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Akinsolu FT, Abodunrin OR, Olagunju MT, Adewole IE, Ola OM, Abel C, Sanni-Adeniyi R, Rahman NO, Akanni OO, Njuguna DW, Soneye IY, Salako AO, Ezechi OC, Varga OE, Akinwale OP. Health workers' perspectives on school-based mass drug administration control programs for soil-transmitted helminthiasis and schistosomiasis in Ogun State, Nigeria. PLoS One 2024; 19:e0302509. [PMID: 38718082 PMCID: PMC11078364 DOI: 10.1371/journal.pone.0302509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/05/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Soil-transmitted helminthiasis (STH) and schistosomiasis (SCH) are among the most prevalent neglected tropical diseases (NTDs), affecting 1.5 billion globally, with a significant burden in sub-Saharan Africa, particularly Nigeria. These diseases impair health and contribute to socio-economic challenges, especially in children, undermining educational and future economic prospects. The 2030 NTD Roadmap highlights Mass Drug Administration (MDA) as a critical strategy for controlling these NTDs, targeting vulnerable populations like school-age children. Despite some successes, challenges persist, indicating the need for deeper insights into program implementation. This study focuses on the perspectives of health workers implementing MDA in selected local government areas (LGAs) of Ogun State, Nigeria, aiming to identify challenges and enablers that align with the broader NTD 2030 goals. METHODOLOGY/PRINCIPAL FINDINGS The study used a qualitative research approach involving focus group discussions and in-depth interviews with health workers engaged in neglected tropical disease control programs in Ogun State, Nigeria, between July and September 2022. A semi-structured questionnaire guided the exploration of ideas, and the data were analyzed using the QRS Nvivo 12 software package. The study found that the school-based MDA control program's efficacy largely relies on strong collaborations and partnerships, particularly with educators, community heads, and other stakeholders. These alliances and strategic communication methods, like town announcements and media campaigns, have been pivotal in reaching communities. However, the program does grapple with hurdles such as parental misconceptions, limited funds, insufficient staffing, and misalignment with the Ministry of Education. It is recommended to boost funding, foster early stakeholder involvement, enhance mobilization techniques, and consider introducing a monitoring card system similar to immunization. CONCLUSIONS/SIGNIFICANCE The MDA Integrated Control Programs for STH and SCH in Ogun State schools demonstrate a holistic approach, integrating knowledge, collaboration, communication, and feedback. Health workers have shown commitment and adeptness in their roles. However, achieving maximum efficacy requires addressing critical barriers, such as parental misconceptions and funding challenges. Adopting the recommended strategies, including proactive communication, increased remuneration, and introducing a tracking system, can significantly enhance the program's reach and impact. The involvement of all stakeholders, from health workers to community leaders and parents, is essential for the program's sustainability and success.
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Affiliation(s)
- Folahanmi T. Akinsolu
- Department of Public Health, Lead City University, Ibadan, Oyo State, Nigeria
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Lagos State, Nigeria
| | - Olunike R. Abodunrin
- Department of Public Health, Lead City University, Ibadan, Oyo State, Nigeria
- Department of Planning and Research, Lagos State Health Management Agency, Lagos, Lagos State, Nigeria
| | - Mobolaji T. Olagunju
- Department of Epidemiology and Biostatistics, Nanjing Medical University, Nanjing, China
| | - Ifeoluwa E. Adewole
- Department of Public Health, Lead City University, Ibadan, Oyo State, Nigeria
| | - Oluwabukola M. Ola
- Department of Public Health, Lead City University, Ibadan, Oyo State, Nigeria
| | - Chukwuemeka Abel
- Department of Public Health, Lead City University, Ibadan, Oyo State, Nigeria
| | | | - Nurudeen O. Rahman
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Olukunmi O. Akanni
- Department of Public Health, Lead City University, Ibadan, Oyo State, Nigeria
| | - Diana W. Njuguna
- School of Nursing, Dedan Kimathi University of Technology, Nyeri, Kenya
| | - Islamiat Y. Soneye
- Department of Public Health, Ogun State Ministry of Health, Ota, Ogun State, Nigeria
| | - Abideen O. Salako
- Department of Public Health, Lead City University, Ibadan, Oyo State, Nigeria
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Lagos State, Nigeria
| | - Oliver C. Ezechi
- Department of Public Health, Lead City University, Ibadan, Oyo State, Nigeria
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Lagos State, Nigeria
| | - Orsolya E. Varga
- Department of Public Health and Epidemiology, University of Debrecen, Debrecen, Hungary
| | - Olaoluwa P. Akinwale
- Department of Public Health, Lead City University, Ibadan, Oyo State, Nigeria
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Lagos State, Nigeria
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Zeynudin A, Degefa T, Suleman S, Abamecha A, Hajikelil Z, Wieser A. Prevalence and Determinants of Geohelminthiasis among School-Age Children in Jimma City, Ethiopia. J Trop Med 2023; 2023:8811795. [PMID: 38058563 PMCID: PMC10696475 DOI: 10.1155/2023/8811795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/02/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023] Open
Abstract
School-age children (SAC) are at a higher risk of geohelminth or soil-transmitted helminth (STH) infections due to their practice of walking and playing barefoot, lack of adequate sanitary facilities, and poor personal hygiene. In Ethiopia, periodic deworming has been implemented since 2013 with the aim of interrupting the transmission of STH in children by 2025. To evaluate the likely success of such a control program, it is crucial to monitor the transmission of STH, especially in peri-urban settings where environmental sanitation is modest. The aim of this study was to determine the prevalence and determinants of STH infections among SAC in peri-urban areas of Jimma City, Southwestern Ethiopia. A community-based cross-sectional study was conducted in five peri-urban Kebeles of Jimma City from July to September, 2021. Systematic random sampling was used to select 522 households with at least one child, and 478 children (5-15 years old) were recruited randomly from the households. Data on sociodemographic and potential risk factors were collected using a structured questionnaire. Stool samples from each study participant were collected and examined microscopically using the Kato-Katz technique. Multivariate logistic regression model was used to identify risk factors associated with STH infections. The prevalence of any STH among SAC was 23.4%, with Ascaris lumbricoides being the predominant STH species (15.7%), followed by Trichuris trichiura (9%) and hookworm (2.1%). Most (86.6%) of the STH-positive SAC had a single infection and a light infection intensity (88.2%), with a mean intensity of 367.4 eggs per gram. Location of Kebele (AOR = 2.73; 95% CI: 1.21-6.16, p=0.016), lack of hand washing after defecation (AOR = 6.39; 95% CI: 3.16-12.95, p < 0.001), untrimmed fingernails (AOR = 2.65; 95% CI: 1.56-4.51, p < 0.001), and lack of previous deworming (AOR = 2.90; 95% CI: 1.47-5.74, p=0.002) were significant predictors for STH infections among SAC. In conclusion, the study revealed that STH infections are significant health problem in the peri-urban areas of Jimma City. Strengthening periodic deworming and improving children's hygiene through health education are required to reduce the transmission.
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Affiliation(s)
- Ahmed Zeynudin
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Teshome Degefa
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Sultan Suleman
- School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Abdulhakim Abamecha
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Zuber Hajikelil
- Department of Medical Laboratory Sciences, Wolkite University, Wolkite, Ethiopia
| | - Andreas Wieser
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilian-Universitat (LMU) Munich, Munich 80802, Germany
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Phillips AE, Ower AK, Mekete K, Liyew EF, Maddren R, Mengistu B, Anjulo U, Chernet M, Dunn JC, Mohammed H, Belay H, Gidey B, Tasew G, Tadesse G, Salasibew M, Tollera G, Anderson R. Baseline soil-transmitted helminth and schistosome infection in the Geshiyaro project, Ethiopia: A unique transmission interruption project using biometric fingerprinting for longitudinal individual analysis. PLoS Negl Trop Dis 2023; 17:e0011589. [PMID: 37851666 PMCID: PMC10615263 DOI: 10.1371/journal.pntd.0011589] [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: 08/25/2023] [Revised: 10/30/2023] [Accepted: 09/07/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND The Geshiyaro project aims to assess the feasibility of interrupting transmission of soil-transmitted helminths (STH) and schistosome (SCH) infection in the Wolaita zone of southern Ethiopia through high coverage community-wide mass drug administration (MDA), in combination with improved water, sanitation, and hygiene services and behaviour change communication delivered through the existing health care infrastructure. To accurately measure treatment coverage a population census was conducted enrolling individuals with biometric fingerprinting and barcoded ID cards. This paper details the baseline census and parasitology surveys conducted before the start of any interventions. METHODS The census was conducted in five of the 15 Wolaita districts between October 2018 and December 2019, enrolling all consenting participants from every household. Simultaneously, a cross-sectional parasitology survey was conducted in 130 out of 361 randomly selected communities from all 15 districts, with 100 individuals across all age groups (infant to adult) per community providing stool and urine for analysis by duplicate Kato-Katz and a point-of-care circulating cathodic antigen (POC-CCA) to test for Schistosoma mansoni and STH, and microhaematuria and urine filtration for Schistosoma haematobium. Of the 130 communities, 30 were randomly selected for annual, longitudinal parasitological monitoring, with 150 randomly selected individuals from infant to adult providing two days of stool and urine samples for analysis by the same diagnostic tests per community. RESULTS In total 97,919 households participated in the baseline census enrolling 466,071 individuals, with parasitological data obtained from 10,785 people. At baseline, 15.5% were infected with at least one STH species, with Ascaris lumbricoides (9.5%), followed by hookworm (7.2%) and Trichuris trichiura (1.8%). Substantial heterogeneity in STH prevalence was observed between communities ranging from 0% to 61% where most infections were low intensity. Schistosoma mansoni infection was the dominant schistosome infection (0.85% by Kato-Katz and 13.3% by POC-CCA trace negative and 21.5% trace positive), with few Schistosoma haematobium infections identified (2.77% haematuria positive and 0.13% positive by urine filtration). CONCLUSIONS While the national control program in Ethiopia has made good progress in reducing prevalence of STH and SCH in Wolaita since it was launched in 2015, there remain areas of persistent infection suggesting the existence of environmental or behavioural risk factors that contribute to ongoing transmission. This project aims to identify the most efficient intervention strategies to reduce community burden and reach interruption of transmission.
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Affiliation(s)
- Anna E. Phillips
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, St Mary’s Campus, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | - Alison K. Ower
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, St Mary’s Campus, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | | | | | - Rosie Maddren
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, St Mary’s Campus, London, United Kingdom
| | - Birhan Mengistu
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, St Mary’s Campus, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | - Ufaysa Anjulo
- Children’s Investment Fund Foundation, London, United Kingdom
| | - Melkie Chernet
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Julia C. Dunn
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, St Mary’s Campus, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | | | - Habtamu Belay
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Geremew Tasew
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | | | - Roy Anderson
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, St Mary’s Campus, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
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Semahegn A, Manyazewal T, Getachew E, Fekadu B, Assefa E, Kassa M, Davey G, Hopkins M, Araya M, Woldehanna T, Hanlon C, Fekadu A. Burden of neglected tropical diseases and access to medicine and diagnostics in Ethiopia: a scoping review. Syst Rev 2023; 12:140. [PMID: 37580784 PMCID: PMC10424375 DOI: 10.1186/s13643-023-02302-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 07/28/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND More than 1.7 billion people are affected by neglected tropical diseases (NTDs) worldwide. Forty percent of the NTD-affected people live in Africa with the poorest, most vulnerable, and hard to reach geographical areas. The NTDs cause significant social and economic burden and deepen marginalization and stigmatization. The World Health Organization's current roadmap for NTD aims to prevent, control, eliminate, or eradicate 20 tropical diseases. Ethiopia experiences a high burden of these diseases, but current access to diagnostics, medicine, and/or care has been little explored to inform the country's NTD strategic plan. The overall purpose of the scoping review was to map and characterize the burden of NTDs and challenges in access to diagnostics, medicine, and/or care in Ethiopia. METHODS A systematic search of evidence was conducted in PubMed, Cochrane Library, and Google Scholar from January 2000 until May 2022, without restrictions of language or study design. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review was followed for screening of studies. Key findings were extracted and narrated qualitatively. RESULTS The search resulted in 4532 articles, of which 105 met the inclusion criteria and were included in the scoping review under three themes: burden of NTDs, access to diagnostics, medicine and/or care, and key barriers. Although gains have been made in the prevention and control of NTDs in Ethiopia, the burden remains high, and progress in access to diagnostics, medicine/drugs, and/or care is very slow. Poverty, poor quality of life, and underfunding of NTD programs decelerate the process of NTD elimination program in the country. CONCLUSIONS The scoping review identified a considerable number of studies on the burden of NTDs in Ethiopia and strategies for diagnosis, treatment, and/or care; however, there is a paucity of evidence on the suitability and potential benefits of novel diagnostic technologies and medicines in the country. A regular review and analysis of such country-level evidence is important to inform the country NTDs roadmap and local implementation strategies.
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Affiliation(s)
- Agumasie Semahegn
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
- Department of Population, Family and Reproductive Health, School of Public Health, Unversity of Ghana, Accra, Ghana.
| | - Tsegahun Manyazewal
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eyerusalem Getachew
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bethelhem Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Esubalew Assefa
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Health Economics and Policy Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Department of Economics, Faculty of Arts and Social Sciences, The Open University, Milton Keynes, UK
| | - Munir Kassa
- Ministry of Health of Ethiopia, Addis Ababa, Ethiopia
| | - Gail Davey
- Global Health & Infection Department, Brighton and Sussex Medical School, Brighton, UK
- School of Public Health, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Michael Hopkins
- Science Policy Research Unit, University of Sussex, Brighton, UK
| | - Mesele Araya
- College of Business and Economics, Addis Ababa University, Addis Ababa, Ethiopia
- Policy Studies Institute, Addis Ababa, Ethiopia
| | - Tassew Woldehanna
- College of Business and Economics, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Global Health & Infection Department, Brighton and Sussex Medical School, Brighton, UK
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Lebu S, Kibone W, Muoghalu CC, Ochaya S, Salzberg A, Bongomin F, Manga M. Soil-transmitted helminths: A critical review of the impact of co-infections and implications for control and elimination. PLoS Negl Trop Dis 2023; 17:e0011496. [PMID: 37561673 PMCID: PMC10414660 DOI: 10.1371/journal.pntd.0011496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Abstract
Researchers have raised the possibility that soil-transmitted helminth (STH) infections might modify the host's immune response against other systemic infections. STH infections can alter the immune response towards type 2 immunity that could then affect the likelihood and severity of other illnesses. However, the importance of co-infections is not completely understood, and the impact and direction of their effects vary considerably by infection. This review synthesizes evidence regarding the relevance of STH co-infections, the potential mechanisms that explain their effects, and how they might affect control and elimination efforts. According to the literature reviewed, there are both positive and negative effects associated with STH infections on other diseases such as malaria, human immunodeficiency virus (HIV), tuberculosis, gestational anemia, pediatric anemia, neglected tropical diseases (NTDs) like lymphatic filariasis, onchocerciasis, schistosomiasis, and trachoma, as well as Coronavirus Disease 2019 (COVID-19) and human papillomavirus (HPV). Studies typically describe how STHs can affect the immune system and promote increased susceptibility, survival, and persistence of the infection in the host by causing a TH2-dominated immune response. The co-infection of STH with other diseases has important implications for the development of treatment and control strategies. Eliminating parasites from a human host can be more challenging because the TH2-dominated immune response induced by STH infection can suppress the TH1 immune response required to control other infections, resulting in an increased pathogen load and more severe disease. Preventive chemotherapy and treatment are currently the most common approaches used for the control of STH infections, but these approaches alone may not be adequate to achieve elimination goals. Based on the conclusions drawn from this review, integrated approaches that combine drug administration with water, sanitation and hygiene (WASH) interventions, hygiene education, community engagement, and vaccines are most likely to succeed in interrupting the transmission of STH co-infections. Gaining a better understanding of the behavior and relevance of STH co-infections in the context of elimination efforts is an important intermediate step toward reducing the associated burden of disease.
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Affiliation(s)
- Sarah Lebu
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Winnie Kibone
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Chimdi C. Muoghalu
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Stephen Ochaya
- Department of Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
- Department of Biology, Faculty of Science, Gulu University, Gulu, Uganda
- Department of Clinical Pathology, Uppsala Academic Hospital, Uppsala, Sweden
| | - Aaron Salzberg
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Felix Bongomin
- Department of Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Musa Manga
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Rwamwejo F, Ndatinya GI, Mkata MI, Blauman A, Regnier D, Lackner SC. Assessing the knowledge, attitudes, practices, and perspectives of stakeholders of the deworming program in rural Rwanda. PLoS Negl Trop Dis 2023; 17:e0010759. [PMID: 37552654 PMCID: PMC10437854 DOI: 10.1371/journal.pntd.0010759] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 08/18/2023] [Accepted: 07/17/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Worm infections are among the most prevalent neglected tropical diseases worldwide. Schistosomiasis and soil-transmitted helminths infections, most common worm infections affecting Rwandan school-aged children, are addressed by the national deworming program since 2014. To date, no published studies have assessed the knowledge, attitudes, and practices of the key implementers of the national deworming program conducted at village and school level in Rwanda. This study aimed to assess key stakeholders' knowledge, attitudes, practices, and perspectives about the decentralized national deworming program. METHODS/PRINCIPAL FINDINGS We carried out a quantitative, cross-sectional study with complementary in-depth interviews in two districts of Rwanda in June 2021. From the 852 surveyed community health workers and teachers, 54.1% had a knowledge score considered good (≥80%). The mean knowledge score was 78.04%. From the multivariate analysis, lack of training was shown to increase the odds of having poor knowledge (OR 0.487, 95% CI: 0.328-0.722, p <0.001). The in-depths interviews revealed poor water access and hesitance from caregivers as perceived challenges to the success of the deworming program. CONCLUSION Our findings demonstrate the importance of training community health workers and schoolteachers on worm infections as they are the key implementers of the deworming program. This would enhance their capacity to provide health education and sensitization on misconceptions and misinformation towards deworming. Moreover, research is needed to assess the impact of poor access to water, sanitation and hygiene facilities on the prevalence of worm infections in Rwanda.
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Affiliation(s)
- Fernand Rwamwejo
- Director General’s office, Rwanda Biomedical Center, Kigali, Rwanda
| | - Grace Iliza Ndatinya
- Department of Community Health and Social Medicine, University of Global Equity, Kigali, Rwanda
| | | | - Amy Blauman
- Programme unit, World Food Programme, Kigali, Rwanda
| | - Denis Regnier
- Department of Humanities and Social Sciences, University of Global Health Equity, Kigali, Rwanda
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Maddren R, Phillips A, Ower A, Landeryou T, Mengistu B, Anjulo U, Firdawek E, Negussu N, Anderson R. Correction: Soil-transmitted helminths and schistosome infections in Ethiopia: a systematic review of progress in their control over the past 20 years. Parasit Vectors 2023; 16:203. [PMID: 37328904 DOI: 10.1186/s13071-023-05815-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023] Open
Affiliation(s)
- Rosie Maddren
- London Centre for Neglected Tropical Disease Research (LCNTDR), Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, UK.
| | - Anna Phillips
- London Centre for Neglected Tropical Disease Research (LCNTDR), Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Alison Ower
- London Centre for Neglected Tropical Disease Research (LCNTDR), Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Toby Landeryou
- London Centre for Neglected Tropical Disease Research (LCNTDR), Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | | | - Ufaysa Anjulo
- Disease Prevention and Health Promotion Core Process, Ministry of Health, Wolaita, Ethiopia
| | - Ewnetu Firdawek
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Nebiyu Negussu
- Neglected Tropical Diseases, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Roy Anderson
- London Centre for Neglected Tropical Disease Research (LCNTDR), Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
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Prevalence and intensity of soil-transmitted helminth infections and associated risk factors among household heads living in the peri-urban areas of Jimma town, Oromia, Ethiopia: A community-based cross-sectional study. PLoS One 2022; 17:e0274702. [PMID: 36107925 PMCID: PMC9477373 DOI: 10.1371/journal.pone.0274702] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/02/2022] [Indexed: 11/29/2022] Open
Abstract
Background Ethiopia has set national targets for eliminating soil-transmitted helminths (STH) as public health problems by 2020 and for breaking their transmission by 2025 using periodic mass treatment of children in endemic areas. However, the status of STH infection among the adults living in the same communities remains unknown. The aim of this study, therefore, was to determine the prevalence and intensity of STH infections and associated factors among the household heads in the peri-urban areas of Jimma town, Oromia, Ethiopia. Methods A community-based cross-sectional study was conducted in five peri-urban kebeles (smallest administrative unit in Ethiopia) of Jimma town from May to July 2021. A semi-structured questionnaire was used to collect data on socio-demographic and predisposing factors. The Kato-Katz concentration technique was utilized to detect and quantify the STH in stool samples. Both bivariate and multivariate analyses were done. P-value <0.05 was considered statistically significant. Results A total of 376 household heads (19.9% women and 80.1% men) from peri-urban areas were included in the study. The overall STH prevalence was 18.1% (95% CI: 14.6–22.1) with A. lumbricoides being the predominant species (11.4%) followed by T. trichiura (7.2%) and hookworm (2.1%). Most of the STH positive household heads had single infections (85.3%) and light-intensity infections (88.5%). Wealth status (AOR = 2.7; 95% CI: 1.31–5.50, P = 0.007), hand washing habits before meals (AOR = 7.07; 95% CI: 1.79–27.88, p = 0.005), fingernails status (AOR = 2.99; 95% CI: 1.59–5.65, p = 0.001), and toilet facility type (AOR = 2.06; 95% CI: 1.13–3.76, p = 0.017) were found to have statistically significant associations with the STH infection. Conclusion The findings of this study showed a nearly moderate level of STH prevalence among household heads in the peri-urban community. This could serve as an important reservoir for reinfection of the treated children and other at-risk groups in the community.
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Tamir Z, Animut A, Dugassa S, Gebreselassie A, Tsegaye A, Kassa T, Eguale T, Kebede T, Negash Y, Mekonnen Z, Erko B. Intestinal helminthiasis survey with emphasis on schistosomiasis in Koga irrigation scheme environs, northwest Ethiopia. PLoS One 2022; 17:e0272560. [PMID: 35939493 PMCID: PMC9359581 DOI: 10.1371/journal.pone.0272560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 07/22/2022] [Indexed: 11/19/2022] Open
Abstract
Background Distribution of schistosomiasis is more focal due to spatial heterogeneities in intermediate host snail dynamics and water contact behavior of humans. This makes the search for new transmission foci of schistosomiasis and its connection with malacologically receptive water bodies essential for effective control of its transmission. This study was intended to assess the prevalence of intestinal helminth infections among schoolchildren and Schistosoma mansoni transmission in Koga irrigation scheme surroundings, northwest Ethiopia. Materials and methods Cross-sectional parasitological and malacological surveys were conducted in three schools and nearby water bodies, respectively around Koga irrigation scheme. Stool specimens were collected from 421 randomly selected schoolchildren and microscopically examined using Kato-Katz and formol-ether concentration methods. Malacological surveys were carried out and the identified Biomphalaria pfeifferi snails were screened for schistosome infection. Swiss albino mice were exposed to schistosome cercariae shed by Biomphalaria pfeifferi for definite identification of Schistosoma species. Results Among the examined schoolchildren, 22.6% (95% CI: 18.7%-26.9%) were positive for at least one intestinal helminths species. Ascaris lumbricoides was the most frequent intestinal helminth detected among forty (9.5%) children. Schistosoma mansoni was detected among 4.8% (95% CI: 2.9%-7.2%) of children and its prevalence was significantly higher among male children (p = 0.038) and those attending in Mengesha Jemberie Primary School (p = 0.044). Biomphalaria pfeifferi snails were identified in water bodies in close proximity to Mengesha Jemberie and Wotete Abay Primay schools. Schistosoma mansoni adult worms were harvested after exposure of mice to cercariae shed from Biomphalaria pfeifferi snails collected from water bodies nearby Mengesha Jemberie Primary School. Conclusions Schistosoma mansoni infection of schoolchildren, findings of schistosome infected snails and establishment of mice infection confirm that transmission is taking place in the study areas. Hence, snail control and other measures such as provision of sanitary facilities and health education are recommended.
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Affiliation(s)
- Zemenu Tamir
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
| | - Abebe Animut
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sisay Dugassa
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Araya Gebreselassie
- Department of Zoological Sciences, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Aster Tsegaye
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tesfu Kassa
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tadesse Eguale
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tadesse Kebede
- Department of Microbiology Immunology and Parasitology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yohannes Negash
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zeleke Mekonnen
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Berhanu Erko
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
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Mohammed H, Landeryou T, Chernet M, Liyew EF, Wulataw Y, Getachew B, Difabachew H, Phillips A, Maddren R, Ower A, Mekete K, Belay H, Endrias T, Anjulo U, Tasew G, Anderson R, Tollera G, Abate E. Comparing the accuracy of two diagnostic methods for detection of light Schistosoma haematobium infection in an elimination setting in Wolaita Zone, South Western Ethiopia. PLoS One 2022; 17:e0267378. [PMID: 35486627 PMCID: PMC9053789 DOI: 10.1371/journal.pone.0267378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/07/2022] [Indexed: 11/18/2022] Open
Abstract
Reagent urinalysis dipstick and filtration have been recommended diagnostic methods for the detection of urogenital schistosomiasis. However, the accurate diagnosis of light infections using these methods presents a major challenge. This study evaluates the diagnosis accuracy of light infection with Schistosoma haematobium in study participants living in Wolaita Zone, an area targeted for sustainable control of Schistosomiasis, and ultimately interrupt transmission. Urine samples were collected from children and adults in surveys carried out during baseline and longitudinal sentinel site surveys conducted from 2018 to 2020. All urine samples were tested using a reagent urinalysis dipstick test (Haemastix) to detect microhaematuria with reference urine filtration technique as a proxy for S. haematobium infection. Sensitivity and specificity were determined in diagnosing urogenital schistosomiasis. Cohen’s Kappa statistics was done for the agreement of these diagnostic methods. A total of 12,102 participants were enrolled in the current baseline study. Among them, 285 (2.35%) samples tested positive for microhaematuria and 21 (0.20%) positive for S. haematobium eggs. A total of 4,357 samples were examined in year 1 and year 2 using urine dipsticks, and urine filtration 172 (3.95%) and 2 (0.05%) were positive for microhaematuria and S. haematobium eggs. The reagent urinalysis dipsticks showed the highest sensitivity and specificity for diagnosing light intensity of infection,100% (95% CI:85.18–100.00) and 97.4% (95% CI: 97.10–97.60), respectively. There is a slight agreement between the two methods (Kappa = 0.09, 95% CI: 0.01–0.18). The present study revealed very low prevalence and light intensity of S. haematobium infections. The study also highlights that the dipstick test is considered a useful adjunct diagnostic tool for population-based control of urogenital schistosomiasis.
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Affiliation(s)
- Hussein Mohammed
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- * E-mail:
| | - Toby Landeryou
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | - Melkie Chernet
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ewnetu Firdawek Liyew
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Yonas Wulataw
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Birhanu Getachew
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Hailemariam Difabachew
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Anna Phillips
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | - Rosie Maddren
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | - Alison Ower
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | - Kalkidan Mekete
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Habtamu Belay
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Tujuba Endrias
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ufaysa Anjulo
- Disease Prevention and Health Promotion Core Process, Ministry of Health, Wolaita, Ethiopia
| | - Geremew Tasew
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Roy Anderson
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | - Getachew Tollera
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ebba Abate
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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Coverage evaluation surveys following soil-transmitted helminthiasis and schistosomiasis mass drug administration in Wolaita Zone of Ethiopia-The Geshiyaro project. PLoS One 2021; 16:e0260722. [PMID: 34932602 PMCID: PMC8691621 DOI: 10.1371/journal.pone.0260722] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/15/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The Geshiyaro project aims to break transmission of soil-transmitted helminths and schistosomiasis in the Wolaita Zone of Ethiopia through a combination of two interventions: behavior change communication (BCC) for increased water, sanitation and hygiene (WaSH) infrastructure use alongside preventive chemotherapy (PC) using albendazole (ALB) and praziquantel (PZQ), targeted to reach 90% treatment coverage. Coverage evaluation surveys (CES) were conducted post-treatment, and the resultant survey coverage was compared to reported administrative coverage. This provided a secondary confirmation of the Geshiyaro project coverages, and is used to monitor the success of each Mass Drug Administration (MDA) round. METHODS A community-based cross-sectional study was conducted in 13 woredas (districts) of the Wolaita Zone. All eligible individuals from the selected households were invited for an interview. The study design, sample size, analysis and report writing were conducted according to the World Health Organization (WHO) CES guidelines for PC. RESULTS The study interviewed a total of 3,568 households and 18,875 individuals across 13 woredas in the Wolaita Zone. Overall, the survey coverage across all studied woredas was 81.5% (95% CI; 80.9-82.0%) for both ALB and PZQ. Reported administrative coverage across all studied woredas was higher than survey coverage, 92.7% and 91.2% for ALB and PZQ, respectively. A significant portion of individuals (17.6%) were not offered PC. The predominant reason for not achieving the target coverage of 90% was beneficiary absenteeism during MDA (6.6% ALB, 6.8% PZQ), followed by drug distributors failing to reach all households (4.7% ALB, 4.8% PZQ), and beneficiaries not informed of the program (1.3% ALB, 1.7% PZQ). CONCLUSION Programmatic actions will need to be taken during the next MDA campaign to achieve the targeted Geshiyaro project coverage threshold across data collection and program engagement. Adequate training and supervision on recording and reporting administrative coverage should be provided, alongside improved social mobilization of treated communities to increase participation, and strengthened institutional partnerships and communication.
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Sirak B, Asres K, Hailu A, Dube M, Arnold N, Häberli C, Keiser J, Imming P. In Vitro Antileishmanial and Antischistosomal Activities of Anemonin Isolated from the Fresh Leaves of Ranunculus multifidus Forsk. Molecules 2021; 26:molecules26247473. [PMID: 34946555 PMCID: PMC8703683 DOI: 10.3390/molecules26247473] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/03/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022] Open
Abstract
Leishmaniasis and schistosomiasis are neglected tropical diseases (NTDs) infecting the world’s poorest populations. Effectiveness of the current antileishmanial and antischistosomal therapies are significantly declining, which calls for an urgent need of new effective and safe drugs. In Ethiopia fresh leaves of Ranunculus multifidus Forsk. are traditionally used for the treatment of various ailments including leishmaniasis and eradication of intestinal worms. In the current study, anemonin isolated from the fresh leaves of R. multifidus was assessed for its in vitro antileishmanial and antischistosomal activities. Anemonin was isolated from the hydro-distilled extract of the leaves of R. multifidus. Antileishmanial activity was assessed on clinical isolates of the promastigote and amastigote forms of Leishmania aethiopica and L. donovani clinical isolates. Resazurin reduction assay was used to determine antipromastigote activity, while macrophages were employed for antiamastigote and cytotoxicity assays. Antischistosomal assays were performed against adult Schistosoma mansoni and newly transformed schistosomules (NTS). Anemonin displayed significant antileishmanial activity with IC50 values of 1.33 nM and 1.58 nM against promastigotes and 1.24 nM and 1.91 nM against amastigotes of L. aethiopica and L. donovani, respectively. It also showed moderate activity against adult S. mansoni and NTS (49% activity against adult S. mansoni at 10 µM and 41% activity against NTS at 1 µM). The results obtained in this investigation indicate that anemonin has the potential to be used as a template for designing novel antileishmanial and antischistosomal pharmacophores.
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Affiliation(s)
- Betelhem Sirak
- Department of Pharmaceutical Chemistry and Pharmacognosy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 1176, Ethiopia;
- Department of Pharmacy, College of Medicine and Health Sciences, Arba Minch University, Arba Minch P.O. Box 21, Ethiopia
| | - Kaleab Asres
- Department of Pharmaceutical Chemistry and Pharmacognosy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 1176, Ethiopia;
- Correspondence: (K.A.); (P.I.)
| | - Asrat Hailu
- Department of Microbiology, Immunology and Parasitology, Faculty of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 1176, Ethiopia;
| | - Mthandazo Dube
- Department of Bioorganic Chemistry, Leibniz Institute of Plant Biochemistry, Weinberg 3, D-06120 Halle (Saale), Germany; (M.D.); (N.A.)
| | - Norbert Arnold
- Department of Bioorganic Chemistry, Leibniz Institute of Plant Biochemistry, Weinberg 3, D-06120 Halle (Saale), Germany; (M.D.); (N.A.)
| | - Cecile Häberli
- Swiss Tropical and Public Health Institute, Socinstr. 57, CH-4051 Basel, Switzerland; (C.H.); (J.K.)
- University of Basel, CH-4051 Basel, Switzerland
| | - Jennifer Keiser
- Swiss Tropical and Public Health Institute, Socinstr. 57, CH-4051 Basel, Switzerland; (C.H.); (J.K.)
- University of Basel, CH-4051 Basel, Switzerland
| | - Peter Imming
- Institut fuer Pharmazie, Martin-Luther-Universitaet Halle-Wittenberg, Kurt-Mothes-Str. 3, 06120 Halle (Saale), Germany
- Correspondence: (K.A.); (P.I.)
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13
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Ponpetch K, Erko B, Bekana T, Richards L, Liang S. Biogeographical characteristics of Schistosoma mansoni endemic areas in Ethiopia: a systematic review and meta analysis. Infect Dis Poverty 2021; 10:83. [PMID: 34099066 PMCID: PMC8185935 DOI: 10.1186/s40249-021-00864-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/19/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND In Ethiopia, schistosomiasis is caused by Schistosoma mansoni and S. haematobium with the former being widespread and more than 4 million people are estimated to be infected by S. mansoni annually with 35 million at risk of infection. Although many school- and community-based epidemiological surveys were conducted over the past decades, the national distribution of schistosomiasis endemic areas and associated socio-environmental determinants remain less well understood. In this paper, we review S. mansoni prevalence of infections and describe key biogeographical characteristics in the endemic areas in Ethiopia. METHODS We developed a database of S. mansoni infection surveys in Ethiopia through a systematic review by searching articles published between 1975 and 2019 on electronic online databases including PubMed, ScienceDirect, and Web of Science. A total of 62 studies involving 95 survey locations were included in the analysis. We estimated adjusted prevalence of infection from each survey by considering sensitivity and specificity of diagnostic tests using Bayesian approach. All survey locations were georeferenced and associated environmental and geographical characteristics (e.g. elevation, normalized difference vegetation index, soil properties, wealth index, and climatic data) were described using descriptive statistics and meta-analysis. RESULTS The results showed that the surveys exhibited a wide range of adjusted prevalence of infections from 0.5% to 99.5%, and 36.8% of the survey sites had adjusted prevalence of infection higher than 50%. S. mansoni endemic areas were distributed in six regional states with the majority of surveys being in Amhara and Oromia. Endemic sites were found at altitudes from 847.6 to 3141.8 m above sea level, annual mean temperatures between 17.9 and 29.8 ℃, annual cumulative precipitation between 1400 and 1898 mm, normalized difference vegetation index between 0.03 and 0.8, wealth index score between -68 857 and 179 756; and sand, silt, and clay fraction in soil between 19.1-47.2, 23.0-36.7, and 20.0-52.8 g/100 g, respectively. CONCLUSIONS The distribution of S. mansoni endemic areas and prevalence of infections exhibit remarked environmental and ecological heterogeneities. Future research is needed to understand how much these heterogeneities drive the parasite distribution and transmission in the region.
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Affiliation(s)
- Keerati Ponpetch
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, 32610, USA.
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, 32610, USA.
- Faculty of Public Health and Allied Health Sciences, Ministry of Public Health, Sirindhorn College of Public Health Trang, Praboromarajchanok Institute, Nonthaburi, Thailand.
| | - Berhanu Erko
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Teshome Bekana
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lindsay Richards
- University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Song Liang
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, 32610, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, 32610, USA
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