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Alonso S, Arinaitwe M, Atuhaire A, Nankasi AB, Prada JM, McIntosh E, Lamberton PHL. The short-term impact of Schistosoma mansoni infection on health-related quality of life: implications for current elimination policies. Proc Biol Sci 2024; 291:20240449. [PMID: 38864320 DOI: 10.1098/rspb.2024.0449] [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: 05/24/2023] [Accepted: 04/11/2024] [Indexed: 06/13/2024] Open
Abstract
The WHO aims to eliminate schistosomiasis as a public health problem by 2030. However, standard morbidity measures poorly correlate to infection intensities, hindering disease monitoring and evaluation. This is exacerbated by insufficient evidence on Schistosoma's impact on health-related quality of life (HRQoL). We conducted community-based cross-sectional surveys and parasitological examinations in moderate-to-high Schistosoma mansoni endemic communities in Uganda. We calculated parasitic infections and used EQ-5D instruments to estimate and compare HRQoL utilities in these populations. We further employed Tobit/linear regression models to predict HRQoL determinants. Two-thirds of the 560 participants were diagnosed with parasitic infection(s), 49% having S. mansoni. No significant negative association was observed between HRQoL and S. mansoni infection status/intensity. However, severity of pain urinating (β = -0.106; s.e. = 0.043) and body swelling (β = -0.326; s.e. = 0.005), increasing age (β = -0.016; s.e. = 0.033), reduced socio-economic status (β = 0.128; s.e. = 0.032), and being unemployed predicted lower HRQoL. Symptom severity and socio-economic status were better predictors of short-term HRQoL than current S. mansoni infection status/intensity. This is key to disentangling the link between infection(s) and short-term health outcomes, and highlights the complexity of correlating current infection(s) with long-term morbidity. Further evidence is needed on long-term schistosomiasis-associated HRQoL, health and economic outcomes to inform the case for upfront investments in schistosomiasis interventions.
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Affiliation(s)
- Sergi Alonso
- School of Biodiversity, One Health and Veterinary Medicine & Wellcome Centre for Integrative Parasitology, University of Glasgow , Glasgow, UK
| | - Moses Arinaitwe
- Vector Borne and Neglected Tropical Diseases Control Division, Ministry of Health , Kampala, Uganda
| | - Alon Atuhaire
- Vector Borne and Neglected Tropical Diseases Control Division, Ministry of Health , Kampala, Uganda
| | - Andrina Barungi Nankasi
- Vector Borne and Neglected Tropical Diseases Control Division, Ministry of Health , Kampala, Uganda
| | - Joaquín M Prada
- Department of Comparative Biomedical Sciences, Faculty of Health & Medical Sciences, University of Surrey , Guildford, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment, School of Health & Wellbeing, University of Glasgow , Glasgow, UK
| | - Poppy H L Lamberton
- School of Biodiversity, One Health and Veterinary Medicine & Wellcome Centre for Integrative Parasitology, University of Glasgow , Glasgow, UK
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Gruninger SK, Rasamoelina T, Rakotoarivelo RA, Razafindrakoto AR, Rasolojaona ZT, Rakotozafy RM, Soloniaina PR, Rakotozandrindrainy N, Rausche P, Doumbia CO, Jaeger A, Zerbo A, von Thien H, Klein P, van Dam G, Tannich E, Schwarz NG, Lorenz E, May J, Rakotozandrindrainy R, Fusco D. Prevalence and risk distribution of schistosomiasis among adults in Madagascar: a cross-sectional study. Infect Dis Poverty 2023; 12:44. [PMID: 37098581 PMCID: PMC10127445 DOI: 10.1186/s40249-023-01094-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: 12/19/2022] [Accepted: 04/09/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND The goal to eliminate the parasitic disease of poverty schistosomiasis as a public health problem is aligned with the 2030 United Nations agenda for sustainable development goals, including universal health coverage (UHC). Current control strategies focus on school-aged children, systematically neglecting adults. We aimed at providing evidence for the need of shifting the paradigm of schistosomiasis control programs from targeted to generalized approaches as key element for both the elimination of schistosomiasis as a public health problem and the promotion of UHC. METHODS In a cross-sectional study performed between March 2020 and January 2021 at three primary health care centers in Andina, Tsiroanomandidy and Ankazomborona in Madagascar, we determined prevalence and risk factors for schistosomiasis by a semi-quantitative PCR assay from specimens collected from 1482 adult participants. Univariable and multivariable logistic regression were performed to evaluate odd ratios. RESULTS The highest prevalence of S. mansoni, S. haematobium and co-infection of both species was 59.5%, 61.3% and 3.3%, in Andina and Ankazomborona respectively. Higher prevalence was observed among males (52.4%) and main contributors to the family income (68.1%). Not working as a farmer and higher age were found to be protective factors for infection. CONCLUSIONS Our findings provide evidence that adults are a high-risk group for schistosomiasis. Our data suggests that, for ensuring basic health as a human right, current public health strategies for schistosomiasis prevention and control need to be re-addressed towards more context specific, holistic and integrated approaches.
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Affiliation(s)
- Sarah Katharina Gruninger
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | | | - Rivo Andry Rakotoarivelo
- Department of Infectious Diseases, University of Fianarantsoa Andrainjato, 301, Fianarantsoa, Madagascar
| | | | | | - Rodson Morin Rakotozafy
- Department of Microbiology and Parasitology, University of Antananarivo, 101, Antananarivo, Madagascar
| | | | - Njary Rakotozandrindrainy
- Department of Microbiology and Parasitology, University of Antananarivo, 101, Antananarivo, Madagascar
| | - Pia Rausche
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Cheick Oumar Doumbia
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
- University Clinical Research Centre (UCRC), University of Sciences Technics and Technologies of Bamako (USTTB), Bamako, Mali
| | - Anna Jaeger
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Alexandre Zerbo
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Heidrun von Thien
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
- Department of Parasitology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Philipp Klein
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Govert van Dam
- Department of Parasitology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Egbert Tannich
- National Reference Centre for Tropical Pathogens (NRC), Hamburg, Germany
| | - Norbert Georg Schwarz
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Eva Lorenz
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jürgen May
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
- Department of Tropical Medicine I, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - Daniela Fusco
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
- German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany.
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Opio CK, Kazibwe F, Rejani L, Kabatereine NB, Ocama P. Hepatic schistosomiasis, upper gastrointestinal bleeding, and health related quality of life measurements from the Albert Nile Basin. J Patient Rep Outcomes 2021; 5:112. [PMID: 34718894 PMCID: PMC8557235 DOI: 10.1186/s41687-021-00389-9] [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: 12/03/2020] [Accepted: 10/17/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Health related quality of life measurements are vital elements of public health surveillance that uncover unmet health needs and predict the success of health interventions. We described health related quality of life measurements using the EuroQoL 5-dimension (EQ-VAS/EQ-5D) instrument and associated factors among patients with upper gastrointestinal bleeding (UGIB) and hepatic schistosomiasis at a rural health facility in the Albert Nile Basin, Uganda. METHODS AND MATERIALS This was a cross-sectional study at Pakwach Health Centre IV. Participants included adult inpatients and outpatients with a history of UGIB and ultrasound evidence of hepatic schistosomiasis. We evaluated and recorded each participant's medical history, physical examination, laboratory tests results, ultrasound results, and endoscopy findings. We also recorded health related quality of life measurements using the EuroQoL 5-dimension instrument and derived disability weights from EQ-VAS and EQ-5D measurements. These were our dependent variables. Descriptive and inferential statistics were generated summarizing our findings. RESULTS We found 103 participants had a history of upper gastrointestinal bleeding and hepatosplenic schistosomiasis. Sixty percent were between the ages of 30-49 years, 59% were females, 74% were farmers, 92% had splenomegaly, 88% had varices at endoscopy, 22% were medical emergencies with acute variceal upper gastrointestinal bleeding, and 62% had anemia. Measures of the different dimensions of health from 101 participants with patient reported outcomes revealed 77 (76%) participants experienced problems in self-care, 89 (88%) participants reported anxiety or depression, and 89 (88%) participants experienced pain or discomfort. The median EQ-VAS derived disability weights and median EQ-5D index-derived disability weights were 0.3 and 0.34, respectively. Acute upper gastrointestinal bleeding, praziquantel drug treatment, and age by decade predicted higher EQ-VAS derived disability weights (p value < 0.05). Under weight (Body mass index ≤ 18.5), acute upper gastrointestinal bleeding, ascites, age by decade, female gender, and praziquantel drug treatment predicted higher EQ-5D index- derived disability weights (p value < 0.05). CONCLUSION Adult patients with upper gastrointestinal bleeding and hepatic schistosomiasis from this primary health facility experience poor health and considerable health loss. Several factors predicted increased health loss. These factors probably represent key areas of health intervention towards mitigating increased health loss in this population.
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Affiliation(s)
- Christopher K. Opio
- Aga Khan University Hospital, 3rd Parkland Avenue, PO Box 30270-00100, Nairobi, Kenya
| | - Francis Kazibwe
- Public Health Department, Bishop Stuart University, PO Box 9, Mbarara, Uganda
| | - Lalitha Rejani
- Makerere University College of Health Sciences, PO Box 7072, Kampala, Uganda
| | | | - Ponsiano Ocama
- Makerere University College of Health Sciences, PO Box 7072, Kampala, Uganda
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Persistence of Schistosomiasis-Related Morbidity in Northeast Brazil: An Integrated Spatio-Temporal Analysis. Trop Med Infect Dis 2021; 6:tropicalmed6040193. [PMID: 34842851 PMCID: PMC8628971 DOI: 10.3390/tropicalmed6040193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/08/2021] [Accepted: 10/19/2021] [Indexed: 12/03/2022] Open
Abstract
Objective: To analyze the temporal trend and spatial patterns of schistosomiasis-related morbidity in Northeast Brazil, 2001–2017. Methods: Ecological study, of time series and spatial analysis, based on case notifications and hospital admission data, as provided by the Ministry of Health. Results: Of a total of 15,574,392 parasitological stool examinations, 941,961 (6.0%) were positive, mainly on the coastline of Pernambuco, Alagoas and Sergipe states. There was a reduction from 7.4% (2002) to 3.9% (2017) of positive samples and in the temporal trend of the detection rate (APC—11.6*; Confidence Interval 95%—13.9 to −9.1). There was a total of 5879 hospital admissions, with 40.4% in Pernambuco state. The hospitalization rate reduced from 0.82 (2001) to 0.02 (2017) per 100,000 inhabitants. Conclusion: Despite the reduction in case detection and hospitalizations, the persistence of focal areas of the disease in coastal areas is recognized. This reduction may indicate a possible positive impact of control on epidemiological patterns, but also operational issues related to access to healthcare and the development of surveillance and control actions in the Unified Health System.
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Roriz SJ, Pereira TA, Vaz de Melo Trindade G, Caporali JFDM, Lambertucci JR. Quality of Life Assessment Among Patients Living With Hepatosplenic Schistosomiasis and Schistosomal Myeloradiculopathy. Front Med (Lausanne) 2021; 8:629484. [PMID: 34141713 PMCID: PMC8203918 DOI: 10.3389/fmed.2021.629484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 05/10/2021] [Indexed: 12/12/2022] Open
Abstract
Schistosomiasis is a major public health problem in tropical areas of the world. Health-related quality of life (HRQOL) measurement is being widely used to evaluate the impact of a disease or treatment in several aspects of daily life. However, few studies evaluated the impact of severe forms of schistosomiasis on HRQOL of affected individuals and compared them to healthy controls with a similar socio-demographic background. Our aims were to evaluate the HRQOL in patients with hepatosplenic schistosomiasis (HS) and schistosomal myeloradiculopathy (SMR) and healthy volunteers (HV) and determine if clinical complications of the disease are associated with HRQOL scores. We interviewed and evaluated the HRQOL in 49 patients with HS, 22 patients with SMR, and 26 HV from an outpatient clinic of the Federal University of Minas Gerais University Hospital using the WHOQOL-BREF questionnaire. SMR and HS patients had a significantly lower overall quality of life score when comparing with the HV control group (p = 0.003 and p = 0.005, respectively). Multivariate ordinal regression model adjusted for sex, age, and educational level indicated that HS and SMR patients have three and five times more chances of having a lower quality of life than healthy volunteers (Odds Ratio 3.13 and 5.04, respectively). There was no association between complications of HS disease and quality of life scores. In contrast, worse quality of life was observed in SMR patients that presented back or leg pain, leg paresthesia, and bladder dysfunction. In conclusion, HS and SMR significantly impact the overall quality of life of the affected individuals, reinforcing the importance of efforts to control and eradicate this debilitating disease and suggesting that multidisciplinary clinical management of schistosomiasis patients would be more appropriate and could potentially improve patient's quality of life.
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Affiliation(s)
- Silvana Júnia Roriz
- Graduate Program in Infectious Diseases and Tropical Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Thiago Almeida Pereira
- Graduate Program in Infectious Diseases and Tropical Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Guilherme Vaz de Melo Trindade
- Graduate Program in Infectious Diseases and Tropical Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.,Physiology, School of Medicine, National University of Ireland, Galway, Galway, Ireland
| | - Júlia Fonseca de Morais Caporali
- Graduate Program in Infectious Diseases and Tropical Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.,Department of Internal Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - José Roberto Lambertucci
- Graduate Program in Infectious Diseases and Tropical Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.,Department of Internal Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Vilches TN, Graeff-Teixeira C, Yang HM. Assessing the effects of diagnostic sensitivity on schistosomiasis dynamics. J Theor Biol 2021; 523:110727. [PMID: 33887298 DOI: 10.1016/j.jtbi.2021.110727] [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: 06/29/2020] [Revised: 03/29/2021] [Accepted: 04/12/2021] [Indexed: 11/26/2022]
Abstract
Schistosomiasis is a parasite infection that affects millions of people around the world. It is endemic in 13 different states in Brazil and responsible for increasing morbidity in the population. One of its main characteristics is a heterogeneous distribution of worm burden in the human population, which makes the diagnosis difficult. We aimed to investigate how the sensitivity of the diagnostic method may contribute to successful control interventions against infections in a population. In order to do that, we present an ordinary differential equations model that considers three levels of worm burden in the human population, a snail population, and a miracidium reservoir. Through a steady-state analysis and its local stability, we show how this worm-burden heterogeneity can be responsible for the persistence of infection, especially due to reinfection in the highest level of worm burden. The analysis highlights sensitive diagnosis, besides treatment and sanitary improvements, as a key factor for schistosomiasis transmission control.
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Webb JA, Fabreau G, Spackman E, Vaughan S, McBrien K. The cost-effectiveness of schistosomiasis screening and treatment among recently resettled refugees to Canada: an economic evaluation. CMAJ Open 2021; 9:E125-E133. [PMID: 33622765 PMCID: PMC8034375 DOI: 10.9778/cmajo.20190057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Many refugees and asylum seekers from countries where schistosomiasis is endemic are infected with the Schistosoma parasite when they arrive in Canada. We assessed, from a systemic perspective, which of the following management strategies by health care providers is cost-effective: testing for schistosomiasis and treating if the individual is infected, treating presumptively or waiting for symptoms to emerge. METHODS We constructed a decision-tree model to examine the cost-effectiveness of 3 management strategies: watchful waiting, screening and treatment, and presumptive treatment. We obtained data for the model from the literature and other sources, to predict deaths and chronic complications caused by schistosomiasis, as well as costs and net monetary benefit. RESULTS Presumptive treatment was cost-saving if the prevalence of schistosomiasis in the target population was greater than 2.1%. In our baseline analysis, presumptive treatment was associated with an increase of 0.156 quality-adjusted life years and a cost saving of $405 per person, compared with watchful waiting. It was also more effective and less costly than screening and treatment. INTERPRETATION Among recently resettled refugees and asylum claimants in Canada, from countries where schistosomiasis is endemic, presumptive treatment was predicted to be less costly and more effective than watchful waiting or screening and treatment. Our results support a revision of the current Canadian recommendations.
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Affiliation(s)
- John A Webb
- South Zone Medical Affairs, Alberta Health Services (Webb); Department of Community Health Sciences (Fabreau, Spackman, McBrien), O'Brien Institute for Public Health (Fabreau, Spackman, McBrien), Department of Medicine (Fabreau, Vaughan), Division of Infectious Diseases (Vaughan) and Department of Family Medicine (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Gabriel Fabreau
- South Zone Medical Affairs, Alberta Health Services (Webb); Department of Community Health Sciences (Fabreau, Spackman, McBrien), O'Brien Institute for Public Health (Fabreau, Spackman, McBrien), Department of Medicine (Fabreau, Vaughan), Division of Infectious Diseases (Vaughan) and Department of Family Medicine (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Eldon Spackman
- South Zone Medical Affairs, Alberta Health Services (Webb); Department of Community Health Sciences (Fabreau, Spackman, McBrien), O'Brien Institute for Public Health (Fabreau, Spackman, McBrien), Department of Medicine (Fabreau, Vaughan), Division of Infectious Diseases (Vaughan) and Department of Family Medicine (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Stephen Vaughan
- South Zone Medical Affairs, Alberta Health Services (Webb); Department of Community Health Sciences (Fabreau, Spackman, McBrien), O'Brien Institute for Public Health (Fabreau, Spackman, McBrien), Department of Medicine (Fabreau, Vaughan), Division of Infectious Diseases (Vaughan) and Department of Family Medicine (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Kerry McBrien
- South Zone Medical Affairs, Alberta Health Services (Webb); Department of Community Health Sciences (Fabreau, Spackman, McBrien), O'Brien Institute for Public Health (Fabreau, Spackman, McBrien), Department of Medicine (Fabreau, Vaughan), Division of Infectious Diseases (Vaughan) and Department of Family Medicine (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta
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