Baseline prevalence and intensity of schistosomiasis at sentinel sites in Madagascar: Informing a national control strategy

Temperature affects predation of schistosome-competent snails by a novel invader, the marbled crayfish Procambarus virginalis

The human burden of environmentally transmitted infectious diseases can depend strongly on ecological factors, including the presence or absence of natural enemies. The marbled crayfish (Procambarus virginalis) is a novel invasive species that can tolerate a wide range of ecological conditions and colonize diverse habitats. Marbled crayfish first appeared in Madagascar in 2005 and quickly spread across the country, overlapping with the distribution of freshwater snails that serve as the intermediate host of schistosomiasis-a parasitic disease of poverty with human prevalence ranging up to 94% in Madagascar. It has been hypothesized that the marbled crayfish may serve as a predator of schistosome-competent snails in areas where native predators cannot and yet no systematic study to date has been conducted to estimate its predation rate on snails. Here, we experimentally assessed marbled crayfish consumption of uninfected and infected schistosome-competent snails (Biomphalaria glabrata and Bulinus truncatus) across a range of temperatures, reflective of the habitat range of the marbled crayfish in Madagascar. We found that the relationship between crayfish consumption and temperature is unimodal with a peak at ~27.5°C. Per-capita consumption increased with body size and was not affected either by snail species or their infectious status. We detected a possible satiation effect, i.e., a small but significant reduction in per-capita consumption rate over the 72-hour duration of the predation experiment. Our results suggest that ecological parameters, such as temperature and crayfish weight, influence rates of consumption and, in turn, the potential impact of the marbled crayfish invasion on snail host populations.

Review of Recent Prevalence of Urogenital Schistosomiasis in Sub-Saharan Africa and Diagnostic Challenges in the Field Setting

Human schistosomiasis is one of neglected tropical diseases that remain highly prevalent in sub-Saharan Africa (SSA). Human schistosomiasis is mainly caused by two species, Schistosoma haematobium and S. mansoni, leading to urogenital and intestinal schistosomiasis, respectively. The World Health Organization (WHO) recommends mass drug administration (MDA) with praziquantel as the primary method of global intervention. Currently, MDA with praziquantel covers over half of the target population in endemic SSA countries. However, an accurate diagnosis is crucial for monitoring and evaluating the effectiveness of MDA. The standard diagnosis of both urogenital and intestinal schistosomiasis relies on the microscopic identification of eggs. However, the diagnostic sensitivity of this approach is low, especially for light or ultra-light infections. This is because Schistosoma eggs are laid inside of the venous plexus of the urinary bladder or mesenteric vein, where the adult flukes live. Approximately half of the eggs circulate in the blood vessels or are packed in neighboring tissues, while the remaining half are expelled into the lumen of the urinary bladder or intestine intermittently when the blood vessels are ruptured. In the field setting, the accuracy of any diagnostic method is critical for proper management of the intervention. The present article reviews the recent prevalence of urogenital schistosomiasis in SSA and highlights the practical limitations of diagnostic methods such as urine microscopy, urine reagent strips, molecular diagnosis, and ultrasound scanning in the field setting. Despite continuous global efforts to eliminate schistosomiasis over the past 20 years, many areas still remain endemic in SSA. No single diagnostic approach achieves acceptable sensitivity and specificity in the field setting. Therefore, any field survey should employ a combination of these methods based on the purpose of the study to accurately monitor and evaluate urogenital schistosomiasis. Based on diagnostic values and a cost-benefit analysis, a urine reagent strip test can replace urine microscopy in the field setting. The WHO criteria by ultrasound diagnosis should be updated including the echogenic snow sign and contour distortion.

Prevalence and risk distribution of schistosomiasis among adults in Madagascar: a cross-sectional study

BACKGROUND

The goal to eliminate the parasitic disease of poverty schistosomiasis as a public health problem is aligned with the 2030 United Nations agenda for sustainable development goals, including universal health coverage (UHC). Current control strategies focus on school-aged children, systematically neglecting adults. We aimed at providing evidence for the need of shifting the paradigm of schistosomiasis control programs from targeted to generalized approaches as key element for both the elimination of schistosomiasis as a public health problem and the promotion of UHC.

METHODS

In a cross-sectional study performed between March 2020 and January 2021 at three primary health care centers in Andina, Tsiroanomandidy and Ankazomborona in Madagascar, we determined prevalence and risk factors for schistosomiasis by a semi-quantitative PCR assay from specimens collected from 1482 adult participants. Univariable and multivariable logistic regression were performed to evaluate odd ratios.

RESULTS

The highest prevalence of S. mansoni, S. haematobium and co-infection of both species was 59.5%, 61.3% and 3.3%, in Andina and Ankazomborona respectively. Higher prevalence was observed among males (52.4%) and main contributors to the family income (68.1%). Not working as a farmer and higher age were found to be protective factors for infection.

CONCLUSIONS

Our findings provide evidence that adults are a high-risk group for schistosomiasis. Our data suggests that, for ensuring basic health as a human right, current public health strategies for schistosomiasis prevention and control need to be re-addressed towards more context specific, holistic and integrated approaches.

Prevalence of urinary schistosomiasis in women: a systematic review and meta-analysis of recently published literature (2016-2020)

BACKGROUND

Urinary schistosomiasis is a serious threat in endemic territories of Africa and the Middle East. The status of female urinary schistosomiasis (FUS) in published literature between 2016 and 2020 was investigated.

METHODS

A systematic search in PubMed, Scopus, Google Scholar, and Web of Science, based on the 'Preferred Reporting Items for Systematic Reviews and Meta-analyses' checklist, and a meta-analysis using random-effects model to calculate the weighted estimates and 95% confidence intervals (95% CIs) were done.

RESULTS

Totally, 113 datasets reported data on 40,531 women from 21 African countries, showing a pooled prevalence of 17.5% (95% CI: 14.8-20.5%). Most studies (73) were performed in Nigeria, while highest prevalence was detected in Mozambique 58% (95% CI: 56.9-59.1%) (one study). By sample type and symptoms, vaginal lavage [25.0% (95% CI: 11.4-46.1%)] and hematuria 19.4% (95% CI: 12.2-29.4%) showed higher FUS frequency. Studies using direct microscopy diagnosed a 17.1% (95% CI: 14.5-20.1%) prevalence rate, higher than PCR-based studies 15.3% (95% CI: 6.1-33.2%). Except for sample type, all other variables had significant association with the overall prevalence of FUS.

CONCLUSIONS

More studies are needed to evaluate the true epidemiology of FUS throughout endemic regions.

A cluster randomized controlled trial for assessing POC-CCA test based praziquantel treatment for schistosomiasis control in pregnant women and their young children: study protocol of the freeBILy clinical trial in Madagascar

Background

Mass drug administration (MDA) of praziquantel is one of the main control measures against human schistosomiasis. Although there are claims for including pregnant women, infants and children under the age of 5 years in high-endemic regions in MDA campaigns, they are usually not treated without a diagnosis. Diagnostic tools identifying infections at the primary health care centre (PHCC) level could therefore help to integrate these vulnerable groups into control programmes. freeBILy (fast and reliable easy-to-use-diagnostics for eliminating bilharzia in young children and mothers) is an international consortium focused on implementing and evaluating new schistosomiasis diagnostic strategies. In Madagascar, the study aims to determine the effectiveness of a test-based schistosomiasis treatment (TBST) strategy for pregnant women and their infants and children up until the age of 2 years.

Methods

A two-armed, cluster-randomized, controlled phase III trial including 5200 women and their offspring assesses the impact of TBST on child growth and maternal haemoglobin in areas of medium to high endemicity of Schistosoma mansoni. The participants are being tested with the point of care-circulating cathodic antigen (POC-CCA) test, a commercially available urine-based non-invasive rapid diagnostic test for schistosomiasis. In the intervention arm, a POC-CCA-TBST strategy is offered to women during pregnancy and 9 months after delivery, for their infants at 9 months of age. In the control arm, study visit procedures are the same, but without the POC-CCA-TBST procedure. All participants are being offered the POC-CCA-TBST 24 months after delivery. This trial is being integrated into the routine maternal and child primary health care programmes at 40 different PHCC in Madagascar’s highlands. The purpose of the trial is to assess the effectiveness of the POC-CCA-TBST for controlling schistosomiasis in young children and mothers.

Discussion

This trial assesses a strategy to integrate pregnant women and their children under the age of 2 years into schistosomiasis control programmes using rapid diagnostic tests. It includes local capacity building for clinical trials and large-scale intervention research.

Trial registration

Pan-African Clinical Trial Register PACTR201905784271304. Retrospectively registered on 15 May 2019

A 12-year follow-up of intestinal schistosomiasis in pre-school-aged children in Assoni Village, Eastern Senegal

Background

To monitor the prevalence of schistosomiasis in school-aged children (SAC), the National Bilharzia Control Program (PNLB) was set up by the Senegalese authorities; however, geographically isolated Bedik ethnic groups that did not benefit from this program were found to be heavily infected with Schistosoma mansoni. This observation led us to implement a new schistosomiasis control program in 2008 under the aegis of the non-governmental organization “Le Kaïcedrat” and in partnership with the PNLB/WHO to monitor the prevalence of schistosomiasis in this area. In the village of Assoni, where 100% of SAC were infected, analysis of the stools of pre-school-aged children (PSAC) showed that they were massively infected, so we decided to focus our program on them.

Methods

From 2008 to 2020, we (i) monitored the prevalence of S. mansoni in PSAC in Assoni using double-stool smear preparation, (ii) treated the infected PSAC with a standard dose of praziquantel 40 mg/kg, (iii) ran educational campaigns each year in the village, and (iv) built latrines to improve sanitation and reduce schistosomiasis transmission. Linear regression was used to examine the trend in the annual schistosomiasis prevalence and a two-sided of Chi-squared test was used to compare prevalence between the different age groups of PSAC.

Results

We observed an extremely high prevalence of schistosomiasis (78%) in PSAC before implementation of the program in 2008. Contamination occurred in very young children, as 64.3% of children under 2 years old were infected. Moreover, prevalence increased with age and reached 96.8% in children 4 to < 6 years old. Our annual interventions in Assoni Village raised awareness among villagers that water bodies were areas of significant infestation, allowed the building of 88 latrines and led to a decrease in prevalence in PSAC as only 11% of these children were infected in 2020.

Conclusion

Our study allowed Assoni to be the first village in Senegal to treat PSAC since 2014, but only on an individual basis. It also shows that schistosomiasis is difficult to eradicate and that multi-sectorial actions are required to keep its prevalence at a low level.

Graphic abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s40249-021-00867-8.

Schistosomiasis with a Focus on Africa

Schistosomiasis is a common neglected tropical disease of impoverished people and livestock in many developing countries in tropical Africa, the Middle East, Asia, and Latin America. Substantial progress has been made in controlling schistosomiasis in some African countries, but the disease still prevails in most parts of sub-Saharan Africa with an estimated 800 million people at risk of infection. Current control strategies rely primarily on treatment with praziquantel, as no vaccine is available; however, treatment alone does not prevent reinfection. There has been emphasis on the use of integrated approaches in the control and elimination of the disease in recent years with the development of health infrastructure and health education. However, there is a need to evaluate the present status of African schistosomiasis, primarily caused by Schistosoma mansoni and S. haematobium, and the factors affecting the disease as the basis for developing more effective control and elimination strategies in the future. This review provides an historical perspective of schistosomiasis in Africa and discusses the current status of control efforts in those countries where the disease is endemic.

Serology- and Blood-PCR-Based Screening for Schistosomiasis in Pregnant Women in Madagascar-A Cross-Sectional Study and Test Comparison Approach

This work was conducted as a cross sectional study to define the disease burden of schistosomiasis in pregnant Madagascan women and to evaluate serological and molecular diagnostic assays. A total of 1154 residual EDTA blood samples from pregnant Madagascan women were assessed. The nucleic acid extractions were subjected to in-house real-time PCRs specifically targeting S. mansoni complex, S. haematobium complex, and African Schistosoma spp. on genus level, while the EDTA plasma samples were analyzed using Schistosoma-specific IgG and IgM commercial ELISA and immunofluorescence assays. The analyses indicated an overall prevalence of schistosomiasis in Madagascan pregnant women of 40.4%, with only minor regional differences and differences between serology- and blood PCR-based surveillance. The S. mansoni specific real-time PCR showed superior sensitivity of 74% (specificity 80%) compared with the genus-specific real-time PCR (sensitivity 13%, specificity 100%) in blood. The laborious immunofluorescence (sensitivity IgM 49%, IgG 87%, specificity IgM 85%, IgG 96%) scored only slightly better than the automatable ELISA (sensitivity IgM 38%, IgG 88%, specificity IgM 78%, IgG 91%). Infections with S. mansoni were detected only. The high prevalence of schistosomiasis recorded here among pregnant women in Madagascar calls for actions in order to reduce the disease burden.

Five-Year Follow-Up on the Prevalence and Intensity of Infections of Schistosoma mansoni in a Hard-to-Reach District of Madagascar

Schistosomiasis is a major public health problem in Madagascar. The WHO recommends preventive chemotherapy by mass drug administration (MDA) with praziquantel as the primary approach to control Schistosoma mansoni-related morbidity in endemic populations, alongside complementary interventions such as health education. The impact of annual MDA and health education programs was assessed in the hard-to-reach Marolambo district of eastern Madagascar, an area endemic for S. mansoni. Repeated cross-sectional studies undertaken 2015-2019 examined between 300 and 381 school-aged children (aged 5-14 years) annually. The prevalence and infection intensity of S. mansoni were assessed by urine-circulating cathodic antigen (CCA) dipsticks and coproscopy using Kato-Katz (KK) methodologies. After four rounds of annual MDA, a reduction in S. mansoni prevalence was seen in CCA (93.9% in year 1-87.7% in year 5; P = 0.007) and KK (73.9% in year 1-59.4% in year 5; P < 0.0001). The prevalence of heavy-intensity infections roughly halved from 23.7% to 10.1% (P < 0.0001), and the mean intensity of infection fell by 55.0% (480.2-216.3 eggs per gram of feces). A malacological survey found Biomphalaria pfeifferi snail intermediate hosts in multiple water contact sites including rice paddies, streams, and Nosivolo River. Despite reductions in infection prevalence and intensity, schistosomiasis still poses a significant public health challenge in Marolambo district. Twice yearly MDA cycles and/or community-wide MDA are suggested to better reduce infections. Expanding health education, improving standards of water, sanitation and hygiene, and attention on snail-related control will also be important, especially in rice paddy irrigated areas.

Prevalence and pattern of waterborne parasitic infections in eastern Africa: A systematic scoping review

Waterborne parasitic diseases form one of common and important public health and economic problems in low- and middle-income countries, though little is known on the burden and patterns of these diseases in most regions. This systematic scoping review informs on the prevalence and pattern of waterborne parasitic infections in eastern Africa from 1st of January 1941 to 31st of December 2019. The review found limited number of published studies on waterborne parasitic diseases, though 13 of the 15 studied countries in eastern Africa provided one or more published report(s) totalling 47 reports. Focus of studies was mainly on schistosomiasis where 44.8% of the 47 retrieved studies reported it. Other frequently reported diseases were giardiasis (23.4% of reports), soil-transmitted helminths (23.4%) and amoebiasis (21.3%). Rarely reported diseases were malaria, cryptosporidiosis, isosporiasis, dracunculiasis and trichomoniasis. Based on parasitological examinations, schistosomiasis prevalence ranged from 17 to 33% in Burundi, 1.9 to 73.9% in Ethiopia, 2.1 to 18% in Kenya, 7.2 to 88.6% in Uganda, 22.9 to 86.3% in Tanzania, 27.2 to 65.8% in Somalia, 15 to >50% in Mauritius, 2.4% in Eritrea and 5.0 to 93.7% in Madagascar. Amoebiasis prevalence was 4.6–15,3% (Ethiopia), 5.9–58.3% (Kenya), 54.5% (Rwanda), 0.7–2.7% (Sudan), 19.93% (Uganda) and 4.5–5.0% (Seychelles). Giardiasis prevalence was 0.6–55.0% (Ethiopia), 16.6% (Kenya), 3.6% (Rwanda), 21.1% (Sudan), 40.7% (Uganda), 45.0% (Eritrea) and 3.3–6.0% (Seychelles). Soil-transmitted helminths prevalence was 41.7–52.4% (Ethiopia), 32.4–40.7% (Kenya), 9997 cases (Rwanda), 85.0% (Somalia), 4.7% (Madagascar) and 1.1–84% (Seychelles), Ascaris lumbricoides, Trichuris trichiura and hookworms were the most common helminths detected. Malaria prevalence was 2.9–4.31% (Ethiopia), an annual episode of 9 million people (Sudan), 13.0% (Tanzania), 146 hospital cases (Madagascar), 1.4–2.0% (Seychelles) and <5.0% in Djibouti. It is also observed that >50% of the populations in eastern Africa region lack improved drinking water sources or sanitation facilities. This may account for the observed high prevalence of the diseases. The author also suggests likely underestimation of the prevalence as most waterborne parasitic diseases are neglected and cases likely only recorded and left unpublished in health facilities. Thus for a thorough mapping of burdens of these diseases, grey literature, including hospital records must be reviewed while interventions focusing on improved water and sanitation are likely to reduce the burden considerably.

Ecological plasticity and commercial impact of invasive marbled crayfish populations in Madagascar

Background

The marbled crayfish (Procambarus virginalis) is a monoclonal, parthenogenetically reproducing freshwater crayfish species that has formed multiple stable populations worldwide. Madagascar hosts a particularly large and rapidly expanding colony of marbled crayfish in a unique environment characterized by a very high degree of ecological diversity.

Results

Here we provide a detailed characterization of five marbled crayfish populations in Madagascar and their habitats. Our data show that the animals can tolerate a wide range of ecological parameters, consistent with their invasive potential. While we detected marbled crayfish in sympatry with endemic crayfish species, we found no evidence for the transmission of the crayfish plague pathogen, a potentially devastating oomycete. Furthermore, our results also suggest that marbled crayfish are active predators of the freshwater snails that function as intermediate hosts for human schistosomiasis. Finally, we document fishing, farming and market sales of marbled crayfish in Madagascar.

Conclusions

Our results provide a paradigm for the complex network of factors that promotes the invasive spread of marbled crayfish. The commercial value of the animals is likely to result in further anthropogenic distribution.

Electronic supplementary material

The online version of this article (10.1186/s12898-019-0224-1) contains supplementary material, which is available to authorized users.

Urogenital Schistosomiasis among Schoolchildren and the Associated Risk Factors in Selected Rural Communities of Kwara State, Nigeria

Urogenital schistosomiasis is a chronic parasitic disease that causes severe morbidity among schoolchildren in many poor-resource communities in Nigeria. We investigated the prevalence, intensity, and risk factors of the infection in three communities of Kwara State to ascertain the current status of the disease. Of the 724 urine samples screened, using filtration method, 332 (45.6%) school-aged children were infected with average intensity and mean population eggs load of 127.9 eggs/10 ml of urine and 0.794, respectively. Prevalence and intensity of infection varied with communities: high in Ajase-Ipo (57.1%; X = 100.7 ± 23.01 eggs/10 ml) and low in Shonga (37.5%; X = 91.4 ± 78.0). Infection was significantly (P < 0.05) higher in males (50.8%) than the females (42.4%). Similarly, infection significantly (P < 0.05) increased with increasing age. Multivariate logistic analysis of risk factors revealed that lack of portable drinking water (adjusted odd ratio (aOR) = 4.76; 95% CI = 2.64-5.98), unemployment (aOR = 2.23; 1.87-2.294), lack of knowledge of infection (aOR = 2.16; 0.59-3.83), and frequent contact with contaminated water bodies (aOR = 2.01; 1.45-2.70) were important predictors of urinary schistosomiasis. Therefore, continuous evaluation of the intervention strategies that address risk factors must compliment Mass Drug Administration to curtail the transmission and debilitating health consequences of infection in endemic settings.

Some facts on south asian schistosomiasis and need for international collaboration

In this review, we are discussing South Asian schistosomiasis; more specifically species which are responsible for schistosomiasis in India or South Asia -Schistosoma indicum, S. spindale, S. nasale, S. incognitum, S. gimvicum (S.haematobium), Bivitellobilharzia nairi, Orientobilharzia bomfordi, O. dattai, O. turkestanicum and O.harinasutai, their survival strategies such as mild pathology to the host, producing low egg number and utilizing fresh water snails (Indoplanorbis exustus and Lymnaea luteola) in stagnant water bodies like ponds, lakes, ditches, low laying areas, marshy lands and rice fields. Presently, correct identification of blood fluke species, their immature stages, male schistosomes and their intermediate host details like strain variations, susceptibilities, ecologies are not well studied. Species like B. nairi, O. bomfordi, O. harinasutai (Lymnaea rubiginosa intermediate host for O.harinasutai in Thailand) are also not well studied. Moreover, snail species like Oncomalania spp are not from South Asia, but species of Tricula or Neotricula are reported from this geography, which gives indications of S. mekongi like blood fluke presence in the area. Although in humans, cercarial dermatitis is rampant in rural population with occasional reporting of schistosome eggs in stools, human schistosomiasis is considered absent from this region, despite finding a foci (now dead) of urinary schistosomiasis in Gimvi village of Ratnagiri district, Maharashtra, India. There is great difficulty in diagnosing the infection in man and animals due to low egg production, hence development of a single step antigen detection test is the need of the hour. Interestingly, lethal effect of praziquantel was seen against S.haematobium and S.mansoni. However, this drug failed to cause significant reduction of S. incognitum and S. spindale experimentally suggesting some differences in the biology of two groups of the schistosomes. Triclabendazole showed adulticidal effect at a dose rate of 20 mg/kg body against female schistosome worms, but at lower dose (10 mg/kg body wt) of the drug, a dose that is used in treating bovine fascioliasis, it is providing chances of drug resistance of the persisting schistosomes against triclabendazole. Though the South Asian institutes have all the facilities to tackle issues related to existing schistosomes, it is recommended to develop an international collaboration by establishing an international centre on schistosomiasis in India.

Cognitive deficits and educational loss in children with schistosome infection-A systematic review and meta-analysis

Background

By means of meta-analysis of information from all relevant epidemiologic studies, we examined the hypothesis that Schistosoma infection in school-aged children (SAC) is associated with educational loss and cognitive deficits.

Methodology/Principal findings

This review was prospectively registered in the PROSPERO database (CRD42016040052). Medline, Biosis, and Web of Science were searched for studies published before August 2016 that evaluated associations between Schistosoma infection and cognitive or educational outcomes. Cognitive function was defined in four domains—learning, memory, reaction time, and innate intelligence. Educational outcome measures were defined as attendance and scholastic achievement. Risk of bias (ROB) was evaluated using the Newcastle-Ottawa quality assessment scale. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated to compare cognitive and educational measures for Schistosoma infected /not dewormed vs. uninfected/dewormed children. Sensitivity analyses by study design, ROB, and sequential exclusion of individual studies were implemented. Thirty studies from 14 countries, including 38,992 SAC between 5–19 years old, were identified. Compared to uninfected children and children dewormed with praziquantel, the presence of Schistosoma infection and/or non-dewormed status was associated with deficits in school attendance (SMD = -0.36, 95%CI: -0.60, -0.12), scholastic achievement (SMD = -0.58, 95%CI: -0.96, -0.20), learning (SMD = -0.39, 95%CI: -0.70, -0.09) and memory (SMD = -0.28, 95%CI: -0.52, -0.04) tests. By contrast, Schistosoma-infected/non-dewormed and uninfected/dewormed children were similar with respect to performance in tests of reaction time (SMD = -0.06, 95%CI: -0.42, 0.30) and intelligence (SMD = -0.25, 95%CI: -0.57, 0.06). Schistosoma infection-associated deficits in educational measures were robust among observational studies, but not among interventional studies. The significance of infection-associated deficits in scholastic achievement was sensitive to ROB. Schistosoma infection-related deficits in learning and memory tests were invariant by ROB and study design.

Conclusion/Significance

Schistosoma infection/non-treatment was significantly associated with educational, learning, and memory deficits in SAC. Early treatment of children in Schistosoma-endemic regions could potentially mitigate these deficits.

Trial registration

ClinicalTrials.gov CRD42016040052

Empirical evidence for cognitive or educational benefits of anti-Schistosoma treatment is currently uncertain, despite the recommended practice of wide-scale deworming with praziquantel. We addressed this knowledge gap by synthesizing information from 30 relevant epidemiologic studies reporting on 38,992 children between 5–19 years old from 14 countries. In those studies, Schistosoma infection or non-dewormed status was associated with educational loss and cognitive deficits. Specifically, there were small to moderate deficits in both school attendance and scholastic achievement. Similarly, Schistosoma infection or non-dewormed status was associated with deficits in learning and memory domains of psychometrically tested cognitive function. However, there was no evidence of Schistosoma infection- or non-deworming-associated deficits on tests of innate intelligence or reaction-time. Overall, compared to Schistosoma-uninfected or to dewormed children, the presence of Schistosoma infection or non-dewormed status was associated with educational, learning, and memory deficits in school-aged children. The combined evidence suggests that early treatment of children in Schistosoma-endemic regions could mitigate these deficits.

High burden of Schistosoma mansoni infection in school-aged children in Marolambo District, Madagascar

Background

A school-based survey was undertaken to assess prevalence and infection intensity of schistosomiasis in school-aged children in the Marolambo District of Madagascar.

Methods

School-aged children from six purposively selected schools were tested for Schistosoma haematobium by urine filtration and Schistosoma mansoni using circulating cathodic antigen (CCA) and Kato-Katz stool analysis. The investigators did not address soil-transmitted helminths (STH) in this study.

Results

Of 399 school-aged children screened, 93.7% were infected with S. mansoni based on CCA analysis. Kato-Katz analysis of stool revealed S. mansoni infection in 73.6% (215/ 292). Heavy infections (> 400 eggs per gram) were common (32.1%; 69/ 215), with a mean of 482 eggs per gram of stool. Moderate infection intensities were detected in 31.2% (67/ 215) and light infection intensities in 36.7% (79/ 215) of infected participants. No infection with S. haematobium was detected by urine filtration.

Conclusions

Intestinal schistosomiasis appears a considerable public health issue in this remote area of Madagascar where there is a pressing need for mass drug administration.

Incidental pseudolymphomatous bladder inflammatory polyp revealing urinary schistosomiasis

A 25-year-old female who had returned from a trip to Madagascar that was not reported, underwent an endoscopic bladder polyp resection. Histopathology examination revealed an intense pseudolymphomatous inflammatory polyp caused by a Schistosoma infection. Bladder polyps due to schistosomiasis represent a rare condition in developed countries and have to be ruled out in the case of any intense unexplained inflammation.