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Mathewson JD, van der Spek L, Mazigo HD, Kabona G, de Vlas SJ, Nshala A, Rood EJJ. Enabling targeted mass drug administration for schistosomiasis in north-western Tanzania: Exploring the use of geostatistical modeling to inform planning at sub-district level. PLoS Negl Trop Dis 2024; 18:e0011896. [PMID: 38227610 PMCID: PMC10817176 DOI: 10.1371/journal.pntd.0011896] [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: 06/12/2023] [Revised: 01/26/2024] [Accepted: 01/02/2024] [Indexed: 01/18/2024] Open
Abstract
INTRODUCTION Schistosomiasis is a parasitic disease in Tanzania affecting over 50% of the population. Current control strategies involve mass drug administration (MDA) campaigns at the district level, which have led to problems of over- and under-treatment in different areas. WHO guidelines have called for more targeted MDA to circumvent these problems, however a scarcity of prevalence data inhibits decision makers from prioritizing sub-district areas for MDA. This study demonstrated how geostatistics can be used to inform planning for targeted MDA. METHODS Geostatistical sub-district (ward-level) prevalence estimates were generated through combining a zero-inflated poisson model and kriging approach (regression kriging). To make predictions, the model used prevalence survey data collected in 2021 of 17,400 school children in six regions of Tanzania, along with several open source ecological and socio-demographic variables with known associations with schistosomiasis. RESULTS The model results show that regression kriging can be used to effectively predict the ward level parasite prevalence of the two species of Schistosoma endemic to the study area. Kriging was found to further improve the regression model fit, with an adjusted R-squared value of 0.51 and 0.32 for intestinal and urogenital schistosomiasis, respectively. Targeted treatment based on model predictions would represent a shift in treatment away from 193 wards estimated to be over-treated to 149 wards that would have been omitted from the district level MDA. CONCLUSIONS Geostatistical models can help to support NTD program efficiency and reduce disease transmission by facilitating WHO recommended targeted MDA treatment through provision of prevalence estimates where data is scarce.
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Affiliation(s)
- Jake D. Mathewson
- Kit-Royal Tropical Institute, Epidemiology, Center for Applied Spatial Epidemiology (CASE), Amsterdam, The Netherlands
| | - Linda van der Spek
- Kit-Royal Tropical Institute, Epidemiology, Center for Applied Spatial Epidemiology (CASE), Amsterdam, The Netherlands
| | - Humphrey D. Mazigo
- School of Medicine, Department of Medical Parasitology & Entomology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - George Kabona
- Ministry of Health, National Neglected Tropical Diseases Control Programme, Dodoma, Tanzania
| | - Sake J. de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Ente J. J. Rood
- Kit-Royal Tropical Institute, Epidemiology, Center for Applied Spatial Epidemiology (CASE), Amsterdam, The Netherlands
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Fine-scale heterogeneity in Schistosoma mansoni force of infection measured through antibody response. Proc Natl Acad Sci U S A 2020; 117:23174-23181. [PMID: 32868437 PMCID: PMC7502727 DOI: 10.1073/pnas.2008951117] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Schistosomiasis is one of the most common parasitic diseases in the world, and most infected people (90%) live in Africa. Global control efforts use measures of population-level transmission to target programs and assess progress toward elimination. Monitoring Schistosoma mansoni transmission has traditionally relied on examining stool with microscopy, which is difficult to scale in large programs and has low sensitivity as infection burdens decline. Our results show that antibody-based measures of transmission align well with stool-based measures, provide higher sensitivity at lower levels of transmission, and enable fine-scale estimates of force of infection by geography and age. The findings represent a major step toward use of serosurveillance to guide schistosomiasis control efforts in Africa. Schistosomiasis is among the most common parasitic diseases in the world, with over 142 million people infected in low- and middle-income countries. Measuring population-level transmission is centrally important in guiding schistosomiasis control programs. Traditionally, human Schistosoma mansoni infections have been detected using stool microscopy, which is logistically difficult at program scale and has low sensitivity when people have low infection burdens. We compared serological measures of transmission based on antibody response to S. mansoni soluble egg antigen (SEA) with stool-based measures of infection among 3,663 preschool-age children in an area endemic for S. mansoni in western Kenya. We estimated force of infection among children using the seroconversion rate and examined how it varied geographically and by age. At the community level, serological measures of transmission aligned with stool-based measures of infection (ρ = 0.94), and serological measures provided more resolution for between-community differences at lower levels of infection. Force of infection showed a clear gradient of transmission with distance from Lake Victoria, with 94% of infections and 93% of seropositive children in communities <1.5 km from the lake. Force of infection increased through age 3 y, by which time 65% (95% CI: 53%, 75%) of children were SEA positive in high-transmission communities—2 y before they would be reached by school-based deworming programs. Our results show that serologic surveillance platforms represent an important opportunity to guide and monitor schistosomiasis control programs, and that in high-transmission settings preschool-age children represent a key population missed by school-based deworming programs.
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Walker JW, Kittur N, Binder S, Castleman JD, Drake JM, Campbell CH, King CH, Colley DG. Environmental Predictors of Schistosomiasis Persistent Hotspots following Mass Treatment with Praziquantel. Am J Trop Med Hyg 2020; 102:328-338. [PMID: 31889506 PMCID: PMC7008331 DOI: 10.4269/ajtmh.19-0658] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Schistosomiasis control programs rely heavily on mass drug administration (MDA) campaigns with praziquantel for preventative chemotherapy. Areas where the prevalence and/or intensity of schistosomiasis infection remains high even after several rounds of treatment, termed "persistent hotspots" (PHSs), have been identified in trials of MDA effectiveness conducted by the Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) in Kenya, Mozambique, Tanzania, and Côte d'Ivoire. In this analysis, we apply a previously developed set of criteria to classify the PHS status of 531 study villages from five SCORE trials. We then fit logistic regression models to data from SCORE and publically available georeferenced datasets to evaluate the influence of local environmental and population features, pre-intervention infection burden, and treatment scheduling on PHS status in each trial. The frequency of PHS in individual trials ranged from 35.3% to 71.6% in study villages. Significant relationships between PHS status and MDA frequency, distance to freshwater, rainfall, baseline schistosomiasis burden, elevation, land cover type, and village remoteness were each observed in at least one trial, although the strength and direction of these relationships was not always consistent among study sites. These findings suggest that PHSs are driven in part by environmental conditions that modify the risk and frequency of reinfection.
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Affiliation(s)
- Joseph W Walker
- Center for the Ecology of Infectious Disease, University of Georgia, Athens, Georgia.,University of Georgia College of Public Health, Athens, Georgia
| | - Nupur Kittur
- Schistosomiasis Consortium for Operational Research and Evaluation (SCORE), Center for Tropical and Emerging Global Diseases (CTEGD), University of Georgia, Athens, Georgia
| | - Sue Binder
- Schistosomiasis Consortium for Operational Research and Evaluation (SCORE), Center for Tropical and Emerging Global Diseases (CTEGD), University of Georgia, Athens, Georgia
| | - Jennifer D Castleman
- Schistosomiasis Consortium for Operational Research and Evaluation (SCORE), Center for Tropical and Emerging Global Diseases (CTEGD), University of Georgia, Athens, Georgia
| | - John M Drake
- Odum School of Ecology, University of Georgia, Athens, Georgia.,Center for the Ecology of Infectious Disease, University of Georgia, Athens, Georgia
| | - Carl H Campbell
- Schistosomiasis Consortium for Operational Research and Evaluation (SCORE), Center for Tropical and Emerging Global Diseases (CTEGD), University of Georgia, Athens, Georgia
| | - Charles H King
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Schistosomiasis Consortium for Operational Research and Evaluation (SCORE), Center for Tropical and Emerging Global Diseases (CTEGD), University of Georgia, Athens, Georgia
| | - Daniel G Colley
- Department of Microbiology, University of Georgia, Athens, Georgia.,Schistosomiasis Consortium for Operational Research and Evaluation (SCORE), Center for Tropical and Emerging Global Diseases (CTEGD), University of Georgia, Athens, Georgia
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Nagi S, Chadeka EA, Sunahara T, Mutungi F, Justin YKD, Kaneko S, Ichinose Y, Matsumoto S, Njenga SM, Hashizume M, Shimada M, Hamano S. Risk factors and spatial distribution of Schistosoma mansoni infection among primary school children in Mbita District, Western Kenya. PLoS Negl Trop Dis 2014; 8:e2991. [PMID: 25058653 PMCID: PMC4109881 DOI: 10.1371/journal.pntd.0002991] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 05/19/2014] [Indexed: 11/21/2022] Open
Abstract
Background An increasing risk of Schistosoma mansoni infection has been observed around Lake Victoria, western Kenya since the 1970s. Understanding local transmission dynamics of schistosomiasis is crucial in curtailing increased risk of infection. Methodology/Principal Findings We carried out a cross sectional study on a population of 310 children from eight primary schools. Overall, a total of 238 (76.8%) children were infected with S. mansoni, while seven (2.3%) had S. haematobium. The prevalence of hookworm, Trichuris trichiura and Ascaris lumbricoides were 6.1%, 5.2% and 2.3%, respectively. Plasmodium falciparum was the only malaria parasite detected (12.0%). High local population density within a 1 km radius around houses was identified as a major independent risk factor of S. mansoni infection. A spatial cluster of high infection risk was detected around the Mbita causeway following adjustment for population density and other potential risk factors. Conclusions/Significance Population density was shown to be a major factor fuelling schistosome infection while individual socio-economic factors appeared not to affect the infection risk. The high-risk cluster around the Mbita causeway may be explained by the construction of an artificial pathway that may cause increased numbers of S. mansoni host snails through obstruction of the waterway. This construction may have, therefore, a significant negative impact on the health of the local population, especially school-aged children who frequently come in contact with lake water. It is estimated that more than ten percent of the world's population is at risk of schistosome transmission, with over 90% of infections occurring in sub-Saharan Africa. In Kenya, schistosomiasis remains a major public health concern particularly around Lake Victoria. The objective of this study was to identify the risk factors associated with Schistosoma mansoni infection among schoolchildren on the shores and adjacent islands of Lake Victoria in Mbita district, western Kenya. High local population density was identified as an important risk factor for S. mansoni infection. Socio-economic factors were not found to be significantly associated with infection risk. Our study suggests that environmental changes related to causeway construction and the dense human population around Mbita town may result in favourable ecological conditions for S. mansoni transmission.
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Affiliation(s)
- Sachiyo Nagi
- Department of Parasitology, Institute of Tropical Medicine, Nagasaki University (NUITM), Nagasaki, Japan
- Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan
| | - Evans A. Chadeka
- Department of Parasitology, Institute of Tropical Medicine, Nagasaki University (NUITM), Nagasaki, Japan
| | - Toshihiko Sunahara
- Department of Vector Biology and Environment, Institute of Tropical Medicine, Nagasaki University (NUITM), Nagasaki, Japan
| | - Faith Mutungi
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Yombo K. Dan Justin
- Department of Parasitology, Institute of Tropical Medicine, Nagasaki University (NUITM), Nagasaki, Japan
- Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan
| | - Satoshi Kaneko
- Department of EcoEpidemiology, Institute of Tropical Medicine, Nagasaki University (NUITM), Nagasaki, Japan
| | - Yoshio Ichinose
- Nagasaki University Nairobi Research Station, NUITM-KEMRI Project, Nairobi, Kenya
| | - Sohkichi Matsumoto
- Department of Infectious Disease Control and International Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Sammy M. Njenga
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Masahiro Hashizume
- Department of Paediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University (NUITM), Nagasaki, Japan
| | - Masaaki Shimada
- Department of EcoEpidemiology, Institute of Tropical Medicine, Nagasaki University (NUITM), Nagasaki, Japan
- Nagasaki University Nairobi Research Station, NUITM-KEMRI Project, Nairobi, Kenya
- * E-mail: (MS); (SH)
| | - Shinjiro Hamano
- Department of Parasitology, Institute of Tropical Medicine, Nagasaki University (NUITM), Nagasaki, Japan
- Nagasaki University Nairobi Research Station, NUITM-KEMRI Project, Nairobi, Kenya
- * E-mail: (MS); (SH)
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Meurs L, Mbow M, Boon N, van den Broeck F, Vereecken K, Dièye TN, Abatih E, Huyse T, Mboup S, Polman K. Micro-geographical heterogeneity in Schistosoma mansoni and S. haematobium infection and morbidity in a co-endemic community in northern Senegal. PLoS Negl Trop Dis 2013; 7:e2608. [PMID: 24386499 PMCID: PMC3873272 DOI: 10.1371/journal.pntd.0002608] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 11/13/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Schistosoma mansoni and S. haematobium are co-endemic in many areas in Africa. Yet, little is known about the micro-geographical distribution of these two infections or associated disease within such foci. Such knowledge could give important insights into the drivers of infection and disease and as such better tailor schistosomiasis control and elimination efforts. METHODOLOGY In a co-endemic farming community in northern Senegal (346 children (0-19 y) and 253 adults (20-85 y); n = 599 in total), we studied the spatial distribution of S. mansoni and S. haematobium single and mixed infections (by microscopy), S. mansoni-specific hepatic fibrosis, S. haematobium-specific urinary tract morbidity (by ultrasound) and water contact behavior (by questionnaire). The Kulldorff's scan statistic was used to detect spatial clusters of infection and morbidity, adjusted for the spatial distribution of gender and age. PRINCIPAL FINDINGS Schistosoma mansoni and S. haematobium infection densities clustered in different sections of the community (p = 0.002 and p = 0.023, respectively), possibly related to heterogeneities in the use of different water contact sites. While the distribution of urinary tract morbidity was homogeneous, a strong geospatial cluster was found for severe hepatic fibrosis (p = 0.001). Particularly those people living adjacent to the most frequently used water contact site were more at risk for more advanced morbidity (RR = 6.3; p = 0.043). CONCLUSIONS/SIGNIFICANCE Schistosoma infection and associated disease showed important micro-geographical heterogeneities with divergent patterns for S. mansoni and S. haematobium in this Senegalese community. Further in depth investigations are needed to confirm and explain our observations. The present study indicates that local geospatial patterns should be taken into account in both research and control of schistosomiasis. The observed extreme focality of schistosomiasis even at community level, suggests that current strategies may not suffice to move from morbidity control to elimination of schistosomiasis, and calls for less uniform measures at a finer scale.
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Affiliation(s)
- Lynn Meurs
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Moustapha Mbow
- Institute of Tropical Medicine, Antwerp, Belgium
- Laboratory of Bacteriology and Virology, Centre Hospitalier Universitaire Aristide Le Dantec, Dakar, Senegal
| | - Nele Boon
- Institute of Tropical Medicine, Antwerp, Belgium
- Laboratory of Biodiversity and Evolutionary Genomics, University of Leuven, Leuven, Belgium
| | - Frederik van den Broeck
- Institute of Tropical Medicine, Antwerp, Belgium
- Laboratory of Biodiversity and Evolutionary Genomics, University of Leuven, Leuven, Belgium
| | | | - Tandakha Ndiaye Dièye
- Laboratory of Bacteriology and Virology, Centre Hospitalier Universitaire Aristide Le Dantec, Dakar, Senegal
| | | | - Tine Huyse
- Institute of Tropical Medicine, Antwerp, Belgium
- Laboratory of Biodiversity and Evolutionary Genomics, University of Leuven, Leuven, Belgium
| | - Souleymane Mboup
- Laboratory of Bacteriology and Virology, Centre Hospitalier Universitaire Aristide Le Dantec, Dakar, Senegal
| | - Katja Polman
- Institute of Tropical Medicine, Antwerp, Belgium
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Mupfasoni D, Karibushi B, Koukounari A, Ruberanziza E, Kaberuka T, Kramer MH, Mukabayire O, Kabera M, Nizeyimana V, Deville MA, Ruxin J, Webster JP, Fenwick A. Polyparasite helminth infections and their association to anaemia and undernutrition in Northern Rwanda. PLoS Negl Trop Dis 2009; 3:e517. [PMID: 19753110 PMCID: PMC2737105 DOI: 10.1371/journal.pntd.0000517] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Accepted: 08/20/2009] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Intestinal schistosomiasis and soil-transmitted helminth (STH) infections constitute major public health problems in many parts of sub-Saharan Africa. In this study we examined the functional significance of such polyparasite infections in anemia and undernutrition in Rwandan individuals. METHODS Three polyparasite infection profiles were defined, in addition to a reference profile that consisted of either no infections or low-intensity infection with only one of the focal parasite species. Logistic regression models were applied to data of 1,605 individuals from 6 schools in 2 districts of the Northern Province before chemotherapeutic treatment in order to correctly identify individuals who were at higher odds of being anaemic and/or undernourished. FINDINGS Stunted relative to nonstunted, and males compared to females, were found to be at higher odds of being anaemic independently of polyparasite infection profile. The odds of being wasted were 2-fold greater for children with concurrent infection of at least 2 parasites at M+ intensity compared to those children with the reference profile. Males compared to females and anaemic compared to nonanaemic children were significantly more likely to be stunted. None of the three polyparasite infection profiles were found to have significant effects on stunting. CONCLUSION The present data suggest that the levels of polyparasitism, and infection intensities in the Rwandan individuals examined here may be lower as compared to other recent similar epidemiological studies in different regions across sub-Saharan Africa. Neither the odds of anaemia nor the odds of stunting were found to be significantly different in the three-polyparasite infection profiles. However, the odds of wasting were higher in those children with at least two parasites at M+ intensity compared to those children with the reference profile. Nevertheless, despite the low morbidity levels indicated in the population under study here, we recommend sustainable efforts for the deworming of affected populations to be continued in order to support the economic development of the country.
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Affiliation(s)
| | | | - Artemis Koukounari
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
- * E-mail:
| | | | | | - Michael H. Kramer
- TRAC Plus - Center for Treatment and Research on AIDS, Malaria, Tuberculosis and Other Epidemics, Kigali, Rwanda
| | | | | | - Vianney Nizeyimana
- TRAC Plus - Center for Treatment and Research on AIDS, Malaria, Tuberculosis and Other Epidemics, Kigali, Rwanda
| | - Marie-Alice Deville
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Josh Ruxin
- Access Project, Kigali, Rwanda
- The Earth Institute, Columbia University, New York, New York, United States of America
| | - Joanne P. Webster
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Alan Fenwick
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
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Rapid mapping of schistosomiasis and other neglected tropical diseases in the context of integrated control programmes in Africa. Parasitology 2009; 136:1707-18. [PMID: 19450373 DOI: 10.1017/s0031182009005940] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is growing interest and commitment to the control of schistosomiasis and other so-called neglected tropical diseases (NTDs). Resources for control are inevitably limited, necessitating assessment methods that can rapidly and accurately identify and map high-risk communities so that interventions can be targeted in a spatially-explicit and cost-effective manner. Here, we review progress made with (1) mapping schistosomiasis across Africa using available epidemiological data and, more recently, climate-based risk prediction; (2) the development and use of morbidity questionnaires for rapid identification of high-risk communities of urinary schistosomiasis; and (3) innovative sampling-based approaches for intestinal schistosomiasis, using the lot quality assurance sampling technique. Experiences are also presented for the rapid mapping of other NTDs, including onchocerciasis, loiasis and lymphatic filariasis. Future directions for an integrated rapid mapping approach targeting multiple NTDs simultaneously are outlined, including potential challenges in developing an integrated survey tool. The lessons from the mapping of human helminth infections may also be relevant for the rapid mapping of malaria as its control efforts are intensified.
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Matthys B, Tschannen AB, Tian-Bi NT, Comoé H, Diabaté S, Traoré M, Vounatsou P, Raso G, Gosoniu L, Tanner M, Cissé G, N'Goran EK, Utzinger J. Risk factors for Schistosoma mansoni and hookworm in urban farming communities in western Côte d'Ivoire. Trop Med Int Health 2007; 12:709-23. [PMID: 17550468 DOI: 10.1111/j.1365-3156.2007.01841.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To identify risk factors for Schistosoma mansoni and hookworm infections in urban farming communities, and to investigate small-scale spatial patterns of infection prevalence. METHODS A cross-sectional survey was carried out in 113 farming households (586 individuals) and 21 non-farming households (130 individuals) from six agricultural zones in the town of Man, western Côte d'Ivoire. Heads of households were interviewed on common agricultural activities, land and water use, education attainment, socioeconomic status and sanitation facilities. Household members provided stool specimens that were processed by the Kato-Katz technique and a formol-ether concentration method and diagnosed for S. mansoni, hookworms and other soil-transmitted helminths and intestinal protozoa. Bayesian statistics were employed for spatial analyses. RESULTS The prevalences of S. mansoni and hookworm in farming households were 51.4% and 24.7%, respectively. Risk factors for a S. mansoni infection comprised living in close proximity to the Kô River, water contact with irrigation wells and ponds and low education attainment. Living in zones of smallholder irrigated rice plots or large rice perimeters, using water from domestic wells, and low socioeconomic status were risk factors for a hookworm infection. We found significant spatial heterogeneity between agricultural zones, with the highest infection prevalences of S. mansoni and hookworm in the zone where there was a large rice perimeter. CONCLUSIONS In this urban setting, both S. mansoni and hookworm infections were related to specific agricultural activities. Health education and active participation of urban farmers for the control of schistosomiasis and soil-transmitted helminthiasis is recommended.
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Affiliation(s)
- Barbara Matthys
- Department of Public Health and Epidemiology, Swiss Tropical Institute, Basel, Switzerland
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Friedman JF, Phillips-Howard PA, Mirel LB, Terlouw DJ, Okello N, Vulule JM, Hawley WA, Nahlen BL, ter Kuile F. Progression of stunting and its predictors among school-aged children in western Kenya. Eur J Clin Nutr 2005; 59:914-22. [PMID: 15928684 DOI: 10.1038/sj.ejcn.1602161] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The objectives of this study were (1) to assess whether a cohort of school-aged children experiences progression of stunting over a 2-y-period of observation and (2) to identify baseline nutritional and body composition risk factors for the progression of stunting. METHODS As part of a large-scale, randomized controlled trial assessing the impact of insecticide-treated bednets (ITNs) on nutritional status, we longitudinally followed a cohort of school-aged children over a 2-y-period in western Kenya. Anthropometric measurements were made at four time points from which Z-scores for height-for-age (HAZ), weight-for-age (WAZ), and body mass index (BMIZ) were calculated. Two measures of body composition, upper arm fat area and upper arm muscle area, were derived from mid-upper arm circumference (MUAC) and triceps skinfold thickness. RESULTS Subjects experienced a mean change in HAZ from baseline to 9 months of -0.16 [-0.19, -0.13], from baseline to 16 months of -0.18 [-0.22, -0.15], and from baseline to 24 months of -0.36 [-0.41, -0.31]. Thus, the average individual's change in HAZ at the three follow-up time points is significantly less than zero, meaning that, on average, the cohort is deviating further from NCHS reference medians over time. The baseline nutritional measure that explained the greatest amount of variance in the progression of stunting was the upper arm muscle area Z-score (F=8.1; P=0.005). CONCLUSIONS This longitudinal study provides further evidence from a distinct ecological setting regarding the progression of undernutrition during middle childhood in the developing world. It suggests that school-aged children in the developing world do not experience catch-up growth or remain stable. Rather, they continue to deviate from NCHS standards, accruing greater height deficits with age. In addition, absolute lean body mass explained the most variability in the progression of stunting, which supports cross-sectional findings from other studies.
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Affiliation(s)
- J F Friedman
- US Department of State, Institute of International Education, Fulbright Fellowships, Washington, DC, USA.
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KISU TOMOKO, SHIRATORI KIYOSHI, CALLYST FRANCIS, ATAKA YUJI, KANEDA EIKO, NGOMUO ELISONGUO, SHAYO RICHARDJ, SHIMADA MASAAKI. THE EFFECT OF MEDICATION ON QUESTIONNAIRE ANALYSIS OF CHILDREN WITH SCHISTOSOMA MANSONI INFECTION IN TANZANIA. Trop Med Health 2005. [DOI: 10.2149/tmh.33.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Abstract
New schistosomiasis control initiatives have been launched to reduce significantly the current global burden of this disease, mainly through regular administration of praziquantel to schoolchildren living in endemic areas. Because schistosomiasis is distributed focally, epidemiological tools for rapid and inexpensive identification of communities at highest risk of morbidity are required to target praziquantel most efficiently. This article outlines the development and validation of simple questionnaires for screening of Schistosoma haematobium and Schistosoma mansoni in sub-Saharan Africa.
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Affiliation(s)
- Christian Lengeler
- Swiss Tropical Institute, Dept of Epidemiology and Public Health, PO Box, CH-4002 Basel, Switzerland.
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Abstract
In this article, an account of some of the hot areas in schistosomiasis research is given, emphasizing what has been achieved during the past several years in impact assessment and identifying the research frontiers where further action is needed.
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Affiliation(s)
- Nils Robert Bergquist
- UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), CH-1211 Geneva 27, Switzerland.
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