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Obonyo CO, Rawago FO, Makworo NK, Muok EMO. Efficacy and safety of single-dose artesunate plus sulfalene/pyrimethamine combined with praziquantel for the treatment of children with Schistosoma mansoni or Schistosoma haematobium in western Kenya: a randomised, open-label controlled trial. Parasit Vectors 2024; 17:279. [PMID: 38943214 PMCID: PMC11212220 DOI: 10.1186/s13071-024-06359-6] [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: 01/17/2024] [Accepted: 06/16/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND Reliance on praziquantel for the treatment and control of schistosomiasis is likely to facilitate the emergence of drug resistance. Combination therapy targeting adult and juvenile schistosome worms is urgently needed to improve praziquantel efficacy and delay the potential development of drug resistance. We assessed the efficacy and safety of single-dose praziquantel combined with single-dose artesunate plus sulfalene-pyrimethamine in the treatment of Kenyan children with schistosomiasis. METHODS This was an open-label, randomised clinical trial involving 426 school-aged children (7-15 years old) diagnosed with Schistosoma mansoni (by Kato-Katz) or S. haematobium (by urine filtration). They were randomly assigned (1:1:1) to receive a single dose of praziquantel (40 mg/kg), a single dose of artesunate plus sulfalene-pyrimethamine (12 mg/kg artesunate) or combination therapy using a single dose of praziquantel (40 mg/kg) combined with a single dose of artesunate plus sulfalene-pyrimethamine (12 mg/kg artesunate). The primary outcome was cure and egg reduction rates at 6 weeks post-treatment in the available case population. Adverse events were assessed within 3 h after treatment. RESULTS Of the 426 children enrolled, 135 received praziquantel, 150 received artesunate plus sulfalene-pyrimethamine, and 141 received combination therapy. Outcome data were available for 348 (81.7%) children. For S. mansoni-infected children (n = 335), the cure rates were 75.6%, 60.7%, and 77.8%, and the egg reduction rates were 80.1%, 85.0%, and 88.4% for praziquantel, artesunate plus sulfalene-pyrimethamine, and combination therapy, respectively. For S. haematobium-infected children (n = 145), the corresponding cure rates were 81.4%, 71.1%, and 82.2%, and the egg reduction rates were 95.6%, 97.1%, and 97.7%, respectively. Seventy-one (16.7%) children reported mild-intensity adverse events. The drugs were well tolerated and no serious adverse events were reported. CONCLUSIONS A single oral dose of praziquantel combined with artesunate plus sulfalene-pyrimethamine cured a high proportion of children with S. haematobium but did not significantly improve the treatment efficacy for either urinary or intestinal schistosomiasis. Sequential administration of praziquantel and artesunate plus sulfalene-pyrimethamine may enhance the efficacy and safety outcomes.
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Affiliation(s)
- Charles O Obonyo
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
| | - Fredrick O Rawago
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Nicholas K Makworo
- Division of Vector-Borne and Neglected Tropical Diseases, County Department of Health, Migori, Kenya
| | - Erick M O Muok
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
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Barry H, Lhomme E, Surénaud M, Nouctara M, Robinson C, Bockstal V, Valea I, Somda S, Tinto H, Meda N, Greenwood B, Thiébaut R, Lacabaratz C. Helminth exposure and immune response to the two-dose heterologous Ad26.ZEBOV, MVA-BN-Filo Ebola vaccine regimen. PLoS Negl Trop Dis 2024; 18:e0011500. [PMID: 38603720 PMCID: PMC11037528 DOI: 10.1371/journal.pntd.0011500] [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: 07/12/2023] [Revised: 04/23/2024] [Accepted: 02/28/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND The exposure to parasites may influence the immune response to vaccines in endemic African countries. In this study, we aimed to assess the association between helminth exposure to the most prevalent parasitic infections, schistosomiasis, soil transmitted helminths infection and filariasis, and the Ebola virus glycoprotein (EBOV GP) antibody concentration in response to vaccination with the Ad26.ZEBOV, MVA-BN-Filo vaccine regimen in African and European participants using samples obtained from three international clinical trials. METHODS/PRINCIPAL FINDINGS We conducted a study in a subset of participants in the EBL2001, EBL2002 and EBL3001 clinical trials that evaluated the Ad26.ZEBOV, MVA-BN-Filo vaccine regimen against EVD in children, adolescents and adults from the United Kingdom, France, Burkina Faso, Cote d'Ivoire, Kenya, Uganda and Sierra Leone. Immune markers of helminth exposure at baseline were evaluated by ELISA with three commercial kits which detect IgG antibodies against schistosome, filarial and Strongyloides antigens. Luminex technology was used to measure inflammatory and activation markers, and Th1/Th2/Th17 cytokines at baseline. The association between binding IgG antibodies specific to EBOV GP (measured on day 21 post-dose 2 and on Day 365 after the first dose respectively), and helminth exposure at baseline was evaluated using a multivariable linear regression model adjusted for age and study group. Seventy-eight (21.3%) of the 367 participants included in the study had at least one helminth positive ELISA test at baseline, with differences of prevalence between studies and an increased prevalence with age. The most frequently detected antibodies were those to Schistosoma mansoni (10.9%), followed by Acanthocheilonema viteae (9%) and then Strongyloides ratti (7.9%). Among the 41 immunological analytes tested, five were significantly (p < .003) lower in participants with at least one positive helminth ELISA test result: CCL2/MCP1, FGFbasic, IL-7, IL-13 and CCL11/Eotaxin compared to participants with negative helminth ELISA tests. No significant association was found with EBOV-GP specific antibody concentration at 21 days post-dose 2, or at 365 days post-dose 1, adjusted for age group, study, and the presence of any helminth antibodies at baseline. CONCLUSIONS/SIGNIFICANCE No clear association was found between immune markers of helminth exposure as measured by ELISA and post-vaccination response to the Ebola Ad26.ZEBOV/ MVA-BN-Filo vaccine regimen. TRIAL REGISTRATION NCT02416453, NCT02564523, NCT02509494. ClinicalTrials.gov.
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Affiliation(s)
- Houreratou Barry
- Centre MURAZ, Institut National de Santé Publique Bobo-Dioulasso, Burkina Faso
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219; Inria SISTM team, Bordeaux, France
| | - Edouard Lhomme
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219; Inria SISTM team, Bordeaux, France
- CHU Bordeaux, Department of Medical Information, Bordeaux, France
- Vaccine Research Institute (VRI), Créteil, France
| | - Mathieu Surénaud
- Vaccine Research Institute (VRI), Créteil, France
- Université Paris-Est Créteil, Faculté de Médecine, INSERM U955, Team 16, Créteil, France
| | - Moumini Nouctara
- Centre MURAZ, Institut National de Santé Publique Bobo-Dioulasso, Burkina Faso
| | | | - Viki Bockstal
- Janssen Vaccines & Prevention B.V., Leiden, Netherlands
| | - Innocent Valea
- Centre MURAZ, Institut National de Santé Publique Bobo-Dioulasso, Burkina Faso
- Institut de Recherche en Sciences de la Santé/Unité de Recherche Clinique de Nanoro, Burkina Faso
| | - Serge Somda
- Centre MURAZ, Institut National de Santé Publique Bobo-Dioulasso, Burkina Faso
- Université Nazi BONI, UFR Sciences Exactes et Appliquées, Bobo-Dioulasso, Burkina Faso
| | - Halidou Tinto
- Centre MURAZ, Institut National de Santé Publique Bobo-Dioulasso, Burkina Faso
- Institut de Recherche en Sciences de la Santé/Unité de Recherche Clinique de Nanoro, Burkina Faso
| | - Nicolas Meda
- Centre MURAZ, Institut National de Santé Publique Bobo-Dioulasso, Burkina Faso
- UFR Sciences de la santé, Université joseph Ki Zerbo, Ouagadougou, Burkina Faso
| | - Brian Greenwood
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Rodolphe Thiébaut
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219; Inria SISTM team, Bordeaux, France
- CHU Bordeaux, Department of Medical Information, Bordeaux, France
- Vaccine Research Institute (VRI), Créteil, France
| | - Christine Lacabaratz
- Vaccine Research Institute (VRI), Créteil, France
- Université Paris-Est Créteil, Faculté de Médecine, INSERM U955, Team 16, Créteil, France
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Ismail HAHA, Cha S, Jin Y, Hong ST. Implications for selecting persistent hot spots of schistosomiasis from community- and school-based surveys in Blue Nile, North Kordofan, and Sennar States, Sudan. PARASITES, HOSTS AND DISEASES 2023; 61:216-224. [PMID: 37258270 DOI: 10.3347/phd.23022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/28/2023] [Indexed: 06/02/2023]
Abstract
In several schistosomiasis-endemic countries, the prevalence has remained high in some areas owing to reinfection despite repeated mass drug administration (MDA) interventions; these areas are referred to as persistent hot spots. Identifying hotspots is critical for interrupting transmission. This study aimed to determine an effective means of identifying persistent hot spots. First, we investigated the differences between Schistosoma haematobium and Schistosoma mansoni prevalence among school-aged children (SAC) estimated by a community-based survey, for which local key informants purposively selected communities, and a randomly sampled school-based survey. A total of 6,225 individuals residing in 60 villages in 8 districts of North Kordofan, Blue Nile, or Sennar States, Sudan participated in a community-based survey in March 2018. Additionally, the data of 3,959 students attending 71 schools in the same 8 districts were extracted from a nationwide school-based survey conducted in January 2017. The community-based survey identified 3 districts wherein the prevalence of S. haematobium or S. mansoni infection among SAC was significantly higher than that determined by the randomly sampled school survey (e.g., S. haematobium in the Sennar district: 10.8% vs. 1.1%, P<0.001). At the state level, the prevalence of schistosomiasis among SAC, as determined by the community-based survey, was consistently significantly higher than that determined by the school-based survey. Purposeful selection of villages or schools based on a history of MDA, latrine coverage, open defecation, and the prevalence of bloody urine improved the ability for identifying persistent hot spots.
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Affiliation(s)
| | - Seungman Cha
- Department of Global Development and Entrepreneurship, Graduate School of Global Development and Entrepreneurship, Handong Global University, Pohang, 37554, Korea
| | - Yan Jin
- Department of Microbiology, Dongguk University College of Medicine, Gyeongju 38066, Korea
| | - Sung-Tae Hong
- Department of Tropical Medicine and Parasitology, Seoul National University College of Medicine, Seoul 03080, Korea
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Ismail HAHA, Cha S, Jin Y, Hong ST. Programmatic Implications for Schistosomiasis Elimination Based on Community-Based Survey in the Blue Nile, North Kordofan, and Sennar States, Sudan. Life (Basel) 2023; 13:life13041049. [PMID: 37109578 PMCID: PMC10143570 DOI: 10.3390/life13041049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
Schistosomiasis prevalence has remained high in some areas due to reinfection despite repeated mass drug administration interventions. We aimed to explore its risk factors in order to help to design adequate interventions in such high-transmission areas. A total of 6225 individuals residing in 60 villages in 8 districts of North Kordofan, Blue Nile, or Sennar States, Sudan participated in the community-based survey in March 2018. First, we investigated Schistosoma haematobium and Schistosoma mansoni prevalences among school-aged children and adults. Second, the associations between risk factors and schistosomiasis were explored. Those without any type of latrine in their households had higher odds of being infected with schistosomiasis than those with a latrine (odds ratio (OR) = 1.53; 95% confidence interval (CI) 1.20-1.94; p = 0.001), and the odds of being positive for schistosomiasis among people living in a household without an improved latrine were higher than for their counterparts with an improved latrine (OR = 1.63; CI 1.05-2.55; p = 0.03). Furthermore, people with households or outside compounds found to contain human faeces had higher odds of being infected with schistosomiasis than their counterparts (OR = 1.36, 95% CI 1.01-1.83, p = 0.04). Installing an improved latrine and eliminating open defecation should be highlighted in schistosomiasis elimination projects in high-transmission areas.
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Affiliation(s)
| | - Seungman Cha
- Department of Global Development and Entrepreneurship, Graduate School of Global Development and Entrepreneurship, Handong Global University, Pohang 37554, Republic of Korea
| | - Yan Jin
- Department of Microbiology, Dongguk University College of Medicine, Gyeongju 10326, Republic of Korea
| | - Sung-Tae Hong
- Department of Tropical Medicine and Parasitology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
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Zdesenko G, Mduluza T, Mutapi F. Pharmacogenetics of Praziquantel Metabolism: Evaluating the Cytochrome P450 Genes of Zimbabwean Patients During a Schistosomiasis Treatment. Front Genet 2022; 13:914372. [PMID: 35754834 PMCID: PMC9213834 DOI: 10.3389/fgene.2022.914372] [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: 04/06/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
Schistosomiasis is a parasitic disease infecting over 236 million people annually, with the majority affected residing on the African continent. Control of this disease is reliant on the drug praziquantel (PZQ), with treatment success dependent on an individual reaching PZQ concentrations lethal to schistosomes. Despite the complete reliance on PZQ to treat schistosomiasis in Africa, the characterization of the pharmacogenetics associated with PZQ metabolism in African populations has been sparse. We aimed to characterize genetic variation in the drug-metabolising cytochrome P450 enzymes (CYPs) and determine the association between each variant and the efficacy of PZQ treatment in Zimbabwean patients exposed to Schistosoma haematobium infection. Genomic DNA from blood samples of 114 case-control Zimbabweans infected with schistosomes were sequenced using the CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP3A4, and CYP3A5 genes as targets. Bioinformatic tools were used to identify and predict functional effects of detected single nucleotide polymorphisms (SNPs). A random forest (RF) model was then used to assess SNPs most predictive of PZQ efficacy, with a misclassification rate of 29%. SNPs were detected across all six genes, with 70 SNPs identified and multiple functional changes to the CYP enzymes predicted. Only four SNPs were significantly associated with PZQ efficacy using χ2 tests, with rs951840747 (OR: 3.61, p = 0.01) in the CYP1A2 gene having the highest odds of an individual possessing this SNP clearing infection, and rs6976017 (OR: 2.19, p = 0.045) of CYP3A5 determined to be the most predictive of PZQ efficacy via the RF. Only the rs28371702 (CC) genotype (OR: 2.36, p = 0.024) of CYP2D6 was significantly associated with an unsuccessful PZQ treatment. This study adds to the genomic characterization of the diverse populations in Africa and identifies variants relevant to other pharmacogenetic studies crucial for the development and usage of drugs in these populations.
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Affiliation(s)
- Grace Zdesenko
- Ashworth Laboratories, Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, United Kingdom.,Ashworth Laboratories, NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Edinburgh, United Kingdom
| | - Takafira Mduluza
- Ashworth Laboratories, NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Edinburgh, United Kingdom.,Department of Biochemistry, University of Zimbabwe, Harare, Zimbabwe
| | - Francisca Mutapi
- Ashworth Laboratories, Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, United Kingdom.,Ashworth Laboratories, NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Edinburgh, United Kingdom
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Ondigo BN, Hamilton RE, Magomere EO, Onkanga IO, Mwinzi PN, Odiere MR, Ganley-Leal L. Potential Utility of Systemic Plasma Biomarkers for Evaluation of Pediatric Schistosomiasis in Western Kenya. Front Immunol 2022; 13:887213. [PMID: 35603171 PMCID: PMC9121796 DOI: 10.3389/fimmu.2022.887213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/08/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction Current diagnostic tools for schistosomiasis are limited, and new tests are necessary to enhance disease diagnosis and surveillance. Identification of novel disease-specific biomarkers may facilitate the development of such tests. We evaluated a panel of biomarkers used in sepsis and parasitic diseases for their potential suitability in the diagnosis of schistosomiasis. Objective The study evaluated the levels of systemic plasma biomarkers in relation to Schistosoma mansoni infection and parasite burden. Methods Six biomarkers were measured in the plasma of children from schistosomiasis-endemic regions using ELISA. The concentration of soluble CD23 (sCD23) and lipopolysaccharide (LPS) was tested in 199 and 124 plasma samples, respectively, while interleukin-6 (IL-6), soluble triggering receptor expressed on myeloid (sTREM) cells, eotaxin-1, and fatty acid-binding protein (FABP) concentrations were tested in 30 plasma samples. Results The concentration of IL-6, eotaxin-1, FABP, and LPS was similar between schistosome-infected and uninfected children. The schistosome-infected children had higher median levels of sTREM and sCD23 as compared to uninfected children, 119.0 (29.9-208.9) versus 10.7 (0.0-73.4) (p = 0.046) and 2,549.0 (1,899.0-3,356.0) vs. 2,035.0 (1,448.0-2,939.0) (p = 0.05), respectively. In addition, sTREM was positively correlated with egg density (p = 0.017). Conclusion Our data show that active schistosomiasis per se is associated with elevated levels of sTREM and sCD23. sTREM has potential diagnostic and prognostic values. However, these biomarkers did not distinguish between children with low egg burden and uninfected children.
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Affiliation(s)
- Bartholomew N. Ondigo
- Department of Biochemistry and Molecular Biology, Faculty of Science, Egerton University, Egerton, Kenya,*Correspondence: Bartholomew N. Ondigo,
| | - Rachael E. Hamilton
- School of Public Health, Boston University, Boston, MA, United States,Global Development, Elegance Biotechnologies, Wayne, PA, United States
| | - Edwin O. Magomere
- Department of Biochemistry and Molecular Biology, Faculty of Science, Egerton University, Egerton, Kenya
| | - Isaac O. Onkanga
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Pauline N. Mwinzi
- Regional Office for Africa, World Health Organization, Brazzaville, Democratic Republic of Congo
| | - Maurice R. Odiere
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Lisa Ganley-Leal
- Global Development, Elegance Biotechnologies, Wayne, PA, United States
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Fredrick M, Danson M, John K, Stanislaus K, David N, Maina N, Michael G, Suleiman M, Mercy A. Schistosoma mansoni and soil transmtted helminths in olive baboons and potential zoonosis. Vet Med Sci 2021; 7:2026-2031. [PMID: 33942545 PMCID: PMC8464276 DOI: 10.1002/vms3.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/25/2021] [Accepted: 04/01/2021] [Indexed: 11/30/2022] Open
Abstract
Zoonotic pathogens are among the most important causes of ill health all over the world. The presence of these pathogens in free ranging baboons may have significant implications for humans. In Kenya, the encroachment of wildlife habitats has led to increased interaction between humans and wildlife especially non-human primates. The current study therefore aimed at investigating any possible zoonotic gastrointestinal helminths of olive baboons (Papio anubis) at the human-wildlife interface in two park borders and a ranch in Kenya, namely, Tsavo West National Park, Tana River Primate Reserve and Mutara Ranch, Laikipia, Kenya. One hundred and forty-seven baboons were used in the study. They were trapped in the wild, sampled for stool marked and then released back to the wild. Gastrointestinal (GIT) helminths identified were Strongyloides, Oesophagostomum, Enterobius spp and Trichuris Trichiura from all the three sites while Schistosoma mansoni was only detected from Tsavo baboons and with very low incidence (2.1%). The prevalence of these parasites varied among the sites but significant difference in prevalence was only noted in Strongyloides and Oesophagostomum (p < 0.05) among the three sites. This therefore implies that even with control measures instituted on the human population, baboons will always be a source of zoonotic GIT helminths especially S. mansoni even if the incidence are low. There is need to put in place measures aiming to reduce their interactions with humans and also try to control these infections in the baboons.
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Affiliation(s)
- Maloba Fredrick
- Department of Zoological SciencesKenyatta UniversityNairobiKenya
| | - Mwangi Danson
- Department of Conservation BiologyInstitute of Primate ResearchNairobiKenya
| | - Kagira John
- Jommo Kenyatta University of Agriculture and TechnologyNairobiKenya
| | - Kivai Stanislaus
- Department of Conservation BiologyInstitute of Primate ResearchNairobiKenya
| | | | | | - Gicheru Michael
- Department of Zoological SciencesKenyatta UniversityNairobiKenya
| | | | - Akinyi Mercy
- Department of Conservation BiologyInstitute of Primate ResearchNairobiKenya
- Department of BiologyDuke UniversityDurhamNCUSA
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Risk Factors Associated with Helminthic Intestinal Infection in Lurambi Subcounty, Kakamega, Kenya. J Parasitol Res 2021; 2020:8810519. [PMID: 33489319 PMCID: PMC7790573 DOI: 10.1155/2020/8810519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/01/2020] [Accepted: 12/12/2020] [Indexed: 02/04/2023] Open
Abstract
Background Soil-transmitted helminths (STHs) and schistosome infections have been known to be major causes of morbidity and mortality in sub-Saharan countries. School aged and preschool children are known to be at high risk of infection. Therefore, the aim of this study was to determine the prevalence and risk factors associated with soil-transmitted helminths among school-going children in Lurambi Subcounty, Kakamega, Kenya. Method A cross-sectional study was conducted from Jan 2020 to Feb 2020 among 392 randomly selected primary school-going children aged 5 to 14 years old in six primary schools. Risk factors associated with STH infection were obtained using a structured questionnaire answered by the children's caregivers. Stool samples were examined using the standard quantitative Kato-Katz technique. The data was analyzed using SPSS version 20 and Epi Info version 7.2.3.1. Result A total of 278 children provided stool samples for analysis. The overall prevalence of intestinal helminths was 14.4% (40/278). The prevalence of Ascaris lumbricoides was 11.5% (32/278), 0.4% (1/278) for hookworm, 0.4% (1/278) for Trichuris trichiura, and 2.1% (6/278) for Schistosoma mansoni; coinfection was detected in 0.4% (1/278). The intensity of infection ranged between light and moderate. Significant risk factors for STH infection included failure to wash hands before eating (OR: 3.529; P = 0.041), failure to wash fruits and vegetables before eating (OR: 2.3129; P = 0.005), and not washing hands after soil contact (OR: 2.1529; P = 0.005). Age (Z = 2.4006, P = 0.0164) was a risk factor only for infection with Schistosoma mansoni. Conclusion Preventive chemotherapy and proper hygienic and sanitation practices should be integrated to achieve elimination of STH and Schistosoma mansoni in Lurambi Subcounty and at large in Kenya.
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Chibwana FD, Tumwebaze I, Mahulu A, Sands AF, Albrecht C. Assessing the diversity and distribution of potential intermediate hosts snails for urogenital schistosomiasis: Bulinus spp. (Gastropoda: Planorbidae) of Lake Victoria. Parasit Vectors 2020; 13:418. [PMID: 32795373 PMCID: PMC7427762 DOI: 10.1186/s13071-020-04281-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/03/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The Lake Victoria basin is one of the most persistent hotspots of schistosomiasis in Africa, the intestinal form of the disease being studied more often than the urogenital form. Most schistosomiasis studies have been directed to Schistosoma mansoni and their corresponding intermediate snail hosts of the genus Biomphalaria, while neglecting S. haematobium and their intermediate snail hosts of the genus Bulinus. In the present study, we used DNA sequences from part of the cytochrome c oxidase subunit 1 (cox1) gene and the internal transcribed spacer 2 (ITS2) region to investigate Bulinus populations obtained from a longitudinal survey in Lake Victoria and neighbouring systems during 2010-2019. METHODS Sequences were obtained to (i) determine specimen identities, diversity and phylogenetic positions, (ii) reconstruct phylogeographical affinities, and (iii) determine the population structure to discuss the results and their implications for the transmission and epidemiology of urogenital schistosomiasis in Lake Victoria. RESULTS Phylogenies, species delimitation methods (SDMs) and statistical parsimony networks revealed the presence of two main groups of Bulinus species occurring in Lake Victoria; B. truncatus/B. tropicus complex with three species (B. truncatus, B. tropicus and Bulinus sp. 1), dominating the lake proper, and a B. africanus group, prevalent in banks and marshes. Although a total of 47 cox1 haplotypes, were detected within and outside Lake Victoria, there was limited haplotype sharing (only Haplotype 6 was shared between populations from Lake Victoria open waters and neighbouring aquatic systems) - an indication that haplotypes are specific to habitats. CONCLUSIONS The Bulinus fauna of Lake Victoria consists of at least B. truncatus, B. tropicus, Bulinus sp. 1 (B. trigonus?) and B. ugandae. The occurrence and wide distribution of Bulinus species in Lake Victoria potentially implies the occurrence of urogenital schistosomiasis in communities living along the shores and on islands of the lake who depend solely on the lake for their livelihood. More in-depth studies are needed to obtain a better picture of the extent of the disease in the Lake Victoria basin.
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Affiliation(s)
- Fred D. Chibwana
- Department of Animal Ecology and Systematics, Justus Liebig University Giessen, Giessen, Germany
- Department of Zoology and Wildlife Conservation, University of Dar es Salaam, Dar es Salaam, Tanzania
| | - Immaculate Tumwebaze
- Department of Animal Ecology and Systematics, Justus Liebig University Giessen, Giessen, Germany
| | - Anna Mahulu
- Department of Animal Ecology and Systematics, Justus Liebig University Giessen, Giessen, Germany
| | - Arthur F. Sands
- Department of Animal Ecology and Systematics, Justus Liebig University Giessen, Giessen, Germany
| | - Christian Albrecht
- Department of Animal Ecology and Systematics, Justus Liebig University Giessen, Giessen, Germany
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Assaré RK, N’Tamon RN, Bellai LG, Koffi JA, Mathieu TBI, Ouattara M, Hürlimann E, Coulibaly JT, Diabaté S, N’Goran EK, Utzinger J. Characteristics of persistent hotspots of Schistosoma mansoni in western Côte d'Ivoire. Parasit Vectors 2020; 13:337. [PMID: 32616074 PMCID: PMC7333430 DOI: 10.1186/s13071-020-04188-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 06/13/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Preventive chemotherapy with praziquantel is the cornerstone of schistosomiasis control. However, in some social-ecological settings, the prevalence and/or intensity of Schistosoma infection does not lower meaningfully despite multiple rounds of preventive chemotherapy, a phenomenon termed persistent hotspot (PHS). We assessed the characteristics of PHS in a Schistosoma mansoni-endemic area of Côte d'Ivoire. METHODS In October 2016, a cross-sectional survey was conducted in 14 schools in the western part of Côte d'Ivoire, one year after multiple rounds of preventive chemotherapy. In each school, 50 children aged 9-12 years provided two stool samples and one urine sample. Stool samples were subjected to triplicate Kato-Katz thick smears for S. mansoni diagnosis. Urine samples were examined by a filtration method for S. haematobium eggs. PHS was defined as failure to achieve a reduction in the prevalence of S. mansoni infection of at least 35% and/or a reduction of infection intensity of at least 50%. Six schools underwent more detailed investigations, including a questionnaire survey for demographic characteristics and a malacological survey. RESULTS In the six schools subjected to detailed investigations, the overall prevalence of S. mansoni and S. haematobium was 9.5% and 2.6%, respectively. Four schools were classified as PHS. The S. mansoni prevalence in the four PHS was 10.9% compared to 6.6% in the remaining two schools. The S. mansoni infection intensity, expressed as arithmetic mean eggs per gram of stool (EPG) among infected children, was 123.8 EPG in PHS and 18.7 EPG in the other two schools. Children bathing in open freshwater bodies were at higher odds of S. mansoni infection (odds ratio: 4.5, 95% confidence interval: 1.6-12.6). A total of 76 human-water contact sites (53 in PHS and 23 in the other schools) were examined and 688 snails were collected, including potential intermediate host snails of Schistosoma (Biomphalaria pfeifferi, Bulinus forskalii, Bu. globosus and Bu. truncatus). CONCLUSION Children in PHS schools bathed more frequently in open freshwater bodies, and hence, they are more exposed to Schistosoma transmission. Our findings call for an integrated control approach, complementing preventive chemotherapy with other interventions, particularly in PHS settings.
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Affiliation(s)
- Rufin K. Assaré
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, 22 BP 582, Abidjan 22, Côte d’Ivoire
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, 01 BP 1303, Abidjan 01, Côte d’Ivoire
- Swiss Tropical and Public Health Institute, CH-4002, Basel, Switzerland
- University of Basel, CH-4003, Basel, Switzerland
| | - Roméo N. N’Tamon
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, 22 BP 582, Abidjan 22, Côte d’Ivoire
| | - Louise G. Bellai
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, 22 BP 582, Abidjan 22, Côte d’Ivoire
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, 01 BP 1303, Abidjan 01, Côte d’Ivoire
- Swiss Tropical and Public Health Institute, CH-4002, Basel, Switzerland
- University of Basel, CH-4003, Basel, Switzerland
| | - Judicaelle A. Koffi
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, 01 BP 1303, Abidjan 01, Côte d’Ivoire
- Unité de Formation et de Recherche Science de l’Homme et de la Société, Université Félix Houphouët-Boigny, 08 BP 865, Abidjan 08, Côte d’Ivoire
| | - Tra-Bi I. Mathieu
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, 22 BP 582, Abidjan 22, Côte d’Ivoire
| | - Mamadou Ouattara
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, 22 BP 582, Abidjan 22, Côte d’Ivoire
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, 01 BP 1303, Abidjan 01, Côte d’Ivoire
| | - Eveline Hürlimann
- Swiss Tropical and Public Health Institute, CH-4002, Basel, Switzerland
- University of Basel, CH-4003, Basel, Switzerland
| | - Jean T. Coulibaly
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, 22 BP 582, Abidjan 22, Côte d’Ivoire
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, 01 BP 1303, Abidjan 01, Côte d’Ivoire
- Swiss Tropical and Public Health Institute, CH-4002, Basel, Switzerland
- University of Basel, CH-4003, Basel, Switzerland
| | - Salia Diabaté
- Centre d’Entomologie Médicale et Vétérinaire, 27 BP 529, Abidjan 27, Côte d’Ivoire
| | - Eliézer K. N’Goran
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, 22 BP 582, Abidjan 22, Côte d’Ivoire
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, 01 BP 1303, Abidjan 01, Côte d’Ivoire
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, CH-4002, Basel, Switzerland
- University of Basel, CH-4003, Basel, Switzerland
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11
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Connecting Female Genital Schistosomiasis and Menstrual Hygiene Initiatives. Trends Parasitol 2020; 36:410-412. [PMID: 32298628 DOI: 10.1016/j.pt.2020.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 02/25/2020] [Accepted: 02/25/2020] [Indexed: 11/20/2022]
Abstract
Effective future control of female genital schistosomiasis (FGS) requires an integrated and multisectoral approach, bringing together HIV, sexual and reproductive health, and reproductive rights sectors. In this article, an underappreciated but important connection between FGS and menstrual hygiene initiatives in Africa is highlighted.
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12
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Becker JM, Ganatra AA, Kandie F, Mühlbauer L, Ahlheim J, Brack W, Torto B, Agola EL, McOdimba F, Hollert H, Fillinger U, Liess M. Pesticide pollution in freshwater paves the way for schistosomiasis transmission. Sci Rep 2020; 10:3650. [PMID: 32107456 PMCID: PMC7046736 DOI: 10.1038/s41598-020-60654-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 02/14/2020] [Indexed: 12/19/2022] Open
Abstract
Schistosomiasis is a severe neglected tropical disease caused by trematodes and transmitted by freshwater snails. Snails are known to be highly tolerant to agricultural pesticides. However, little attention has been paid to the ecological consequences of pesticide pollution in areas endemic for schistosomiasis, where people live in close contact with non-sanitized freshwaters. In complementary laboratory and field studies on Kenyan inland areas along Lake Victoria, we show that pesticide pollution is a major driver in increasing the occurrence of host snails and thus the risk of schistosomiasis transmission. In the laboratory, snails showed higher insecticide tolerance to commonly found pesticides than associated invertebrates, in particular to the neonicotinoid Imidacloprid and the organophosphate Diazinon. In the field, we demonstrated at 48 sites that snails were present exclusively in habitats characterized by pesticide pollution and eutrophication. Our analysis revealed that insensitive snails dominated over their less tolerant competitors. The study shows for the first time that in the field, pesticide concentrations considered “safe” in environmental risk assessment have indirect effects on human health. Thus we conclude there is a need for rethinking the environmental risk of low pesticide concentrations and of integrating agricultural mitigation measures in the control of schistosomiasis.
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Affiliation(s)
- Jeremias M Becker
- Helmholtz Centre for Environmental Research - UFZ, Department System-Ecotoxicology, Permoserstrasse 15, 04318, Leipzig, Germany.,RWTH Aachen University, Department of Ecosystem Analysis, Institute for Environmental Research, Worringerweg 1, 52074, Aachen, Germany
| | - Akbar A Ganatra
- International Centre of Insect Physiology and Ecology (icipe), Human Health department, P.O. Box 30772-00100, Nairobi, Kenya. .,Egerton University, Biological sciences, P.O Box 536-20115, Njoro, Kenya.
| | - Faith Kandie
- RWTH Aachen University, Department of Ecosystem Analysis, Institute for Environmental Research, Worringerweg 1, 52074, Aachen, Germany.,International Centre of Insect Physiology and Ecology (icipe), Human Health department, P.O. Box 30772-00100, Nairobi, Kenya
| | - Lina Mühlbauer
- Helmholtz Centre for Environmental Research - UFZ, Department System-Ecotoxicology, Permoserstrasse 15, 04318, Leipzig, Germany.,Ruprecht-Karl-University of Heidelberg, Faculty of Biosciences, Im Neuenheimer Feld 234, 69120, Heidelberg, Germany
| | - Jörg Ahlheim
- Helmholtz Centre for Environmental Research - UFZ, Department System-Ecotoxicology, Permoserstrasse 15, 04318, Leipzig, Germany
| | - Werner Brack
- Helmholtz Centre for Environmental Research - UFZ, Department System-Ecotoxicology, Permoserstrasse 15, 04318, Leipzig, Germany.,RWTH Aachen University, Department of Ecosystem Analysis, Institute for Environmental Research, Worringerweg 1, 52074, Aachen, Germany
| | - Baldwyn Torto
- International Centre of Insect Physiology and Ecology (icipe), Human Health department, P.O. Box 30772-00100, Nairobi, Kenya
| | - Eric L Agola
- Centre for Biotechnology Research and Development, Kenya Medical Research institute (KEMRI), P.O. Box 54840-00200, Nairobi, Kenya.,The Technical University of Kenya, P.O. Box 52428-00200, Nairobi, Kenya
| | - Francis McOdimba
- International Centre of Insect Physiology and Ecology (icipe), Human Health department, P.O. Box 30772-00100, Nairobi, Kenya.,Egerton University, Biological sciences, P.O Box 536-20115, Njoro, Kenya
| | - Henner Hollert
- RWTH Aachen University, Department of Ecosystem Analysis, Institute for Environmental Research, Worringerweg 1, 52074, Aachen, Germany.,Department Evolutionary Ecology and Environmental Toxicology, Institute of Ecology, Evolution and Diversity, Faculty Biological Sciences, Goethe University Frankfurt, Frankfurt, 60438, Germany
| | - Ulrike Fillinger
- International Centre of Insect Physiology and Ecology (icipe), Human Health department, P.O. Box 30772-00100, Nairobi, Kenya.
| | - Matthias Liess
- Helmholtz Centre for Environmental Research - UFZ, Department System-Ecotoxicology, Permoserstrasse 15, 04318, Leipzig, Germany. .,RWTH Aachen University, Department of Ecosystem Analysis, Institute for Environmental Research, Worringerweg 1, 52074, Aachen, Germany.
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13
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Takeuchi R, Njenga SM, Ichinose Y, Kaneko S, Estrada CA, Kobayashi J. Is there a gap between health education content and practice toward schistosomiasis prevention among schoolchildren along the shores of Lake Victoria in Kenya? PLoS Negl Trop Dis 2019; 13:e0007572. [PMID: 31425499 PMCID: PMC6715249 DOI: 10.1371/journal.pntd.0007572] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 08/29/2019] [Accepted: 06/22/2019] [Indexed: 01/07/2023] Open
Abstract
Despite provision of preventive measures against schistosomiasis such as mass drug administration (MDA), the prevalence of Schistosoma mansoni remains high in communities living near Lake Victoria. This study aimed to analyse the status of schistosomiasis, including its prevalence, health education, knowledge, attitudes, and practices (KAP) among pupils, and water use in schools in Mbita situated along the shores of Lake Victoria. Four primary schools were selected as target schools and pupils in classes six and seven were recruited as study participants. The prevalence of S. mansoni was examined by Kato-Katz method. Simultaneously, a KAP survey toward schistosomiasis was conducted among the pupils. Health education contents were extracted from textbooks. All primary schools in the study site were surveyed regarding how each secured water used for daily school life. The prevalence of S. mansoni was 56% and 36% in 2015 and 2016, respectively. 60–70% of pupils chose a correct answer for the mode of transmission. More than 70% of pupils answered that bathing in Lake Victoria causes Schistosoma infection; however, more than 70% of pupils bathed in Lake Victoria sometimes or every day. According to the science textbook, “avoiding contact with contaminated water” is the way to prevent schistosomiasis; however, 66% of schools asked pupils to bring water from Lake Victoria. The prevalence of S. mansoni among pupils remains high. Schoolchildren are taught to avoid contact with contaminated water but are often asked to fetch water from the lake. From the school health viewpoint, health education that reflects the social and cultural context of the community in the contents and teaching methods are needed. In addition to this, provision of sanitation infrastructure is needed. A comprehensive and innovative approach which harmonises central and local governments and other stakeholders, as well as community is important to prevent schistosomiasis. According to WHO, it is estimated that at least 206 million people required preventive treatment for schistosomiasis in 2016 and of those at least 90% live in Africa. Moreover, school-age children are most affected by this worm. In Kenya, despite preventive measures against schistosomiasis such as mass drug administration (MDA) in primary schools, it remains a major public health problem, especially along the shores of Lake Victoria. Our study revealed that the prevalence of Schistosoma mansoni was high among pupils despite their knowledge about schistosomiasis transmission. This can be attributed to lack of safe water supply and latrines. A comprehensive approach which harmonises central and local governments and other stakeholders, as well as community is needed to prevent schistosomiasis. For example, the combination of health education (in which schools play as focal point) with provision of water infrastructure, encouragement to use and construct toilets in both schools and community/households, snail control, and MDA with monitoring can be employed to control and prevent schistosomiasis. From the school health viewpoint, it is necessary to develop health education contents and teaching methods that reflect the social and cultural context of the community in order to improve their behaviour and change the social norm.
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Affiliation(s)
- Rie Takeuchi
- Kenya Research Station, Institute of Tropical Medicine, Nagasaki University, Nairobi, Kenya
- * E-mail:
| | - Sammy M. Njenga
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Yoshio Ichinose
- Kenya Research Station, Institute of Tropical Medicine, Nagasaki University, Nairobi, Kenya
| | - Satoshi Kaneko
- Kenya Research Station, Institute of Tropical Medicine, Nagasaki University, Nairobi, Kenya
- Department of Eco-epidemiology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Crystal A. Estrada
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Okinawa, Japan
| | - Jun Kobayashi
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Okinawa, Japan
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14
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Gichuki PM, Kepha S, Mulewa D, Masaku J, Kwoba C, Mbugua G, Mazigo HD, Mwandawiro C. Association between Schistosoma mansoni infection and access to improved water and sanitation facilities in Mwea, Kirinyaga County, Kenya. BMC Infect Dis 2019; 19:503. [PMID: 31174478 PMCID: PMC6556037 DOI: 10.1186/s12879-019-4105-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 05/17/2019] [Indexed: 11/24/2022] Open
Abstract
Background Schistosomiasis remains a public health problem in Central Kenya despite concerted control efforts. Access to improved water and sanitation has been emphasized as important control measures. Few studies have assessed the association between access to improved water sources and sanitation facilities with Schistosoma mansoni infection in different environmental settings. This study assessed the association between S. mansoni infection and household access to improved water sources and sanitation facilities in Mwea, Kirinyaga County, Kenya. Methods A cross sectional study was conducted between the months of August and October 2017. A total of 905 household heads from seven villages were interviewed and their stool samples screened for S. mansoni using the Kato Katz technique. Comparisons of demographic factors by S. mansoni infection were tested for significance using the chi-square test (χ2) or the Fisher exact test for categorical variables. Variables associated with S. mansoni infection were analyzed using univariable analysis and the strength of the association measured as odds ratio (OR) using mixed effects logistic regression at 95% CI, with values considered significant at p < 0.05. Results The overall prevalence of S. mansoni was, 23.1% (95% CI: 20.5–26.0%), with majority of the infections being of light intensity. Rurumi village had the highest prevalence at 33.3%, with Kirogo village having the least prevalence at 7.0%. Majority (84.1%) of the households lacked access to improved water sources but had access to improved sanitation facilities (75%). Households with access to piped water had the lowest S. mansoni infections. However, there was no significant association between S. mansoni infections with either the main source of water in the household (Odds Ratio (OR) =0.782 (95% CI: 0.497–1.229) p = 0.285 or sanitation facilities (OR = 1.018 (95% CI: 0.705–1.469) p = 0.926. Conclusion Our study suggests that S. mansoni is still a public health problem among all age groups in Mwea irrigation scheme, Kirinyaga County, Central Kenya. Majority of the households lacks access to improved water sources but have access to improved sanitation facilities. This study recommends initiatives to ensure adequate provision of improved water sources, and the inclusion of the adult community in preventive chemotherapy programs. Electronic supplementary material The online version of this article (10.1186/s12879-019-4105-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Paul M Gichuki
- Eastern and Southern Africa Center for International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), P.O BOX 54840-00200, Nairobi, Kenya. .,School of Health Sciences, Meru University of Science and Technology, P.O BOX 972-60200, Meru, Kenya.
| | - Stella Kepha
- London School of Tropical Medicine and Hygiene, Keppel St, Bloomsbury, London, WCIE 7HT, UK.,School of Public Health, Pwani University, P.O BOX 195-80108, Mombasa, Kenya
| | - Damaris Mulewa
- Eastern and Southern Africa Center for International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), P.O BOX 54840-00200, Nairobi, Kenya
| | - Janet Masaku
- Eastern and Southern Africa Center for International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), P.O BOX 54840-00200, Nairobi, Kenya
| | - Celestine Kwoba
- Vectorborne diseases Control Unit, Ministry of Health, P.o box 86-10303, Wanguru, Kenya
| | - Gabriel Mbugua
- School of Health Sciences, Meru University of Science and Technology, P.O BOX 972-60200, Meru, Kenya
| | - Humphrey D Mazigo
- Department of Medical Parasitology, School of Medicine, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Charles Mwandawiro
- Eastern and Southern Africa Center for International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), P.O BOX 54840-00200, Nairobi, Kenya
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15
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de Glanville WA, Thomas LF, Cook EAJ, Bronsvoort BMDC, Wardrop N, Wamae CN, Kariuki S, Fèvre EM. General contextual effects on neglected tropical disease risk in rural Kenya. PLoS Negl Trop Dis 2018; 12:e0007016. [PMID: 30576335 PMCID: PMC6342328 DOI: 10.1371/journal.pntd.0007016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 01/22/2019] [Accepted: 11/22/2018] [Indexed: 01/20/2023] Open
Abstract
The neglected tropical diseases (NTDs) are characterized by their tendency to cluster within groups of people, typically the poorest and most marginalized. Despite this, measures of clustering, such as within-group correlation or between-group heterogeneity, are rarely reported from community-based studies of NTD risk. We describe a general contextual analysis that uses multi-level models to partition and quantify variation in individual NTD risk at multiple grouping levels in rural Kenya. The importance of general contextual effects (GCE) in structuring variation in individual infection with Schistosoma mansoni, the soil-transmitted helminths, Taenia species, and Entamoeba histolytica/dispar was examined at the household-, sublocation- and constituency-levels using variance partition/intra-class correlation co-efficients and median odds ratios. These were compared with GCE for HIV, Plasmodium falciparum and Mycobacterium tuberculosis. The role of place of residence in shaping infection risk was further assessed using the spatial scan statistic. Individuals from the same household showed correlation in infection for all pathogens, and this was consistently highest for the gastrointestinal helminths. The lowest levels of household clustering were observed for E. histolytica/dispar, P. falciparum and M. tuberculosis. Substantial heterogeneity in individual infection risk was observed between sublocations for S. mansoni and Taenia solium cysticercosis and between constituencies for infection with S. mansoni, Trichuris trichiura and Ascaris lumbricoides. Large overlapping spatial clusters were detected for S. mansoni, T. trichiura, A. lumbricoides, and Taenia spp., which overlapped a large cluster of elevated HIV risk. Important place-based heterogeneities in infection risk exist in this community, and these GCEs are greater for the NTDs and HIV than for TB and malaria. Our findings suggest that broad-scale contextual drivers shape infectious disease risk in this population, but these effects operate at different grouping-levels for different pathogens. A general contextual analysis can provide a foundation for understanding the complex ecology of NTDs and contribute to the targeting of interventions.
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Affiliation(s)
- William A. de Glanville
- Centre for Immunity, Infection and Evolution, Institute for Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
- International Livestock Research Institute, Nairobi, Kenya
| | - Lian F. Thomas
- Centre for Immunity, Infection and Evolution, Institute for Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
- International Livestock Research Institute, Nairobi, Kenya
| | - Elizabeth A. J. Cook
- Centre for Immunity, Infection and Evolution, Institute for Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
- International Livestock Research Institute, Nairobi, Kenya
| | - Barend M. de C. Bronsvoort
- The Roslin Institute, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Roslin, Midlothian, United Kingdom
| | - Nicola Wardrop
- Department of Geography and Environment, University of Southampton, Highfield Campus, Southampton, United Kingdom
| | - Claire N. Wamae
- School of Pharmacy and Health Sciences, United States International University, Nairobi, Kenya
| | - Samuel Kariuki
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Eric M. Fèvre
- International Livestock Research Institute, Nairobi, Kenya
- Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Neston, United Kingdom
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16
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Sircar AD, Mwinzi PNM, Onkanga IO, Wiegand RE, Montgomery SP, Secor WE. Schistosoma mansoni Mass Drug Administration Regimens and Their Effect on Morbidity among Schoolchildren over a 5-Year Period-Kenya, 2010-2015. Am J Trop Med Hyg 2018; 99:362-369. [PMID: 29893197 PMCID: PMC6090338 DOI: 10.4269/ajtmh.18-0067] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 03/22/2018] [Indexed: 12/24/2022] Open
Abstract
Schistosomiasis control programs are designed to reduce morbidity by providing mass drug administration (MDA) of praziquantel to at-risk populations. We compared morbidity markers between two cohorts of Kenyan schoolchildren that initially had high prevalence of Schistosoma mansoni infections. One cohort (N = 416 at year 1) received four rounds of annual MDA in a community-wide treatment (CWT) strategy. The other cohort (N = 386 at year 1) received school-based treatment (SBT) every other year over the 4-year period. We measured infection with S. mansoni and soil-transmitted helminths (STH) as well as subtle morbidity markers at year 1, year 3, and year 5 and compared cohorts with mixed models after controlling for age and gender. At year 5, neither overall S. mansoni prevalence nor the prevalence of high infection-intensity S. mansoni infection was significantly reduced compared with baseline in either the CWT cohort (N = 277 remaining) or the SBT cohort (N = 235 remaining). Nevertheless, by year 5, children in both cohorts demonstrated significant decreases in wasting, ultrasound-detected organomegaly, and STH infection along with significantly improved pediatric quality-of-life scores compared with year 1. Stunting did not change over time, but children who were S. mansoni egg-positive at year 5 had significantly more stunting than children without schistosomiasis. The only significant difference between arms at year 5 was a lower prevalence of STH infections in the CWT group.
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Affiliation(s)
- Anita D. Sircar
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pauline N. M. Mwinzi
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Isaac O. Onkanga
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Ryan E. Wiegand
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan P. Montgomery
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - W. Evan Secor
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
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17
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Abudho BO, Ndombi EM, Guya B, Carter JM, Riner DK, Kittur N, Karanja DMS, Secor WE, Colley DG. Impact of Four Years of Annual Mass Drug Administration on Prevalence and Intensity of Schistosomiasis among Primary and High School Children in Western Kenya: A Repeated Cross-Sectional Study. Am J Trop Med Hyg 2018. [PMID: 29532768 PMCID: PMC5953387 DOI: 10.4269/ajtmh.17-0908] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Schistosomiasis remains a major public health problem in Kenya. The World Health Organization recommends preventive chemotherapy with praziquantel (PZQ) to control morbidity due to schistosomiasis. Morbidity is considered linked to intensity of infection, which along with prevalence is used to determine the frequency of mass drug administration (MDA) to school-age children. We determined the impact of annual school-based MDA on children across all primary and high school years using a repeated cross-sectional study design in five schools near Lake Victoria in western Kenya, an area endemic for Schistosoma mansoni. At baseline and for the following four consecutive years, between 897 and 1,440 school children in Grades 1-12 were enrolled and evaluated by Kato-Katz for S. mansoni and soil-transmitted helminths (STH), followed by annual MDA with PZQ and albendazole. Four annual rounds of MDA with PZQ were associated with reduced S. mansoni prevalence in all school children (44.7-14.0%; P < 0.001) and mean intensity of infection by 91% (90.4 to 8.1 eggs per gram [epg] of stool; P < 0.001). Prevalence of high-intensity infection (≥ 400 epg) decreased from 6.8% at baseline to 0.3% by the end of the study. Soil-transmitted helminth infections, already low at baseline, also decreased significantly over the years. In this high prevalence area, annual school-based MDA with high coverage across all Grades (1-12) resulted in rapid and progressive declines in overall prevalence and intensity of infection. This decrease was dramatic in regard to heavy infections in older school-attending children.
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Affiliation(s)
- Bernard O Abudho
- Department of Biomedical Sciences, School of Public Health, Maseno University, Maseno, Kenya.,Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Eric M Ndombi
- Department of Pathology, Kenyatta University, Nairobi, Kenya.,Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Bernard Guya
- Department of Biomedical Sciences, School of Public Health, Maseno University, Maseno, Kenya
| | - Jennifer M Carter
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Diana K Riner
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Nupur Kittur
- Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Diana M S Karanja
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - W Evan Secor
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Daniel G Colley
- Department of Microbiology, University of Georgia, Athens, Georgia.,Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
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18
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Wiegand RE, Mwinzi PNM, Montgomery SP, Chan YL, Andiego K, Omedo M, Muchiri G, Ogutu MO, Rawago F, Odiere MR, Karanja DMS, Secor WE. A Persistent Hotspot of Schistosoma mansoni Infection in a Five-Year Randomized Trial of Praziquantel Preventative Chemotherapy Strategies. J Infect Dis 2017; 216:1425-1433. [PMID: 28968877 PMCID: PMC5913648 DOI: 10.1093/infdis/jix496] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 09/13/2017] [Indexed: 12/28/2022] Open
Abstract
Background Persistent hotspots have been described after mass drug administration (MDA) for the control of schistosomiasis, but they have not been studied during the course of a multiyear MDA program. Methods In data from a 5-year study of school-based and village-wide preventive chemotherapy strategies for Schistosoma mansoni, spatial scan statistics were used to find infection hotspots in 3 populations: 5- to 8-year-olds, 9- to 12-year-olds, and adults. Negative binomial regression was used to analyze changes from baseline, and receiver operating characteristic analyses were used to predict which villages would reach prevalence and intensity endpoints. Results We identified a persistent hotspot, not associated with study arm, where S. mansoni infection prevalence and intensity did not decrease as much as in villages outside the hotspot. Significant differences from baseline were realized after 1 year of MDA: we did not identify factors that moderated this relationship. Villages meeting specified endpoints at year 5 were predicted from prior year data with moderately high sensitivity and specificity. Conclusions The MDA strategies were less effective at reducing prevalence and intensity in the hotspot compared with other villages. Villages that reached year 5 endpoints could be detected earlier, which may provide the opportunity to amend intervention strategies.
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Affiliation(s)
- Ryan E Wiegand
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pauline N M Mwinzi
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu
| | - Susan P Montgomery
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Kennedy Andiego
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu
| | - Martin Omedo
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu
| | - Geoffrey Muchiri
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu
| | - Michael O Ogutu
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu
| | - Fredrick Rawago
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu
| | - Maurice R Odiere
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu
| | - Diana M S Karanja
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu
| | - W Evan Secor
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
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Won KY, Kanyi HM, Mwende FM, Wiegand RE, Goodhew EB, Priest JW, Lee YM, Njenga SM, Secor WE, Lammie PJ, Odiere MR. Multiplex Serologic Assessment of Schistosomiasis in Western Kenya: Antibody Responses in Preschool Aged Children as a Measure of Reduced Transmission. Am J Trop Med Hyg 2017; 96:1460-1467. [PMID: 28719280 PMCID: PMC5462587 DOI: 10.4269/ajtmh.16-0665] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Currently, impact of schistosomiasis control programs in Schistosoma mansoni–endemic areas is monitored primarily by assessment of parasitologic indicators only. Our study was conducted to evaluate the use of antibody responses as a way to measure the impact of schistosomiasis control programs. A total of 3,612 serum samples collected at three time points from children 1–5 years of age were tested for antibody responses to two schistosome antigens (soluble egg antigen [SEA] and Sm25) by multiplex bead assay. The overall prevalence of antibody responses to SEA was high at baseline (50.0%). After one round of mass drug administration (MDA), there was minimal change in odds of SEA positivity (odds ratio [OR] = 1.02, confidence interval [CI] = 0.79–1.32, P = 0.89). However, after two rounds of treatment, there was a slight decrease in odds of SEA positivity (OR = 0.80, CI = 0.63–1.02, P = 0.08). In contrast to the SEA results, prevalence of antibody responses to Sm25 was lowest at baseline (14.1%) and higher in years 2 (19.8%) and 3 (18.4%). After one round of MDA, odds of Sm25 positivity increased significantly (OR = 1.51, CI = 1.14–2.02, P = 0.005) and remained significantly higher than baseline after two rounds of MDA (OR = 1.37, CI = 1.07–1.76, P = 0.01). There was a significant decrease in the proportion of 1-year-olds with positive SEA responses from 33.1% in year 1 to 13.2% in year 3 and a corresponding decrease in the odds (OR = 3.25, CI = 1.75–6.08, P < 0.001). These results provide preliminary evidence that schistosomiasis program impact can be monitored using serologic responses.
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Affiliation(s)
- Kimberly Y Won
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Henry M Kanyi
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Faith M Mwende
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Ryan E Wiegand
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - E Brook Goodhew
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeffrey W Priest
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yeuk-Mui Lee
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sammy M Njenga
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - W Evan Secor
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Patrick J Lammie
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maurice R Odiere
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
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20
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Pennance T, Person B, Muhsin MA, Khamis AN, Muhsin J, Khamis IS, Mohammed KA, Kabole F, Rollinson D, Knopp S. Urogenital schistosomiasis transmission on Unguja Island, Zanzibar: characterisation of persistent hot-spots. Parasit Vectors 2016; 9:646. [PMID: 27986092 PMCID: PMC5162088 DOI: 10.1186/s13071-016-1847-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 10/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Elimination of urogenital schistosomiasis transmission is a priority for the Zanzibar Ministry of Health. Preventative chemotherapy together with additional control interventions have successfully alleviated much of the disease burden. However, a persistently high Schistosoma haematobium prevalence is found in certain areas. Our aim was to characterise and evaluate these persistent "hot-spots" of transmission and reinfection in comparison with low-prevalence areas, to support the intervention planning for schistosomiasis elimination in Zanzibar. METHODS Prevalences of S. haematobium were annually determined by a single urine filtration in schoolchildren from 45 administrative areas (shehias) in Unguja in 2012, 2013 and 2014. Coverage data for biannual treatment with praziquantel were available from ministerial databases and internal surveys. Among the 45 shehias, five hot-spot (≥ 15 % prevalence) and two low-prevalence (≤ 5 %) shehias were identified and surveyed in mid-2014. Human-water contact sites (HWCSs) and the presence of S. haematobium-infected and uninfected Bulinus globosus, as well as safe water sources (SWSs) and their reliability in terms of water availability were determined and mapped. RESULTS We found no major difference in the treatment coverage between persistent hot-spot and low-prevalence shehias. On average, there were considerably more HWCSs containing B. globosus in hot-spot than in low-prevalence shehias (n = 8 vs n = 2) and also more HWCSs containing infected B. globosus (n = 2 vs n = 0). There was no striking difference in the average abundance of SWSs in hot-spot and low-prevalence shehias (n = 45 vs n = 38) and also no difference when considering SWSs with a constant water supply (average: 62 % vs 62 %). The average number of taps with a constant water supply, however, was lower in hot-spot shehias (n = 7 vs n = 14). Average distances from schools to the nearest HWCS were considerably shorter in hot-spot shehias (n = 229 m vs n = 722 m). CONCLUSION The number of HWCSs, their infestation with B. globosus and their distance to schools seem to play a major role for a persistently high S. haematobium prevalence in children. In addition to treatment, increasing access to reliably working taps, targeted snail control at HWCSs near schools and enhanced behaviour change measures are needed to reduce prevalences in hot-spot areas and to finally reach elimination. TRIAL REGISTRATION ISRCTN48837681 .
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Affiliation(s)
- Tom Pennance
- Wolfson Wellcome Biomedical Laboratories, Department of Life Sciences, Natural History Museum, Cromwell Road, London, SW7 5BD, UK.,Department of Pathology and Pathogen Biology, Centre for Emerging, Endemic and Exotic Diseases, Royal Veterinary College, University of London, Hawkshead Lane, Hatfield, Hertfordshire, AL9 7TA, UK
| | - Bobbie Person
- Independent Consultant, Schistosomiasis Consortium for Operational Research and Evaluation, University of Georgia, Athens, GA, USA
| | - Mtumweni Ali Muhsin
- Zanzibar Neglected Tropical Diseases Programme, Ministry of Health, P.O. Box 236, Zanzibar Town, Unguja, United Republic of Tanzania
| | - Alipo Naim Khamis
- Zanzibar Neglected Tropical Diseases Programme, Ministry of Health, P.O. Box 236, Zanzibar Town, Unguja, United Republic of Tanzania
| | - Juma Muhsin
- Zanzibar Neglected Tropical Diseases Programme, Ministry of Health, P.O. Box 236, Zanzibar Town, Unguja, United Republic of Tanzania
| | - Iddi Simba Khamis
- Zanzibar Neglected Tropical Diseases Programme, Ministry of Health, P.O. Box 236, Zanzibar Town, Unguja, United Republic of Tanzania
| | - Khalfan Abdallah Mohammed
- Zanzibar Neglected Tropical Diseases Programme, Ministry of Health, P.O. Box 236, Zanzibar Town, Unguja, United Republic of Tanzania
| | - Fatma Kabole
- Zanzibar Neglected Tropical Diseases Programme, Ministry of Health, P.O. Box 236, Zanzibar Town, Unguja, United Republic of Tanzania
| | - David Rollinson
- Wolfson Wellcome Biomedical Laboratories, Department of Life Sciences, Natural History Museum, Cromwell Road, London, SW7 5BD, UK
| | - Stefanie Knopp
- Wolfson Wellcome Biomedical Laboratories, Department of Life Sciences, Natural History Museum, Cromwell Road, London, SW7 5BD, UK. .,Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, CH-4002, Basel, Switzerland. .,University of Basel, Petersplatz 1, CH-4003, Basel, Switzerland.
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21
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Kepha S, Nuwaha F, Nikolay B, Gichuki P, Edwards T, Allen E, Njenga SM, Mwandawiro CS, Brooker SJ. Epidemiology of coinfection with soil transmitted helminths and Plasmodium falciparum among school children in Bumula District in western Kenya. Parasit Vectors 2015; 8:314. [PMID: 26063324 PMCID: PMC4486705 DOI: 10.1186/s13071-015-0891-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 05/07/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Many school children living in Africa are infected with plasmodia and helminth species and are consequently at risk of coinfection. However, the epidemiology of such coinfection and the implications of coinfection for children's health remain poorly understood. This study describes the epidemiology of Ascaris lumbricoides-Plasmodium and hookworm-Plasmodium coinfection among school children living in western Kenya and investigates the associated risk factors. METHODS As part of a randomized trial, a baseline cross-sectional survey was conducted among school children aged 5-18 years in 23 schools in Bumula District. Single stool samples were collected to screen for helminth infections using the Kato-Katz technique and malaria parasitaemia was determined from a finger prick blood sample. Demographic and anthropometric data were also collected. RESULTS Overall, 46.4% of the children were infected with Plasmodium falciparum while 27.6% of the children were infected with at least one soil transmitted helminth (STH) species, with hookworm being the most common (16.8%) followed by A. lumbricoides (15.3%). Overall 14.3% of the children had STH-Plasmodium coinfection, with hookworm-Plasmodium (9.0%) coinfection being the most common. Geographical variation in the prevalence of coinfection occurred between schools. In multivariable logistic regression analysis, hookworm was positively associated with P. falciparum infection. In stratified analysis, hookworm infection was associated with increased odds of P. falciparum infection among both boys (P < 0.001) and girls (P = 0.01), whereas there was no association between A. lumbricoides and P. falciparum. CONCLUSION These findings demonstrate STH infections are still prevalent, despite the ongoing national deworming programme in Kenya, and that malaria parasitaemia is widespread, such that coinfection occurs among a proportion of children. A subsequent trial will allow us to investigate the implications of coinfection for the risk of clinical malaria.
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Affiliation(s)
- Stella Kepha
- College of Health Sciences, Makerere University, Kampala, Uganda. .,Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
| | - Fred Nuwaha
- College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Birgit Nikolay
- London School of Hygiene & Tropical Medicine, London, UK.
| | - Paul Gichuki
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
| | - Tansy Edwards
- London School of Hygiene & Tropical Medicine, London, UK.
| | | | - Sammy M Njenga
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
| | - Charles S Mwandawiro
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
| | - Simon J Brooker
- London School of Hygiene & Tropical Medicine, London, UK. .,KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
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22
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Davis SM, Wiegand RE, Mulama F, Kareko EI, Harris R, Ochola E, Samuels AM, Rawago F, Mwinzi PM, Fox LM, Odiere MR, Won KY. Morbidity associated with schistosomiasis before and after treatment in young children in Rusinga Island, western Kenya. Am J Trop Med Hyg 2015; 92:952-8. [PMID: 25758651 DOI: 10.4269/ajtmh.14-0346] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 01/19/2015] [Indexed: 11/07/2022] Open
Abstract
Schistosoma mansoni infection is a major cause of organomegaly and ultimately liver fibrosis in adults. Morbidity in pre-school-aged children is less defined, and they are currently not included in mass drug administration (MDA) programs for schistosomiasis control. We report results of a study of the association of schistosomiasis with organomegaly in a convenience sample of 201 children under 7 years old in Rusinga, Kenya on two cross-sectional visits, before and after praziquantel treatment. Data included stool examination and serology for schistosomiasis, the Niamey ultrasound protocol to stage hepatosplenic morbidity including organomegaly, and potential confounders including malaria. Unadjusted and adjusted Poisson regressions were performed. The baseline prevalence of schistosomiasis by antibody and/or stool was 80.3%. Schistomiasis was associated with hepatomegaly (adjusted prevalence ratio [aPR] = 1.4; 95% confidence interval [CI]: 1.0-2.1) and splenomegaly (aPR = 2.1; 95% CI: 1.2-3.7). The association with hepatomegaly persisted posttreatment (aPR = 1.4; 95% CI: 1.1-1.6). Schistosomiasis was associated with morbidity in this cohort. Efforts to include young children in mass treatment campaigns should intensify.
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Affiliation(s)
- Stephanie M Davis
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Data Management Activity, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Neglected Tropical Diseases Unit, Kisumu, Kenya; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Radiology, Geisel School of Medicine at Dartmouth University, Hanover, New Hampshire
| | - Ryan E Wiegand
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Data Management Activity, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Neglected Tropical Diseases Unit, Kisumu, Kenya; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Radiology, Geisel School of Medicine at Dartmouth University, Hanover, New Hampshire
| | - Fridah Mulama
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Data Management Activity, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Neglected Tropical Diseases Unit, Kisumu, Kenya; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Radiology, Geisel School of Medicine at Dartmouth University, Hanover, New Hampshire
| | - Edmund Ireri Kareko
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Data Management Activity, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Neglected Tropical Diseases Unit, Kisumu, Kenya; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Radiology, Geisel School of Medicine at Dartmouth University, Hanover, New Hampshire
| | - Robert Harris
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Data Management Activity, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Neglected Tropical Diseases Unit, Kisumu, Kenya; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Radiology, Geisel School of Medicine at Dartmouth University, Hanover, New Hampshire
| | - Elizabeth Ochola
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Data Management Activity, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Neglected Tropical Diseases Unit, Kisumu, Kenya; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Radiology, Geisel School of Medicine at Dartmouth University, Hanover, New Hampshire
| | - Aaron M Samuels
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Data Management Activity, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Neglected Tropical Diseases Unit, Kisumu, Kenya; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Radiology, Geisel School of Medicine at Dartmouth University, Hanover, New Hampshire
| | - Fredrick Rawago
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Data Management Activity, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Neglected Tropical Diseases Unit, Kisumu, Kenya; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Radiology, Geisel School of Medicine at Dartmouth University, Hanover, New Hampshire
| | - Pauline M Mwinzi
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Data Management Activity, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Neglected Tropical Diseases Unit, Kisumu, Kenya; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Radiology, Geisel School of Medicine at Dartmouth University, Hanover, New Hampshire
| | - LeAnne M Fox
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Data Management Activity, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Neglected Tropical Diseases Unit, Kisumu, Kenya; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Radiology, Geisel School of Medicine at Dartmouth University, Hanover, New Hampshire
| | - Maurice R Odiere
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Data Management Activity, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Neglected Tropical Diseases Unit, Kisumu, Kenya; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Radiology, Geisel School of Medicine at Dartmouth University, Hanover, New Hampshire
| | - Kimberly Y Won
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Data Management Activity, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Neglected Tropical Diseases Unit, Kisumu, Kenya; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Radiology, Geisel School of Medicine at Dartmouth University, Hanover, New Hampshire
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23
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Mugono M, Konje E, Kuhn S, Mpogoro FJ, Morona D, Mazigo HD. Intestinal schistosomiasis and geohelminths of Ukara Island, North-Western Tanzania: prevalence, intensity of infection and associated risk factors among school children. Parasit Vectors 2014; 7:612. [PMID: 25533267 PMCID: PMC4297386 DOI: 10.1186/s13071-014-0612-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 12/18/2014] [Indexed: 12/02/2022] Open
Abstract
Background Schistosoma mansoni and soil-transmitted helminths (STH) are among the most prevalent and highly neglected tropical diseases in Tanzania. However, little is known on the distribution of these infections in rural settings, especially in the island areas on Lake Victoria. Identifying the local risk factors of S. mansoni and soil-transmitted helminths is one step towards understanding their transmission patterns and will facilitate the design of cost-effective intervention measures. The present study was therefore conducted to determine the prevalence, intensity of infection and risk factors associated with S. mansoni and soil-transmitted helminth infections among school children in Ukara Island. Methods This was a cross sectional study which enrolled 774 school children aged 4-15 years in 5 primary schools in Ukara Island, North-Western Tanzania. Single stool samples were collected, processed using the Kato Katz technique and examined for eggs of S. mansoni and geohelminths under a light microscope. A pre-tested questionnaire was used to collect socio-demographic information. Results Overall, 494/773 (63.91%, 95% CI; 45.19-90.36) of the study participants were infected with S. mansoni and the overall geometrical mean eggs per gram (GM-epg) of feaces were 323.41epg (95% CI: 281.09 – 372.11). The overall prevalence of soil-transmitted helminth (STH) was 6.73% (n = 52/773, 95% CI = 4.39 – 10.32) with the most prevalent species being hookworms, 5.69% (n = 44/773, 95% CI; 3.68 – 8.79). Location of school in the study villages (P < 0.0001), parent occupation, fishing (P < 0.03) and reported involvement in fishing activities (P < 0.048) remained significantly associated with the prevalence and intensity of S.mansoni infection. Conclusion Schistosoma mansoni infection is highly prevalent in the islands whereas the prevalence of soil-transmitted helminths is low. The risk of infection with S. mansoni and the intensity of infection increased along the shorelines of Lake Victoria. These findings call for the need to urgently implement integrated control interventions, starting with targeted mass drug administration. Electronic supplementary material The online version of this article (doi:10.1186/s13071-014-0612-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Moshi Mugono
- School of Public Health, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania.
| | - Evelyne Konje
- School of Public Health, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania.
| | - Susan Kuhn
- Department of Paediatrics, Section of Infectious Diseases, University of Calgary, Calgary, Canada.
| | - Filbert J Mpogoro
- School of Public Health, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania.
| | - Domenica Morona
- Department of Medical Parasitology and Entomology, School of Medicine, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania.
| | - Humphrey D Mazigo
- Department of Medical Parasitology and Entomology, School of Medicine, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania.
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24
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Makaula P, Sadalaki JR, Muula AS, Kayuni S, Jemu S, Bloch P. Schistosomiasis in Malawi: a systematic review. Parasit Vectors 2014; 7:570. [PMID: 25490938 PMCID: PMC4288699 DOI: 10.1186/s13071-014-0570-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 11/25/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Schistosomiasis remains an important public health problem that undermines social and economic development in tropical regions of the world, mainly Sub-Saharan Africa. We are not aware of any systematic review of the literature of the epidemiology and transmission of schistosomiasis in Malawi since 1985. Therefore, we reviewed the current state of knowledge of schistosomiasis epidemiology and transmission in this country and identified knowledge gaps and relevant areas for future research and research governance. METHODS We conducted computer-aided literature searches of Medline, SCOPUS and Google Scholar using the keywords: "schistosomiasis", "Bilharzia", "Bulinus" and "Biomphalaria" in combination with "Malawi". These searches were supplemented by iterative reviews of reference lists for relevant publications in peer reviewed international scientific journals or other media. The recovered documents were reviewed for their year of publication, location of field or laboratory work, authorship characteristics, ethics review, funding sources as well as their findings regarding parasite and intermediate host species, environmental aspects, geographical distribution, seasonality of transmission, and infection prevalence and intensities. REVIEW A total of 89 documents satisfied the inclusion criteria and were reviewed. Of these, 76 were published in international scientific journals, 68 were peer reviewed and 54 were original research studies. Most of the documents addressed urinary schistosomiasis and about two thirds of them dealt with the definitive host. Few documents addressed the parasites and the intermediate hosts. While urinary schistosomiasis occurs in most parts of Malawi, intestinal schistosomiasis mainly occurs in the central and southern highlands, Likoma Island and Lower Shire. Studies in selected communities estimated prevalence rates of up to 94.9% for Schistosoma haematobium and up to 67.0% for Schistosoma mansoni with considerable geographical variation. The main intermediate host species are Bulinus globosus and Bulinus nyassanus for urinary schistosomiasis and Biomphalaria pfeifferi for intestinal schistosomiasis. Seasonality of transmission tends to vary according to geographical, environmental, biological and behavioural factors. CONCLUSION Transmission of schistosomiasis in Malawi appears to be highly focal, with considerable variation in space and time. Many locations have not been covered by epidemiological investigations and, thus, information on the transmission of schistosomiasis in Malawi remains fragmented. Functional infection risk assessment systems based on systematic investigations and surveillance are required for developing informed prevention and control strategies.
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Affiliation(s)
- Peter Makaula
- Research for Health Environment and Development, P.O. Box 345, Mangochi, Malawi.
| | - John R Sadalaki
- School of Public Health and Family Medicine, Department of Public Health, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi.
| | - Adamson S Muula
- School of Public Health and Family Medicine, Department of Public Health, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi.
| | - Sekeleghe Kayuni
- Medical Aid Society of Malawi (MASM) Medi Clinics, P.O. Box 1254, Blantyre, Malawi.
| | - Samuel Jemu
- Ministry of Health, P.O. Box 30377, Capital City, Lilongwe 3, Malawi.
| | - Paul Bloch
- Steno Health Promotion Center, Steno Diabetes Center, Niels Steensens Vej 8, DK-2820, Gentofte, Denmark.
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Andereck JW, Kipp AM, Ondiek M, Vermund SH. Helminth prevalence among adults in rural Kenya: a stool survey for soil-transmitted helminths and schistosomiasis in Nyanza province. Trans R Soc Trop Med Hyg 2014; 108:804-9. [PMID: 25359321 DOI: 10.1093/trstmh/tru164] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Soil-transmitted helminth (STH) prevalence in children is high in rural southwestern Kenya, but adult prevalence data are scarce. A 2010 study of a village in Nyanza province found a pediatric STH prevalence of 44% using a direct stool-smear method. Adult STH prevalence and associated predictors was measured in the same village. METHODS Adults (≥18 years) presenting at the out-patient department of the small hospital or community outreach events completed a short questionnaire and provided stool samples. Light microscopy for ova and larvae was conducted using a stool concentration technique to improve sensitivity. Multivariable regression models were used to identify predictors of STH prevalence. RESULTS Among 344 adults, STH prevalence was 15.7% (54/344). Hookworm was most common (13.1%; 45/344), followed by Ascaris lumbricoides (6.1%; 21/344) and Trichuris trichiura (0.6%; 2/344). Twelve participants (3.5%; 12/344) had multiple STHs and three (0.9%; 3/344) had Schistosoma mansoni. Female sex, older age and lower education level were significant STH predictors. CONCLUSIONS Adult STH prevalence was lower than previous studies of children from the same village. Adults with the identified risk factors had a prevalence of ≥20%, which may warrant periodic, targeted deworming of adults with these risk factors given the low cost and low toxicity of anthelmintic drugs.
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Affiliation(s)
| | - Aaron M Kipp
- Vanderbilt Institute for Global Health, Nashville, Tennessee, USA Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Sten H Vermund
- Vanderbilt Institute for Global Health, Nashville, Tennessee, USA Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Ndeffo Mbah ML, Skrip L, Greenhalgh S, Hotez P, Galvani AP. Impact of Schistosoma mansoni on malaria transmission in Sub-Saharan Africa. PLoS Negl Trop Dis 2014; 8:e3234. [PMID: 25329403 PMCID: PMC4199517 DOI: 10.1371/journal.pntd.0003234] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 09/02/2014] [Indexed: 01/22/2023] Open
Abstract
Background Sub-Saharan Africa harbors the majority of the global burden of malaria and schistosomiasis infections. The co-endemicity of these two tropical diseases has prompted investigation into the mechanisms of coinfection, particularly the competing immunological responses associated with each disease. Epidemiological studies have shown that infection with Schistosoma mansoni is associated with a greater malaria incidence among school-age children. Methodology We developed a co-epidemic model of malaria and S. mansoni transmission dynamics which takes into account key epidemiological interaction between the two diseases in terms of elevated malaria incidence among individuals with S. mansoni high egg output. The model was parameterized for S. mansoni high-risk endemic communities, using epidemiological and clinical data of the interaction between S. mansoni and malaria among children in sub-Saharan Africa. We evaluated the potential impact of the S. mansoni–malaria interaction and mass treatment of schistosomiasis on malaria prevalence in co-endemic communities. Principal Findings Our results suggest that in the absence of mass drug administration of praziquantel, the interaction between S. mansoni and malaria may reduce the effectiveness of malaria treatment for curtailing malaria transmission, in S. mansoni high-risk endemic communities. However, when malaria treatment is used in combination with praziquantel, mass praziquantel administration may increase the effectiveness of malaria control intervention strategy for reducing malaria prevalence in malaria- S. mansoni co-endemic communities. Conclusions/Significance Schistosomiasis treatment and control programmes in regions where S. mansoni and malaria are highly prevalent may have indirect benefits on reducing malaria transmission as a result of disease interactions. In particular, mass praziquantel administration may not only have the direct benefit of reducing schistosomiasis infection, it may also reduce malaria transmission and disease burden. Malaria and Schistosoma mansoni are co-endemic in many regions of sub-Saharan Africa. Evidence from clinical and epidemiological studies support the hypothesis that concurrent infection with S. mansoni is associated with greater malaria incidence among school-age children. We use mathematical modeling to evaluate the epidemiological impact of S. mansoni infection on malaria transmission in sub-Saharan Africa. Using epidemiological data on the increased risk of malaria incidence in S. mansoni endemic communities from Senegal, we developed a co-epidemic model of malaria and S. mansoni transmission dynamics to address key epidemiological interactions between the two diseases. Parameterizing our model for S. mansoni high-risk endemic communities, we show that the interaction between S. mansoni and malaria may reduce the effectiveness of malaria treatment for curtailing malaria transmission. Moreover, we show that in addition to reducing schistosomiasis health burden, mass praziquantel administration will generate indirect benefit in terms of reducing malaria transmission and disease burden in S. mansoni–malaria co-endemic communities. Our findings indicate the possible benefit of scaling up schistosomiasis control efforts in sub-Saharan Africa, and especially in areas were S. mansoni and malaria are highly prevalent.
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Affiliation(s)
- Martial L. Ndeffo Mbah
- School of Public Health, Yale University, New Haven, Connecticut, United States of America
- * E-mail:
| | - Laura Skrip
- School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - Scott Greenhalgh
- School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - Peter Hotez
- National School of Tropical Medicine, and Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development, Baylor College of Medicine, Houston, Texas, United States of America
| | - Alison P. Galvani
- School of Public Health, Yale University, New Haven, Connecticut, United States of America
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27
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Sime H, Deribe K, Assefa A, Newport MJ, Enquselassie F, Gebretsadik A, Kebede A, Hailu A, Shafi O, Aseffa A, Reithinger R, Brooker SJ, Pullan RL, Cano J, Meribo K, Pavluck A, Bockarie MJ, Rebollo MP, Davey G. Integrated mapping of lymphatic filariasis and podoconiosis: lessons learnt from Ethiopia. Parasit Vectors 2014; 7:397. [PMID: 25164687 PMCID: PMC4153915 DOI: 10.1186/1756-3305-7-397] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 08/20/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO), international donors and partners have emphasized the importance of integrated control of neglected tropical diseases (NTDs). Integrated mapping of NTDs is a first step for integrated planning of programmes, proper resource allocation and monitoring progress of control. Integrated mapping has several advantages over disease specific mapping by reducing costs and enabling co-endemic areas to be more precisely identified. We designed and conducted integrated mapping of lymphatic filariasis (LF) and podoconiosis in Ethiopia; here we present the methods, challenges and lessons learnt. METHODS Integrated mapping of 1315 communities across Ethiopia was accomplished within three months. Within these communities, 129,959 individuals provided blood samples that were tested for circulating Wuchereria bancrofti antigen using immunochromatographic card tests (ICT). Wb123 antibody tests were used to further establish exposure to LF in areas where at least one ICT positive individual was detected. A clinical algorithm was used to reliably diagnose podoconiosis by excluding other potential causes of lymphoedema of the lower limb. RESULTS A total of 8110 individuals with leg swelling were interviewed and underwent physical examination. Smartphones linked to a central database were used to collect data, which facilitated real-time data entry and reduced costs compared to traditional paper-based data collection approach; their inbuilt Geographic Positioning System (GPS) function enabled simultaneous capture of geographical coordinates. The integrated approach led to efficient use of resources and rapid mapping of an enormous geographical area and was well received by survey staff and collaborators. Mobile based technology can be used for such large scale studies in resource constrained settings such as Ethiopia, with minimal challenges. CONCLUSIONS This was the first integrated mapping of podoconiosis and LF globally. Integrated mapping of podoconiosis and LF is feasible and, if properly planned, can be quickly achieved at nationwide scale.
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Affiliation(s)
| | - Kebede Deribe
- Brighton and Sussex Medical School, Falmer, Brighton, United Kingdom.
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