1
|
Martinez SG, Mbabazi PS, Sebitloane MH, Vwalika B, Mocumbi S, Galaphaththi-Arachchige HN, Holmen SD, Randrianasolo B, Roald B, Olowookorun F, Hyera F, Mabote S, Nemungadi TG, Ngcobo TV, Furumele T, Ndhlovu PD, Gerdes MW, Gundersen SG, Mkhize-Kwitshana ZL, Taylor M, Mhlanga REE, Kjetland EF. The WHO atlas for female-genital schistosomiasis: Co-design of a practicable diagnostic guide, digital support and training. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002249. [PMID: 38498490 PMCID: PMC10947668 DOI: 10.1371/journal.pgph.0002249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 01/29/2024] [Indexed: 03/20/2024]
Abstract
Up to 56 million young and adult women of African origin suffer from Female Genital Schistosomiasis (FGS). The transmission of schistosomiasis happens through contact with schistosomiasis infested fresh water in rivers and lakes. The transmission vector is the snail that releases immature worms capable of penetrating the human skin. The worm then matures and mates in the blood vessels and deposits its eggs in tissues, causing urogenital disease. There is currently no gold standard for FGS diagnosis. Reliable diagnostics are challenging due to the lack of appropriate instruments and clinical skills. The World Health Organisation (WHO) recommends "screen-and-treat" cervical cancer management, by means of visual inspection of characteristic lesions on the cervix and point-of-care treatment as per the findings. FGS may be mistaken for cervical cancer or sexually transmitted diseases. Misdiagnosis may lead to the wrong treatment, increased risk of exposure to other infectious diseases (human immunodeficiency virus and human papilloma virus), infertility and stigmatisation. The necessary clinical knowledge is only available to a few experts in the world. For an appropriate diagnosis, this knowledge needs to be transferred to health professionals who have minimal or non-existing laboratory support. Co-design workshops were held with stakeholders (WHO representative, national health authority, FGS experts and researchers, gynaecologists, nurses, medical doctors, public health experts, technical experts, and members of the public) to make prototypes for the WHO Pocket Atlas for FGS, a mobile diagnostic support tool and an e-learning tool for health professionals. The dissemination targeted health facilities, including remote areas across the 51 anglophone, francophone and lusophone African countries. Outcomes were endorsed by the WHO and comprise a practical diagnostic guide for FGS in low-resource environments.
Collapse
Affiliation(s)
| | - Pamela S. Mbabazi
- National Planning Authority of the Government of the Republic of Uganda, Kampala, Uganda
| | - Motshedisi H. Sebitloane
- Discipline of Obstetrics and Gynaecology, School of Clinical Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Bellington Vwalika
- Department of Obstetrics and Gynaecology, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Sibone Mocumbi
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique
| | | | - Sigve D. Holmen
- Department of Infectious Diseases Ullevaal, Norwegian Centre for Imported and Tropical Diseases, Oslo University Hospital, Oslo, Norway
| | | | - Borghild Roald
- Center for Paediatric and Pregnancy Related Pathology, Department of Pathology, Oslo University Hospital, and Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Francis Hyera
- Department of Public Health Medicine, Faculty of Health Sciences, Walter Sisulu University (WSU), Mthatha, South Africa
| | - Sheila Mabote
- Instituto Nacional de Saúde–INS (National Health Institute), Marracuene, Mozambique
| | - Takalani G. Nemungadi
- National Department of Health, Pretoria, Communicable Diseases Control Directorate, Pretoria, South Africa
| | - Thembinkosi V. Ngcobo
- National Department of Health, Pretoria, Communicable Diseases Control Directorate, Pretoria, South Africa
| | - Tsakani Furumele
- National Department of Health, Pretoria, Communicable Diseases Control Directorate, Pretoria, South Africa
| | - Patricia D. Ndhlovu
- BRIGHT Academy, Centre for Bilharzia and Tropical Health Research, Ugu District, KwaZulu-Natal, South Africa
| | - Martin W. Gerdes
- Department of Information and Communication Technologies, University of Agder, Kristiansand, Norway
| | - Svein G. Gundersen
- Institute for Global Development and Planning, University of Agder, Kristiansand, Norway
| | - Zilungile L. Mkhize-Kwitshana
- School of Laboratory Medicine & Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Research Capacity Division, South African Medical Research Council, Tygerberg, South Africa
| | - Myra Taylor
- School of Laboratory Medicine & Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Roland E. E. Mhlanga
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Eyrun F. Kjetland
- Department of Infectious Diseases Ullevaal, Norwegian Centre for Imported and Tropical Diseases, Oslo University Hospital, Oslo, Norway
- School of Laboratory Medicine & Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
2
|
Nemungadi TG, Kleppa E, Galappaththi-Arachchige HN, Pillay P, Gundersen SG, Vennervald BJ, Ndhlovu PD, Taylor M, Naidoo S, Kjetland EF. Predictors for participation in mass-treatment and female genital schistosomiasis re-investigation, and the effect of praziquantel treatment in South African adolescents. PLoS Negl Trop Dis 2024; 18:e0011798. [PMID: 38536861 PMCID: PMC11020363 DOI: 10.1371/journal.pntd.0011798] [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: 11/15/2023] [Revised: 04/16/2024] [Accepted: 03/12/2024] [Indexed: 04/18/2024] Open
Abstract
OBJECTIVE Female Genital Schistosomiasis (FGS) causes intravaginal lesions and symptoms that could be mistaken for sexually transmitted diseases or cancer. In adults, FGS lesions [grainy sandy patches (GSP), homogenous yellow patches (HYP), abnormal blood vessels and rubbery papules] are refractory to treatment. The effect of treatment has never been explored in young women; it is unclear if gynaecological investigation will be possible in this young age group (16-23 years). We explored the predictors for accepting anti-schistosomal treatment and/or gynaecological reinvestigation in young women, and the effects of anti-schistosomal mass-treatment (praziquantel) on the clinical manifestations of FGS at an adolescent age. METHOD The study was conducted between 2011 and 2013 in randomly selected, rural, high schools in Ilembe, uThungulu and Ugu Districts, KwaZulu-Natal Province, East Coast of South Africa. At baseline, gynaecological investigations were conducted in female learners in grades 8 to 12, aged 16-23 years (n = 2293). Mass-treatment was offered in the low-transmission season between May and August (a few in September, n = 48), in accordance with WHO recommendations. Reinvestigation was offered after a median of 9 months (range 5-14 months). Univariate, multivariable and logistic regression analysis were used to measure the association between variables. RESULTS Prevalence: Of the 2293 learners who came for baseline gynaecological investigations, 1045 (46%) had FGS lesions and/or schistosomiasis, 209/1045 (20%) had GSP; 208/1045 (20%) HYP; 772/1045 (74%) had abnormal blood vessels; and 404/1045 (39%) were urine positive. Overall participation rate for mass treatment and gynaecological investigation: Only 26% (587/2293) learners participated in the mass treatment and 17% (401/2293) participated in the follow up gynaecological reinvestigations. Loss to follow-up among those with FGS: More than 70% of learners with FGS lesions at baseline were lost to follow-up for gynaecological investigations: 156/209 (75%) GSP; 154/208 (74%) HYP; 539/722 (75%) abnormal blood vessels; 238/404 (59%) urine positive. The grade 12 pupil had left school and did not participate in the reinvestigations (n = 375; 16%). Follow-up findings: Amongst those with lesions who came for both treatment and reinvestigation, 12/19 still had GSP, 8/28 had HYP, and 54/90 had abnormal blood vessels. Only 3/55 remained positive for S. haematobium ova. Factors influencing treatment and follow-up gynaecological investigation: HIV, current water contact, water contact as a toddler and urinary schistosomiasis influenced participation in mass treatment. Grainy sandy patches, abnormal blood vessels, HYP, previous pregnancy, current water contact, water contact as a toddler and father present in the family were strongly associated with coming back for follow-up gynaecological investigation. Challenges in sample size for follow-up analysis of the effect of treatment: The low mass treatment uptake and loss to follow up among those who had baseline FGS reduced the chances of a larger sample size at follow up investigation. However, multivariable analysis showed that treatment had effect on the abnormal blood vessels (adjusted odds ratio = 2.1, 95% CI 1.1-3.9 and p = 0.018). CONCLUSION Compliance to treatment and gynaecological reinvestigation was very low. There is need to embark on large scale awareness and advocacy in schools and communities before implementing mass-treatment and investigation studies. Despite challenges in sample size and significant loss to follow-up, limiting the ability to fully understand the treatment's effect, multivariable analysis demonstrated a significant treatment effect on abnormal blood vessels.
Collapse
Affiliation(s)
- Takalani Girly Nemungadi
- Discipline of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Elisabeth Kleppa
- Norwegian Centre for Imported and Tropical Diseases, Oslo University Hospital, Oslo, Norway
| | | | - Pavitra Pillay
- Department of Biomedical and Clinical Technology, Durban University of Technology, KwaZulu-Natal, Durban, South Africa
| | - Svein Gunnar Gundersen
- Institute for Global Development and Planning, University of Agder, Kristiansand, Norway
| | - Birgitte Jyding Vennervald
- Section for Parasitology and Aquatic Pathobiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Myra Taylor
- Discipline of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Saloshni Naidoo
- Discipline of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Eyrun Floerecke Kjetland
- Discipline of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Norwegian Centre for Imported and Tropical Diseases, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
3
|
Sturt A, Bristowe H, Webb E, Hansingo I, Phiri C, Mudenda M, Mapani J, Mweene T, Levecke B, Cools P, van Dam G, Corstjens P, Ayles H, Hayes R, Francis S, van Lieshout L, Vwalika B, Kjetland E, Bustinduy A. Visual diagnosis of female genital schistosomiasis in Zambian women from hand-held colposcopy: agreement of expert image review and association with clinical symptoms. Wellcome Open Res 2023; 8:14. [PMID: 36864924 PMCID: PMC9971661 DOI: 10.12688/wellcomeopenres.18737.2] [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] [Accepted: 04/17/2023] [Indexed: 05/09/2023] Open
Abstract
Background: Female genital schistosomiasis (FGS) can occur in S. haematobium infection and is caused by egg deposition in the genital tract. Confirming a diagnosis of FGS is challenging due to the lack of a diagnostic reference standard. A 2010 expert-led consensus meeting proposed visual inspection of the cervicovaginal mucosa as an adequate reference standard for FGS diagnosis. The agreement of expert human reviewers for visual-FGS has not been previously described. Methods: In two Zambian communities, non-menstruating, non-pregnant, sexually-active women aged 18-31 years participating in the HPTN 071 (PopART) Population-Cohort were enrolled in a cross-sectional study. Self-collected genital swabs and a urine specimen were collected at a home visit; trained midwives performed cervicovaginal lavage (CVL) and hand-held colposcopy at a clinic visit. S. haematobium eggs and circulating anodic antigen (CAA) were detected from urine. Two senior physicians served as expert reviewers and independently diagnosed visual-FGS as the presence of sandy patches, rubbery papules or abnormal blood vessels in cervicovaginal images obtained by hand-held colposcopy. PCR-FGS was defined as Schistosoma DNA detected by real-time PCR in any genital specimen (CVL or genital swab). Results: Of 527 women with cervicovaginal colposcopic images, 468/527 (88.8%) were deemed interpretable by Reviewer 1 and 417/527 (79.1%) by Reviewer 2. Visual-FGS was detected in 35.3% (165/468) of participants by expert review of colposcopic images by Reviewer 1 and in 63.6% (265/417) by Reviewer 2. Cohen's kappa statistic for agreement between the two reviewers was 0.16, corresponding to "slight" agreement. The reviewers made concordant diagnoses in 38.7% (204/527) participants (100 negative, 104 positive) and discordant diagnoses in 31.8% (168/527) participants. Conclusions: The unexpectedly low level of correlation between expert reviewers highlights the imperfect nature of visual diagnosis for FGS based on cervicovaginal images. This finding is a call to action for improved point-of-care diagnostics for female genital schistosomiasis.
Collapse
Affiliation(s)
- Amy Sturt
- Department of Medicine, Division of Infectious Diseases, Veterans Affairs Healthcare System, Palo Alto, CA, 94304, USA
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University, Palo Alto, California, 94305, USA
| | | | - Emily Webb
- MRC International Statistic and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Isaiah Hansingo
- Department of Obstetrics and Gynecology, Livingstone Central Hospital, Livingstone, Zambia
| | | | - Maina Mudenda
- Department of Obstetrics and Gynecology, Livingstone Central Hospital, Livingstone, Zambia
| | - Joyce Mapani
- Department of Obstetrics and Gynecology, Livingstone Central Hospital, Livingstone, Zambia
| | | | - Bruno Levecke
- Department of Translational Physiology, Infectiology, and Public Health, Ghent University, Merelbeke, B-9820, Belgium
| | - Piet Cools
- Department of Translational Physiology, Infectiology, and Public Health, Ghent University, Merelbeke, B-9820, Belgium
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, B-9000, Belgium
| | - Govert van Dam
- Department of Parasitology, Leiden University Medical Center, Leiden, 2300 RC, The Netherlands
| | - Paul Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, 2300 RC, The Netherlands
| | - Helen Ayles
- Zambart, Lusaka, Zambia
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Richard Hayes
- MRC International Statistic and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Suzanna Francis
- MRC International Statistic and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Lisette van Lieshout
- Department of Parasitology, Leiden University Medical Center, Leiden, 2300 RC, The Netherlands
| | - Bellington Vwalika
- Department of Obstetrics and Gynecology, University of Lusaka, Lusaka, Zambia
| | - Eyrun Kjetland
- Department of Infectious Diseases, Oslo University Hospital, Oslo, 0450, Norway
- University of KwaZulu-Natal, Durban, 4041, South Africa
| | - Amaya Bustinduy
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| |
Collapse
|
4
|
Makia CM, Fesuh NB, Amabo EN, Gamba VA, Oluwole AS, Stothard R. Urogenital schistosomiasis (UGS) and female genital schistosomiasis (FGS) in Cameroon: an observational assessment of key reproductive health determinants of girls and women in the Matta Health Area. BMJ Open 2023; 13:e063392. [PMID: 36787976 PMCID: PMC9930553 DOI: 10.1136/bmjopen-2022-063392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVES AND SETTING Across sub-Saharan Africa, urogenital schistosomiasis (UGS), in particular female genital schistosomiasis (FGS), is a significant waterborne parasitic disease, with its direct burden on the sexual and reproductive health (SRH) of sufferers infrequently measured. UGS has an established control plan, which in most endemic regions as in Cameroon, still excludes FGS considerations. Highlighting existent associations between UGS and FGS could increase the management of FGS within UGS interventions. This study seeks to identify current associations among FGS and UGS with some reproductive health indicators, to provide formative information for better integrated control. PARTICIPANTS 304 females aged 5-69 years were all examined for UGS by urine filtration and microscopy. Among these, 193 women and girls were eligible for clinical FGS assessment based on age (>13). After selective questioning for FGS symptoms, a subgroup of 67 women and girls consented for clinical examination for FGS using portable colposcopy, with observed sequelae classified according to the WHO FGS pocket atlas. OUTCOME Overall UGS and FGS prevalence was measured, with FGS-related/UGS-related reproductive health symptoms recorded. Associations between FGS and UGS were investigated by univariate and multivariate logistic regression analyses. RESULTS Overall UGS prevalence was 63.8% (194/304), where FGS prevalence (subgroup) was 50.7% (34/67). FGS manifestation increased significantly with increasing age, while a significant decrease with ascending age was observed for UGS. Lower abdominal pain (LAP) vaginal itches (VI) and coital pain (CP) were identified as the main significant shared symptoms of both FGS and UGS, while LAP with menstrual irregularity (MI) appeared a strong symptomatic indicator for FGS. CONCLUSION LAP, MI, CP and VI are the potential SRH indicators that could be exploited in future for targeting of praziquantel provision to FGS sufferers within primary care, complementary with existing praziquantel distribution for UGS sufferers in Schistosoma haematobium endemic areas.
Collapse
Affiliation(s)
- Christine Masong Makia
- Social Sciences and Management, Catholic University of Central Africa, Yaounde, Centre, Cameroon
| | - Nono Betrand Fesuh
- Department of Mathematics and Physical Sciences, National Advanced School of Engineering, University of Yaoundé 1, Yaoundé, Centre, Cameroon
| | | | - Victoria A Gamba
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Nairobi, Kenya
| | - Akinola Stephen Oluwole
- Department of Pure and Applied Zoology, Federal University of Agriculture Abeokuta, Abeokuta, Ogun, Nigeria
| | - Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| |
Collapse
|
5
|
Sturt A, Bristowe H, Webb E, Hansingo I, Phiri C, Mudenda M, Mapani J, Mweene T, Levecke B, Cools P, van Dam G, Corstjens P, Ayles H, Hayes R, Francis S, van Lieshout L, Vwalika B, Kjetland E, Bustinduy A. Visual diagnosis of female genital schistosomiasis in Zambian women from hand-held colposcopy: agreement of expert image review. Wellcome Open Res 2023; 8:14. [PMID: 36864924 PMCID: PMC9971661 DOI: 10.12688/wellcomeopenres.18737.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 01/11/2023] Open
Abstract
Female genital schistosomiasis (FGS) can occur in S. haematobium infection and is caused by parasite egg deposition in the genital tract. Confirming a diagnosis of FGS is challenging due to the lack of a diagnostic reference standard. A 2010 expert-led consensus meeting proposed visual inspection of the cervicovaginal mucosa as an adequate reference standard for FGS diagnosis. The agreement of expert human reviewers for visual-FGS has not been previously described. Methods: In two Zambian communities, non-menstruating, non-pregnant, sexually-active women aged 18-31 years participating in the HPTN 071 (PopART) Population-Cohort were enrolled in a cross-sectional study. Self-collected genital swabs and a urine specimen were collected at a home visit; trained midwives performed CVL and hand-held colposcopy at a clinic visit. S. haematobium eggs and circulating anodic antigen (CAA) were detected from urine. Two expert reviewers independently diagnosed visual-FGS as the presence of sandy patches, rubbery papules or abnormal blood vessels in digital cervicovaginal images obtained by hand-held colposcopy. PCR-FGS was defined as Schistosoma DNA detected by real-time PCR in any genital specimen (CVL or genital swab). Results: Of 527 women with cervicovaginal colposcopic images, 468/527 (88.8%) were deemed interpretable by Reviewer 1 and 417/527 (79.1%) by Reviewer 2. Visual-FGS was detected in 35.3% (165/468) of participants by expert review of colposcopic images by Reviewer 1 and in 63.6% (265/417) by Reviewer 2. Cohen's kappa statistic for agreement between the two expert reviewers was 0.16, corresponding to "slight" agreement. The reviewers made concordant diagnoses in 38.7% (204/527) participants (100 negative, 104 positive) and discordant diagnoses in 31.8% (168/527) participants. Conclusions: The unexpectedly low level of correlation between expert reviewers highlights the imperfect nature of visual diagnosis for FGS based on cervicovaginal images obtained with a hand-held colposcope. This finding is a call to action for improved point-of-care diagnostics for female genital schistosomiasis.
Collapse
Affiliation(s)
- Amy Sturt
- Department of Medicine, Division of Infectious Diseases, Veterans Affairs Healthcare System, Palo Alto, CA, 94304, USA
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University, Palo Alto, California, 94305, USA
| | | | - Emily Webb
- MRC International Statistic and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Isaiah Hansingo
- Department of Obstetrics and Gynecology, Livingstone Central Hospital, Livingstone, Zambia
| | | | - Maina Mudenda
- Department of Obstetrics and Gynecology, Livingstone Central Hospital, Livingstone, Zambia
| | - Joyce Mapani
- Department of Obstetrics and Gynecology, Livingstone Central Hospital, Livingstone, Zambia
| | | | - Bruno Levecke
- Department of Translational Physiology, Infectiology, and Public Health, Ghent University, Merelbeke, B-9820, Belgium
| | - Piet Cools
- Department of Translational Physiology, Infectiology, and Public Health, Ghent University, Merelbeke, B-9820, Belgium
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, B-9000, Belgium
| | - Govert van Dam
- Department of Parasitology, Leiden University Medical Center, Leiden, 2300 RC, The Netherlands
| | - Paul Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, 2300 RC, The Netherlands
| | - Helen Ayles
- Zambart, Lusaka, Zambia
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Richard Hayes
- MRC International Statistic and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Suzanna Francis
- MRC International Statistic and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Lisette van Lieshout
- Department of Parasitology, Leiden University Medical Center, Leiden, 2300 RC, The Netherlands
| | - Bellington Vwalika
- Department of Obstetrics and Gynecology, University of Lusaka, Lusaka, Zambia
| | - Eyrun Kjetland
- Department of Infectious Diseases, Oslo University Hospital, Oslo, 0450, Norway
- University of KwaZulu-Natal, Durban, 4041, South Africa
| | - Amaya Bustinduy
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| |
Collapse
|
6
|
Improving the Response of Health Systems to Female Genital Schistosomiasis in Endemic Countries through a Gender-Sensitive Human Rights-Based Framework. Diseases 2022; 10:diseases10040125. [PMID: 36547211 PMCID: PMC9777435 DOI: 10.3390/diseases10040125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/28/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022] Open
Abstract
The right to health was enshrined in the constitution of the World Health Organization in 1946 and in the Universal Declaration of Human Rights in 1948, which also guaranteed women's fundamental freedoms and dignity. The Declaration of Human Rights was signed by almost every country in the world. Nonetheless, gender inequalities in health and health systems continue to persist, especially in lower and middle income countries that are disproportionately affected by a litany of neglected diseases. In this paper, we focus on one of the most neglected human rights, development, and reproductive health issues globally, female genital schistosomiasis (FGS), which imposes enormous unacknowledged suffering on an estimated 56 million women and girls in Sub-Saharan Africa. Despite increasing calls for attention to FGS, no country has fully incorporated it into its health system. An appropriate response will require a comprehensive approach, guided by human rights mandates and the redress of FGS-related gender inequalities. In this paper, we propose the application of existing human rights and its clients, women, and girls affected by FGS as rights holders. Within the different components or building blocks of the health system, we propose elements of an appropriate health system response using the four components identified within the FGS Accelerated Scale Together (FAST) Package-awareness raising, prevention of infection, training of health personnel, and diagnosis and treatment. The framework is aspirational, its recommended elements and actions are not exhaustive, and countries will need to adapt it to their own situations and resource availability. However, it can be a useful guide to help health systems define how to begin to incorporate FGS into their programming in a way that responds to their human rights obligations in a gender- and culturally sensitive manner.
Collapse
|
7
|
Nemungadi TG, Furumele TE, Gugerty MK, Djirmay AG, Naidoo S, Kjetland EF. Establishing and Integrating a Female Genital Schistosomiasis Control Programme into the Existing Health Care System. Trop Med Infect Dis 2022; 7:tropicalmed7110382. [PMID: 36422933 PMCID: PMC9696272 DOI: 10.3390/tropicalmed7110382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/02/2022] [Accepted: 11/09/2022] [Indexed: 11/19/2022] Open
Abstract
Female genital schistosomiasis (FGS) is a complication of Schistosoma haematobium infection, and imposes a health burden whose magnitude is not fully explored. It is estimated that up to 56 million women in sub-Saharan Africa have FGS, and almost 20 million more cases will occur in the next decade unless infected girls are treated. Schistosomiasis is reported throughout the year in South Africa in areas known to be endemic, but there is no control programme. We analyze five actions for both a better understanding of the burden of FGS and reducing its prevalence in Africa, namely: (1) schistosomiasis prevention by establishing a formal control programme and increasing access to treatment, (2) introducing FGS screening, (3) providing knowledge to health care workers and communities, (4) vector control, and (5) water, sanitation, and hygiene. Schistosomiasis is focal in South Africa, with most localities moderately affected (prevalence between 10% and 50%), and some pockets that are high risk (more than 50% prevalence). However, in order to progress towards elimination, the five actions are yet to be implemented in addition to the current (and only) control strategy of case-by-case treatment. The main challenge that South Africa faces is a lack of access to WHO-accredited donated medication for mass drug administration. The establishment of a formal and funded programme would address these issues and begin the implementation of the recommended actions.
Collapse
Affiliation(s)
- Takalani Girly Nemungadi
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa
- Communicable Disease Control Directorate, National Department of Health, Pretoria 0001, South Africa
- Correspondence:
| | - Tsakani Ernica Furumele
- Communicable Disease Control Directorate, National Department of Health, Pretoria 0001, South Africa
| | - Mary Kay Gugerty
- Evans School of Public Policy & Governance, University of Washington, Seattle, WA 98195-3055, USA
| | - Amadou Garba Djirmay
- Department of the Control of Neglected Tropical Diseases, World Health Organization, 1211 Geneva, Switzerland
| | - Saloshni Naidoo
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa
| | - Eyrun Flörecke Kjetland
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, 0424 Oslo, Norway
| |
Collapse
|
8
|
Sang HC, Mwinzi PNM, Odiere MR, Onkanga I, Rawago F, Pillay P, Kjetland EF. Absence of lower genital tract lesions among women of reproductive age infected with Schistosoma mansoni: A cross-sectional study using a colposcope in Western Kenya. PLoS Negl Trop Dis 2022; 16:e0010473. [PMID: 35802746 PMCID: PMC9299320 DOI: 10.1371/journal.pntd.0010473] [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: 05/21/2021] [Revised: 07/20/2022] [Accepted: 05/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Female genital schistosomiasis (FGS) constitutes four different lesions known to be caused by Schistosoma haematobium ova deposited in the genital tract. Schistosoma mansoni ova may also be found in the genital tract. However, it is not known if S. mansoni causes lower genital tract lesions characteristic of FGS.
Methodology
This study was conducted in 8 villages along the shores of Lake Victoria, western Kenya. Stool and urine samples, collected from women of reproductive age on three consecutive days, were analysed for S. mansoni and S. haematobium infection. S. mansoni positive and S. haematobium negative willing participants, aged 18–50 years were invited to answer a questionnaire (demographics, symptoms), undergo a gynaecological examination and cytology specimen collection by an FGS expert.
Principal findings
Gynaecologic investigations were conducted in 147 S. mansoni-positive women who had a mean infection intensity of 253.3 epg (95% CI: 194.8–311.9 epg). Nearly 90% of them used Lake Victoria as their main water source. None were found to have cervicovaginal grainy sandy patches or rubbery papules. Homogenous yellow patches were found in 12/147 (8.2%) women. Women with homogenous yellow patches were significantly older (47 years) than the rest (34 years, p = 0.001). No association was found between intensity of S. mansoni infection and homogenous yellow patches (p = 0.70) or abnormal blood vessels (p = 0.14). S. mansoni infection intensity was not associated with genital itch, bloody or malodorous vaginal discharge.
Conclusion
S. mansoni infection was neither associated with lower genital tract lesions nor symptoms typically found in women with FGS.
Collapse
Affiliation(s)
- Huldah C. Sang
- Neglected Tropical Diseases Unit, Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Pauline N. M. Mwinzi
- Neglected Tropical Diseases Unit, Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Maurice R. Odiere
- Neglected Tropical Diseases Unit, Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Isaac Onkanga
- Neglected Tropical Diseases Unit, Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Fredrick Rawago
- Neglected Tropical Diseases Unit, Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Pavitra Pillay
- Department of Biomedical and Clinical Technology, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
| | - Eyrun Floerecke Kjetland
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway
- Discipline of Public Health, Nelson Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- * E-mail:
| |
Collapse
|
9
|
Nemungadi TG, Kleppa E, van Dam GJ, Corstjens PLAM, Galappaththi-Arachchige HN, Pillay P, Gundersen SG, Vennervald BJ, Ndhlovu P, Taylor M, Naidoo S, Kjetland EF. Female Genital Schistosomiasis Lesions Explored Using Circulating Anodic Antigen as an Indicator for Live Schistosoma Worms. FRONTIERS IN TROPICAL DISEASES 2022. [DOI: 10.3389/fitd.2022.821463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BackgroundIn areas where reinfection with schistosomiasis is rampant, it is not known if the lesions of Female Genital Schistosomaisis are a consequence of live worms, or caused by dead ova. Live schistosome worms regurgitate Circulating Anodic Antigen (CAA). We sought to explore the association between the different lesions of FGS (grainy sandy patches, homogenous yellow patches, rubbery papules and abnormal blood vessels) and the presence of live worms as indicated by S. haematobium-derived CAA in blood.Materials and MethodsIn this cross-sectional study, rural high schools were randomly selected from Ilembe, uThungulu and Ugu Districts on the East Coast of South Africa, KwaZulu-Natal Province. Serum samples for CAA analysis were collected from 246 female learners aged 16 - 23 years. Uncorrected chi-square and odds ratio with 95% confidence interval (CI) were used to evaluate the null hypothesis.ResultsCAA was positive in 82/246 (33%) of the participants. Sandy patches were found in 123 (50%) of the study population. Grainy sandy patches were significantly associated with CAA even after controlling for age (Adjusted Odds Ratio (AOR) 4.2, 95% CI 2.3 - 7.9, p < 0.001). Likewise, abnormal blood vessels were associated with CAA (AOR 3.0, 95% CI 1.5-4.5, p = 0.001) whereas homogenous yellow patches were not associated with CAA (p = 0.57). Rubbery papules were not found in this study population.ConclusionGrainy sandy patches and abnormal blood vessels are found more commonly in women who harbour live Schistosoma haematobium worms whilst homogenous yellow patches may indicate chronic tissue damage due to dead ova.
Collapse
|
10
|
Bustinduy AL, Randriansolo B, Sturt AS, Kayuni SA, Leustcher PDC, Webster BL, Van Lieshout L, Stothard JR, Feldmeier H, Gyapong M. An update on female and male genital schistosomiasis and a call to integrate efforts to escalate diagnosis, treatment and awareness in endemic and non-endemic settings: The time is now. ADVANCES IN PARASITOLOGY 2022; 115:1-44. [PMID: 35249661 DOI: 10.1016/bs.apar.2021.12.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The last decades have brought important insight and updates in the diagnosis, management and immunopathology of female genital schistosomiasis (FGS) and male genital schistosomiasis (MGS). Despite sharing a common parasitic aetiological agent, FGS and MGS have typically been studied separately. Infection with Schistosoma haematobium manifests with gender-specific clinical manifestations and consequences of infection, albeit having a similar pathogenesis within the human genital tract. Schistosoma haematobium is a known urinary bladder carcinogen, but its potential causative role in other types of neoplasia, such as cervical cancer, is not fully understood. Furthermore, the impact of praziquantel treatment on clinical outcomes remains largely underexplored, as is the interplay of FGS/MGS with relevant reproductive tract infections such as HIV and Human Papillomavirus. In non-endemic settings, travel and immigrant health clinics need better guidance to correctly identify and treat FGS and MGS. Our review outlines the latest advances and remaining knowledge gaps in FGS and MGS research. We aim to pave a way forward to formulate more effective control measures and discuss elimination targets. With a growing community awareness in health practitioners, scientists and epidemiologists, alongside the sufferers from these diseases, we aspire to witness a new generation of young women and men free from the downstream disabling manifestations of disease.
Collapse
Affiliation(s)
- Amaya L Bustinduy
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | | | - Amy S Sturt
- Section of Infectious Diseases, Veterans Affairs Palo Alto Health Care System, Palo Alto, United States
| | - Seke A Kayuni
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; MASM Medi Clinics Limited, Blantyre, Malawi
| | - Peter D C Leustcher
- Centre for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Lisette Van Lieshout
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - J Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Hermann Feldmeier
- Charité University Medicine Berlin, Institute of Microbiology, Infectious Diseases and Immunology, Berlin, Germany
| | - Margaret Gyapong
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| |
Collapse
|
11
|
Archer J, Patwary FK, Sturt AS, Webb EL, Phiri CR, Mweene T, Hayes RJ, Ayles H, Brienen EAT, van Lieshout L, Webster BL, Bustinduy AL. Validation of the isothermal Schistosoma haematobium Recombinase Polymerase Amplification (RPA) assay, coupled with simplified sample preparation, for diagnosing female genital schistosomiasis using cervicovaginal lavage and vaginal self-swab samples. PLoS Negl Trop Dis 2022; 16:e0010276. [PMID: 35286336 PMCID: PMC8947142 DOI: 10.1371/journal.pntd.0010276] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 03/24/2022] [Accepted: 02/24/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Female genital schistosomiasis (FGS) is a neglected and disabling gynecological disease that can result from infection with the parasitic trematode Schistosoma haematobium. Accurate diagnosis of FGS is crucial for effective case management, surveillance and control. However, current methods for diagnosis and morbidity assessment can be inaccessible to those at need, labour intensive, costly and unreliable. Molecular techniques such as PCR can be used to reliably diagnose FGS via the detection of Schistosoma DNA using cervicovaginal lavage (CVL) samples as well as lesser-invasive vaginal self-swab (VSS) and cervical self-swab samples. PCR is, however, currently unsuited for use in most endemic settings. As such, in this study, we assessed the use of a rapid and portable S. haematobium recombinase polymerase amplification (Sh-RPA) isothermal molecular diagnostic assay, coupled with simplified sample preparation methodologies, to detect S. haematobium DNA using CVL and VSS samples provided by patients in Zambia. METHODOLOGY/PRINCIPAL FINDINGS VSS and CVL samples were screened for FGS using a previously developed Sh-RPA assay. DNA was isolated from VSS and CVL samples using the QIAamp Mini kit (n = 603 and 527, respectively). DNA was also isolated from CVL samples using two rapid and portable DNA extraction methods: 1) the SpeedXtract Nucleic Acid Kit (n = 223) and 2) the Extracta DNA Tissue Prep Kit (n = 136). Diagnostic performance of the Sh-RPA using VSS DNA extacts (QIAamp Mini kit) as well as CVL DNA extracts (QIAamp Mini kit, SpeedXtract Nucleic Acid Kit and Extracta DNA Tissue Prep Kit) was then compared to a real-time PCR reference test. Results suggest that optimal performance may be achieved when the Sh-RPA is used with PuVSS samples (sensitivity 93.3%; specificity 96.6%), however no comparisons between different DNA extraction methods using VSS samples could be carried out within this study. When using CVL samples, sensitivity of the Sh-RPA ranged between 71.4 and 85.7 across all three DNA extraction methods when compared to real-time PCR using CVL samples prepared using the QIAamp Mini kit. Interestingly, of these three DNA extraction methods, the rapid and portable SpeedXtract method had the greatest sensitivity and specificity (85.7% and 98.1%, respectively). Specificity of the Sh-RPA was >91% across all comparisons. CONCLUSIONS/SIGNIFICANCE These results supplement previous findings, highlighting that the use of genital self-swab sampling for diagnosing FGS should be explored further whilst also demonstrating that rapid and portable DNA isolation methods can be used to detect S. haematobium DNA within clinical samples using RPA. Although further development and assessment is needed, it was concluded that the Sh-RPA, coupled with simplified sample preparation, shows excellent promise as a rapid and sensitive diagnostic tool capable of diagnosing FGS at the point-of-care in resource-poor schistosomiasis-endemic settings.
Collapse
Affiliation(s)
- John Archer
- Wolfson Wellcome Biomedical Laboratories, Department of Zoology, Natural History Museum, Cromwell Road, London, United Kingdom
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
| | - Farhan K. Patwary
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom
| | - Amy S. Sturt
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom
| | - Emily L. Webb
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom
| | | | - Tobias Mweene
- School of Medicine, University of Zambia, Zambart, Lusaka, Zambia
| | - Richard J. Hayes
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom
| | - Helen Ayles
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom
- School of Medicine, University of Zambia, Zambart, Lusaka, Zambia
| | - Eric A. T. Brienen
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Lisette van Lieshout
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Bonnie L. Webster
- Wolfson Wellcome Biomedical Laboratories, Department of Zoology, Natural History Museum, Cromwell Road, London, United Kingdom
| | - Amaya L. Bustinduy
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom
| |
Collapse
|
12
|
Shams M, Khazaei S, Ghasemi E, Nazari N, Javanmardi E, Majidiani H, Bahadory S, Anvari D, Fatollahzadeh M, Nemati T, Asghari A. Prevalence of urinary schistosomiasis in women: a systematic review and meta-analysis of recently published literature (2016-2020). Trop Med Health 2022; 50:12. [PMID: 35093180 PMCID: PMC8800356 DOI: 10.1186/s41182-022-00402-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 01/12/2022] [Indexed: 12/14/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Morteza Shams
- Zoonotic Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Sasan Khazaei
- Department of Parasitology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Ezatollah Ghasemi
- Department of Medical Parasitology, School of Medicine, Dezful University of Medical Sciences, Dezful, Iran
| | - Naser Nazari
- Department of Parasitology and Mycology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Erfan Javanmardi
- Clinical Research Development Center, "The Persian Gulf Martyrs" Hospital of Bushehr University of Medical Sciences, Bushehr, Iran
| | - Hamidreza Majidiani
- Department of Basic Medical Sciences, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Saeed Bahadory
- Department of Parasitology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Davood Anvari
- Department of Parasitology, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
- School of Medicine, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Mohammad Fatollahzadeh
- Department of Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Taher Nemati
- Department of Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Asghari
- Department of Medical Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
13
|
Sturt AS, Webb EL, Himschoot L, Phiri CR, Mapani J, Mudenda M, Kjetland EF, Mweene T, Levecke B, van Dam GJ, Corstjens PLAM, Ayles H, Hayes RJ, van Lieshout L, Hansingo I, Francis SC, Cools P, Bustinduy AL. Association of Female Genital Schistosomiasis With the Cervicovaginal Microbiota and Sexually Transmitted Infections in Zambian Women. Open Forum Infect Dis 2021; 8:ofab438. [PMID: 34557562 PMCID: PMC8454507 DOI: 10.1093/ofid/ofab438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/20/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The cervicovaginal microbiota, including sexually transmitted infections (STIs), have not been well described in female genital schistosomiasis (FGS). METHODS Women (aged 18-31, sexually active, nonpregnant) were invited to participate at the final follow-up of the HPTN 071 (PopART) Population Cohort in January-August 2018. We measured key species of the cervicovaginal microbiota (Lactobacillus crispatus, L. iners, Gardnerella vaginalis, Atopobium vaginae, and Candida) and STIs (Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium) using quantitative PCR (qPCR). We evaluated associations of the microbiota and STI presence and concentration with FGS (qPCR-detected Schistosoma DNA in any of 3 genital specimens). RESULTS The presence and concentration of key cervicovaginal species did not differ between participants with (n = 30) or without FGS (n = 158). A higher proportion of participants with FGS had T. vaginalis compared with FGS-negative women (P = .08), with further analysis showing that T. vaginalis was more prevalent among women with ≥2 Schistosoma qPCR-positive genital specimens (50.0%, 8/16) than among FGS-negative women (21.5%, 34/158; P = .01). CONCLUSIONS We found weak evidence of an association between the presence of T. vaginalis and FGS, with a stronger association in women with a higher-burden FGS infection. Additional research is needed on potential between-parasite interactions, especially regarding HIV-1 vulnerability.
Collapse
Affiliation(s)
- Amy S Sturt
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Emily L Webb
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Lisa Himschoot
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Joyce Mapani
- Department of Obstetrics and Gynecology, Livingstone Central Hospital, Livingstone, Zambia
| | - Maina Mudenda
- Department of Obstetrics and Gynecology, Livingstone Central Hospital, Livingstone, Zambia
| | - Eyrun F Kjetland
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
- University of KwaZulu-Natal, Durban, South Africa
| | | | - Bruno Levecke
- Department of Virology, Parasitology, and Immunology, Ghent University, Merelbeke, Belgium
| | - Govert J van Dam
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Paul L A M Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands
| | - Helen Ayles
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Zambart, Lusaka, Zambia
| | - Richard J Hayes
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Lisette van Lieshout
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Isaiah Hansingo
- Department of Obstetrics and Gynecology, Livingstone Central Hospital, Livingstone, Zambia
| | - Suzanna C Francis
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Piet Cools
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Virology, Parasitology, and Immunology, Ghent University, Merelbeke, Belgium
| | - Amaya L Bustinduy
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
14
|
Sturt AS, Webb EL, Phiri CR, Mudenda M, Mapani J, Kosloff B, Cheeba M, Shanaube K, Bwalya J, Kjetland EF, Francis SC, Corstjens PLAM, van Dam GJ, van Lieshout L, Hansingo I, Ayles H, Hayes RJ, Bustinduy AL. Female Genital Schistosomiasis and HIV-1 Incidence in Zambian Women: A Retrospective Cohort Study. Open Forum Infect Dis 2021; 8:ofab349. [PMID: 34337098 PMCID: PMC8320261 DOI: 10.1093/ofid/ofab349] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/29/2021] [Indexed: 12/19/2022] Open
Abstract
Background Female genital schistosomiasis (FGS) has been associated with prevalent HIV-1. We estimated the incidence of HIV-1 infection in Zambian women with and without FGS. Methods Women (aged 18–31, nonpregnant, sexually active) were invited to participate in this study in January–August 2018 at the final follow-up of the HPTN 071 (PopART) Population Cohort. HIV-1-negative participants at enrollment (n = 492) were included in this analysis, with testing to confirm incident HIV-1 performed in HPTN 071 (PopART). The association of incident HIV-1 infection with FGS (Schistosoma DNA detected by polymerase chain reaction [PCR] in any genital specimen) was assessed with exact Poisson regression. Results Incident HIV-1 infections were observed in 4.1% (20/492) of participants. Women with FGS were twice as likely to seroconvert as women without FGS but with no statistical evidence for a difference (adjusted rate ratio, 2.16; 95% CI, 0.21–12.30; P = .33). Exploratory analysis suggested an association with HIV-1 acquisition among women with ≥2 positive genital PCR specimens (rate ratio, 6.02; 95% CI, 0.58–34.96; P = .13). Conclusions Despite higher HIV seroconversion rates in women with FGS, there was no statistical evidence of association, possibly due to low power. Further longitudinal studies should investigate this association in a setting with higher schistosomiasis endemicity.
Collapse
Affiliation(s)
- Amy S Sturt
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Emily L Webb
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Maina Mudenda
- Department of Obstetrics and Gynaecology, Livingstone Central Hospital, Livingstone, Zambia
| | - Joyce Mapani
- Department of Obstetrics and Gynaecology, Livingstone Central Hospital, Livingstone, Zambia
| | - Barry Kosloff
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.,Zambart, Lusaka, Zambia
| | | | | | | | - Eyrun F Kjetland
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway.,Discipline of Public Health, University of KwaZulu-Natal, Discipline of Public Health, Durban, South Africa
| | - Suzanna C Francis
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Paul L A M Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands
| | - Govert J van Dam
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Lisette van Lieshout
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Isaiah Hansingo
- Department of Obstetrics and Gynaecology, Livingstone Central Hospital, Livingstone, Zambia
| | - Helen Ayles
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.,Zambart, Lusaka, Zambia
| | - Richard J Hayes
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Amaya L Bustinduy
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
15
|
Søfteland S, Sebitloane MH, Taylor M, Roald BB, Holmen S, Galappaththi-Arachchige HN, Gundersen SG, Kjetland EF. A systematic review of handheld tools in lieu of colposcopy for cervical neoplasia and female genital schistosomiasis. Int J Gynaecol Obstet 2021; 153:190-199. [PMID: 33316096 PMCID: PMC8248063 DOI: 10.1002/ijgo.13538] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/18/2020] [Accepted: 12/11/2020] [Indexed: 11/23/2022]
Abstract
Background Visualization of the lesions in the lower genital tract is the mainstay for diagnosis of the four lesions found in female genital schistosomiasis (FGS), but colposcopes are generally not available in low‐resource settings. Objective We sought to review handheld devices that could potentially be used for FGS diagnosis. Search strategy We searched Medline and Embase 2015–2019 for handheld devices used in cervical cancer screening and FGS diagnosis. Selection criteria We excluded studies that did not compare the device to standard‐of‐care colposcopes or histopathology. Main results and conclusion In 11 studies, four handheld colposcopes, two smartphones, and one compact digital camera were evaluated. Two handheld colposcopes were found to be potentially adequate for FGS diagnosis, namely Gynocular and Mobile ODT. The smartphones and digital camera did not have sufficient magnification to diagnose grainy sandy patches, one of the FGS lesion types. Customized software should be made to support the diagnosis of both FGS and cervical neoplasia. Real‐time postgraduate training and quality control should be considered in future studies of handheld colposcopes. For patients from schistosomiasis endemic areas, we recommend that handheld devices are used for FGS. Studies are needed to determine which of the two devices is most adequate for FGS diagnosis in schistosomiasis endemic areas. Handheld colposcopy for schistosomiasis endemic areas should be adequate for both cervical cancer and genital schistosomiasis diagnoses.
Collapse
Affiliation(s)
- Solrun Søfteland
- Norwegian Center for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Motshedisi Hannah Sebitloane
- Discipline of Obstetrics and Gynecology, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Myra Taylor
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Borghild Barth Roald
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Center for Pediatric and Pregnancy Related Pathology, Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Sigve Holmen
- Norwegian Center for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway
| | | | - Svein Gunnar Gundersen
- Institute for Global Development and Planning, University of Agder, Kristiansand, Norway
| | - Eyrun Floerecke Kjetland
- Norwegian Center for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway.,Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
16
|
Koukounari A, Jamil H, Erosheva E, Shiff C, Moustaki I. Latent Class Analysis: Insights about design and analysis of schistosomiasis diagnostic studies. PLoS Negl Trop Dis 2021; 15:e0009042. [PMID: 33539357 PMCID: PMC7888681 DOI: 10.1371/journal.pntd.0009042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 02/17/2021] [Accepted: 12/18/2020] [Indexed: 11/18/2022] Open
Abstract
Various global health initiatives are currently advocating the elimination of schistosomiasis within the next decade. Schistosomiasis is a highly debilitating tropical infectious disease with severe burden of morbidity and thus operational research accurately evaluating diagnostics that quantify the epidemic status for guiding effective strategies is essential. Latent class models (LCMs) have been generally considered in epidemiology and in particular in recent schistosomiasis diagnostic studies as a flexible tool for evaluating diagnostics because assessing the true infection status (via a gold standard) is not possible. However, within the biostatistics literature, classical LCM have already been criticised for real-life problems under violation of the conditional independence (CI) assumption and when applied to a small number of diagnostics (i.e. most often 3-5 diagnostic tests). Solutions of relaxing the CI assumption and accounting for zero-inflation, as well as collecting partial gold standard information, have been proposed, offering the potential for more robust model estimates. In the current article, we examined such approaches in the context of schistosomiasis via analysis of two real datasets and extensive simulation studies. Our main conclusions highlighted poor model fit in low prevalence settings and the necessity of collecting partial gold standard information in such settings in order to improve the accuracy and reduce bias of sensitivity and specificity estimates. Accurate schistosomiasis diagnosis is essential to assess the impact of large scale and repeated mass drug administration to control or even eliminate this disease. However, in schistosomiasis diagnostic studies, several inherent study design issues pose a real challenge for the currently available statistical tools used for diagnostic modelling and associated data analysis and conclusions. More specifically, those study design issues are: 1) the inclusion of small number of diagnostic tests (i.e. most often five), 2) non formal consensus about a schistosomiasis gold standard, 3) the contemporary use of relatively small sample sizes in relevant studies due to lack of research funding, 4) the differing levels of prevalence of the studied disease even within the same area of one endemic country and 5) other real world factors such as: the lack of appropriate equipment, the variability of certain methods due to biological phenomena and training of technicians across the endemic countries because of scarce financial resources contributing to the existing lack of a schistosomiasis gold standard. The current study aims to caution practitioners from blindly applying statistical models with small number of diagnostic tests and sample sizes, proposing design guidelines of future schistosomiasis diagnostic accuracy studies with recommendations for further research. While our study is centred around the diagnosis of schistosomiasis, we feel that the recommendations can be adapted to other major tropical infectious diseases as well.
Collapse
Affiliation(s)
- Artemis Koukounari
- Product Development Personalized Health Care, F. Hoffmann-La Roche Ltd., Welwyn Garden, United Kingdom
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Haziq Jamil
- Mathematical Sciences, Faculty of Science, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Elena Erosheva
- Department of Statistics, School of Social Work, Center for Statistics and the Social Sciences, University of Washington, Seattle, Washington, United States of America
| | - Clive Shiff
- Molecular Microbiology and Immunology Department, John Hopkins Bloomberg School of Public Health
| | - Irini Moustaki
- Department of Statistics, London School of Economics and Political Science, London, United Kingdom
| |
Collapse
|
17
|
Bengu MD, Dorsamy V, Moodley J. Schistosomiasis infections in South African pregnant women: A review. S Afr J Infect Dis 2020. [DOI: 10.4102/sajid.v35i1.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
18
|
King CH, Binder S, Shen Y, Whalen CC, Campbell CH, Wiegand RE, Olsen A, Secor WE, Montgomery SP, Musuva R, Mwinzi PNM, Magnussen P, Kinung’hi S, Andrade GN, Ezeamama AE, Colley DG. SCORE Studies on the Impact of Drug Treatment on Morbidity due to Schistosoma mansoni and Schistosoma haematobium Infection. Am J Trop Med Hyg 2020; 103:30-35. [PMID: 32400348 PMCID: PMC7351303 DOI: 10.4269/ajtmh.19-0830] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/26/2020] [Indexed: 01/14/2023] Open
Abstract
The Schistosomiasis Consortium for Operational Research (SCORE) was funded in 2008 to improve the evidence base for control and elimination of schistosomiasis-better understanding of the systemic morbidities experienced by children in schistosomiasis-endemic areas and the response of these morbidities to treatment, being essential for updating WHO guidelines for mass drug administration (MDA) in endemic areas. This article summarizes the SCORE studies that aimed to gauge the impact of MDA-based treatment on schistosomiasis-related morbidities. Morbidity cohort studies were embedded in the SCORE's larger field studies of gaining control of schistosomiasis in Kenya and Tanzania. Following MDA, cohort children had less undernutrition, less portal vein dilation, and increased quality of life in Year 5 compared with baseline. We also conducted a pilot study of the Behavioral Assessment System for Children (BASC-2) in conjunction with the Kenya gaining control study, which demonstrated beneficial effects of treatment on classroom behavior. In addition, the SCORE's Rapid Answers Project performed systematic reviews of previously available data, providing two meta-analyses related to morbidity. The first documented children's infection-related deficits in school attendance and achievement and in formal tests of learning and memory. The second showed that greater reductions in egg output following drug treatment correlates significantly with reduced odds of most morbidities. Overall, these SCORE morbidity studies provided convincing evidence to support the use of MDA to improve the health of school-aged children in endemic areas. However, study findings also support the need to use enhanced metrics to fully assess and better control schistosomiasis-associated morbidity.
Collapse
Affiliation(s)
- Charles H. King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Sue Binder
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Ye Shen
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia
| | - Christopher C. Whalen
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia
| | - Carl H. Campbell
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Ryan E. Wiegand
- Division of Parasitic Diseases and Malaria, Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Annette Olsen
- Section for Parasitology and Aquatic Pathobiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - William Evan Secor
- Division of Parasitic Diseases and Malaria, Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan P. Montgomery
- Division of Parasitic Diseases and Malaria, Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rosemary Musuva
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Pauline N. M. Mwinzi
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Pascal Magnussen
- Centre for Medical Parasitology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Safari Kinung’hi
- National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania
| | - Gisele N. Andrade
- Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Amara E. Ezeamama
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - Daniel G. Colley
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
- Department of Microbiology, University of Georgia, Athens, Georgia
| |
Collapse
|
19
|
Sturt AS, Webb EL, Phiri CR, Mweene T, Chola N, van Dam GJ, Corstjens PLAM, Wessels E, Stothard JR, Hayes R, Ayles H, Hansingo I, van Lieshout L, Bustinduy AL. Genital self-sampling compared with cervicovaginal lavage for the diagnosis of female genital schistosomiasis in Zambian women: The BILHIV study. PLoS Negl Trop Dis 2020; 14:e0008337. [PMID: 32663222 PMCID: PMC7360036 DOI: 10.1371/journal.pntd.0008337] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/29/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Given the potentially causal association of female genital schistosomiasis (FGS) with HIV-1 infection, improved diagnostics are urgently needed to scale-up FGS surveillance. The BILHIV (bilharzia and HIV) study assessed the performance of home-based self-collection methods (cervical and vaginal swabs) compared to cervicovaginal lavage (CVL) for the detection of Schistosoma DNA by real-time polymerase chain reaction (PCR). METHODS Between January and August 2018, a consecutive series of female participants from the Population-Cohort of the previous HIV prevention trial HPTN 071 (PopART), resident in Livingstone, Zambia were invited to take part in BILHIV if they were 18-31 years old, non-pregnant and sexually active. Genital self-collected swabs and a urine specimen were obtained and a questionnaire completed at home visits. CVL was obtained at clinic follow-up. RESULTS 603 women self-collected genital swabs. Of these, 527 women had CVL performed by a mid-wife during clinic follow-up. Schistosoma DNA was more frequently detected in genital self-collected specimens (24/603, 4.0%) compared to CVL (14/527, 2.7%). Overall, 5.0% (30/603) women had female genital schistosomiasis, defined as a positive PCR by any genital sampling method (cervical swab PCR, vaginal swab PCR, or CVL PCR) and 95% (573/603) did not have a positive genital PCR. The sensitivity of any positive genital self-collected swab against CVL was 57.1% (95% CI 28.9-82.3%), specificity 97.3% (95.5-98.5%). In a subset of participants with active schistosome infection, determined by detectable urine Circulating Anodic Antigen (CAA) (15.1%, 91/601), positive PCR (4.3%, 26/601), or positive microscopy (5.5%, 33/603), the sensitivity of any positive self-collected specimen against CVL was 88.9% (51.8-99.7%). CONCLUSIONS Genital self-sampling increased the overall number of PCR-based FGS diagnoses in a field setting, compared with CVL. Home-based sampling may represent a scalable alternative method for FGS community-based diagnosis in endemic resource limited settings.
Collapse
Affiliation(s)
- Amy S. Sturt
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Emily L. Webb
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | - Govert J. van Dam
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul L. A. M. Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Els Wessels
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - J. Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Richard Hayes
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Helen Ayles
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Zambart, Lusaka, Zambia
| | - Isaiah Hansingo
- Department of Obstetrics and Gynaecology, Livingstone Central Hospital, Livingstone, Zambia
| | - Lisette van Lieshout
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Amaya L. Bustinduy
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
20
|
Faust CL, Osakunor DNM, Downs JA, Kayuni S, Stothard JR, Lamberton PHL, Reinhard-Rupp J, Rollinson D. Schistosomiasis Control: Leave No Age Group Behind. Trends Parasitol 2020; 36:582-591. [PMID: 32430274 DOI: 10.1016/j.pt.2020.04.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 01/11/2023]
Abstract
Despite accelerating progress towards schistosomiasis control in sub-Saharan Africa, several age groups have been eclipsed by current treatment and monitoring strategies that mainly focus on school-aged children. As schistosomiasis poses a threat to people of all ages, unfortunate gaps exist in current treatment coverage and associated monitoring efforts, preventing subsequent health benefits to preschool-aged children as well as certain adolescents and adults. Expanding access to younger ages through the forthcoming pediatric praziquantel formulation and improving treatment coverage in older ages is essential. This should occur alongside formal inclusion of these groups in large-scale monitoring and evaluation activities. Current omission of these age groups from treatment and monitoring exacerbates health inequities and has long-term consequences for sustainable schistosomiasis control.
Collapse
Affiliation(s)
- Christina L Faust
- Wellcome Centre for Integrative Parasitology, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, UK.
| | - Derick N M Osakunor
- Institute of Immunology and Infection Research, University of Edinburgh, Ashworth Laboratories, King's Buildings, Charlotte Auerbach Road, Edinburgh EH9 3FL, UK
| | - Jennifer A Downs
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Sekeleghe Kayuni
- Department of Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; MASM Medi Clinics Limited, Medical Aid Society of Malawi (MASM), Blantyre, Malawi
| | - J Russell Stothard
- Department of Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Poppy H L Lamberton
- Wellcome Centre for Integrative Parasitology, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, UK
| | | | - David Rollinson
- Global Schistosomiasis Alliance, Natural History Museum, London SW7 5BD, UK
| |
Collapse
|
21
|
Pillay P, Downs JA, Changalucha JM, Brienen EAT, Ramarokoto CE, Leutscher PDC, Vennervald BJ, Taylor M, Kjetland EF, Van Lieshout L. Detection of Schistosoma DNA in genital specimens and urine: A comparison between five female African study populations originating from S. haematobium and/or S. mansoni endemic areas. Acta Trop 2020; 204:105363. [PMID: 32035055 DOI: 10.1016/j.actatropica.2020.105363] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 01/16/2023]
Abstract
Female Genital Schistosomiasis (FGS) is a neglected disease affecting millions, however challenging to diagnose. This explorative descriptive study compares Schistosoma real-time PCR analysis of cervico-vaginal lavages (CVL) with corresponding urine and stool samples of 933 women from five different previously described study populations. Sampling included 310 women from an S. mansoni endemic region in Mwanza, Tanzania and 112 women from a nearby S. haematobium endemic region. Findings were compared with samples collected from S. haematobium endemic regions in South Africa from 394 women and from 117 women from Madagascar of which 79 were urine pre-selected microscopy positive cases from highly-endemic communities and 38 were urine microscopy negatives from a low-endemic community. As anticipated, urine and stool microscopy and gynecological investigations varied substantially between study populations; however, the same Schistosoma real-time PCR was performed in one reference laboratory. Schistosoma DNA was detected in 13% (120/933) of the CVL, ranging from 3% in the S. mansoni Tanzanian endemic region to 61% in the pre-selected Malagasy urine microscopy positive cases. Detectable Schistosoma DNA in CVL was associated with Schistosoma DNA in urine but not with microscopic detection of eggs in urine or by cytological examination. This study confirmed real-time PCR for the detection of Schistosoma DNA in gynecological samples to be a valuable diagnostic tool to study the distribution of FGS within schistosomiasis endemic areas.
Collapse
Affiliation(s)
- P Pillay
- Department of Biomedical and Clinical Technology, Durban University of Technology, South Africa; Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - J A Downs
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, USA
| | - J M Changalucha
- Department of Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - E A T Brienen
- Department of Parasitology, Leiden University Medical Center, The Netherlands
| | - C E Ramarokoto
- Department of Epidemiology, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - P D C Leutscher
- Centre for Clinical Research, North Denmark Regional Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Denmark
| | - B J Vennervald
- Section for Parasitology and Aquatic Pathobiology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - M Taylor
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - E F Kjetland
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo Norway
| | - L Van Lieshout
- Department of Parasitology, Leiden University Medical Center, The Netherlands
| |
Collapse
|
22
|
Female Genital Schistosomiasis and HIV: Research Urgently Needed to Improve Understanding of the Health Impacts of This Important Coinfection. J Acquir Immune Defic Syndr 2019; 80:489-493. [PMID: 30730357 DOI: 10.1097/qai.0000000000001957] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Evidence suggests that there are important interactions between HIV and female genital schistosomiasis (FGS) that may have significant effects on individual and population health. However, the exact way they interact and the health impacts of the interactions are not well understood. In this article, we discuss what is known about the interactions between FGS and HIV, and the potential impact of the interactions. This includes the likelihood that FGS is an important health problem for HIV-positive women in Schistosoma-endemic areas potentially associated with an increased risk of mortality, cancer, and infertility. In addition, it may be significantly impacting the HIV epidemic in sub-Saharan Africa by making young women more susceptible to HIV. We call for immediate action and argue that research is urgently required to address these knowledge gaps and propose a research agenda to achieve this.
Collapse
|
23
|
Murenjekwa W, Makasi R, Ntozini R, Chasekwa B, Mutasa K, Moulton LH, Tielsch JM, Humphrey JH, Smith LE, Prendergast AJ, Bourke CD. Determinants of Urogenital Schistosomiasis Among Pregnant Women and its Association With Pregnancy Outcomes, Neonatal Deaths, and Child Growth. J Infect Dis 2019; 223:1433-1444. [PMID: 31832636 PMCID: PMC8064048 DOI: 10.1093/infdis/jiz664] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 12/11/2019] [Indexed: 11/28/2022] Open
Abstract
Background Schistosoma haematobium is a parasitic helminth that causes urogenital pathology. The impact of urogenital schistosomiasis during pregnancy on birth outcomes and child growth is poorly understood. Methods Risk factors for urogenital schistosomiasis were characterized among 4437 pregnant women enrolled in a cluster-randomized community-based trial in rural Zimbabwe. Infection was defined via urine microscopy (≥1 S. haematobium egg) and urinalysis (hematuria). Associations between infection and pregnancy outcomes were assessed in case-control analyses using conditional logistic regression. The association of maternal infection with birthweight and length-for-age Z scores (LAZ) at 1 and 18 months of age were assessed using generalized estimating equations. Results Urogenital schistosomiasis (egg positive and/or hematuria positive) was detected in 26.8% of pregnant women. Risk factors significantly associated with infection were maternal age, education, marital status, and religion; household drinking water source and latrine; study region; and season. Urogenital schistosomiasis was not significantly associated with adverse pregnancy outcomes (miscarriage, stillbirth, preterm, and small-for-gestational age), birthweight, neonatal death, or LAZ. Conclusions Including pregnant women in antihelminthic treatment programs would benefit a large number of women in rural Zimbabwe. However, clearance of the low-intensity infections that predominate in this context is unlikely to have additive benefits for pregnancy outcomes or child growth. Clinical Trials Registration NCT01824940.
Collapse
Affiliation(s)
| | - Rachel Makasi
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Kuda Mutasa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Lawrence H Moulton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - James M Tielsch
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Jean H Humphrey
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Laura E Smith
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.,Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Andrew J Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.,Blizard Institute, Queen Mary University of London, London, UK
| | - Claire D Bourke
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.,Blizard Institute, Queen Mary University of London, London, UK
| |
Collapse
|
24
|
Hotez PJ, Harrison W, Fenwick A, Bustinduy AL, Ducker C, Sabina Mbabazi P, Engels D, Floerecke Kjetland E. Female genital schistosomiasis and HIV/AIDS: Reversing the neglect of girls and women. PLoS Negl Trop Dis 2019; 13:e0007025. [PMID: 30946746 PMCID: PMC6448816 DOI: 10.1371/journal.pntd.0007025] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Peter J. Hotez
- Texas Children’s Hospital Center for Vaccine Development, National School of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
- Department of Biology, Baylor University, Waco, Texas, United States of America
- * E-mail:
| | - Wendy Harrison
- Schistosomiasis Control Initiative, Department of Epidemiology and Biostatistics, Imperial College London, United Kingdom
| | - Alan Fenwick
- Schistosomiasis Control Initiative, Department of Epidemiology and Biostatistics, Imperial College London, United Kingdom
| | - Amaya L. Bustinduy
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Pamela Sabina Mbabazi
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Dirk Engels
- Uniting to Combat NTDs, London, United Kingdom
| | - Eyrun Floerecke Kjetland
- Regional Advisory Unit for Imported and Tropical Diseases, Department of Infectious Diseases, Ullevaal, Oslo University Hospital, Oslo, Norway
- Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|