of the total were classified with a low practice score. CONCLUSION Low knowledge about symptoms and transmission by caregivers was the outstanding risk factor for infection in pre-school age children (OR = 16.93, 95%CI: 3.93-72.82), and lack of knowledge that avoiding entering the river prevents schistosomiasis was the main risk factor for morbidity in PSAC (OR = 8.14, 95%CI: 1.14-58.25).
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Affiliation(s)
- Raquel Sánchez-Marqués
- Departamento de Parasitología, Facultad de Farmacia, Universidad de Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Fernando Salvador
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Tropical Medicine Unit Vall d’Hebron-Drassanes, Infectious Diseases Department, Vall d’Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Cristina Bocanegra
- Tropical Medicine Unit Vall d’Hebron-Drassanes, Infectious Diseases Department, Vall d’Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | | | | | - Joan Martínez
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Tropical Medicine Unit Vall d’Hebron-Drassanes, Infectious Diseases Department, Vall d’Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
- Hospital Nossa Senhora da Paz, Cubal, Angola
| | - Sandra Aixut
- Tropical Medicine Unit Vall d’Hebron-Drassanes, Infectious Diseases Department, Vall d’Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
- Hospital Nossa Senhora da Paz, Cubal, Angola
| | | | | | - Aina Farrés
- Hospital Nossa Senhora da Paz, Cubal, Angola
| | - María Chopo
- Hospital Nossa Senhora da Paz, Cubal, Angola
| | | | - Santiago Mas-Coma
- Departamento de Parasitología, Facultad de Farmacia, Universidad de Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - María Dolores Bargues
- Departamento de Parasitología, Facultad de Farmacia, Universidad de Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Israel Molina
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Tropical Medicine Unit Vall d’Hebron-Drassanes, Infectious Diseases Department, Vall d’Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
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11
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Guiton R, Drevet JR. Viruses, bacteria and parasites: infection of the male genital tract and fertility. Basic Clin Androl 2023; 33:19. [PMID: 37468865 DOI: 10.1186/s12610-023-00193-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/05/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Infertility affects one couple out of six worldwide. Male infertilty can result from congenital or acquired factors, of which pathogens that reach the genital tract through sexual contact or blood dissemination. The impact of major viral, bacterial and parasitic infections on the male genital tract and fertility has been summarized. RESULTS AND CONCLUSIONS A systematic review of articles published in the Google Scholar and PubMed databases was conducted. It turns out that viruses, as well as bacteria and parasites are major inducers of male genital tract infections and ensuing infertility through damage to the organs and subsequent loss of function and/or through direct damage to the sperm cells. Moreover, not only male infertility results from such infections but these can also be transmitted to women and even to the offspring, thus highlighting the need to efficiently detect, treat and prevent them.
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Affiliation(s)
- Rachel Guiton
- Université Clermont Auvergne, CNRS UMR6293, GReD Institute, 63001, Clermont-Ferrand, France.
| | - Joël R Drevet
- Université Clermont Auvergne, CNRS UMR6293, GReD Institute, 63001, Clermont-Ferrand, France
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12
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Trippler L, Knopp S, Welsche S, Webster BL, Stothard JR, Blair L, Allan F, Ame SM, Juma S, Kabole F, Ali SM, Rollinson D, Pennance T. The long road to schistosomiasis elimination in Zanzibar: A systematic review covering 100 years of research, interventions and control milestones. ADVANCES IN PARASITOLOGY 2023; 122:71-191. [PMID: 37657854 DOI: 10.1016/bs.apar.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
Zanzibar is among the few places in sub-Saharan Africa where interruption of Schistosoma transmission seems an achievable goal. Our systematic review identifies and discusses milestones in schistosomiasis research, control and elimination efforts in Zanzibar over the past 100 years. The search in online databases, libraries, and the World Health Organization Archives revealed 153 records published between May 1928 and August 2022. The content of records was summarised to highlight the pivotal work leading towards urogenital schistosomiasis elimination and remaining research gaps. The greatest achievement following 100 years of schistosomiasis interventions and research is undoubtedly the improved health of Zanzibaris, exemplified by the reduction in Schistosoma haematobium prevalence from>50% historically down to<5% in 2020, and the absence of severe morbidities. Experiences from Zanzibar have contributed to global schistosomiasis guidelines, whilst also revealing challenges that impede progression towards elimination. Challenges include: transmission heterogeneity requiring micro-targeting of interventions, post-treatment recrudescence of infections in transmission hotspots, biological complexity of intermediate host snails, emergence of livestock Schistosoma species complicating surveillance whilst creating the risk for interspecies hybridisation, insufficient diagnostics performance for light intensity infections and female genital schistosomiasis, and a lack of acceptable sanitary alternatives to freshwater bodies. Our analysis of the past revealed that much can be achieved in the future with practical implementation of integrated interventions, alongside operational research. With continuing national and international commitments, interruption of S. haematobium transmission across both islands is within reach by 2030, signposting the future demise of urogenital schistosomiasis across other parts of sub-Saharan Africa.
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Affiliation(s)
- Lydia Trippler
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland.
| | - Stefanie Knopp
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | | | - Bonnie L Webster
- Natural History Museum, London, United Kingdom; London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | | | | | - Fiona Allan
- Natural History Museum, London, United Kingdom; London Centre for Neglected Tropical Disease Research, London, United Kingdom; University of St Andrews, St Andrews, United Kingdom
| | - Shaali Makame Ame
- Neglected Diseases Programme, Zanzibar Ministry of Health, Lumumba, Unguja, United Republic of Tanzania
| | - Saleh Juma
- Neglected Diseases Programme, Zanzibar Ministry of Health, Mkoroshoni, Pemba, United Republic of Tanzania
| | - Fatma Kabole
- Neglected Diseases Programme, Zanzibar Ministry of Health, Lumumba, Unguja, United Republic of Tanzania
| | - Said Mohammed Ali
- Public Health Laboratory - Ivo de Carneri, Wawi, Chake Chake, Pemba, United Republic of Tanzania
| | - David Rollinson
- Natural History Museum, London, United Kingdom; London Centre for Neglected Tropical Disease Research, London, United Kingdom; Global Schistosomiasis Alliance, London, United Kingdom
| | - Tom Pennance
- Natural History Museum, London, United Kingdom; London Centre for Neglected Tropical Disease Research, London, United Kingdom; Western University of Health Sciences, Lebanon, OR, United States.
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13
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Kayuni SA, Alharbi MH, Shaw A, Fawcett J, Makaula P, Lampiao F, Juziwelo L, LaCourse EJ, Verweij JJ, Stothard JR. Detection of male genital schistosomiasis (MGS) by real-time TaqMan® PCR analysis of semen from fishermen along the southern shoreline of Lake Malawi. Heliyon 2023; 9:e17338. [PMID: 37539175 PMCID: PMC10394912 DOI: 10.1016/j.heliyon.2023.e17338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 06/06/2023] [Accepted: 06/14/2023] [Indexed: 08/05/2023] Open
Abstract
Background Male genital schistosomiasis (MGS) is an underappreciated complication of schistosomiasis, first described in 1911. However, its epidemiology, diagnostic testing and case management are not well understood in sub-Saharan Africa. To shed new light on MGS prevalence in Malawi, a longitudinal cohort study was conducted among adult fishermen along the southern shoreline of Lake Malawi using detection of schistosome DNA in participants' semen by real-time TaqMan® PCR analyses. Methods Upon recruitment of 376 participants, 210 submitted urine samples and 114 semen samples for parasitological tests. Thereafter, the available semen samples were subsequently analysed by real-time TaqMan® PCR. Praziquantel (PZQ) treatment was provided to all participants with follow-ups attempted at 1, 3, 6 and 12-months' intervals. Results At baseline, real-time PCR detected a higher MGS cohort prevalence of 26.6% (n = 64, Ct-value range: 18.9-37.4), compared to 10.4% by semen microscopy. In total, 21.9% of participants (n = 114) were detected with MGS either by semen microscopy and/or by real-time PCR. Subsequent analyses at 1-, 3-, 6- and 12-month follow-ups indicated variable detection dynamics. Conclusions This first application of a molecular method, to detect MGS in sub-Saharan Africa, highlights the need for development of such molecular diagnostic tests which should be affordable and locally accessible. Our investigation also notes the persistence of MGS over a calendar year despite praziquantel treatment.
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Affiliation(s)
- Sekeleghe A. Kayuni
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, United Kingdom
- MASM Medi Clinics Limited, Medical Society of Malawi (MASM), P. O. Box 31659, Lilongwe 3, Malawi
- Malawi Liverpool Wellcome (MLW) Clinical Research Programme, Kamuzu University Of Health Sciences (KUHeS), Queen Elizabeth Central Hospital campus, Chipatala Avenue, Blantyre, Malawi
| | - Mohammad H. Alharbi
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, United Kingdom
- Ministry of Health, Buraydah 52367, Saudi Arabia
| | - Alexandra Shaw
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, United Kingdom
| | - Joanna Fawcett
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, United Kingdom
| | - Peter Makaula
- Malawi Liverpool Wellcome (MLW) Clinical Research Programme, Kamuzu University Of Health Sciences (KUHeS), Queen Elizabeth Central Hospital campus, Chipatala Avenue, Blantyre, Malawi
- Research for Health, Environment and Development (RHED), Mangochi, Malawi
| | - Fanuel Lampiao
- Physiology Department, College of Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Lazarus Juziwelo
- National Schistosomiasis and STH Control Programme, Community Health Sciences Unit, Ministry of Health, Lilongwe, Malawi
| | - E. James LaCourse
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, United Kingdom
| | - Jaco J. Verweij
- Elisabeth TweeSteden Hospital Tilburg, Microvida Laboratory for Medical Microbiology and Immunology, Hilvarenbeekseweg 60, Tilburg, the Netherlands
| | - J. Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, United Kingdom
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14
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Kangogo G, Conserve DF, Kayuni S, Kumwenda MK, Dovel KL, Chirombo J, MacPherson P, Corbett EL, Butterworth A, Choko AT. Correlates of prior HIV testing and schistosomiasis treatment: Baseline survey findings from the "creating demand for fishermen's schistosomiasis HIV services" (FISH) cluster-randomized trial in Mangochi, Malawi. PLoS Negl Trop Dis 2023; 17:e0010654. [PMID: 37141380 DOI: 10.1371/journal.pntd.0010654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 05/16/2023] [Accepted: 04/04/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Fishing exposes fishermen to schistosomiasis-infested fresh water and concurrently through precarious livelihoods to risky sexual behaviour, rendering these two infections occupational hazards for fishermen. This study aimed to characterize the knowledge of the two conditions to obtain necessary data for a subsequent cluster randomized trial designed to investigate demand creation strategies for joint HIV-schistosomiasis service provision in fishing villages on the shores of southern Lake Malawi. METHODS Enumeration of all resident fishermen in 45 clusters (fishing communities) was carried out between November 2019 and February 2020. In a baseline survey, fishermen reported their knowledge, attitudes and practices in the uptake of HIV and schistosomiasis services. Knowledge of HIV status and previous receipt of praziquantel were modelled using random effects binomial regression, accounting for clustering. Prevalence of willingness to attend a beach clinic was computed. RESULTS A total of 6,297 fishermen were surveyed from the 45 clusters with harmonic mean number of fishermen per cluster of 112 (95% CI: 97; 134). The mean age was 31.7y (SD: 11.9) and nearly 40% (2,474/6,297) could not read or write. Overall, 1,334/6,293 (21.2%) had never tested for HIV, with 64.4% (3,191/4,956) having tested in the last 12 months, and 5.9% (373/6290) taking antiretroviral therapy (ART). In adjusted analyses, being able to read and write (adjusted risk ratio [aRR: 1.91, 95% CI: 1.59-2.29, p<0.001); previous use of praziquantel (aRR: 2.00,95% CI: 1.73-2.30, p<0.001); knowing a relative or friend who died of HIV (aRR: 1.54,95% CI: 1.33-1.79, p<0.001); and being on ART (aRR: 12.93, 95% CI: 6.25-32.93, p<0.001) were associated with increased likelihood of ever testing for HIV. Only 40% (1,733/4,465) had received praziquantel in the last 12 months. Every additional year of age was associated with 1% decreased likelihood of having taken praziquantel in the last 12 months (aRR: 0.99, 95% CI: 0.98-0.99, p<0.001). However, recent HIV testing increased the likelihood of taking praziquantel by over 2-fold (aRR 2.24, 95% CI: 1.93-2.62, p<0.001). Willingness to attend a mobile beach clinic offering integrated HIV and schistosomiasis services was extremely high at 99.0% (6,224/6,284). CONCLUSION In a setting with an underlying high prevalence of both HIV and schistosomiasis, we found low knowledge of HIV status and low utilization of free schistosomiasis treatment. Among fishermen who accessed HIV services, there was a very high likelihood of taking praziquantel suggesting that integrated service delivery may lead to good coverage. TRIAL REGISTRATION This trial is registered in the ISRCTN registry: ISRCTN14354324; date of registration: 05 October 2020.
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Affiliation(s)
- Geoffrey Kangogo
- Department of Epidemiology and Biostatistics, Saint Louis University, Missouri, United States of America
| | - Donaldson F Conserve
- Department of Prevention and Community Health, George Washington University, District of Columbia, United States of America
| | - Sekeleghe Kayuni
- Department of Medicine, Medical Aid Society of Malawi (MASM), Blantyre, Malawi
| | - Moses K Kumwenda
- Department of Social Science, Malawi Liverpool Wellcome Trust Clinical Research Programme (MLW), Blantyre, Malawi
| | - Kathryn L Dovel
- Department of Medicine, University of California, Los Angeles, United States of America
| | - James Chirombo
- Department of Social Science, Malawi Liverpool Wellcome Trust Clinical Research Programme (MLW), Blantyre, Malawi
| | - Peter MacPherson
- Department of Social Science, Malawi Liverpool Wellcome Trust Clinical Research Programme (MLW), Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Elizabeth L Corbett
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Anthony Butterworth
- Department of Social Science, Malawi Liverpool Wellcome Trust Clinical Research Programme (MLW), Blantyre, Malawi
| | - Augustine Talumba Choko
- Department of Social Science, Malawi Liverpool Wellcome Trust Clinical Research Programme (MLW), Blantyre, Malawi
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15
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Kiesolo FN, Sampa M, Moonga G, Michelo C, Jacobs C. Coverage and predictors of the uptake of the mass drug administration of praziquantel chemotherapy for schistosomiasis in a selected urban setting in Zambia. FRONTIERS IN EPIDEMIOLOGY 2023; 3:1168282. [PMID: 38455938 PMCID: PMC10910951 DOI: 10.3389/fepid.2023.1168282] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/27/2023] [Indexed: 03/09/2024]
Abstract
The burden of schistosomiasis in Zambia has remained high over the years. The World Health Assembly recommended adequate mass drug administration coverage for schistosomiasis using Praziquantel chemotherapy for school-aged children and all at-risks adults. We aimed at investigating the coverage and the factors associated to the uptake for MDA for schistosomiasis in Ng'ombe township of Lusaka, Zambia. A cross-sectional survey was conducted in May and June 2021 via phone calls to the residents of Ng'ombe township. Commcare software was used in the conduct of the survey. Pearson's Chi-square test and multiple logistic regression were conducted using the STATA version 15.0. 769 study participants were randomly selected using systematic sampling, of which 76.3% were younger than 40 years, 64.9% were female, 64.4% were married, 56.3% had reached the secondary educational level and 51.9% were employed. Coverage for MDA for schistosomiasis in Ng'ombe township in 2018 was found to be 49.8% (95% CI: 46.2%-53.4%). Positive predictors of the MDA were prior knowledge of the occurrence of the MDA in 2018 (aOR: 2.892, p < 0.001) and believing that the provision of incentives like snacks was important during the MDA with PZQ in Ng'ombe township (aOR: 1.926, p = 0.001), whereas age (aOR:0.979, p = 0.009), marital status (aOR:0.620, p = 0.006), employment status (aOR:0.587, p = 0.001) were negative predictors of the MDA. Elimination of the burden of schistosomiasis in endemic settings needs the attainment of an optimum coverage and uptake during MDA with PZQ. Therefore, prior knowledge about an impending intervention and the provision of incentives like snacks during the intervention should be prioritized by MDA implementers, while background characteristics such as age, marital status, and employment status need to be taken into consideration when planning and promoting uptake in future MDAs.
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Affiliation(s)
- Felix Nzonzi Kiesolo
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Mutale Sampa
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Given Moonga
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Charles Michelo
- Strategic Centre for Health Systems Metrics & Evaluation, School of Public Health, University of Zambia, Lusaka, Zambia
- Harvest Research Institutes, Harvest University, Lusaka, Zambia
| | - Choolwe Jacobs
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
- Women in Global Health, Lusaka, Zambia
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Basile G, Tamarozzi F, Salas-Coronas J, Soriano-Pérez MJ, Luzón-García P, Moro L, Antinori S, Arsuaga M, Bartoloni A, Tomasoni LR, Gobbi FG, Köhler C, Salvador F, Bocanegra C, Zammarchi L. Management of imported complicated urogenital schistosomiasis in Europe: a TropNet retrospective study. J Travel Med 2023; 30:6956960. [PMID: 36547229 DOI: 10.1093/jtm/taac150] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Schistosomiasis is a neglected tropical disease caused by trematodes of the genus Schistosoma. Schistosoma haematobium causes urogenital schistosomiasis (UGS), a chronic disease characterized by pathology of the urogenital tract leading to potentially severe morbidity for which the treatment is poorly standardized. We conducted a survey in TropNet centres on the clinical presentations and management strategies of complicated urogenital schistosomiasis (cUGS). METHODS We reviewed the clinical records of patients seen at TropNet centres over a 20-year timespan (January 2001-December 2020). Case definition for cUGS included the presence of urogenital cancer, obstructive uropathy, kidney insufficiency of all grades and female or male genital involvement leading to infertility. Collected data included demographic information, patient category (traveller or migrant), imaging data, microbiological data (serology results and presence/absence of eggs in urine), histological features and outcome at last visit recorded. RESULTS Eight centres contributed with at least one case. Overall, 31 patients matched the inclusion criteria. Sub-Saharan Africa was the most likely place of infection for included patients. Median age was 30.6 years (range 21-46, interquartile ranges, IQR 27-33). Most patients (28/31, 90.3%) were males. Hydronephrosis was the most frequent complication, being present in 18 (58.1%) patients, followed by cancer, present in 5 patients (16.1%); 27 patients (87.1%) required surgical management of some sort. Use of praziquantel varied across centres, with six different regimens employed. DISCUSSION Very few cases of cUGSs were found in our survey, possibly indicating underdiagnosis of this condition. Hydronephrosis was the most frequently observed urogenital complication, and most patients required invasive procedures. Infection by S. haematobium can result in considerable morbidity, resulting in clinically challenging presentations requiring a multidisciplinary approach. As such, development of common protocols for early diagnosis and treatment is urgently needed.
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Affiliation(s)
- Gregorio Basile
- Department of Experimental and Clinical Medicine, University of Florence, Florence, 50134 Italy
| | - Francesca Tamarozzi
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, 37024, Italy
| | | | | | - Pilar Luzón-García
- Tropical Medicine Unit, Hospital Universitario Poniente, Almería, 04700, Spain
| | - Lucia Moro
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, 37024, Italy
| | - Spinello Antinori
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università di Milano, Milan, 20157, Italy
| | - Marta Arsuaga
- Imported Diseases and International Health Referral Unit, High Level Isolation Unit, La Paz-Carlos III University Hospital, Madrid, 28029, Spain
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, 50134 Italy
- Infectious and Tropical Diseases Unit, Careggi University and Hospital, Florence, 50134, Italy
| | - Lina Rachele Tomasoni
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, 25125, Italy
| | - Federico Giovanni Gobbi
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, 37024, Italy
| | - Carsten Köhler
- Institute of Tropical Medicine, Travel Medicine and Human parasitology, Center of Competence, Baden-Württtemberg, Universität und Universitätsklinikum Tübingen, Tübingen, 72074, Germany
| | - Fernando Salvador
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, 08035, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Cristina Bocanegra
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, 08035, Spain
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, 50134 Italy
- Infectious and Tropical Diseases Unit, Careggi University and Hospital, Florence, 50134, Italy
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17
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Velleman Y, Blair L, Fleming F, Fenwick A. Water-, Sanitation-, and Hygiene-Related Diseases. Infect Dis (Lond) 2023. [DOI: 10.1007/978-1-0716-2463-0_547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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18
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Fusco D, Martínez-Pérez GZ, Remkes A, De Pascali AM, Ortalli M, Varani S, Scagliarini A. A sex and gender perspective for neglected zoonotic diseases. Front Microbiol 2022; 13:1031683. [PMID: 36338031 PMCID: PMC9632621 DOI: 10.3389/fmicb.2022.1031683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/20/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Daniela Fusco
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg, Germany
- *Correspondence: Daniela Fusco
| | | | - Aaron Remkes
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg, Germany
| | - Alessandra Mistral De Pascali
- Section of Microbiology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Margherita Ortalli
- Section of Microbiology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Stefania Varani
- Section of Microbiology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessandra Scagliarini
- Section of Microbiology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
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Nyangulu W, Sadimba C, Nyirenda J, Twaibu G, Kamwendo J, Chawawa K, Masano A, Chilinda E, Kayuni S, Muula AS, Maleta K. The prevalence of Schistosoma mansoni infection among adults with chronic non-communicable diseases in Malawi. Trop Med Health 2022; 50:56. [PMID: 35986382 PMCID: PMC9389769 DOI: 10.1186/s41182-022-00450-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Schistosomiasis is a parasitic infectious disease caused by flatworms of the Schistosoma genus. The global burden of schistosomiasis is high. In Malawi, schistosomiasis is among the top 20 causes of outpatient department visits in health facilities. Schistosomiasis is among the most important but neglected causes of non-communicable diseases (NCD) peculiar to tropical endemic settings. While much is known about the contribution of S. haematobium to the NCD burden in Malawi, the role of S. mansoni remains largely unknown. METHODS We conducted a cross-sectional study at Mangochi District Hospital. Adults over 18 years diagnosed with NCDs (n = 414), admitted or attending weekly outpatient clinics were recruited between August 2021 and February 2022. Data were collected on sociodemographic characteristics, medical history, body weight, blood pressure, and fasting blood glucose. Stool and midstream urine were collected for Kato-Katz (KK) microscopy and urine point of care-circulating cathodic antigen (POC-CCA) tests, respectively. We computed prevalence of S. mansoni as number of positive KK and CCA tests, each divided by total submitted samples. Univariate and multivariable logistic regression were done to evaluate risk factors of NCDs and association between S. mansoni infection and NCDs. RESULTS We recruited 414 participants, mean age 57 years (SD 16), 67% of whom were female. Prevalence of S. mansoni based on urine CCA was 15% (95% CI: 11-19) and 0% on KK microscopy. Hypertension was the most common condition with a prevalence of 85% (95% CI: 81-89), followed by diabetes mellitus with a prevalence of 42% (95% CI: 37-46) and heart disease with a prevalence of 3% (95% CI: 2-5). S. mansoni infection was not significantly associated with hypertension (OR: 1.2, 95% CI: 0.5-3.1), diabetes (OR: 0.6, 95% CI: 0.3-1.10) or heart disease (OR: 2.0, 95% CI: 0.4-10). CONCLUSIONS We observed moderate prevalence of S. mansoni infection among adults in the study per WHO classification of endemicity. This is within the range observed in children in Mangochi from 10 to 56.7%.
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Affiliation(s)
- Wongani Nyangulu
- Public Health and Nutrition Research Group, Department of Nutrition, Kamuzu University of Health Sciences, Blantyre, Malawi.
| | - Christina Sadimba
- Public Health and Nutrition Research Group, Department of Nutrition, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Joyce Nyirenda
- Public Health and Nutrition Research Group, Department of Nutrition, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - George Twaibu
- Public Health and Nutrition Research Group, Department of Nutrition, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - John Kamwendo
- Public Health and Nutrition Research Group, Department of Nutrition, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Kelvin Chawawa
- Public Health and Nutrition Research Group, Department of Nutrition, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Angella Masano
- Public Health and Nutrition Research Group, Department of Nutrition, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Elizabeth Chilinda
- Public Health and Nutrition Research Group, Department of Nutrition, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Sekeleghe Kayuni
- Department of Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, UK
- Medical Aid Society of Malawi (MASM), MASM Medi Clinics Limited, Blantyre, Malawi
| | - Adamson S Muula
- Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Kenneth Maleta
- Public Health and Nutrition Research Group, Department of Nutrition, Kamuzu University of Health Sciences, Blantyre, Malawi
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20
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Kayuni SA, Al-Harbi MH, Makaula P, Injesi B, Mainga B, Lampiao F, Juziwelo L, LaCourse EJ, Stothard JR. Pathological Abnormalities Observed on Ultrasonography among Fishermen Associated with Male Genital Schistosomiasis (MGS) along the South Lake Malawi Shoreline in Mangochi District, Malawi. Trop Med Infect Dis 2022; 7:tropicalmed7080169. [PMID: 36006261 PMCID: PMC9415567 DOI: 10.3390/tropicalmed7080169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 11/16/2022] Open
Abstract
Schistosome eggs cause granulomata and pathological abnormalities, detectable with non-invasive radiological techniques such as ultrasonography which could be useful in male genital schistosomiasis (MGS). As part of our novel MGS study among fishermen along Lake Malawi, we describe pathologies observed on ultrasonography and praziquantel (PZQ) treatment over time. Fishermen aged 18+ years were recruited, submitted urine and semen for parasitological and molecular testing, and thereafter, transabdominal pelvic and scrotal ultrasonography, assessing pathologies in the prostate, seminal vesicles, epididymis and testes. Standard PZQ treatment and follow-up invitation at 1-, 3-, 6- and 12-months’ time-points were offered. A total of 130 recruited fishermen underwent ultrasonography at baseline (median age: 32.0 years); 27 (20.9%, n = 129) had S. haematobium eggs in urine (median: 1.0 egg/10 mL), 10 (12.3%, n = 81) in semen (defined as MGS, median: 2.9 eggs/mL ejaculate) and 16 (28.1%, n = 57) had a positive seminal Schistosoma real-time PCR. At baseline, 9 fishermen (6.9%, n = 130) had abnormalities, with 2 positive MGS having prostatic and testicular nodules. Fewer abnormalities were observed on follow-up. In conclusion, pathologies detected in male genitalia by ultrasonography can describe MGS morbidity in those with positive parasitological and molecular findings. Ultrasonography advances and accessibility in endemic areas can support monitoring of pathologies’ resolution after treatment.
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Affiliation(s)
- Sekeleghe A. Kayuni
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
- MASM Medi Clinics Limited, Medical Society of Malawi (MASM), Lilongwe P.O. Box 1254, Malawi
- Correspondence: ; Tel.: +265-888-367367
| | - Mohammad H. Al-Harbi
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Peter Makaula
- Research for Health, Environment and Development (RHED), Mangochi P.O. Box 345, Malawi
| | - Boniface Injesi
- MASM Medi Clinics Limited, Medical Society of Malawi (MASM), Lilongwe P.O. Box 1254, Malawi
| | - Bright Mainga
- Laboratory Department, Mangochi District Hospital, Mangochi District Assembly, Mangochi P.O. Box 1854, Malawi
| | - Fanuel Lampiao
- Physiology Department, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Mahatma Gandhi Road, Blantyre 312225, Malawi
| | - Lazarus Juziwelo
- National Schistosomiasis and Soil-Transmitted Helminths Control Programme, Community Health Sciences Unit, Ministry of Health, Lilongwe P.O. Box 30377, Malawi
| | - E. James LaCourse
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - J. Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
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21
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Orish VN, Morhe EKS, Azanu W, Alhassan RK, Gyapong M. The parasitology of female genital schistosomiasis. CURRENT RESEARCH IN PARASITOLOGY & VECTOR-BORNE DISEASES 2022; 2:100093. [PMID: 35719849 PMCID: PMC9198370 DOI: 10.1016/j.crpvbd.2022.100093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/14/2022] [Accepted: 05/19/2022] [Indexed: 11/17/2022]
Abstract
Female genital schistosomiasis (FGS) is the gynaecological presentation of Schistosoma haematobium infection, resulting from egg deposition in the female genital tract. Despite the fact that this condition has been reported in the early days of the discovery of S. haematobium in Egypt, its existence has been grossly neglected, causing many women in schistosomiasis-endemic areas to go through a preventable, debilitating, and stigmatizing presentation of FGS. To prevent this, increasing awareness of FGS is necessary for all, especially healthcare providers, to improve the diagnosis, management, and treatment. As proposed by the FAST package project, several healthcare professionals with different specializations are expected to be involved in the management of FGS. It is therefore important that basic updated knowledge on the parasitology of the disease be acquired by healthcare professionals. This review provides basic information necessary to improve the knowledge of FGS among healthcare professionals in areas endemic to schistosomiasis. Armed with these basic details, healthcare professionals can improve their confidence in the management and treatment of FGS, contributing significantly to the control and prevention of FGS in endemic areas.
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Affiliation(s)
- Verner N. Orish
- Department of Microbiology and Immunology, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Emmanuel Komla Senanu Morhe
- Department of Obstetrics and Gynecology, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Wisdom Azanu
- Department of Obstetrics and Gynecology, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Robert K. Alhassan
- Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Margaret Gyapong
- Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
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Bustinduy AL, Randriansolo B, Sturt AS, Kayuni SA, Leustcher PDC, Webster BL, Van Lieshout L, Stothard JR, Feldmeier H, Gyapong M. An update on female and male genital schistosomiasis and a call to integrate efforts to escalate diagnosis, treatment and awareness in endemic and non-endemic settings: The time is now. ADVANCES IN PARASITOLOGY 2022; 115:1-44. [PMID: 35249661 DOI: 10.1016/bs.apar.2021.12.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The last decades have brought important insight and updates in the diagnosis, management and immunopathology of female genital schistosomiasis (FGS) and male genital schistosomiasis (MGS). Despite sharing a common parasitic aetiological agent, FGS and MGS have typically been studied separately. Infection with Schistosoma haematobium manifests with gender-specific clinical manifestations and consequences of infection, albeit having a similar pathogenesis within the human genital tract. Schistosoma haematobium is a known urinary bladder carcinogen, but its potential causative role in other types of neoplasia, such as cervical cancer, is not fully understood. Furthermore, the impact of praziquantel treatment on clinical outcomes remains largely underexplored, as is the interplay of FGS/MGS with relevant reproductive tract infections such as HIV and Human Papillomavirus. In non-endemic settings, travel and immigrant health clinics need better guidance to correctly identify and treat FGS and MGS. Our review outlines the latest advances and remaining knowledge gaps in FGS and MGS research. We aim to pave a way forward to formulate more effective control measures and discuss elimination targets. With a growing community awareness in health practitioners, scientists and epidemiologists, alongside the sufferers from these diseases, we aspire to witness a new generation of young women and men free from the downstream disabling manifestations of disease.
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Affiliation(s)
- Amaya L Bustinduy
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | | | - Amy S Sturt
- Section of Infectious Diseases, Veterans Affairs Palo Alto Health Care System, Palo Alto, United States
| | - Seke A Kayuni
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; MASM Medi Clinics Limited, Blantyre, Malawi
| | - Peter D C Leustcher
- Centre for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Lisette Van Lieshout
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - J Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Hermann Feldmeier
- Charité University Medicine Berlin, Institute of Microbiology, Infectious Diseases and Immunology, Berlin, Germany
| | - Margaret Gyapong
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
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Shams M, Khazaei S, Ghasemi E, Nazari N, Javanmardi E, Majidiani H, Bahadory S, Anvari D, Fatollahzadeh M, Nemati T, Asghari A. Prevalence of urinary schistosomiasis in women: a systematic review and meta-analysis of recently published literature (2016-2020). Trop Med Health 2022; 50:12. [PMID: 35093180 PMCID: PMC8800356 DOI: 10.1186/s41182-022-00402-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 01/12/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Urinary schistosomiasis is a serious threat in endemic territories of Africa and the Middle East. The status of female urinary schistosomiasis (FUS) in published literature between 2016 and 2020 was investigated. METHODS A systematic search in PubMed, Scopus, Google Scholar, and Web of Science, based on the 'Preferred Reporting Items for Systematic Reviews and Meta-analyses' checklist, and a meta-analysis using random-effects model to calculate the weighted estimates and 95% confidence intervals (95% CIs) were done. RESULTS Totally, 113 datasets reported data on 40,531 women from 21 African countries, showing a pooled prevalence of 17.5% (95% CI: 14.8-20.5%). Most studies (73) were performed in Nigeria, while highest prevalence was detected in Mozambique 58% (95% CI: 56.9-59.1%) (one study). By sample type and symptoms, vaginal lavage [25.0% (95% CI: 11.4-46.1%)] and hematuria 19.4% (95% CI: 12.2-29.4%) showed higher FUS frequency. Studies using direct microscopy diagnosed a 17.1% (95% CI: 14.5-20.1%) prevalence rate, higher than PCR-based studies 15.3% (95% CI: 6.1-33.2%). Except for sample type, all other variables had significant association with the overall prevalence of FUS. CONCLUSIONS More studies are needed to evaluate the true epidemiology of FUS throughout endemic regions.
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Affiliation(s)
- Morteza Shams
- Zoonotic Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Sasan Khazaei
- Department of Parasitology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Ezatollah Ghasemi
- Department of Medical Parasitology, School of Medicine, Dezful University of Medical Sciences, Dezful, Iran
| | - Naser Nazari
- Department of Parasitology and Mycology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Erfan Javanmardi
- Clinical Research Development Center, "The Persian Gulf Martyrs" Hospital of Bushehr University of Medical Sciences, Bushehr, Iran
| | - Hamidreza Majidiani
- Department of Basic Medical Sciences, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Saeed Bahadory
- Department of Parasitology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Davood Anvari
- Department of Parasitology, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
- School of Medicine, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Mohammad Fatollahzadeh
- Department of Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Taher Nemati
- Department of Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Asghari
- Department of Medical Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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Conserve DF, Kayuni S, Kumwenda MK, Dovel KL, Choko AT. Assessing the efficacy of an integrated intervention to create demand for fishermen’s schistosomiasis and HIV services (FISH) in Mangochi, Malawi: Study protocol for a cluster randomized control trial. PLoS One 2022; 17:e0262237. [PMID: 34995323 PMCID: PMC8741025 DOI: 10.1371/journal.pone.0262237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 12/06/2021] [Indexed: 11/19/2022] Open
Abstract
Background Both HIV and schistosomiasis are major public health problems worldwide with 1.8 million new HIV infections, and up to 110 million untreated schistosomiasis cases globally. Although a causal link has not been established, there are strong suggestions that having schistosomiasis increases onward transmission of HIV from co-infected men to women. With both HIV and schistosomiasis treatment readily available in Malawi, there is a need to investigate the feasibility, acceptability and health impacts of joint management of these two hazards, with special focus on health education and demand-creation for fishermen. The aim of this project is to identify optimal models of delivering integrated HIV and schistosomiasis services for fishermen, particularly investigating the effect of using social networks, HIV self-test kits and beach clinic services in Mangochi, Malawi. Methods We have mapped 45 boat teams or landing sites for a 3-arm cluster randomized trial using “boat team” as the unit of randomization. The three arms are: 1) Standard of care (SOC) with leaflets explaining the importance of receiving presumptive treatment for schistosomiasis (praziquantel) and HIV services for fishermen, and two intervention arms of 2) SOC + a peer explaining the leaflet to his fellow fishermen in a boat team; and 3) arm 2 with HIV self-test kits delivered to the boat team fishermen by the peer. The primary outcomes measured at 9 months of trial delivery will compare differences between arms in the proportions of boat-team fishermen: 1) who self-report starting antiretroviral therapy or undergoing voluntary medical male circumcision; and 2) who have ≥1 S. haematobium egg seen on light microscopy of the filtrate from 10mls urine (“egg-positive”). Discussion This is the first evaluation of an integrated HIV and schistosomiasis services intervention for fishermen, particularly investigating the effect of using social networks, HIVST kits and beach clinic services. The findings will support future efforts to integrate HIVST with other health services for fishermen in similar settings if found to be efficacious. Trial registration This trial is registered in the ISRCTN registry: ISRCTN14354324; date of registration: 05 October 2020. https://www.isrctn.com/ISRCTN14354324?q=ISRCTN14354324&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10&searchType=basic-search. Linked to protocol version number 1.4 of 11 January 2021.
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Affiliation(s)
- Donaldson F. Conserve
- Department of Prevention and Community Health, Milken Institute of Public Health, George Washington University, Washington, District of Columbia, United States of America
| | | | - Moses K. Kumwenda
- Malawi Liverpool Wellcome Trust Clinical Research Programme (MLW), Blantyre, Malawi
| | - Kathryn L. Dovel
- David Geffen School of Medicine, The University of California, Los Angeles, California, United States of America
| | - Augustine Talumba Choko
- Malawi Liverpool Wellcome Trust Clinical Research Programme (MLW), Blantyre, Malawi
- * E-mail:
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Cimini A, Ricci M, Gigliotti PE, Pugliese L, Chiaravalloti A, Danieli R, Schillaci O. Medical Imaging in the Diagnosis of Schistosomiasis: A Review. Pathogens 2021; 10:pathogens10081058. [PMID: 34451522 PMCID: PMC8401107 DOI: 10.3390/pathogens10081058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/14/2021] [Accepted: 08/18/2021] [Indexed: 12/15/2022] Open
Abstract
Schistosomiasis is one of the most important parasitic diseases and it is endemic in tropical and subtropical areas. Clinical and laboratory data are fundamental for the diagnosis of schistosomiasis, but diagnostic imaging techniques such as x-rays, ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography/computed tomography (PET/CT) may be helpful in the evaluation of disease severity and complications. In this context, the aim of this review is to explore the actual role of diagnostic imaging in the diagnosis of schistosomiasis, underlining advantages and drawbacks providing information about the utilization of diagnostic imaging techniques in this context. Furthermore, we aim to provide a useful guide regarding imaging features of schistosomiasis for radiology and nuclear medicine physicians of non-endemic countries: in fact, in the last years non-endemic countries have experienced important flows of migrants from endemic areas, therefore it is not uncommon to face cases of this disease in daily practice.
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Affiliation(s)
- Andrea Cimini
- Department of Biomedicine and Prevention, University Tor Vergata, Via Cracovia 50, 00133 Rome, Italy; (M.R.); (P.E.G.); (L.P.); (A.C.); (O.S.)
- Correspondence: ; Tel.: +39-(06)-20902467
| | - Maria Ricci
- Department of Biomedicine and Prevention, University Tor Vergata, Via Cracovia 50, 00133 Rome, Italy; (M.R.); (P.E.G.); (L.P.); (A.C.); (O.S.)
| | - Paola Elda Gigliotti
- Department of Biomedicine and Prevention, University Tor Vergata, Via Cracovia 50, 00133 Rome, Italy; (M.R.); (P.E.G.); (L.P.); (A.C.); (O.S.)
| | - Luca Pugliese
- Department of Biomedicine and Prevention, University Tor Vergata, Via Cracovia 50, 00133 Rome, Italy; (M.R.); (P.E.G.); (L.P.); (A.C.); (O.S.)
- Department of Radiology, San Giovanni Calibita Fatebenefratelli Hospital, Via di Ponte di Quattro Capi 39, 00186 Rome, Italy
| | - Agostino Chiaravalloti
- Department of Biomedicine and Prevention, University Tor Vergata, Via Cracovia 50, 00133 Rome, Italy; (M.R.); (P.E.G.); (L.P.); (A.C.); (O.S.)
- Nuclear Medicine Section, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Roberta Danieli
- Department of Human Sciences and Promotion of the Quality of Life, University San Raffaele, Via di Val Cannuta 247, 00166 Rome, Italy;
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University Tor Vergata, Via Cracovia 50, 00133 Rome, Italy; (M.R.); (P.E.G.); (L.P.); (A.C.); (O.S.)
- Nuclear Medicine Section, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
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26
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Wiegand RE, Secor WE, Fleming FM, French MD, King CH, Montgomery SP, Evans D, Utzinger J, Vounatsou P, de Vlas SJ. Control and Elimination of Schistosomiasis as a Public Health Problem: Thresholds Fail to Differentiate Schistosomiasis Morbidity Prevalence in Children. Open Forum Infect Dis 2021; 8:ofab179. [PMID: 34307724 PMCID: PMC8297701 DOI: 10.1093/ofid/ofab179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/14/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Current World Health Organization guidelines utilize prevalence of heavy-intensity infections (PHIs), that is, ≥50 eggs per 10 mL of urine for Schistosoma haematobium and ≥400 eggs per gram of stool for S. mansoni, to determine whether a targeted area has controlled schistosomiasis morbidity or eliminated schistosomiasis as a public health problem. The relationship between these PHI categories and morbidity is not well understood. METHODS School-age participants enrolled in schistosomiasis monitoring and evaluation cohorts from 2003 to 2008 in Burkina Faso, Mali, Niger, Tanzania, Uganda, and Zambia were surveyed for infection and morbidity at baseline and after 1 and 2 rounds of preventive chemotherapy. Logistic regression was used to compare morbidity prevalence among participants based on their school's PHI category. RESULTS Microhematuria levels were associated with the S. haematobium PHI categories at all 3 time points. For any other S. haematobium or S. mansoni morbidity that was measured, PHI categories did not differentiate morbidity prevalence levels consistently. CONCLUSIONS These analyses suggest that current PHI categorizations do not differentiate the prevalence of standard morbidity markers. A reevaluation of the criteria for schistosomiasis control is warranted.
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Affiliation(s)
- Ryan E Wiegand
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - W Evan Secor
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Charles H King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio, USA
| | - Susan P Montgomery
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Darin Evans
- United States Agency for International Development, Washington, DC, USA
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Penelope Vounatsou
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sake J de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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27
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Aula OP, McManus DP, Jones MK, Gordon CA. Schistosomiasis with a Focus on Africa. Trop Med Infect Dis 2021; 6:109. [PMID: 34206495 PMCID: PMC8293433 DOI: 10.3390/tropicalmed6030109] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 12/19/2022] Open
Abstract
Schistosomiasis is a common neglected tropical disease of impoverished people and livestock in many developing countries in tropical Africa, the Middle East, Asia, and Latin America. Substantial progress has been made in controlling schistosomiasis in some African countries, but the disease still prevails in most parts of sub-Saharan Africa with an estimated 800 million people at risk of infection. Current control strategies rely primarily on treatment with praziquantel, as no vaccine is available; however, treatment alone does not prevent reinfection. There has been emphasis on the use of integrated approaches in the control and elimination of the disease in recent years with the development of health infrastructure and health education. However, there is a need to evaluate the present status of African schistosomiasis, primarily caused by Schistosoma mansoni and S. haematobium, and the factors affecting the disease as the basis for developing more effective control and elimination strategies in the future. This review provides an historical perspective of schistosomiasis in Africa and discusses the current status of control efforts in those countries where the disease is endemic.
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Affiliation(s)
- Oyime Poise Aula
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane 4006, Australia;
- Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia
| | - Donald P. McManus
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane 4006, Australia;
| | - Malcolm K. Jones
- School of Veterinary Sciences, University of Queensland, Gatton 4343, Australia;
| | - Catherine A. Gordon
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane 4006, Australia;
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28
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Kayuni SA, Alharbi MH, Makaula P, Lampiao F, Juziwelo L, LaCourse EJ, Stothard JR. Male Genital Schistosomiasis Along the Shoreline of Lake Malawi: Baseline Prevalence and Associated Knowledge, Attitudes and Practices Among Local Fishermen in Mangochi District, Malawi. Front Public Health 2021; 9:590695. [PMID: 34095041 PMCID: PMC8175656 DOI: 10.3389/fpubh.2021.590695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
Male genital schistosomiasis (MGS) is an often-overlooked chronic consequence of urogenital schistosomiasis (UGS) associated with Schistosoma haematobium eggs and associated pathologies in the genital system of afflicted men. Despite the first formal description of MGS in 1911 by Madden, its epidemiology, diagnostic testing and case management of today are not well-described. However, since several interactions between MGS and the Human Immunodeficiency Virus (HIV) are known, there is renewed public health interest in MGS across sub-Saharan Africa (SSA). To shed new light upon MGS in Malawi, a longitudinal cohort study was set up among fishermen along the southern shoreline of Lake Malawi in Mangochi District, Malawi, to document its prevalence and assess mens' knowledge, attitudes and practices (KAP). After providing informed written consent, fishermen (n = 376) aged 18+ years (median age: 30 years, range: 18-70 years) were recruited and submitted urine and semen for point-of-care (POC) field and laboratory diagnostic parasitological tests. Individual questionnaires were administered to assess their KAP, with praziquantel (PZQ) treatment provided to all participants. Baseline prevalence of MGS (S. haematobium eggs in semen) was 10.4% (n = 114, median: 5.0 eggs per ml, range: 0.1-30.0) while for UGS (S. haematobium eggs in urine) was 17.1% (n = 210, median: 2.3 eggs per 10 ml, range: 0.1-186.0) and 3.8% were positive by POC circulating cathodic antigen (POC-CCA), indicative of a Schistosoma mansoni infection. Just under 10% of participants reported having experienced symptoms associated with MGS, namely genital or coital pain, or haemospermia. A total of 61.7% reported previous difficulties in accessing PZQ therapy, with 34.8% having received PZQ therapy before. There was a significant correlation between MGS infection and the frequency of fishing in a week (rho = -0.25, n = 100, p = 0.01). In conclusion, MGS is prevalent among local fishermen yet knowledge of the disease is poor. We therefore call for improved availability and accessibility to MGS diagnostics, PZQ treatment within ongoing control interventions. This will improve the lives and reproductive health of men, their partners and communities in this shoreline environment of Lake Malawi.
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Affiliation(s)
- Sekeleghe A Kayuni
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom.,MASM Medi Clinics Limited, Medical Aid Society of Malawi (MASM), Blantyre, Malawi
| | - Mohammad H Alharbi
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Peter Makaula
- Research for Health, Environment and Development (RHED), Mangochi, Malawi
| | - Fanuel Lampiao
- Physiology Department, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Lazarus Juziwelo
- National Schistosomiasis and STH Control Programme, Community Health Sciences Unit, Ministry of Health, Lilongwe, Malawi
| | - E James LaCourse
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - J Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Wiegand RE, Secor WE, Fleming FM, French MD, King CH, Deol AK, Montgomery SP, Evans D, Utzinger J, Vounatsou P, de Vlas SJ. Associations between infection intensity categories and morbidity prevalence in school-age children are much stronger for Schistosoma haematobium than for S. mansoni. PLoS Negl Trop Dis 2021; 15:e0009444. [PMID: 34033646 PMCID: PMC8183985 DOI: 10.1371/journal.pntd.0009444] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 06/07/2021] [Accepted: 05/04/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND World Health Organization (WHO) guidelines for measuring global progress in schistosomiasis control classify individuals with Schistosoma spp. infections based on the concentration of excreted eggs. We assessed the associations between WHO infection intensity categories and morbidity prevalence for selected S. haematobium and S. mansoni morbidities in school-age children. METHODOLOGY A total of 22,488 children aged 6-15 years from monitoring and evaluation cohorts in Burkina Faso, Mali, Niger, Uganda, Tanzania, and Zambia from 2003-2008 were analyzed using Bayesian logistic regression. Models were utilized to evaluate associations between intensity categories and the prevalence of any urinary bladder lesion, any upper urinary tract lesion, microhematuria, and pain while urinating (for S. haematobium) and irregular hepatic ultrasound image pattern (C-F), enlarged portal vein, laboratory-confirmed diarrhea, and self-reported diarrhea (for S. mansoni) across participants with infection and morbidity data. PRINCIPAL FINDINGS S. haematobium infection intensity categories possessed consistent morbidity prevalence across surveys for multiple morbidities and participants with light infections had elevated morbidity levels, compared to negative participants. Conversely, S. mansoni infection intensity categories lacked association with prevalence of the morbidity measures assessed. CONCLUSIONS/SIGNIFICANCE Current status infection intensity categories for S. haematobium were associated with morbidity levels in school-age children, suggesting urogenital schistosomiasis morbidity can be predicted by an individual's intensity category. Conversely, S. mansoni infection intensity categories were not consistently indicative of childhood morbidity at baseline or during the first two years of a preventive chemotherapy control program.
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Affiliation(s)
- Ryan E. Wiegand
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - W. Evan Secor
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | - Charles H. King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Arminder K. Deol
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Susan P. Montgomery
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Darin Evans
- United States Agency for International Development, Washington DC, United States of America
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Penelope Vounatsou
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sake J. de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Abstract
BACKGROUND Schistosomiasis is a parasitic disease caused by trematode worms of the genus Schistosoma and belongs to the neglected tropical diseases. The disease has been reported in 78 countries, with around 290.8 million people in need of treatment in 2018. Schistosomiasis is predominantly considered a rural disease with a subsequent focus of research and control activities in rural settings. Over the past decades, occurrence and even expansion of schistosomiasis foci in peri-urban and urban settings have increasingly been observed. Rural-urban migration in low- and middle-income countries and subsequent rapid and unplanned urbanization are thought to explain these observations. Fifty-five percent (55%) of the world population is already estimated to live in urban areas, with a projected increase to 68% by 2050. In light of rapid urbanization and the efforts to control morbidity and ultimately achieve elimination of schistosomiasis, it is important to deepen our understanding of the occurrence, prevalence, and transmission of schistosomiasis in urban and peri-urban settings. A systematic literature review looking at urban and peri-urban schistosomiasis was therefore carried out as a first step to address the research and mapping gap. METHODOLOGY Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic computer-aided literature review was carried out using PubMed, ScienceDirect, and the World Health Organization Database in November 2019, which was updated in March 2020. Only papers for which at least the abstract was available in English were used. Relevant publications were screened, duplicates were removed, guidelines for eligibility were applied, and eligible studies were reviewed. Studies looking at human Schistosoma infections, prevalence, and intensity of infection in urban and peri-urban settings were included as well as those focusing on the intermediate host snails. PRINCIPAL FINDINGS A total of 248 publications met the inclusion criteria. The selected studies confirm that schistosomiasis is prevalent in peri-urban and urban areas in the countries assessed. Earlier studies report higher prevalence levels in urban settings compared to data extracted from more recent publications, yet the challenge of migration, rapid uncontrolled urbanization, and resulting poor living conditions highlight the potential for continuous or even newly established transmission to take place. CONCLUSIONS The review indicates that schistosomiasis has long existed in urban and peri-urban areas and remains a public health problem. There is, however, a challenge of comparability of settings due to the lack of a clear definition of what constitutes urban and peri-urban. There is a pressing need for improved monitoring of schistosomiasis in urban communities and consideration of treatment strategies.
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Søfteland S, Sebitloane MH, Taylor M, Roald BB, Holmen S, Galappaththi-Arachchige HN, Gundersen SG, Kjetland EF. A systematic review of handheld tools in lieu of colposcopy for cervical neoplasia and female genital schistosomiasis. Int J Gynaecol Obstet 2021; 153:190-199. [PMID: 33316096 PMCID: PMC8248063 DOI: 10.1002/ijgo.13538] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/18/2020] [Accepted: 12/11/2020] [Indexed: 11/23/2022]
Abstract
Background Visualization of the lesions in the lower genital tract is the mainstay for diagnosis of the four lesions found in female genital schistosomiasis (FGS), but colposcopes are generally not available in low‐resource settings. Objective We sought to review handheld devices that could potentially be used for FGS diagnosis. Search strategy We searched Medline and Embase 2015–2019 for handheld devices used in cervical cancer screening and FGS diagnosis. Selection criteria We excluded studies that did not compare the device to standard‐of‐care colposcopes or histopathology. Main results and conclusion In 11 studies, four handheld colposcopes, two smartphones, and one compact digital camera were evaluated. Two handheld colposcopes were found to be potentially adequate for FGS diagnosis, namely Gynocular and Mobile ODT. The smartphones and digital camera did not have sufficient magnification to diagnose grainy sandy patches, one of the FGS lesion types. Customized software should be made to support the diagnosis of both FGS and cervical neoplasia. Real‐time postgraduate training and quality control should be considered in future studies of handheld colposcopes. For patients from schistosomiasis endemic areas, we recommend that handheld devices are used for FGS. Studies are needed to determine which of the two devices is most adequate for FGS diagnosis in schistosomiasis endemic areas. Handheld colposcopy for schistosomiasis endemic areas should be adequate for both cervical cancer and genital schistosomiasis diagnoses.
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Affiliation(s)
- Solrun Søfteland
- Norwegian Center for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Motshedisi Hannah Sebitloane
- Discipline of Obstetrics and Gynecology, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Myra Taylor
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Borghild Barth Roald
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Center for Pediatric and Pregnancy Related Pathology, Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Sigve Holmen
- Norwegian Center for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway
| | | | - Svein Gunnar Gundersen
- Institute for Global Development and Planning, University of Agder, Kristiansand, Norway
| | - Eyrun Floerecke Kjetland
- Norwegian Center for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway.,Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Mehta SD, Okal D, Otieno F, Green SJ, Nordgren RK, Huibner S, Bailey RC, Bhaumik DK, Landay A, Kaul R. Schistosomiasis is associated with rectal mucosal inflammation among Kenyan men who have sex with men. Int J STD AIDS 2021; 32:694-703. [PMID: 33533314 DOI: 10.1177/0956462420985973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Schistosoma mansoni infection is hyperendemic in Lake Victoria communities and associated with cervicovaginal immune alterations and HIV acquisition. We assessed the hypothesis that schistosomiasis correlates with greater rectal inflammation in men who have sex with men (MSM) in Kisumu, Kenya. Methods: In this cross-sectional study of 38 HIV-negative MSM aged 18-35 years, schistosomiasis was diagnosed by urine circulating cathodic antigen (CCA). Microbiome was assessed in rectal swabs by 16S rRNA gene amplicon sequencing, and rectal inflammation by quartile normalized summative score of inflammatory cytokines (IL-1α, IL-1β, IL-8, and TNF-α). Elastic net (EN) regression identified taxa associated with inflammation. Multivariable linear regression estimated the association between inflammation score and schistosomiasis and bacteria identified in EN. Results: Most men were CCA positive (24/38; 63%), and median rectal inflammation score was significantly higher in these participants (11 vs. 8, p = 0.04). In multivariable regression, CCA-positive men had 2.85-point greater inflammation score (p = 0.009). The relative abundance of Succinivibrio (coefficient = -1.13, p = 0.002) and Pseudomonas (coefficient = -1.04, p = 0.001) were negatively associated with inflammation. Discussion: CCA positivity was associated with rectal mucosal inflammation, controlling for rectal microbiome composition. Given its high prevalence and contribution to inflammation, schistosomiasis may have important implications for HIV transmission in this vulnerable population.
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Affiliation(s)
- Supriya D Mehta
- Division of Epidemiology & Biostatistics, 14681University of Illinois at Chicago School of Public Health, Chicago, USA
| | - Duncan Okal
- Nyanza Reproductive Health Society, Kisumu, Kenya
| | | | - Stefan J Green
- Sequencing Core, Research Resources Center, 14681University of Illinois at Chicago, Chicago, USA
| | - Rachel K Nordgren
- Division of Epidemiology & Biostatistics, 14681University of Illinois at Chicago School of Public Health, Chicago, USA
| | - Sanja Huibner
- Division of Infectious Diseases, University of Toronto School of Medicine, Toronto, Canada
| | - Robert C Bailey
- Division of Epidemiology & Biostatistics, 14681University of Illinois at Chicago School of Public Health, Chicago, USA
| | - Dulal K Bhaumik
- Division of Epidemiology & Biostatistics, 14681University of Illinois at Chicago School of Public Health, Chicago, USA
| | - Alan Landay
- Department of Internal Medicine, 2468Rush University, Chicago, USA
| | - Rupert Kaul
- Division of Infectious Diseases, University of Toronto School of Medicine, Toronto, Canada
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Masong MC, Wepnje GB, Marlene NT, Gamba V, Mengue MT, Kouokam E, Stothard JR, Ekobo ALS. Female Genital Schistosomiasis (FGS) in Cameroon: A formative epidemiological and socioeconomic investigation in eleven rural fishing communities. PLOS GLOBAL PUBLIC HEALTH 2021; 1:e0000007. [PMID: 36962084 PMCID: PMC10022362 DOI: 10.1371/journal.pgph.0000007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/15/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Female Genital Schistosomiasis (FGS) is most often caused by presence of Schistosoma haematobium eggs lodged in the female reproductive tract which results in chronic fibrosis and scarring. In Cameroon, despite high community prevalences of urine-patent S. haematobium infections, FGS has yet to be studied in depth. To shed light on the clinical prevalence and socioeconomic effects of FGS, we undertook a formative community-based epidemiological and qualitative survey. METHOD A cross sectional multidisciplinary study of 304 girls and women from 11 remote rural fishing communities in Cameroon was undertaken using parasitological sampling, clinical colposcopy, and interviews. The lived experiences of those with FGS were documented using a process of ethnography with participant observation and in-depth interviews. RESULT Amongst 304 women and girls aged >5 years (Median age: 18; Interquartile range: 9.6-28), 198 females were eligible for FGS testing and 58 adult women were examined by clinical colposcopy. Of these, 34 were positive for FGS (proportion: 58.6%; 95% CI: 45.8-70.4), younger girls showing a higher FGS prevalence, and older women not shedding eggs showing a pattern for cervical lesions from earlier infection. In a subset of women with FGS selected purposively (12/58), in-depth interviews with participant observation revealed out-of-pocket expenditures of up to 500USD related health spending for repeated diagnosis and treatment of gynecological illnesses, and 9 hours daily lost reproductive labour. Psychosocial unrest, loss in social capital, and despair were linked with sub-fertility and persistent vaginal itch. CONCLUSION With our first formative evidence on prevalence, socioeconomic effects and experiences of FGS amongst women and girls in Cameroon, we have clarified to a new level of detail the deficit in provision of and access to peripheral health services in remote areas of Cameroon. Using this information, there is now strong evidence for national programs and services on women's health and schistosomiasis to update and revise policies targeted on prevention and management of FGS. We therefore stress the need for regular provision of Praziquantel treatment to adolescent girls and women in S. haematobium endemic areas, alongside better access to tailored diagnostic services that can detect FGS and appropriately triage care at primary health level.
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Affiliation(s)
- Makia Christine Masong
- Department of Social Sciences and Management, Catholic University of Central Africa, Yaoundé, Cameroon
| | | | - Ntsinda Tchoffo Marlene
- Department of Social Sciences and Management, Catholic University of Central Africa, Yaoundé, Cameroon
| | - Victoria Gamba
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | - Marie-Therese Mengue
- Department of Social Sciences and Management, Catholic University of Central Africa, Yaoundé, Cameroon
| | - Estelle Kouokam
- Department of Social Sciences and Management, Catholic University of Central Africa, Yaoundé, Cameroon
| | - J Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Ndassi VD, Anchang-Kimbi JK, Sumbele IUN, Ngufor LA, Nadege K, Kimbi HK. The epidemiological status of urogenital schistosomiasis among reproductive aged individuals in the Tiko Health Area- a semi-urban setting in the Mount Cameroon area. PLoS Negl Trop Dis 2021; 15:e0008978. [PMID: 33428614 PMCID: PMC7822554 DOI: 10.1371/journal.pntd.0008978] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 01/22/2021] [Accepted: 11/11/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Urogenital schistosomiasis (UGS) caused by S. haematobium has enormous reproductive health consequences including infertility. Reproductive aged individuals are a neglected group and not included in control programs in Cameroon. This study investigated the prevalence and severity of S. haematobium infection in the context of gender and socio-economic structures that shape behaviour among reproductive aged individuals living in Tiko, a semi-urban setting, Cameroon. METHODOLOGY/PRINCIPAL FINDINGS A cross-sectional study was carried out in the Tiko Health District (THD) between May to September 2019. Consenting individuals were enrolled using a convenient sampling technique and administered a semi-structured questionnaire to document data on socio-demographic and stream contact behaviour. A urine sample was collected and screened for the presence of S. haematobium ova using reagent strips, filtration and microscopy. The overall prevalence of S. haematobium infection was 22.8% (95% CL: 19.27-26.73) with geometric mean egg load of 18.74 (range: 1-1600) per 10ml of urine. Younger age group (15 - 20years) (OR: 5.13; 95% CL: 1.35-19.42), male (OR: 2.60 3.07; 95% CL: 1.54-4.40) and awareness of UGS (OR: 1.73; 95% CL: 1.02-2.95) were associated with higher odds of exposure to infection. Significantly higher intensity of infection was seen in males, singles and in the age group 15-30 years. It is worth noting that males carried out more activities which entailed longer duration in streams. CONCLUSION/SIGNIFICANCE The prevalence obtained shows that Tiko is a moderate-risk area for UGS with underlying morbidity-inducing infection intensity. The severity of the infection is more in males. Awareness of the disease is not enough to protect these communities from infection, but provision of public infrastructures and health education will limit contact with infested water and thus curtail the infection. There is an urgent need to involve all age groups in control programs.
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Affiliation(s)
- Vicky Daonyle Ndassi
- Department of Zoology and Animal Physiology, Faculty of Science, University of Buea, Buea, Cameroon
| | | | - Irene Ule Ngole Sumbele
- Department of Zoology and Animal Physiology, Faculty of Science, University of Buea, Buea, Cameroon
| | - Lennin Azaofah Ngufor
- Department of Zoology and Animal Physiology, Faculty of Science, University of Buea, Buea, Cameroon
| | - Kouemou Nadege
- Department of Zoology and Animal Physiology, Faculty of Science, University of Buea, Buea, Cameroon
| | - Helen Kuokuo Kimbi
- Department of Zoology and Animal Physiology, Faculty of Science, University of Buea, Buea, Cameroon
- Department of Medical Laboratory Science, Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon
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Sturt AS, Webb EL, Francis SC, Hayes RJ, Bustinduy AL. Beyond the barrier: Female Genital Schistosomiasis as a potential risk factor for HIV-1 acquisition. Acta Trop 2020; 209:105524. [PMID: 32416076 PMCID: PMC7429987 DOI: 10.1016/j.actatropica.2020.105524] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 12/16/2022]
Abstract
Female genital schistosomiasis (FGS) results from egg-deposition in the female reproductive tract primarily by the waterborne parasite Schistosoma (S.) haematobium, and less commonly by Schistosoma (S.) mansoni. FGS affects an estimated 20-56 million women worldwide, mostly in sub-Saharan Africa. There is cross-sectional evidence of increased HIV-1 prevalence in schistosomiasis-infected women, but a causal relationship between FGS and either HIV-1 acquisition or transmission has not been fully established. Beyond the pathognomonic breach in the cervicovaginal barrier caused by FGS, this narrative review explores potential mechanisms for a synergistic relationship between S. haematobium infection, FGS, and HIV-1 acquisition through vaginal inflammation and target cell recruitment.
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Affiliation(s)
- A S Sturt
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom.
| | - E L Webb
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| | - S C Francis
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| | - R J Hayes
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| | - A L Bustinduy
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
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36
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Engels D, Hotez PJ, Ducker C, Gyapong M, Bustinduy AL, Secor WE, Harrison W, Theobald S, Thomson R, Gamba V, Masong MC, Lammie P, Govender K, Mbabazi PS, Malecela MN. Integration of prevention and control measures for female genital schistosomiasis, HIV and cervical cancer. Bull World Health Organ 2020; 98:615-624. [PMID: 33012861 PMCID: PMC7463188 DOI: 10.2471/blt.20.252270] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/11/2020] [Accepted: 06/11/2020] [Indexed: 11/27/2022] Open
Abstract
Female genital schistosomiasis as a result of chronic infection with Schistosoma haematobium (commonly known as bilharzia) continues to be largely ignored by national and global health policy-makers. International attention for large-scale action against the disease focuses on whether it is a risk factor for the transmission of human immunodeficiency virus (HIV). Yet female genital schistosomiasis itself is linked to pain, bleeding and sub- or infertility, leading to social stigma, and is a common issue for women in schistosomiasis-endemic areas in sub-Saharan Africa. The disease should therefore be recognized as another component of a comprehensive health and human rights agenda for women and girls in Africa, alongside HIV and cervical cancer. Each of these three diseases has a targeted and proven preventive intervention: antiretroviral therapy and pre-exposure prophylaxis for HIV; human papilloma virus vaccine for cervical cancer; and praziquantel treatment for female genital schistosomiasis. We discuss how female genital schistosomiasis control can be integrated with HIV and cervical cancer care. Such a programme will be part of a broader framework of sexual and reproductive health and rights, women's empowerment and social justice in Africa. Integrated approaches that join up multiple public health programmes have the potential to expand or create opportunities to reach more girls and women throughout their life course. We outline a pragmatic operational research agenda that has the potential to optimize joint implementation of a package of measures responding to the specific needs of girls and women.
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Affiliation(s)
- Dirk Engels
- Uniting to Combat NTDs, Chemin de la Gouille 8, 1291 Commugny, Switzerland
| | - Peter J Hotez
- National School of Tropical Medicine, Baylor College of Medicine, Houston, United States of America (USA)
| | | | - Margaret Gyapong
- Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Amaya L Bustinduy
- Clinical Research, London School of Hygiene and Tropical Medicine, London, England
| | - William E Secor
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, USA
| | | | - Sally Theobald
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, England
| | - Rachael Thomson
- Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, England
| | - Victoria Gamba
- Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - Makia C Masong
- Catholic University of Central Africa, Yaoundé, Cameroon
| | - Patrick Lammie
- Neglected Tropical Diseases Support Center, The Task Force for Global Health, Decatur, USA
| | - Kreeneshni Govender
- Human Rights and Gender, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland
| | - Pamela S Mbabazi
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Mwelecele N Malecela
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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Zirimenya L, Mahmud-Ajeigbe F, McQuillan R, Li Y. A systematic review and meta-analysis to assess the association between urogenital schistosomiasis and HIV/AIDS infection. PLoS Negl Trop Dis 2020; 14:e0008383. [PMID: 32542045 PMCID: PMC7316344 DOI: 10.1371/journal.pntd.0008383] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/25/2020] [Accepted: 05/12/2020] [Indexed: 01/31/2023] Open
Abstract
Background Urogenital schistosomiasis and HIV/AIDS infections are widespread in sub-Saharan Africa (SSA) leading to substantial morbidity and mortality. The co-occurrence of both diseases has led to the possible hypothesis that urogenital schistosomiasis leads to increased risk of acquiring HIV infection. However, the available evidence concerning this association is inconsistent. The aim of this study was to systematically review and quantitatively synthesize studies that investigated the association between urogenital schistosomiasis and HIV/AIDS infection. Methods A systematic review basing on PRISMA guidelines was conducted. It is registered with PROSPERO, number CRD42018116648. We searched four databases, MEDLINE, EMBASE, Global Health and Global Index Medicus for studies investigating the association between urogenital schistosomiasis and HIV infection. Only studies published in English were considered. Results of the association were summarised by gender. A meta-analysis was performed for studies on females using random-effects model and a pooled OR with 95% confidence interval was reported. Results Of the 993 studies screened, only eight observational studies met the inclusion criteria. Across all studies, the reported unadjusted OR ranged from 0.78 to 3.76. The pooled estimate of unadjusted OR among females was 1.31 (95% CI: 0.87–1.99). Only four of the eight studies reported an adjusted OR. A separate meta-analysis done in the three studies among females that reported an adjusted OR showed that the pooled estimate was 1.85 (95% CI: 1.17–2.92). There were insufficient data to pool results for association between urogenital schistosomiasis and HIV infection in the males. Conclusion Our investigation supports the hypothesis of an association between urogenital schistosomiasis with HIV/AIDS infection in females. Due to insufficient evidence, no conclusion could be drawn in males with urogenital schistosomiasis. Large-scale prospective studies are needed in future. Urogenital schistosomiasis, caused by parasitic trematode Schistosoma haematobium is a significant source of morbidity in sub Saharan Africa. HIV infection caused by a retrovirus is of two subtypes HIV 1 and HIV 2, with subtype HIV 1 being found worldwide and more aggressive, leading to HIV/AIDS. Research on both of these diseases in the same settings, has shown that these diseases cross paths. This has led to the suggestion that there could be a possible association between the two. Here we describe a systematic review that was carried out to determine if there is an association between UGS and HIV/AIDS infections. We searched all published articles available in MEDLINE, EMBASE, Global Health (CABI), and Global Index Medicus before 28th January 2020. We found eight observational studies eligible to be included in the systematic review and no intervention study. Six of these studies were included in the meta-analysis. A summarized meta-analysis of the study findings with adjusted OR showed that there was a likely association between urogenital schistosomiasis and HIV/AIDS infections in females. However, due to limited papers in males, no conclusion could be drawn.
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Affiliation(s)
- Ludoviko Zirimenya
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- University of Edinburgh, Scotland, United Kingdom
- * E-mail:
| | - Fatima Mahmud-Ajeigbe
- University of Edinburgh, Scotland, United Kingdom
- Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria
| | | | - You Li
- University of Edinburgh, Scotland, United Kingdom
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Cozzi D, Bertelli E, Savi E, Verna S, Zammarchi L, Tilli M, Rinaldi F, Pradella S, Agostini S, Miele V. Ultrasound findings in urogenital schistosomiasis: a pictorial essay. J Ultrasound 2020; 23:195-205. [PMID: 31494862 PMCID: PMC7242546 DOI: 10.1007/s40477-019-00405-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/27/2019] [Indexed: 02/01/2023] Open
Abstract
Urogenital schistosomiasis is a parasitic disease caused by S. haematobium which is endemic in tropical and sub-tropical areas but is increasingly diagnosed in temperate non-endemic countries due to migration and international travels. Early identification and treatment of the disease are fundamental to avoid associated severe sequelae such as bladder carcinoma, hydronephrosis leading to kidney failure and reproductive complications. Radiologic imaging, especially through ultrasound examination, has a fundamental role in the assessment of organ damage and follow-up after treatment. Imaging findings of urinary tract schistosomiasis are observed mainly in the ureters and bladder. The kidneys usually appear normal until a late stage of the disease.
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Affiliation(s)
- Diletta Cozzi
- Department of Radiology, Careggi University Hospital, AOU Careggi, L.go Brambilla 3, 50134 Florence, Italy
| | - Elena Bertelli
- Department of Radiology, Careggi University Hospital, AOU Careggi, L.go Brambilla 3, 50134 Florence, Italy
| | - Elena Savi
- Department of Radiology, Careggi University Hospital, AOU Careggi, L.go Brambilla 3, 50134 Florence, Italy
| | - Silvia Verna
- Department of Radiology, Careggi University Hospital, AOU Careggi, L.go Brambilla 3, 50134 Florence, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Marta Tilli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesca Rinaldi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Silvia Pradella
- Department of Radiology, Careggi University Hospital, AOU Careggi, L.go Brambilla 3, 50134 Florence, Italy
| | - Simone Agostini
- Department of Radiology, Careggi University Hospital, AOU Careggi, L.go Brambilla 3, 50134 Florence, Italy
| | - Vittorio Miele
- Department of Radiology, Careggi University Hospital, AOU Careggi, L.go Brambilla 3, 50134 Florence, Italy
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Faust CL, Osakunor DNM, Downs JA, Kayuni S, Stothard JR, Lamberton PHL, Reinhard-Rupp J, Rollinson D. Schistosomiasis Control: Leave No Age Group Behind. Trends Parasitol 2020; 36:582-591. [PMID: 32430274 DOI: 10.1016/j.pt.2020.04.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 01/11/2023]
Abstract
Despite accelerating progress towards schistosomiasis control in sub-Saharan Africa, several age groups have been eclipsed by current treatment and monitoring strategies that mainly focus on school-aged children. As schistosomiasis poses a threat to people of all ages, unfortunate gaps exist in current treatment coverage and associated monitoring efforts, preventing subsequent health benefits to preschool-aged children as well as certain adolescents and adults. Expanding access to younger ages through the forthcoming pediatric praziquantel formulation and improving treatment coverage in older ages is essential. This should occur alongside formal inclusion of these groups in large-scale monitoring and evaluation activities. Current omission of these age groups from treatment and monitoring exacerbates health inequities and has long-term consequences for sustainable schistosomiasis control.
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Affiliation(s)
- Christina L Faust
- Wellcome Centre for Integrative Parasitology, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, UK.
| | - Derick N M Osakunor
- Institute of Immunology and Infection Research, University of Edinburgh, Ashworth Laboratories, King's Buildings, Charlotte Auerbach Road, Edinburgh EH9 3FL, UK
| | - Jennifer A Downs
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Sekeleghe Kayuni
- Department of Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; MASM Medi Clinics Limited, Medical Aid Society of Malawi (MASM), Blantyre, Malawi
| | - J Russell Stothard
- Department of Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Poppy H L Lamberton
- Wellcome Centre for Integrative Parasitology, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, UK
| | | | - David Rollinson
- Global Schistosomiasis Alliance, Natural History Museum, London SW7 5BD, UK
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Kayuni SA, LaCourse EJ, Makaula P, Lampiao F, Juziwelo L, Fawcett J, Shaw A, Alharbi MH, Verweij JJ, Stothard JR. Case Report: Highlighting Male Genital Schistosomiasis (MGS) in Fishermen from the Southwestern Shoreline of Lake Malawi, Mangochi District. Am J Trop Med Hyg 2020; 101:1331-1335. [PMID: 31701858 DOI: 10.4269/ajtmh.19-0562] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Urogenital schistosomiasis causes morbidity within the genitalia but is underreported and infrequently examined in men. To draw attention to male genital schistosomiasis (MGS), a longitudinal cohort study was conducted among fishermen along the southwestern shoreline of Lake Malawi. A case series of five participants is presented inclusive of questionnaire interviews, parasitological examinations, ultrasonography, and provision of a standard dose (40 mg/kg) of praziquantel (PZQ) treatment at baseline, 1-, 3-, 6-, and 12-month follow-up time points. Eggs of Schistosoma haematobium were observed in urine or semen across all time points; parasitological diagnostics were bolstered by real-time PCR for Schistosoma DNA in semen and by portable ultrasonography to document putative MGS-associated morbidity. We highlight the importance of developing standard diagnostic tests for MGS and increasing the accessibility of PZQ treatment to men, especially those in at-risk endemic areas.
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Affiliation(s)
- Sekeleghe A Kayuni
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,MASM Medi Clinics Limited, Medical Society of Malawi (MASM), Blantyre, Malawi
| | - E James LaCourse
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Peter Makaula
- Research for Health Environment and Development (RHED), Mangochi, Malawi
| | - Fanuel Lampiao
- Physiology Department, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Lazarus Juziwelo
- National Schistosomiasis and STH Control Program, Community Health Sciences Unit (CHSU), Ministry of Health, Lilongwe, Malawi
| | - Joanna Fawcett
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Alexandra Shaw
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Mohammad H Alharbi
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jaco J Verweij
- Elisabeth-TweeSteden Hospital Tilburg, Laboratory for Medical Microbiology and Immunology, Tilburg, The Netherlands
| | - J Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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An update on non-invasive urine diagnostics for human-infecting parasitic helminths: what more could be done and how? Parasitology 2019; 147:873-888. [PMID: 31831084 PMCID: PMC7284843 DOI: 10.1017/s0031182019001732] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Reliable diagnosis of human helminth infection(s) is essential for ongoing disease surveillance and disease elimination. Current WHO-recommended diagnostic assays are unreliable in low-endemic near-elimination settings and typically involve the invasive, onerous and potentially hazardous sampling of bodily fluids such as stool and blood, as well as tissue via biopsy. In contrast, diagnosis by use of non-invasive urine sampling is generally painless, more convenient and low risk. It negates the need for specialist staff, can usually be obtained immediately upon request and is better accepted by patients. In some instances, urine-based diagnostic assays have also been shown to provide a more reliable diagnosis of infection when compared to traditional methods that require alternative and more invasive bodily samples, particularly in low-endemicity settings. Given these relative benefits, we identify and review current research literature to evaluate whether non-invasive urine sampling is currently exploited to its full potential in the development of diagnostic tools for human helminthiases. Though further development, assessment and validation are needed before their routine use in control programmes, low-cost, rapid and reliable assays capable of detecting transrenal helminth-derived antigens and cell-free DNA show excellent promise for future use at the point-of-care in high-, medium- and even low-endemicity elimination settings.
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Rabone M, Wiethase JH, Allan F, Gouvras AN, Pennance T, Hamidou AA, Webster BL, Labbo R, Emery AM, Garba AD, Rollinson D. Freshwater snails of biomedical importance in the Niger River Valley: evidence of temporal and spatial patterns in abundance, distribution and infection with Schistosoma spp. Parasit Vectors 2019; 12:498. [PMID: 31640811 PMCID: PMC6805334 DOI: 10.1186/s13071-019-3745-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 10/09/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Sound knowledge of the abundance and distribution of intermediate host snails is key to understanding schistosomiasis transmission and to inform effective interventions in endemic areas. METHODS A longitudinal field survey of freshwater snails of biomedical importance was undertaken in the Niger River Valley (NRV) between July 2011 and January 2016, targeting Bulinus spp. and Biomphalaria pfeifferi (intermediate hosts of Schistosoma spp.), and Radix natalensis (intermediate host of Fasciola spp.). Monthly snail collections were carried out in 92 sites, near 20 localities endemic for S. haematobium. All bulinids and Bi. pfeifferi were inspected for infection with Schistosoma spp., and R. natalensis for infection with Fasciola spp. RESULTS Bulinus truncatus was the most abundant species found, followed by Bulinus forskalii, R. natalensis and Bi. pfeifferi. High abundance was associated with irrigation canals for all species with highest numbers of Bulinus spp. and R. natalensis. Seasonality in abundance was statistically significant in all species, with greater numbers associated with dry season months in the first half of the year. Both B. truncatus and R. natalensis showed a negative association with some wet season months, particularly August. Prevalences of Schistosoma spp. within snails across the entire study were as follows: Bi. pfeifferi: 3.45% (79/2290); B. truncatus: 0.8% (342/42,500); and B. forskalii: 0.2% (24/11,989). No R. natalensis (n = 2530) were infected. Seasonality of infection was evident for B. truncatus, with highest proportions shedding in the middle of the dry season and lowest in the rainy season, and month being a significant predictor of infection. Bulinus spp. and Bi. pfeifferi showed a significant correlation of snail abundance with the number of snails shedding. In B. truncatus, both prevalence of Schistosoma spp. infection, and abundance of shedding snails were significantly higher in pond habitats than in irrigation canals. CONCLUSIONS Evidence of seasonality in both overall snail abundance and infection with Schistosoma spp. in B. truncatus, the main intermediate host in the region, has significant implications for monitoring and interrupting transmission of Schistosoma spp. in the NRV. Monthly longitudinal surveys, representing intensive sampling effort have provided the resolution needed to ascertain both temporal and spatial trends in this study. These data can inform planning of interventions and treatment within the region.
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Affiliation(s)
- Muriel Rabone
- Department of Life Sciences, Natural History Museum, Cromwell Rd, South Kensington, London, SW7 5BD UK
| | - Joris Hendrik Wiethase
- Department of Life Sciences, Natural History Museum, Cromwell Rd, South Kensington, London, SW7 5BD UK
| | - Fiona Allan
- Department of Life Sciences, Natural History Museum, Cromwell Rd, South Kensington, London, SW7 5BD UK
| | - Anouk Nathalie Gouvras
- Department of Life Sciences, Natural History Museum, Cromwell Rd, South Kensington, London, SW7 5BD UK
| | - Tom Pennance
- Department of Life Sciences, Natural History Museum, Cromwell Rd, South Kensington, London, SW7 5BD UK
- School of Biosciences, Cardiff University, Cardiff, CF10 3AT UK
| | - Amina Amadou Hamidou
- Réseau International Schistosomoses, Environnement Aménagement et Lutte (RISEAL-Niger), 333, Avenue des Zarmakoye, B.P. 13724, Niamey, Niger
| | - Bonnie Lee Webster
- Department of Life Sciences, Natural History Museum, Cromwell Rd, South Kensington, London, SW7 5BD UK
| | - Rabiou Labbo
- Réseau International Schistosomoses, Environnement Aménagement et Lutte (RISEAL-Niger), 333, Avenue des Zarmakoye, B.P. 13724, Niamey, Niger
- Centre de Recherche Médicale et Sanitaire (CERMES), Institut Pasteur International Network, 634 Bd de la Nation, BP 10887, Niamey, Niger
| | - Aidan Mark Emery
- Department of Life Sciences, Natural History Museum, Cromwell Rd, South Kensington, London, SW7 5BD UK
| | - Amadou Djirmay Garba
- Réseau International Schistosomoses, Environnement Aménagement et Lutte (RISEAL-Niger), 333, Avenue des Zarmakoye, B.P. 13724, Niamey, Niger
- World Health Organization, Geneva, Switzerland
| | - David Rollinson
- Department of Life Sciences, Natural History Museum, Cromwell Rd, South Kensington, London, SW7 5BD UK
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How can schistosome circulating antigen assays be best applied for diagnosing male genital schistosomiasis (MGS): an appraisal using exemplar MGS cases from a longitudinal cohort study among fishermen on the south shoreline of Lake Malawi. Parasitology 2019; 146:1785-1795. [PMID: 31452477 PMCID: PMC6939168 DOI: 10.1017/s0031182019000969] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We provide an update on diagnostic methods for the detection of urogenital schistosomiasis (UGS) in men and highlight that satisfactory urine-antigen diagnostics for UGS lag much behind that for intestinal schistosomiasis, where application of a urine-based point-of-care strip assay, the circulating cathodic antigen (CCA) test, is now advocated. Making specific reference to male genital schistosomiasis (MGS), we place greater emphasis on parasitological detection methods and clinical assessment of internal genitalia with ultrasonography. Unlike the advances made in defining a clinical standard protocol for female genital schistosomiasis, MGS remains inadequately defined. Whilst urine filtration with microscopic examination for ova of Schistosoma haematobium is a convenient but error-prone proxy of MGS, we describe a novel low-cost sampling and direct visualization method for the enumeration of ova in semen. Using exemplar clinical cases of MGS from our longitudinal cohort study among fishermen along the shoreline of Lake Malawi, the portfolio of diagnostic needs is appraised including: the use of symptomatology questionnaires, urine analysis (egg count and CCA measurement), semen analysis (egg count, circulating anodic antigen measurement and real-time polymerase chain reaction analysis) alongside clinical assessment with portable ultrasonography.
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Kukula VA, MacPherson EE, Tsey IH, Stothard JR, Theobald S, Gyapong M. A major hurdle in the elimination of urogenital schistosomiasis revealed: Identifying key gaps in knowledge and understanding of female genital schistosomiasis within communities and local health workers. PLoS Negl Trop Dis 2019; 13:e0007207. [PMID: 30897093 PMCID: PMC6428244 DOI: 10.1371/journal.pntd.0007207] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 01/31/2019] [Indexed: 12/24/2022] Open
Abstract
Background Urogenital schistosomiasis is endemic throughout Ghana with elevated infection levels in certain areas e.g. Lake Volta Region. While the primary focus of the national control program is on mass drug administration of praziquantel to school-aged children, Female Genital Schistosomiasis (FGS), a disease-specific affliction of girls and women, has been largely overlooked. To better focus future actions, our study investigated the perceptions, knowledge and understanding of FGS amongst community members and health providers. Method/Principal findings We used qualitative methods including 12 focus group discussions and 34 in-depth interviews. We purposively selected 16 communities along the Lake Volta in the Shai-Osudoku District. Participant selection was based on gender, age and occupation; providing an opportunity to explore community understanding of FGS through participants own words and perceptions. Awareness of schistosomiasis was reported and is commonly experienced among children (12–17 years) and younger adults (18–25 years) in the study communities but is typically considered a boy’s disease. Knowledge of FGS was lacking in women, girls and front-line health workers. There was a general misconception that FGS may be the result of sexual promiscuity. Adolescent girls reporting vaginal discharge and itching were often stigmatized by health workers and treated for sexually transmitted infections. Limited alternatives to the river as key source of water meant that all members of the community faced the regular risk of schistosomiasis. Conclusion/Significance There is a clear imperative for the national control program to better engage on FGS and implement interventions to meet girls and women’s needs. The key consideration is to integrate more adequately preventive services with sexual and reproductive primary health care with future training of health workers for improved management of FGS cases. More broadly, harmonizing the portfolio of all actions on FGS is needed, especially with a call for improved access to safe water and sanitation for all those at current or future risk. Female Genital Schistosomiasis (FGS) is a serious, chronic gynecological condition that affects up to 56 million African women and girls. To date, FGS has been mostly overlooked within national neglected tropical disease control programs and associated health systems in sub-Saharan Africa. Furthermore, knowledge and understanding of FGS within affected communities themselves are often incomplete and confused with other ailments. Using qualitative research methods, we explored the knowledge and understanding of girls and women on FGS, as well as, local health care providers’ knowledge and practice relating to FGS. While, our work found that FGS was rarely on the radar of suspicion for health workers, more importantly, adolescent girls were often stigmatized by health care workers when they sought care in public health facilities owing to misdiagnosis of the disease as sexually transmitted infections. Our work speaks to the urgent need for national control programs to expand their remit outside current focus of annual provision of praziquantel to in-school children and integrate such treatments within sexual and reproductive health services available in primary health care services. Ultimately, urogenital and intestinal schistosomiasis is a disease of poverty and there is an urgent need to extend access to improved water and sanitation facilities to all affected communities.
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Affiliation(s)
- Vida Ami Kukula
- Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana
- * E-mail: ,
| | - Eleanor E. MacPherson
- Malawi-Liverpool-Wellcome Trust, Blantyre, Malawi
- Department of International Public Health, COUNTDOWN Consortium, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Irene Honam Tsey
- Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana
| | - J. Russell Stothard
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sally Theobald
- Department of International Public Health, COUNTDOWN Consortium, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Margaret Gyapong
- COUNTDOWN Consortium, Institute for Health Research, University of Health and Allied Sciences, Ho, Ghana
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