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Muvunyi CM, Ngabonziza JCS, Florence M, Mukagatare I, Twagirumukiza M, Ahmed A, Siddig EE. Diversity and Distribution of Fungal Infections in Rwanda: High Risk and Gaps in Knowledge, Policy, and Interventions. J Fungi (Basel) 2024; 10:658. [PMID: 39330417 PMCID: PMC11433616 DOI: 10.3390/jof10090658] [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: 07/08/2024] [Revised: 09/11/2024] [Accepted: 09/12/2024] [Indexed: 09/28/2024] Open
Abstract
Fungal infections (FIs) are spreading globally, raising a significant public health concern. However, its documentation remains sparse in Africa, particularly in Rwanda. This report provides a comprehensive review of FIs in Rwanda based on a systematic review of reports published between 1972 and 2022. The findings reveal a rich diversity of fungal pathogens, including Blastomyces, Candida, Cryptococcus, Histoplasma, Microsporum, Pneumocystis, Rhinosporidium, and Trichophyton caused human infections. Candida infections predominantly affect the vagina mucosa, while Histoplasma duboisi was linked to disseminated infections. Other pathogens, such as Blastomyces dermatitidis and Rhinosporidium seeberi, were associated with cerebellar and nasal mucosa infections, respectively. The widespread observation of soilborne fungi affecting bean crops highlights the pathogens' threat to agricultural productivity, food security, and socioeconomic stability, as well as potential health impacts on humans, animals, and the environment. Of particular importance is that there is no information about FIs among animals in the country. Moreover, the analysis underscores significant limitations in the detection, reporting, and healthcare services related to FIs in the country, indicating gaps in diagnostic capacity and surveillance systems. This is underscored by the predominant use of traditional diagnostic techniques, including culture, cytology, and histopathology in the absence of integrating more sensitive and specific molecular tools in investigating FIs. Developing the diagnostic capacities and national surveillance systems are urgently needed to improve the health of crops, animals, and humans, as well as food security and socioeconomic stability in Rwanda. Also, it is important to indicate severe gaps in the evidence to inform policymaking, guide strategic planning, and improve healthcare and public health services, underscoring the urgent need to build national capacity in fungal diagnosis, surveillance, and research. Raising awareness among the public, scientific community, healthcare providers, and policymakers remains crucial. Furthermore, this report reveals the threats of FIs on public health and food insecurity in Rwanda. A multisectoral one health strategy is essential in research and intervention to determine and reduce the health and safety impacts of fungal pathogens on humans, animals, and the environment.
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Affiliation(s)
| | - Jean Claude Semuto Ngabonziza
- Department of Clinical Biology, University of Rwanda, Kigali P.O. Box 3900, Rwanda
- Research, Innovation and Data Science Division, Rwanda Biomedical Centre, Kigali P.O. Box 7162, Rwanda
| | - Masaisa Florence
- Department of Internal Medicine and Hematology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali P.O. Box 7162, Rwanda
- Clinical Education and Research Division, Kigali University Teaching Hospital, Kigali P.O. Box 655, Rwanda
| | - Isabelle Mukagatare
- Biomedical Services Department, Rwanda Biomedical Centre, Kigali P.O. Box 7162, Rwanda
| | - Marc Twagirumukiza
- Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium
| | - Ayman Ahmed
- Rwanda Biomedical Centre, Kigali P.O. Box 7162, Rwanda;
- Institute of Endemic Diseases, University of Khartoum, Khartoum 11111, Sudan
| | - Emmanuel Edwar Siddig
- Unit of Applied Medical Sciences, Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum 11111, Sudan;
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Kagabo J, Kalinda C, Nshimiyimana P, Mbonigaba JB, Ruberanziza E, Nyandwi E, Rujeni N. Malacological Survey and Spatial Distribution of Intermediate Host Snails in Schistosomiasis Endemic Districts of Rwanda. Trop Med Infect Dis 2023; 8:295. [PMID: 37368713 DOI: 10.3390/tropicalmed8060295] [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: 04/24/2023] [Revised: 05/14/2023] [Accepted: 05/17/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Schistosomiasis, due to S. mansoni, is prevalent in Rwanda. However, there is a paucity of information related to the abundance, species, distribution, and infectivity of Schistosoma intermediate host snails. METHODS Snails were collected from 71 sites, including lakeshores and wetlands. Snails obtained were morphologically identified, and cercariae were shed using standard procedures. Cercariae were molecularly characterized using PCR. GPS coordinates were used to generate geospatial maps of snail distribution that were overlaid with geospatial distribution of schistosomiasis among pre-school children in the same areas. RESULTS Overall, 3653 snails were morphologically classified as Bulinus spp. and 1449 as Biomphalaria spp. A total of 306 snails shed cercariae, 130 of which were confirmed as S. mansoni cercaria by PCR. There was no significant difference in the proportion of S. mansoni cercariae in wetlands compared to lakeshores. CONCLUSION Rwandan water bodies harbor an important number of snails that shed S. mansoni cercariae. Furthermore, a strong spatial correlation was observed between the distribution of schistosomiasis in children and the spatial distribution of snail infectivity with S. mansoni. The presence of Bulinus spp. Suggests a potential risk of S. haematobium, although molecular analysis did not show any current transmission of this parasite.
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Affiliation(s)
- Joseph Kagabo
- School of Health Sciences, University of Rwanda College of Medicine and Health Sciences, KG 11 Ave., Gasabo, Kigali P.O. Box 3286, Rwanda
| | - Chester Kalinda
- Bill and Joyce Cummings Institute of Global Health, University of Global Health Equity (UGHE)|Kigali Heights, Plot 772 KG 7 Ave., Kigali P.O. Box 6955, Rwanda
| | - Project Nshimiyimana
- School of Health Sciences, University of Rwanda College of Medicine and Health Sciences, KG 11 Ave., Gasabo, Kigali P.O. Box 3286, Rwanda
| | | | | | - Elias Nyandwi
- Centre for Geographic Information Systems and Remote Sensing (CGIS), University of Rwanda College of Science and Technology, KN 67 Street, Nyarugenge, Kigali P.O. Box 3900, Rwanda
| | - Nadine Rujeni
- School of Health Sciences, University of Rwanda College of Medicine and Health Sciences, KG 11 Ave., Gasabo, Kigali P.O. Box 3286, Rwanda
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Using Routinely Collected Health Records to Identify the Fine-Resolution Spatial Patterns of Soil-Transmitted Helminth Infections in Rwanda. Trop Med Infect Dis 2022; 7:tropicalmed7080202. [PMID: 36006294 PMCID: PMC9416347 DOI: 10.3390/tropicalmed7080202] [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: 07/13/2022] [Revised: 08/09/2022] [Accepted: 08/16/2022] [Indexed: 11/24/2022] Open
Abstract
Background. Soil-transmitted helminths (STH) are parasitic diseases with significant public health impact. Analysis is generally based on cross-sectional prevalence surveys; outcomes are mostly aggregated to larger spatial units. However, recent research demonstrates that infection levels and spatial patterns differ between STH species and tend to be localized. Methods. Incidence data of STHs including roundworm (Ascaris lumbricoides), whipworm (Trichuris trichiura) and hookworms per primary health facility for 2008 were linked to spatially delineated primary health center service areas. Prevalence data per district for individual and combined STH infections from the 2008 nationwide survey in Rwanda were also obtained. Results. A comparison of reported prevalence and incidence data indicated significant positive correlations for roundworm (R2 = 0.63) and hookworm (R2 = 0.27). Weak positive correlations were observed for whipworm (R2 = 0.02) and the three STHs combined (R2 = 0.10). Incidence of roundworm and whipworm were found to be focalized with significant spatial autocorrelation (Moran’s I > 0: 0.05−0.38 and p ≤ 0.03), with (very) high incidence rates in some focal areas. In contrast, hookworm incidence is ubiquitous and randomly distributed (Moran’s I > 0: 0.006 and p = 0.74) with very low incidence rates. Furthermore, an exploratory regression analysis identified relationships between helminth infection cases and potential environmental and socio-economic risk factors. Conclusions. Findings show that the spatial distribution of STH incidence is significantly associated with soil properties (sand proportion and pH), rainfall, wetlands and their uses, population density and proportion of rural residents. Identified spatial patterns are important for guiding STH prevention and control programs.
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Prevalence, Intensity, and Correlates of Soil-Transmitted Helminth Infections among School Children after a Decade of Preventive Chemotherapy in Western Rwanda. Pathogens 2020; 9:pathogens9121076. [PMID: 33371488 PMCID: PMC7767502 DOI: 10.3390/pathogens9121076] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 02/06/2023] Open
Abstract
Preventive chemotherapy (PC) is a WHO-recommended core intervention measures to eliminate Soil-Transmitted Helminths (STH) as a public health problem by 2020, defined as a reduction in prevalence to <1% of moderate or high-intensity infection. We conducted a cross-sectional study to investigate the prevalence, intensity, and correlates of STH after a decade of PC in Rwanda. A total of 4998 school children (5–15 years old) from four districts along Lake Kivu in the western province were screened for STH using Kato-Katz. The overall prevalence of Soil-transmitted helminths among school children was 77.7% (range between districts = 54% to 92%). Trichirus trichiura was the most common STH (66.8%, range between districts = 23% to 88.2%), followed by Ascaris lumbricoides (49.9%, range between district = 28.5% to 63.3%) and hookworms (1.9%, range between districts = 0.6% to 2.9%). The prevalence of single, double and of triple parasite coinfection were 48.6%, 50.3%, and 1.1%, respectively. The overall prevalence of moderate or high-intensity infection for Trichirus trichiura and Ascaris lumbricoides was 7.1% and 13.9, respectively. Multivariate logistic regression model revealed that male sex, district, stunting, and schistosomiasis coinfection as significant predictors of STH infection. Despite a decade of PC implementation, STH remain a significant public health problem in Rwanda.
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Nyandwi E, Osei FB, Veldkamp T, Amer S. Modeling schistosomiasis spatial risk dynamics over time in Rwanda using zero-inflated Poisson regression. Sci Rep 2020; 10:19276. [PMID: 33159143 PMCID: PMC7648759 DOI: 10.1038/s41598-020-76288-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 10/20/2020] [Indexed: 11/16/2022] Open
Abstract
The recorded clinical cases of S. mansoni at primary health facility level contain an excessive number of zero records. This could mean that no S. mansoni infection occurred (a true zero) in the health facility service area but it could also that at least one infection occurred but none were reported or diagnosed (a false zero). Standard statistical analysis, using exploratory or confirmatory spatial regression, fail to account for this type of data insufficiency. This study developed a zero-inflated Poisson model to explore the spatiotemporal variation in schistosomiasis risk at a fine spatial scale. We used environmental data generated at primary health facility service area level as explanatory variables affecting transmission risk. Identified risk factors were subsequently used to project the spatial variability of S. mansoni infection risk for 2050. The zero-inflated Poisson model shows a considerable increase of relative risk of the schistosomiasis over one decade. Furthermore, the changes between the risk in 2009 and forecasted risk by 2050 indicated both persistent and emerging areas with high relative risk of schistosomiasis infection. The risk of schistosomiasis transmission is 69%, 29%, and 50% higher in areas with rice cultivation, proximity to rice farms, and proximity to a water body respectively. The prediction and forecasting maps provide a valuable tool for monitoring schistosomiasis risk in Rwanda and planning future disease control initiatives in wetland ecosystem development context.
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Affiliation(s)
- Elias Nyandwi
- Faculty of Geo-Information Science and Earth Observation, University of Twente, Enschede, The Netherlands.,Geographic Information Systems and Remote Sensing Centre, University of Rwanda, Kigali, Rwanda
| | - Frank Badu Osei
- Faculty of Geo-Information Science and Earth Observation, University of Twente, Enschede, The Netherlands.
| | - Tom Veldkamp
- Faculty of Geo-Information Science and Earth Observation, University of Twente, Enschede, The Netherlands
| | - Sherif Amer
- Faculty of Geo-Information Science and Earth Observation, University of Twente, Enschede, The Netherlands
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Colley DG, King CH, Kittur N, Ramzy RMR, Secor WE, Fredericks-James M, Ortu G, Clements MN, Ruberanziza E, Umulisa I, Wittmann U, Campbell CH. Evaluation, Validation, and Recognition of the Point-of-Care Circulating Cathodic Antigen, Urine-Based Assay for Mapping Schistosoma mansoni Infections. Am J Trop Med Hyg 2020; 103:42-49. [PMID: 32400347 PMCID: PMC7351311 DOI: 10.4269/ajtmh.19-0788] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Efforts to control Schistosoma mansoni infection depend on the ability of programs to effectively detect and quantify infection levels and adjust programmatic approaches based on these levels and program goals. One of the three major objectives of the Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) has been to develop and/or evaluate tools that would assist Neglected Tropical Disease program managers in accomplishing this fundamental task. The advent of a widely available point-of-care (POC) assay to detect schistosome circulating cathodic antigen (CCA) in urine with a rapid diagnostic test (the POC-CCA) in 2008 led SCORE and others to conduct multiple evaluations of this assay, comparing it with the Kato–Katz (KK) stool microscopy assay—the standard used for more than 45 years. This article describes multiple SCORE-funded studies comparing the POC-CCA and KK assays, the pros and cons of these assays, the use of the POC-CCA assay for mapping of S. mansoni infections in areas across the spectrum of prevalence levels, and the validation and recognition that the POC-CCA, although not infallible, is a highly useful tool to detect low-intensity infections in low-to-moderate prevalence areas. Such an assay is critical, as control programs succeed in driving down prevalence and intensity and seek to either maintain control or move to elimination of transmission of S. mansoni.
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Affiliation(s)
- Daniel G Colley
- Schistosomiasis Consortium for Operational Research and Evaluation (SCORE), Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia.,Department of Microbiology, University of Georgia, Athens, Georgia
| | - Charles H King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio
| | - Nupur Kittur
- Schistosomiasis Consortium for Operational Research and Evaluation (SCORE), Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Reda M R Ramzy
- National Nutrition Institute, General Organization for Teaching Hospitals and Institutes, Cairo, Egypt
| | - William Evan Secor
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Michelle N Clements
- Medical Research Council, Clinical Research Trials Unit, University College London, London, United Kingdom.,Schistosomiasis Control Initiative, London, United Kingdom
| | - Eugene Ruberanziza
- Malaria and Other Parasitic Diseases Division, Neglected Tropical Diseases and Other Parasitic Diseases Unit, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
| | - Irenee Umulisa
- African Leaders Malaria Alliance, Dar-es-Salam, Tanzania.,Malaria and Other Parasitic Diseases Division, Neglected Tropical Diseases and Other Parasitic Diseases Unit, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
| | - Udo Wittmann
- Consult AG Statistical Services, Zurich, Switzerland.,Schistosomiasis Control Initiative, London, United Kingdom
| | - Carl H Campbell
- Schistosomiasis Consortium for Operational Research and Evaluation (SCORE), Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
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7
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Ruberanziza E, Wittmann U, Mbituyumuremyi A, Mutabazi A, Campbell CH, Colley DG, Fleming FM, Ortu G, van Dam GJ, Umulisa I, Tallant J, Kabera M, Semakula M, Corstjens PLAM, Munyaneza T, Lancaster W, Mbonigaba JB, Clements MN. Nationwide Remapping of Schistosoma mansoni Infection in Rwanda Using Circulating Cathodic Antigen Rapid Test: Taking Steps toward Elimination. Am J Trop Med Hyg 2020; 103:315-324. [PMID: 32431276 PMCID: PMC7356434 DOI: 10.4269/ajtmh.19-0866] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The field standard for the detection of Schistosoma mansoni infection is Kato–Katz (KK), although it misses many active infections, especially light infections. In 2014, a reassessment of S. mansoni prevalence was conducted in Rwanda using the more sensitive point-of-care circulating cathodic antigen (POC-CCA) rapid assay. A total of 19,371 children from 399 schools were selected for testing for single urine CCA. Of these, 8,697 children from 175 schools were also tested with single stool double-slide KK. Samples from eight of these 175 schools were tested again with CCA and additionally with the highly specific and sensitive up-converting phosphor-lateral flow circulating anodic antigen (UCP-LF CAA) assay. Latent class analysis was applied to all four test results to assess sensitivity and specificity of POC-CCA and estimate the proportion of trace results from Rwanda likely to be true infections. The overall prevalence of S. mansoni infection in Rwanda when CCA trace results were considered negative was 7.4% (school interquartile range [IQR] 0–8%) and 36.1% (school IQR 20–47%) when trace was considered positive. Prevalence by KK was 2.0% with a mean intensity of infection of 1.66 eggs per gram. The proportion of active infections among children diagnosed with CCA trace was estimated by statistical analysis at 61% (Bayesian credibility interval: 50–72%). These results indicate that S. mansoni infection is still widespread in Rwanda and prevalence is much underestimated by KK testing. Circulating cathodic antigen is an affordable alternative to KK and more suitable for measuring S. mansoni prevalence in low-intensity regions.
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Affiliation(s)
- Eugene Ruberanziza
- Malaria and Other Parasitic Diseases Division, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda.,Neglected Tropical Diseases and Other Parasitic Diseases Unit, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
| | - Udo Wittmann
- Consult A.G. Statistical Servicesc, Zurich, Switzerland.,SCI Foundation, London, United Kingdom
| | - Aimable Mbituyumuremyi
- Malaria and Other Parasitic Diseases Division, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
| | - Alphonse Mutabazi
- Vector Control Unit, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda.,Malaria and Other Parasitic Diseases Division, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
| | - Carl H Campbell
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Global Emerging Diseases, University of Georgia, Athens, Georgia
| | - Daniel G Colley
- Department of Microbiology, University of Georgia, Athens, Georgia.,Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Global Emerging Diseases, University of Georgia, Athens, Georgia
| | | | | | | | - Irenee Umulisa
- African Leaders Malaria Alliance (ALMA), National Institute of Medical Research Complex, Dar-es-Salam, Tanzania
| | | | - Michee Kabera
- Epidemiology Unit, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda.,Malaria and Other Parasitic Diseases Division, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
| | - Muhammed Semakula
- HIV/AIDS and STIs Division, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
| | | | - Tharcisse Munyaneza
- Microbiology Unit, National Reference Laboratory (NRL) Division, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
| | | | - Jean Bosco Mbonigaba
- Neglected Tropical Diseases and Other Parasitic Diseases Unit, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda.,Malaria and Other Parasitic Diseases Division, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
| | - Michelle N Clements
- MRC Clinical Trials Unit, University College London, London, United Kingdom.,SCI Foundation, London, United Kingdom
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Rujeni N, Mazimpaka A, Tumusiime M, Nyandwi E, Rutayisire G, Kayiranga P, Umulisa I, Ruberanziza E, Osier F, Mutapi F. Pre-school aged children are exposed to Schistosoma through Lake Kivu in Rwanda. AAS Open Res 2019; 2:7. [DOI: 10.12688/aasopenres.12930.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2019] [Indexed: 12/24/2022] Open
Abstract
Background: Schistosomiasis is prevalent in many sub-Saharan African countries and transmission is through waters contaminated by infected snails. In Rwanda, although schistosomiasis is endemic, very few epidemiological studies exist; of these, schoolchildren have been the focus, neglecting pre-school-aged children (PSAC). Furthermore, malacological surveys to indicate the potential for transmission are scarce in the country. The aim of this study was to determine the prevalence of schistosomiasis among PSAC living on Nkombo Island in Lake Kivu and to map the distribution and infectivity of snails in the area. Methods: Stool and urine samples were collected from children aged 1 to 4 years and tested for schistosomiasis using the Kato Katz and the point-of-care circulating cathodic antigen (POC-CCA) diagnostic techniques respectively. Snails were collected along the shores at five different locations with human-water contact activities and cercaria shedding was microscopically examined. GPS receivers were used to collect geographical coordinates and snail distribution maps were generated using ArcGIS. A questionnaire was used to assess water contact activities and frequency. Results: A total of 278 PSAC were recruited. Overall, 9.5% (excluding traces) of the tested children reacted positively to the POC-CCA, although there were no ova detected in their stool via Kato Katz. The questionnaire revealed that 48.2% of parents/guardians use Lake Kivu’s water for household activities while 42.4% children are taken to the Lake shores daily. Overall, 13.5% of collected snails shed cercariae. Conclusions: PSAC of Nkombo Island are exposed to Schistosoma parasites through contact with Lake Kivu, which hosts a number of snails shedding cercaria. Exposure is through recreational activities but also through bathing as safe water is scarce in the area. Health education of parents/guardians of these young children should be promoted and the national schistosomiasis control program should be integrated into water supply projects.
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Salmon M, Salmon C, Masoda M, Salumu JM, Bozzi C, Nieburg P, Harrison LM, Humphries D, Abaca Uvon N, Wendel SK, Trout C, Cappello M. Albendazole Treatment Improves Work Capacity in Women Smallholder Farmers Infected with Hookworm: A Double-Blind Randomized Control Trial. Am J Trop Med Hyg 2018; 98:1419-1426. [PMID: 29611504 DOI: 10.4269/ajtmh.17-0403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
An estimated 4.7 billion people live in regions exposed to soil-transmitted helminths, intestinal parasites that have significant impacts on the health of women smallholder farmers. The goal of this trial was to determine whether treatment with albendazole impacts the work capacity of these farmers. This is a prospective double-blind, randomized effectiveness trial. Participants (N = 250) were randomly selected from safe motherhood groups in the Democratic Republic of Congo. Prevalence/intensity of hookworm infection, hemoglobin, and demographics was obtained. At study (Time = 0), participants were randomized into treatment (albendazole 400 mg) and placebo (similar placebo tablet) groups. A step test was administered as a proxy metric for work capacity. Work capacity was defined as ∆heart rate before and after 3 minutes of step testing, in beats per minute. At study (time = 7 months), the step test was repeated and work capacity remeasured. The ∆work capacity (time = 0 minus time = 7 months) was the primary outcome. Investigators/field assistants were blinded to who was enrolled in groups, hookworm status, and step test results. Regression showed highly significant interactive effects of hookworm status and treatment group relative to ∆work capacity after controlling for resting pulse rate and age (P < 0.002). Estimated marginal means for work capacity (WC) for each of four groups (hookworm positive plus placebo, hookworm positive plus treatment, hookworm negative plus placebo, and hookworm negative plus treatment) showed women who were hookworm positive and received treatment decreased heart rate by 9.744 (95% confidence interval [CI]: 6.42, 13.07) beats per minute (increased WC), whereas women who were hookworm positive and received placebo saw a nonsignificant decrease of 0.034 (95% CI: -3.16, 3.84) beats per minute. Treatment with albendazole was associated with improved aerobic work capacity posttreatment. Given modest costs of drug distributions, risk benefits of periodic deworming warrants further study in larger controlled trials.
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Affiliation(s)
- Margaret Salmon
- InnovationCZ, San Francisco, California.,Global Health Emergency Medicine, University Health Network, University of Toronto, Toronto, Canada
| | | | - Maurice Masoda
- Health Education Action Leadership Africa Hospital, Goma, Democratic Republic of Congo
| | | | | | | | - Lisa M Harrison
- Yale Partnerships for Global Health, Yale School of Medicine, New Haven, Connecticut
| | | | - Naomi Abaca Uvon
- Programme National de Lutte contre l'Onchocercose, Ministry of Health, Kinshasa, Democratic Republic of Congo
| | - Sarah K Wendel
- Georgetown University Medical School, Washington, District of Columbia
| | - Clint Trout
- United States Agency for International Development, Yaoundé, Cameroon
| | - Michael Cappello
- Yale Partnerships for Global Health, Yale School of Medicine, New Haven, Connecticut.,Yale School of Public Health, New Haven, Connecticut
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Sokolow SH, Wood CL, Jones IJ, Lafferty KD, Kuris AM, Hsieh MH, De Leo GA. To Reduce the Global Burden of Human Schistosomiasis, Use 'Old Fashioned' Snail Control. Trends Parasitol 2018; 34:23-40. [PMID: 29126819 PMCID: PMC5819334 DOI: 10.1016/j.pt.2017.10.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/30/2017] [Accepted: 10/16/2017] [Indexed: 12/27/2022]
Abstract
Control strategies to reduce human schistosomiasis have evolved from 'snail picking' campaigns, a century ago, to modern wide-scale human treatment campaigns, or preventive chemotherapy. Unfortunately, despite the rise in preventive chemotherapy campaigns, just as many people suffer from schistosomiasis today as they did 50 years ago. Snail control can complement preventive chemotherapy by reducing the risk of transmission from snails to humans. Here, we present ideas for modernizing and scaling up snail control, including spatiotemporal targeting, environmental diagnostics, better molluscicides, new technologies (e.g., gene drive), and 'outside the box' strategies such as natural enemies, traps, and repellants. We conclude that, to achieve the World Health Assembly's stated goal to eliminate schistosomiasis, it is time to give snail control another look.
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Affiliation(s)
- Susanne H Sokolow
- Hopkins Marine Station, Stanford University, Pacific Grove, CA 93950, USA; Marine Science Institute, University of California, Santa Barbara, CA 93106, USA.
| | - Chelsea L Wood
- School of Aquatic and Fishery Sciences, University of Washington, Box 355020, Seattle, WA 98195-5020, USA
| | - Isabel J Jones
- Hopkins Marine Station, Stanford University, Pacific Grove, CA 93950, USA
| | - Kevin D Lafferty
- U.S. Geological Survey, Western Ecological Research Center, c/o Marine Science Institute, University of California, Santa Barbara, CA 93106, USA
| | - Armand M Kuris
- Marine Science Institute, University of California, Santa Barbara, CA 93106, USA
| | - Michael H Hsieh
- Children's National Health System, Washington DC, 20010, USA; The George Washington University, Washington DC, 20037, USA; Biomedical Research Institute, Rockville, MD 20850, USA
| | - Giulio A De Leo
- Hopkins Marine Station, Stanford University, Pacific Grove, CA 93950, USA
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Krücken J, Fraundorfer K, Mugisha JC, Ramünke S, Sifft KC, Geus D, Habarugira F, Ndoli J, Sendegeya A, Mukampunga C, Bayingana C, Aebischer T, Demeler J, Gahutu JB, Mockenhaupt FP, von Samson-Himmelstjerna G. Reduced efficacy of albendazole against Ascaris lumbricoides in Rwandan schoolchildren. INTERNATIONAL JOURNAL FOR PARASITOLOGY-DRUGS AND DRUG RESISTANCE 2017; 7:262-271. [PMID: 28697451 PMCID: PMC5503839 DOI: 10.1016/j.ijpddr.2017.06.001] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/17/2017] [Accepted: 06/21/2017] [Indexed: 12/16/2022]
Abstract
Control of human soil-transmitted helminths (STHs) relies on preventive chemotherapy of schoolchildren applying the benzimidazoles (BZ) albendazole or mebendazole. Anthelmintic resistance (AR) is a common problem in nematodes of veterinary importance but for human STHs, information on drug efficacy is limited and routine monitoring is rarely implemented. Herein, the efficacy of single dose albendazole (400 mg) was evaluated in 12 schools in the Huye district of Rwanda where Ascaris is the predominant STH. Ascaris eggs were detected by wet mount microscopy and the Mini-FLOTAC method to assess cure rate (CR) and faecal egg count reduction (FECR). Blood and faecal samples were analysed for co-infections with Plasmodium sp. and Giardia duodenalis, respectively. Ascaris positive samples collected before and after treatment were analysed for putatively BZ-resistance associated β-tubulin gene single nucleotide polymorphisms. The overall CR was 69.9% by Mini-FLOTAC and 88.6% by wet mount microscopy. The FECR was 75.4% and the 95% calculated confidence intervals were 50.4–87.8% using sample variance, 55.4–88.8% by bootstrapping, and 75.0–75.7% applying a Markov Chain Monte Carlo Bayesian approach. FECR varied widely between 0 and 96.8% for individual schools. No putative BZ-resistance associated polymorphisms were found in the four Ascaris β-tubulin isotype genes examined. Since FECRs <95% indicate reduced efficacy, these findings raise the suspicion of BZ resistance. In the absence of respective molecular evidence, heritable AR in the local Ascaris populations cannot be formally proven. However, since FECRs <95% indicate reduced efficacy, BZ resistance may be suspected which would be alarming and calls for further analyses and routine monitoring in preventive chemotherapy programs.
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Affiliation(s)
- Jürgen Krücken
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Robert-von-Ostertag-Str. 7-13, 14163 Berlin, Germany
| | - Kira Fraundorfer
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Robert-von-Ostertag-Str. 7-13, 14163 Berlin, Germany
| | - Jean Claude Mugisha
- University Teaching Hospital of Butare, University of Rwanda, Butare, Rwanda
| | - Sabrina Ramünke
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Robert-von-Ostertag-Str. 7-13, 14163 Berlin, Germany
| | - Kevin C Sifft
- Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Dominik Geus
- Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Felix Habarugira
- University Teaching Hospital of Butare, University of Rwanda, Butare, Rwanda
| | - Jules Ndoli
- University Teaching Hospital of Butare, University of Rwanda, Butare, Rwanda
| | - Augustin Sendegeya
- University Teaching Hospital of Butare, University of Rwanda, Butare, Rwanda
| | - Caritas Mukampunga
- University Teaching Hospital of Butare, University of Rwanda, Butare, Rwanda
| | - Claude Bayingana
- University Teaching Hospital of Butare, University of Rwanda, Butare, Rwanda
| | - Toni Aebischer
- Mycotic and Parasitic Agents and Mycobacteria, Department of Infectious Diseases, Robert Koch-Institute, Berlin, Germany
| | - Janina Demeler
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Robert-von-Ostertag-Str. 7-13, 14163 Berlin, Germany
| | - Jean Bosco Gahutu
- University Teaching Hospital of Butare, University of Rwanda, Butare, Rwanda
| | - Frank P Mockenhaupt
- Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Georg von Samson-Himmelstjerna
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Robert-von-Ostertag-Str. 7-13, 14163 Berlin, Germany.
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Rujeni N, Morona D, Ruberanziza E, Mazigo HD. Schistosomiasis and soil-transmitted helminthiasis in Rwanda: an update on their epidemiology and control. Infect Dis Poverty 2017; 6:8. [PMID: 28245883 PMCID: PMC5331630 DOI: 10.1186/s40249-016-0212-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 12/08/2016] [Indexed: 11/17/2022] Open
Abstract
Even though Rwanda lies within a region that has a high prevalence of schistosomiasis and soil-transmitted helminth (STH) infections, epidemiological information regarding these infections in the country remains scarce. The present review attempts to compile the available data on schistosomiasis and STHs, from 1940 to 2014, to provide an insight on the epidemiological profile of these infections. This information will, in turn, support the design and implementation of sustainable control measures. The available records indicate that only Schistosoma mansoni and all the major species of STHs are endemic in Rwanda. In 2008, the national prevalence of S. mansoni was reported to be 2.7%, ranging from 0 to 69.5%, and that of STH infections was 65.8% (diagnosed using the Kato-Katz technique). The prevalence of these infections varies from one district to another, with schoolchildren remaining a highly affected group. The main control approach is mass drug administration using albendazole and praziquantel, mostly targeting school-aged children in school environments. In 2008, adult individuals living in areas with a prevalence of S. mansoni ≥30% were also included in the mass drug administration programme. However, despite Rwanda achieving an almost 100% coverage of this programme in 2008–2010, the transmission of S. mansoni and STHs continues to take place, as illustrated by the most recent surveys. If Rwanda is to achieve sustainable control and elimination of schistosomiasis and STHs, there is a need to revise the country’s control strategy and adopt an integrated control approach that involves a combination of measures.
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Affiliation(s)
- Nadine Rujeni
- Department of Biomedical Laboratory Sciences, School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, P.O. Box 3286, Nyarugenge, Rwanda
| | - Domenica Morona
- Department of Medical Parasitology, School of Medicine, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania.
| | - Eugene Ruberanziza
- Rwanda Biomedical Center, Institute of HIV, Disease Prevention and Control, Malaria and Other Parasitic Diseases Division, Neglected Tropical Diseases and Other Parasitic Diseases Unit, Kigali, Rwanda
| | - Humphrey D Mazigo
- Department of Medical Parasitology, School of Medicine, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania
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Campbell SJ, Nery SV, McCarthy JS, Gray DJ, Soares Magalhães RJ, Clements ACA. A Critical Appraisal of Control Strategies for Soil-Transmitted Helminths. Trends Parasitol 2016; 32:97-107. [PMID: 26795294 DOI: 10.1016/j.pt.2015.10.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/10/2015] [Accepted: 10/13/2015] [Indexed: 12/29/2022]
Abstract
Interventions that lead to reductions in soil-transmitted helminths (STHs) include chemotherapy with anthelmintic drugs and improvements in water, sanitation, and hygiene (WASH). In this opinion article we aim to determine the evidence for optimal approaches for STH control. First we explore the evidence for the above interventions. We then appraise two integration strategies: current chemotherapy-oriented integrated neglected tropical disease (NTD) control and expanded 'multicomponent integration', which includes integrated chemotherapy, WASH, and other intervention strategies. While multicomponent integrated control may be an effective approach to sustainably reduce STH transmission, there is a need for evidence to prove the feasibility of this approach.
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Affiliation(s)
- Suzy J Campbell
- Research School of Population Health, College of Medicine, Biology, and Environment, The Australian National University, Canberra, Australia.
| | - Susana V Nery
- Research School of Population Health, College of Medicine, Biology, and Environment, The Australian National University, Canberra, Australia
| | - James S McCarthy
- QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Public Health, University of Queensland, Brisbane, Australia
| | - Darren J Gray
- Research School of Population Health, College of Medicine, Biology, and Environment, The Australian National University, Canberra, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Ricardo J Soares Magalhães
- Children's Health and Environment Program, Queensland Children's Medical Research Institute, University of Queensland, Brisbane, Australia; School of Veterinary Science, University of Queensland, Gatton, Australia
| | - Archie C A Clements
- Research School of Population Health, College of Medicine, Biology, and Environment, The Australian National University, Canberra, Australia
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Nkulikiyinka R, Binagwaho A, Palmer K. The changing importance of key factors associated with anaemia in 6‐ to 59‐month‐old children in a sub‐Saharan African setting where malaria is on the decline: analysis of the Rwanda Demographic and Health Survey 2010. Trop Med Int Health 2015; 20:1722-32. [DOI: 10.1111/tmi.12604] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
| | | | - Katie Palmer
- London School of Hygiene and Tropical Medicine London UK
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Aemero M, Berhe N, Erko B. Status of Schistosoma mansoni prevalence and intensity of infection in geographically apart endemic localities of Ethiopia: a comparison. Ethiop J Health Sci 2015; 24:189-94. [PMID: 25183924 PMCID: PMC4141221 DOI: 10.4314/ejhs.v24i3.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background Schistosomiasis is one of the chronic and neglected tropical diseases affecting rural communities. Heavy infections contribute to anemia and can retard children's growth, physical activity and cognitive function. This study was conducted in order to determine the prevalence, intensity and variation of Schistosoma mansoni infection among human subjects in geographically apart localities. The prevalence and intensity of Schistosoma mansoni infection was assessed in three geographically apart endemic areas of Ethiopia from May to August 2010 through cross-sectional approach. Methods A total of 1073 individuals (528 males and 545 females) were found eligible for the study. Their age ranged from 5–60 years with mean age of 11 years in Wondo Genet, 22 years in Kemissie and 24 years in Sille-Elgo. Small plastic sheets were distributed to the study participants and sizable stool specimens were collected and examined using Kato-Katz method (41.7mg template). Result The prevalence of Schistosoma mansoni infection among the study participants in Kemissie, Wondo Genet and Sille-Elgo was 89.6%, 59.9%, and 31.6%, respectively. The highest geometric mean of egg per gram of stool for Kemissie, Wondo Genet and Sille-Elgo was, 5208 and 346, 8472 and 252, 3960 and 91, respectively. Conclusion It was observed that there was comparable variation in the prevalence and intensity of infection among the study localities. Moreover, it is indicated that S. mansoni is still an ongoing public health problem which requires integrated intervention activities in the country.
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Affiliation(s)
- Mulugeta Aemero
- Department of Biology, College of Natural & Computational Sciences, University of Gondar, Ethiopia
| | - Nega Berhe
- Aklilu Lemma Institute of Pathobiology, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Berhanu Erko
- Aklilu Lemma Institute of Pathobiology, College of Health Sciences, Addis Ababa University, Ethiopia
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Abstract
BACKGROUND Since the genocide occurred in 1994, Rwanda has faced up to the challenge of rebuilding. Public health is a main field to understand this rebuilding. OBJECTIVES In this paper, the aim was to map the scientific research on public health in Rwanda after the genocide and to present the links between different financing systems. METHODS We used bibliographic analyses with Web of Science of papers published during the period 1975-2014. We performed analyses on journals, most cited articles, authors, publication years, organizations, funding companies, countries, and keywords. RESULTS We obtained 86 articles between 1975 and 2014. Most articles were published after 2007. The main countries of research laboratories were the United States of America, Rwanda, England and Belgium and represented the main network collaboration. The relevant keywords were: HIV, woman, child, program, rural and violence. CONCLUSIONS Public health research on Rwanda appeared 14 years after the genocide. A main field was emerging: the spread of HIV with mother-child transmission, and the policies to take this subject into account in rural zones. The network of institutions developing these studies was USA-Rwanda.
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Affiliation(s)
- Brice Poreau
- Institut Santé Publique Relations Internationales (ISPRI) / International Studies Public Health Institute (ISPHI) Rue E. Pons 69004 Lyon - France Tel: +33 45 65 20 753
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Control of neglected tropical diseases in Burundi: partnerships, achievements, challenges, and lessons learned after four years of programme implementation. PLoS Negl Trop Dis 2014; 8:e2684. [PMID: 24785993 PMCID: PMC4006741 DOI: 10.1371/journal.pntd.0002684] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Staudacher O, Heimer J, Steiner F, Kayonga Y, Havugimana JM, Ignatius R, Musemakweri A, Ngabo F, Harms G, Gahutu JB, Mockenhaupt FP. Soil-transmitted helminths in southern highland Rwanda: associated factors and effectiveness of school-based preventive chemotherapy. Trop Med Int Health 2014; 19:812-24. [PMID: 24750543 DOI: 10.1111/tmi.12321] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Preventive chemotherapy of schoolchildren against soil-transmitted helminths (STHs) is widely implemented in Rwanda. However, data on its actual efficacy are lacking. We assessed prevalence, associated factors and manifestation of STH infection among schoolchildren in southern highland Rwanda as well as cure and reinfection rates. METHODS Six hundred and twenty-two children (rural, 301; urban, 321) were included preceding the administration of a single dose of 500 mg mebendazole. Before treatment, and after 2 and 15 weeks, STH infection was determined by Kato-Katz smears and by PCR assays for Ascaris lumbricoides. Clinical and anthropometric data, socio-economic status and factors potentially associated with STH infection were assessed. RESULTS Soil-transmitted helminth (STH) infection was present in 38% of rural and in 13% of urban schoolchildren. Ascaris lumbricoides accounted for 96% of infections. Of these, one-third was detected by PCR exclusively. Factors associated with STH infection differed greatly between rural and urban children. Likewise, STH infection was associated with stunting and anaemia only among urban children. The cure rate after 2 weeks was 92%. Among eight non-cleared A. lumbricoides infections, seven were submicroscopic. Reinfection within 3 months occurred in 7%, but the rate was higher among rural children, and with initially present infection, particularly at comparatively high intensity. CONCLUSIONS The rural-urban difference in factors associated with STH infection and in reinfection rates highlights the need for targeted interventions to reduce transmission. PCR assays may help in detecting low-level infections persisting after treatment. In southern Rwanda, mebendazole is highly effective against the STH infections predominated by A. lumbricoides.
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Affiliation(s)
- Olga Staudacher
- Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
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