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Mazigo HD, Ambrose EE, Mwingira UJ. Where will pediatric praziquantel be needed in Tanzania? Geographical variation in prevalence, and risk factors of Schistosoma mansoni in pre-school aged children in southern and north-western Tanzania. Parasite Epidemiol Control 2024; 24:e00337. [PMID: 38323193 PMCID: PMC10844104 DOI: 10.1016/j.parepi.2024.e00337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/12/2023] [Accepted: 01/23/2024] [Indexed: 02/08/2024] Open
Abstract
Background Pediatric schistosomiasis has been recognized as a public health concern in schistosomiasis endemic areas of sub-Saharan Africa, including Tanzania. However, there is limited epidemiological information relating to pediatric schistosomiasis in Tanzania. Therefore, this current focused on assessing the geographical prevalence of S. mansoni infection and its associated risk factors in pre-school children (PreSAC) in southern and north-western Tanzania. Methods A total of 1585 PreSAC aged 1-6 years were enrolled in a cross-sectional study. A single urine and stool sample were obtained from each child and processed using point-of-care circulating cathodic (POC-CCA) antigen and Kato Katz (K-K) technique. The overall prevalence of S. mansoni infection based on K-K technique and POC-CCA test were 18.6% (95%CI:16.7-20.6) and 28.3% (95%CI:26.1-30.6), respectively. The overall geometrical mean eggs per gram of faeces was 110.38epg (95% CI:97.3-125.3). The age group 4-6 years had the highest prevalence (P < 0.01) of S. mansoni in both diagnostic tests and infection intensity (t = -2.8398, P < 0.005) using K-K technique. On multivariable analysis, only Ukerewe district was associated with S. mansoni infection based on K-K technique (aOR = 2.8 (95%CI:2.1-3.9), P < 0.001). Based on POC-CCA test, age group (4-6 years), aOR = 1.7, 95%CI:1.3-2.2, P < 0.001), Nyasa (aOR = 6.2, 95%CI:3.0-12.5, P < 0.001), Geita (aOR = 4.2, 95%CI:2.1-8.2, P < 0.001) and Ukerewe (aOR = 28.9, 95%CI:15.0-55.8, P < 0.001) districts remained independently associated with S. mansoni infection. Conclusion Schistosoma mansoni is a public health concern among PreSAC in the study districts and its prevalence varies from one geographical setting to another. These findings strongly support the need to include pre-school aged in preventive chemotherapy.
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Affiliation(s)
- Humphrey D. Mazigo
- Department of Medical Parasitology, School of Medicine, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Emmanuela E. Ambrose
- Department of Paediatrics and Child Health, Bugando Medical Centre, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Upendo J. Mwingira
- National Neglected Tropical Diseases Control Programme, National Institute for Medical Research, P.O. Box 9653, 3 Barack Obama Drive, 11101 Dar-Es-Salaam, Tanzania
- RTI International, 701 13 Street NW, Washington, DC 20005, USA
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Ncube MV, Kabuyaya M, Chimbari MJ. Patient journey and resources mapping to implement a praziquantel mass drug administration program for children aged 5 years and below in resource-limited settings. Syst Rev 2022; 11:227. [PMID: 36271455 PMCID: PMC9585827 DOI: 10.1186/s13643-022-02087-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 09/28/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The early childhood development of millions of children in some low- and medium-income countries may be compromised by schistosomiasis infections contracted at the age of 5 years and below. Currently, there are no standard guidelines for treating schistosomiasis in children that are 5 years and younger using praziquantel (PZQ), the only drug that the World Health Organization (WHO) recommends for treating schistosomiasis. The review is on processes and resources involved in the treatment of schistosomiasis in children aged 5 years and below. METHODS An electronic search for peer-reviewed articles published in the period from January 2011 to August 2021 was done in the Academic Search Complete, CINAHL with Full Text, Health Source: Nursing/Academic Edition, and MEDLINE databases via EBSCOHost and Google Scholar databases. The search targeted journals that described the treatment of schistosomiasis in children 5 years and below using praziquantel. RESULTS Thirteen studies met the inclusion criteria. The patient journey for treating schistosomiasis in children aged 5 years old and below using PZQ included the following activities: enrolment of the children into the treatment program; clinical examination; diagnosis; taking anthropometric measurements; feeding the children, making the PZQ palatable to the children; administration of PZQ; and monitoring of side effects. There was also a variation in the resources used to treat children aged 5 and below for schistosomiasis. CONCLUSIONS A PZQ mass drug administration program for children aged 5 years old and below in endemic areas should exclude the diagnosis of schistosomiasis before treatment. The resources required in the treatment process should be affordable, and should not require skills and maintenance resources that are beyond those that are available at the primary healthcare level.
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Affiliation(s)
- Mhlengi Vella Ncube
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa. .,Medical Affairs Institute, Johannesburg, South Africa.
| | - Muhubiri Kabuyaya
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Moses John Chimbari
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Webb EL, Edielu A, Wu HW, Kabatereine NB, Tukahebwa EM, Mubangizi A, Adriko M, Elliott AM, Hope WW, Mawa PA, Friedman JF, Bustinduy AL. The praziquantel in preschoolers (PIP) trial: study protocol for a phase II PK/PD-driven randomised controlled trial of praziquantel in children under 4 years of age. Trials 2021; 22:601. [PMID: 34488846 PMCID: PMC8419815 DOI: 10.1186/s13063-021-05558-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/19/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Over 200 million individuals worldwide are infected with Schistosoma species, with over half of infections occurring in children. Many children experience first infections early in life and this impacts their growth and development; however praziquantel (PZQ), the drug used worldwide for the treatment of schistosomiasis, only has regulatory approval among adults and children over the age of four, although it is frequently used "off label" in endemic settings. Furthermore, pharmacokinetic/pharmacodynamics (PK/PD) evidence suggests the standard PZQ dose of 40 mg/kg is insufficient in preschool-aged children (PSAC). Our goal is to understand the best approaches to optimising the treatment of PSAC with intestinal schistosomiasis. METHODS We will conduct a randomised, controlled phase II trial in a Schistosoma mansoni endemic region of Uganda and a Schistosoma japonicum endemic region of the Philippines. Six hundred children, 300 in each setting, aged 12-47 months with Schistosoma infection will be randomised in a 1:1:1:1 ratio to receive either (1) 40 mg/kg PZQ at baseline and placebo at 6 months, (2) 40 mg/kg PZQ at baseline and 40 mg/kg PZQ at 6 months, (3) 80 mg/kg PZQ at baseline and placebo at 6 months, or (4) 80 mg/kg PZQ at baseline and 80 mg/kg PZQ at 6 months. Following baseline treatment, children will be followed up for 12 months. The co-primary outcomes will be cure rate and egg reduction rate at 4 weeks. Secondary outcomes include drug efficacy assessed by novel antigenic endpoints at 4 weeks, actively collected adverse events and toxicity for 12 h post-treatment, morbidity and nutritional outcomes at 6 and 12 months, biomarkers of inflammation and environmental enteropathy and PZQ PK/PD parameters. DISCUSSION The trial will provide valuable information on the safety and efficacy of the 80 mg/kg PZQ dose in PSAC, and on the impact of six-monthly versus annual treatment, in this vulnerable age group. TRIAL REGISTRATION ClinicalTrials.gov NCT03640377 . Registered on 21 Aug 2018.
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Affiliation(s)
- Emily L Webb
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK.
| | - Andrew Edielu
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Hannah W Wu
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, USA.,Center for International Health Research, Lifespan Hospital, Providence, RI, USA
| | | | | | | | - Moses Adriko
- Vector Control Division, Ministry of Health, Kampala, Uganda
| | - Alison M Elliott
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - William W Hope
- Antimicrobial Pharmacodynamics and Therapeutics, University of Liverpool, Liverpool Health Partners, Liverpool, UK.,Royal Liverpool, Broadgreen University Hospital Trust, Liverpool Health Partners, Liverpool, UK
| | - Patrice A Mawa
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,Department of Immunology, Uganda Virus Research Institute, Entebbe, Uganda.,Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
| | - Jennifer F Friedman
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, USA.,Center for International Health Research, Lifespan Hospital, Providence, RI, USA
| | - Amaya L Bustinduy
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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Mutapi F, Pfavayi L, Osakunor D, Lim R, Kasambala M, Mutemeri A, Rusakaniko S, Chibanda D, Mduluza T. Assessing early child development and its association with stunting and schistosome infections in rural Zimbabwean children using the Griffiths Scales of Child Development. PLoS Negl Trop Dis 2021; 15:e0009660. [PMID: 34379618 PMCID: PMC8357151 DOI: 10.1371/journal.pntd.0009660] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 07/18/2021] [Indexed: 11/19/2022] Open
Abstract
There is a paucity of reference early childhood development (ECD) data at community level in rural Africa. Our objective was to conduct a comprehensive assessment of ECD in rural Zimbabwe and determine the impact of stunting and schistosome infections on ECD. Using the Griffiths Scales of Child Development, we conducted a cross sectional assessment of Eye and Hand Coordination (EHC), Personal-Social-Emotional (PSE), Language and Communication (LC), Foundations of Learning (FL) and Gross Motor (GM) domains and the summary General Development (GD) in 166 children aged 6-72 months. The effects of stunting, malnutrition and Schistosoma haematobium infection on ECD was determined. The impact of praziquantel curative treatment of schistosome infection on the developmental scores was determined through a longitudinal follow up at 6 and 12 months. From an initial 166 children, 11 were found to have developmental deficits warranting further investigation. Of the remaining 155, 58.7% recorded a good (≥ average) score for the overall General Development (GD). Proportions of children scoring above the cut-off (≥ average) for each domain were GM (84.5%), PSE (80.6%), EHC (61.9%), FL (43.9%) and LC (44.5%). The prevalence of stunting was 26.8% (95% CI = 20.1%-34.8%) Scores for stunted children were significantly lower for EHC (p = 0.0042), GM (p = 0.0099), and GD (p = 0.0014) with the fraction of lower scores attributable to stunting being GM = 63.4%, GD = 46.6%, EHC = 45%, and LC = 21%. S. haematobium infection prevalence was 39.7% and mean infection intensity was 5.4 eggs/10 ml urine. Infected children had poorer cognitive performance scores for the FL (p = 0.0005) with 30.8% of poor FL attributable to the infection. Performance in all domains improved to the expected normal or above reference levels at 6 and 12 months post curative treatment of schistosome infections. Our study documented reference values for ECD in rural Zimbabwean children. The study detected deficiencies in the FL domain, which were more pronounced in children, infected with schistosomes, highlighting the need for provision of cognitive stimulation tools and access to early childhood foundation education. There is also need for improved child nutrition and treatment of schistosome infections to improve child development outcomes.
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Affiliation(s)
- Francisca Mutapi
- Institute of Immunology & Infection Research, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
| | - Lorraine Pfavayi
- Institute of Immunology & Infection Research, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Derick Osakunor
- Institute of Immunology & Infection Research, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
| | - Rivka Lim
- Institute of Immunology & Infection Research, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
| | - Maritha Kasambala
- School of Life Sciences, University of KwaZulu-Natal; Westville, South Africa
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA) Zimbabwe, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe of Zimbabwe
| | - Arnold Mutemeri
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Parirenyatwa Hospital, Harare, Zimbabwe
| | - Simbarashe Rusakaniko
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA) Zimbabwe, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe of Zimbabwe
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Parirenyatwa Hospital, Harare, Zimbabwe
| | - Dixon Chibanda
- Department of Psychiatry, College of Health Sciences, University of Zimbabwe, Parirenyatwa Hospital, Harare, Zimbabwe
| | - Takafira Mduluza
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA) Zimbabwe, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe of Zimbabwe
- Department of Biochemistry, University of Zimbabwe, Harare, Zimbabwe
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N'Diaye M, Keita BF, Danfakha F, Keita F, Keita G, Senghor CS, Diop B, Diawara L, Bessin F, Vernet C, Barbier D, Dewavrin P, Klotz F. A 12-year follow-up of intestinal schistosomiasis in pre-school-aged children in Assoni Village, Eastern Senegal. Infect Dis Poverty 2021; 10:89. [PMID: 34176498 PMCID: PMC8237420 DOI: 10.1186/s40249-021-00867-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/21/2021] [Indexed: 12/29/2022] Open
Abstract
Background To monitor the prevalence of schistosomiasis in school-aged children (SAC), the National Bilharzia Control Program (PNLB) was set up by the Senegalese authorities; however, geographically isolated Bedik ethnic groups that did not benefit from this program were found to be heavily infected with Schistosoma mansoni. This observation led us to implement a new schistosomiasis control program in 2008 under the aegis of the non-governmental organization “Le Kaïcedrat” and in partnership with the PNLB/WHO to monitor the prevalence of schistosomiasis in this area. In the village of Assoni, where 100% of SAC were infected, analysis of the stools of pre-school-aged children (PSAC) showed that they were massively infected, so we decided to focus our program on them. Methods From 2008 to 2020, we (i) monitored the prevalence of S. mansoni in PSAC in Assoni using double-stool smear preparation, (ii) treated the infected PSAC with a standard dose of praziquantel 40 mg/kg, (iii) ran educational campaigns each year in the village, and (iv) built latrines to improve sanitation and reduce schistosomiasis transmission. Linear regression was used to examine the trend in the annual schistosomiasis prevalence and a two-sided of Chi-squared test was used to compare prevalence between the different age groups of PSAC. Results We observed an extremely high prevalence of schistosomiasis (78%) in PSAC before implementation of the program in 2008. Contamination occurred in very young children, as 64.3% of children under 2 years old were infected. Moreover, prevalence increased with age and reached 96.8% in children 4 to < 6 years old. Our annual interventions in Assoni Village raised awareness among villagers that water bodies were areas of significant infestation, allowed the building of 88 latrines and led to a decrease in prevalence in PSAC as only 11% of these children were infected in 2020. Conclusion Our study allowed Assoni to be the first village in Senegal to treat PSAC since 2014, but only on an individual basis. It also shows that schistosomiasis is difficult to eradicate and that multi-sectorial actions are required to keep its prevalence at a low level. Graphic abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40249-021-00867-8.
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Affiliation(s)
- Monique N'Diaye
- Normandy University, INSERM U1086 ANTICIPE (Interdisciplinary Research Unit for Cancer Prevention and Treatment), BioTICLA Axis (Biology and Innovative Therapeutics for Ovarian Cancers), Caen, France. .,Faculty of Pharmaceutical Sciences, Department of Biodiversity Health, Microbiology, Biotechnology, UNICAEN, Caen, France. .,NGO Le Kaïcedrat, Paris, France.
| | | | | | - Fili Keita
- Health Post, Bandafassi, Kedougou District, Dakar, Senegal
| | - Gérald Keita
- Health Post, Bandafassi, Kedougou District, Dakar, Senegal
| | | | - Bocar Diop
- Programme National de Lutte Contre Les Bilharzioses (PNLB), Ministry of Health, Dakar, Senegal
| | - Lamine Diawara
- Neglected Tropical Diseases, Inter-Country Support Team for West Africa, World Health Organization, Ouagadougou, Burkina Faso
| | - François Bessin
- Faculty of Pharmaceutical Sciences, Department of Biodiversity Health, Microbiology, Biotechnology, UNICAEN, Caen, France.,NGO Le Kaïcedrat, Paris, France
| | - Charlotte Vernet
- Faculty of Pharmaceutical Sciences, Department of Biodiversity Health, Microbiology, Biotechnology, UNICAEN, Caen, France.,NGO Le Kaïcedrat, Paris, France
| | - Dominique Barbier
- Faculty of Pharmaceutical Sciences, Department of Biodiversity Health, Microbiology, Biotechnology, UNICAEN, Caen, France.,NGO Le Kaïcedrat, Paris, France
| | | | - Francis Klotz
- NGO Le Kaïcedrat, Paris, France.,Military Hospital Val-de-Grâce, Paris, France
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Yin X, N’Goran EK, Ouattara M, Aka NAD, Diakité NR, Bassa FK, Kourany-Lefoll E, Tappert A, Yalkinoglu Ö, Huber E, Bezuidenhout D, Bagchus WM, Hayward B. Comparison of POC-CCA with Kato-Katz in Diagnosing Schistosoma mansoni Infection in a Pediatric L-Praziquantel Clinical Trial. FRONTIERS IN TROPICAL DISEASES 2021. [DOI: 10.3389/fitd.2021.686288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IntroductionTraditionally Schistosoma mansoni infection is diagnosed by the Kato-Katz method. Thick smears from each stool sample are prepared on slides and eggs are counted microscopically. Commercially available point-of-care circulating cathodic antigen (POC-CCA) cassette tests detect schistosomiasis antigens from urine samples in 20 minutes. POC-CCA results are qualitative or semi-quantitative: signal intensity is an indicator of the amount of worm antigens in the sample. Both methods were used in a phase II trial investigating the efficacy and safety of new pediatric formulations of praziquantel (PZQ) among children ≤6 years (NCT02806232). This secondary analysis evaluated the consistency of results between the Kato-Katz and POC-CCA methods.MethodsPOC-CCA was used to pre-screen for S. mansoni infection. Children with positive results were tested by the Kato-Katz method, and those with positive Kato-Katz results (>1 egg/1 occurrence) were enrolled. Participants (N=444) were treated with different formulations and doses of PZQ. POC-CCA and Kato-Katz were performed at 2–3 weeks after treatment to evaluate drug efficacy. Cure rate (CR) was defined as the proportion of participants with a negative result per POC-CCA, or no eggs in the stool samples per Kato-Katz. Kappa statistic was used to assess the agreement on cure status, and Spearman correlation between POC-CCA positivity and Kato-Katz egg counts was evaluated. Sensitivity and specificity of POC-CCA were calculated using Kato-Katz as a reference standard.ResultsCR per POC-CCA, measured 2–3 weeks after treatment, was 52% [95% confidence interval (CI): 48%, 57%] across all treatment arms except in infants aged 3–12 months. CR per Kato-Katz was 83% (95% CI: 79%, 87%). Kappa statistic was 0.16 (95% CI: 0.09, 0.23), indicating that the agreement was slightly better than by chance. Relative to Kato-Katz, POC-CCA’s sensitivity to detect infection was 70% and specificity was 57%. Spearman correlation coefficient between POC-CCA positivity and Kato-Katz egg counts was 0.26 (95% CI: 0.17, 0.34).ConclusionPOC-CCA is sensitive and rapid for diagnosing S. mansoni infection, but its performance and consistency with Kato-Katz requires further investigation among young children.
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Challenges and Opportunities Presented by Current Techniques for Detecting Schistosome Infections in Intermediate Host Snails: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105403. [PMID: 34069316 PMCID: PMC8158760 DOI: 10.3390/ijerph18105403] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/04/2021] [Accepted: 04/06/2021] [Indexed: 12/14/2022]
Abstract
Schistosomiasis, a neglected tropical disease (NTD), causes morbidity and mortality in over 250 million people globally. And 700 million people are at risk of contracting it. It is caused by a parasite of the genus Schistosoma. Freshwater snails of the family Planorbidae are of public health significance as they are intermediate hosts of these highly infective flukes. Accurate diagnostic techniques to detect schistosome infections in intermediate host snails (IHS) and environmental surveillance are needed to institute measures for the interruption of transmission and eventual elimination. We carried out a systematic review of the literature to assess advantages and limitations of different diagnostic techniques for detecting schistosome infections in snails. Literature from Scopus, Web of Science, and PubMed databases from 2008 to 2020 were searched using combinations of predefined search terms with Boolean operators. The studies revealed that conventional diagnostics are widely used, although they are labor-intensive, have low specificity and sensitivity levels, and cannot detect prepatent infections. Whereas more advanced techniques such as immunological, nucleic-acid amplification, and eDNA diagnostics have high sensitivity and specificity levels, they are costly, hence, not suitable for field applications and large-scale surveys. Our review highlights the importance of designing and developing innovative diagnostics that are high in specificity and sensitivity as well as affordable and technically feasible for use in field laboratories and for large-scale surveys.
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Cisse M, Sangare I, Djibougou AD, Tahita MC, Gnissi S, Bassinga JKW, Konda S, Diallo AH. Prevalence and risk factors of Schistosoma mansoni infection among preschool-aged children from Panamasso village, Burkina Faso. Parasit Vectors 2021; 14:185. [PMID: 33794961 PMCID: PMC8017716 DOI: 10.1186/s13071-021-04692-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/17/2021] [Indexed: 12/23/2022] Open
Abstract
Background Schistosomiasis remains a major public health concern in sub-Saharan Africa. Although schistosomiasis is well documented in school-aged children in Burkina Faso, prevalence data among preschool-aged children (PSAC) are limited and outdated, and its risk factors in this group remain poorly documented. The main objective of this study was to assess the prevalence and risk factors associated with Schistosoma (S.) mansoni infection among PSAC from Panamasso village, western Burkina Faso. Methodology A cross-sectional study was carried out among 228 children under 6 years old from Panamasso village. Sociodemographic and water contact data were collected using a structured questionnaire. Kato-Katz and formol-ether concentration techniques were used to detect S. mansoni eggs in stool samples. Urine samples were subjected to a point-of-care circulating cathodic antigen (POC-CCA) cassette test and a centrifugation method to check for both S. mansoni and S. haematobium infection, respectively. Potential risk factors for S. mansoni infection were explored using multivariable logistic regression. Results The mean age of children was 40.2 ± 15.0 months. The prevalence of S. mansoni infection as determined by Kato-Katz, formol-ether concentration and POC-CCA was 42.1%, 39.5% and 80.7%, respectively. Based on the combined results of the three methods, the overall prevalence of S. mansoni infection was 81.1%. No case of S. haematobium infection was found. The geometric mean intensity of S. mansoni infection was 107.2 eggs per gram of feces with 54.2%, 33.3% and 12.5% of the children having light, moderate and heavy infections, respectively. Girls (AOR = 2.9, 95% CI 1.3–6.1), a household located within 500 m from the pond (AOR = 3.0, 95% CI 1.0–8.6) or between 500 and 1000 m from the pond (AOR = 3.0, 95% CI 1.2–7.2), and the child’s history of going to the pond (AOR = 5.0, 95% CI 1.7–14.3) were the variables significantly associated with S. mansoni infection. Conclusion S. mansoni was the sole species infecting a high proportion of PSAC in the study area. A mass drug administration program with praziquantel is therefore urgently required for those below 6 years old. Other control strategies should include increased community-awareness and provision of safe water.![]() Supplementary Information The online version contains supplementary material available at 10.1186/s13071-021-04692-8.
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Affiliation(s)
- Mamoudou Cisse
- Centre MURAZ, Institut National de Santé Publique, Bobo-Dioulasso, Burkina Faso. .,Institut Supérieur des sciences de la Santé, Université Nazi BONI, Bobo-Dioulasso, Burkina Faso.
| | - Ibrahim Sangare
- Centre MURAZ, Institut National de Santé Publique, Bobo-Dioulasso, Burkina Faso.,Institut Supérieur des sciences de la Santé, Université Nazi BONI, Bobo-Dioulasso, Burkina Faso
| | - Arthur D Djibougou
- Centre MURAZ, Institut National de Santé Publique, Bobo-Dioulasso, Burkina Faso
| | - Marc C Tahita
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Souleymane Gnissi
- Centre MURAZ, Institut National de Santé Publique, Bobo-Dioulasso, Burkina Faso
| | | | - Salifou Konda
- Centre MURAZ, Institut National de Santé Publique, Bobo-Dioulasso, Burkina Faso
| | - Abdoulaye H Diallo
- Centre MURAZ, Institut National de Santé Publique, Bobo-Dioulasso, Burkina Faso.,Unité de Formation et de Recherche en Sciences De la Santé, Université Joseph KI-ZERBO, Ouagadougou, Burkina Faso
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9
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Kalinda C, Mindu T, Chimbari MJ. A systematic review and meta-analysis quantifying schistosomiasis infection burden in pre-school aged children (PreSAC) in sub-Saharan Africa for the period 2000-2020. PLoS One 2020; 15:e0244695. [PMID: 33373405 PMCID: PMC7771669 DOI: 10.1371/journal.pone.0244695] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 12/14/2020] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Following the adoption of the World Health Assembly Resolution WHA 65.21 and Neglected Tropical Diseases road map 2021-2030, schistosomiasis control programmes have shifted from morbidity control to disease elimination. However, several gaps continue to be observed in the implementation of control programmes with certain age groups omitted from these campaigns increasing health inequalities and risks of reinfections to previously treated groups. We used the Inverse Variance Heterogeneity (IVhet) model to estimate the prevalence of schistosomiasis infection among preschool-aged children. METHODS We did a systematic review of peer-reviewed literature on schistosomiasis in sub-Saharan Africa for the period January 1, 2000 to November 30, 2020. Quantitative data for cases of schistosomiasis infection were extracted, including country and region where the studies were done, year of publication and specific schistosome species observed. The IVhet model was used to estimate the pooled prevalence estimate (PPE), the heterogeneity and publication bias. RESULTS We screened 2601 articles to obtain 47 eligible studies containing quantitative data on preschool-aged children. Of the selected studies, 44.7% (n = 22) were from East Africa while the least number of studies obtained (2.1%, n = 1) was from Central Africa. 21712 subjects were screened for infection due to Schistosoma spp; 13924 for S. mansoni and 7788 for S. haematobium. The PPE for schistosomiasis among PreSAC was 19% (95% CI: 11-28). Infection due to S. mansoni (IVhet PPE: 22% (95% CI: 9-36) was higher than that due to S. haematobium (15%; 95% CI: 6-25). A Luis Furuya-Kanamori index of 1.83 indicated a lack of publication bias. High level of heterogeneity was observed (I2 > 90%) and this could not be reduced through subgroup analysis. CONCLUSION Schistosomiasis infection among pre-school aged children 6 years old and below is high. This indicates the importance of including this age group in treatment programmes to reduce infection prevalence and long-term morbidities associated with prolonged schistosome infection.
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Affiliation(s)
- Chester Kalinda
- University of Namibia, Katima Mulilo, Namibia
- Department of Public Health, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Tafadzwa Mindu
- Department of Public Health, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Moses John Chimbari
- Department of Public Health, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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10
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Lim RM, Woolhouse MEJ, Mduluza T, Chase-Topping M, Osakunor DNM, Chitsulo L, Mutapi F. Investigating a strategy for quantifying schistosome infection levels in preschool-aged children using prevalence data from school-aged children. PLoS Negl Trop Dis 2020; 14:e0008650. [PMID: 33001969 PMCID: PMC7529243 DOI: 10.1371/journal.pntd.0008650] [Citation(s) in RCA: 2] [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: 02/03/2020] [Accepted: 07/27/2020] [Indexed: 11/27/2022] Open
Abstract
In 2012, the World Health Organisation (WHO) set out a roadmap for eliminating schistosomiasis as a public health problem by 2025. To achieve this target, preschool-aged children (PSAC; aged 6 years and below) will need to be included in schistosomiasis treatment programmes. As the global community discusses the tools and approaches for treating this group, one of the main questions that remains unanswered is how to quantify infection in this age group to inform treatment strategies. The aim of this study was thus to determine whether a relationship exists between levels of schistosome infection in PSAC and school-aged children (SAC), that can be used to determine unknown schistosome infection prevalence levels in PSAC. A systematic search of publications reporting schistosomiasis prevalence in African PSAC and SAC was conducted. The search strategy was formulated using the PRISMA guidelines and SPIDER search strategy tool. The published data was subjected to regression analysis to determine if a relationship exists between infection levels in PSAC and SAC. The interaction between SAC and community treatment history was also entered in the regression model to determine if treatment history significantly affected the relationship between PSAC and SAC prevalence. The results showed that a significant positive relationship exists between infection prevalence levels in PSAC and SAC for Schistosoma mansoni (r = 0.812, df (88, 1), p = <0.0001) and S. haematobium (r = 0.786, df (53, 1), p = <0.0001). The relationship was still significant after allowing for diagnostic method, treatment history, and the African sub-region where the study was conducted (S. mansoni: F = 25.63, df (88, 9), p = <0.0001; S. haematobium: F = 10.20, df (53, 10), p = <0.0001). Using the regression equation for PSAC and SAC prevalence, over 90% of the PSAC prevalence studies were placed in the correct WHO classifications category based on the SAC levels, regardless of treatment history. The study indicated that schistosome prevalence in SAC can be extended as a proxy for infection levels in PSAC, extending on its current use in the adult population. SAC prevalence data could identify where there is a need to accelerate and facilitate the treatment of PSAC for schistosomiasis in Africa. Preschool-aged children (PSAC), i.e. aged ≤ 6 years, are not included in preventative chemotherapy programmes, currently advocated by the WHO for the treatment of schistosomiasis. This is due to the lack of a paediatric formulation of the drug of choice, praziquantel, and the current guidelines which requires diagnosis before treatment. As the global community prepares for the deployment of a new paediatric formulation of praziquantel, there is a need to find a strategy to quantify infection in this age group. In schistosome endemic areas, infection levels in school-aged children (SAC) are already used to inform infection levels in the community. Thus, we investigated the relationship between SAC and PSAC schistosome prevalence levels within the same community, to determine if data from SAC could be used to predict infection levels in PSAC. Our results show that PSAC prevalence levels are significantly correlated with SAC prevalence levels. Our findings are applicable to communities that have received preventative chemotherapy in SAC or in SAC and adults, as well as those that have not received any. Our study indicates that it is possible to extrapolate PSAC prevalence levels from SAC prevalence, and to make a treatment decision on that basis.
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Affiliation(s)
- Rivka M. Lim
- Institute of Immunology & Infection Research, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
- * E-mail:
| | - Mark E. J. Woolhouse
- Usher Institute, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA) at the University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
| | - Takafira Mduluza
- Department of Biochemistry, University of Zimbabwe, Mount Pleasant, Harare, Zimbabwe
| | - Margo Chase-Topping
- Usher Institute, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
- Roslin Institute, Easter Bush, Midlothian, United Kingdom
| | - Derick N. M. Osakunor
- Institute of Immunology & Infection Research, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
| | | | - Francisca Mutapi
- Institute of Immunology & Infection Research, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA) at the University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
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Abdel-Hakeem SS, Abdel-Samiee MA, Abed GH. An Insight into the Potential Parasitological Effect of Schistosoma mansoni Antigens in Infected Mice: Prophylactic Role of Cercarial Antigen. MICROSCOPY AND MICROANALYSIS : THE OFFICIAL JOURNAL OF MICROSCOPY SOCIETY OF AMERICA, MICROBEAM ANALYSIS SOCIETY, MICROSCOPICAL SOCIETY OF CANADA 2020; 26:708-716. [PMID: 32624059 DOI: 10.1017/s1431927620001695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Schistosomiasis is a multifactorial disease that includes environmental, behavioral, parasitic, vector, and host factors. This study aimed to assess the protective effect of single and polyvalent antigens from cercarial antigen preparations (CAPs), soluble worm antigen preparations (SWAPs), and soluble egg antigens (SEAs) which were used as candidate vaccines in an experimental model of Schistosoma mansoni-infected mice. The efficiency of the antigens was tested by determining their effects on fecal egg count, egg viability analysis, and tissue egg counts. Histological and morphometric analyses of granulomas in liver and intestine tissues were performed. In the present study, all immunized groups showed a significant reduction in the average fecal egg count and tissue egg load compared with infected mice. The most substantial reduction in fecal egg count was observed in the combined vaccinated group (23.23 ± 3.2). The group vaccinated with CAP before infection showed the highest reduction in tissue egg load (liver and intestine: 85.22 and 91.70%, respectively). Immunized animals showed a highly significant reduction in the numbers of hepatic granulomas compared with the infected non-immunized group. In conclusion, combining these different antigens (CAP, SWAP, and SEA) augments the protective immunity compared with other immunized groups.
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Affiliation(s)
- Sara S Abdel-Hakeem
- Parasitology Lab., Zoology Department, Faculty of Science, Assiut University, Assiut71516, Egypt
| | - Mahmoud A Abdel-Samiee
- Department of Pathology and Clinical Pathology, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt
| | - Gamal H Abed
- Parasitology Lab., Zoology Department, Faculty of Science, Assiut University, Assiut71516, Egypt
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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.
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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
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Kalinda C, Mutengo M, Chimbari M. A meta-analysis of changes in schistosomiasis prevalence in Zambia: implications on the 2020 elimination target. Parasitol Res 2019; 119:1-10. [PMID: 31773307 DOI: 10.1007/s00436-019-06534-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 10/28/2019] [Indexed: 12/18/2022]
Abstract
Schistosomiasis affects more than 4 million school-aged children in Zambia, mostly in rural communities due to unsafe water and inadequate sanitation facilities. Although several studies were done in Zambia between 1976 and 2019, empirical estimates of the disease burden remain unavailable. Therefore, appraisal of the current schistosomiasis burden is pertinent in the re-evaluation of schistosomiasis-control strategies in Zambia. A random-effect model was used to estimate the prevalence of schistosomiasis infection in Zambia across different age groups for the period between 1976 and 2019. A literature search was done in the following databases: PubMed, ISI Web of Science, Google Scholar, CINAHL, and African Journals Online. Twenty-eight studies with relevant prevalence data were identified and included in the analysis. The pooled prevalence estimate of Schistosoma haematobium and Schistosoma mansoni across studies for the entire period was 35.5% (95% CI: 25.8-45.9) and 34.9% (95% CI: 20.7-50.6), respectively. Prevalence estimates among school-aged children for S. haematobium and S. mansoni were 32.2% (95% CI: 21.1-44.7) and 18.1% (95% CI: 3.0-38.4), respectively. The reported pooled prevalence estimate for S. haematobium among the adults was 54% (95% CI: 23.2-83.7). Only two studies collected information from preschool aged children. Substantial heterogeneity (I2 = 100%, p < 0.0001) was observed among the studies. Although a reduction in disease prevalence was observed from 1990 to 2010, this was not sustained after 2010. In this meta-analysis, S. haematobium was more prevalent compared to S. mansoni, with more cases observed among school-aged children (SAC). Thus, control programs should target age groups that are highly infected or are at high risk of infection.
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Affiliation(s)
- Chester Kalinda
- University of Namibia, Katima Mulilo Campus, Box 1096, Katima Mulilo, Namibia. .,Department of Public Health, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Howard College Campus, Durban, 4001, South Africa.
| | - Mable Mutengo
- Institute of Basic and Biomedical Sciences, Levy Mwanawasa Medical University, P.O Box 33991, Lusaka, Zambia
| | - Moses Chimbari
- Department of Public Health, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Howard College Campus, Durban, 4001, South Africa
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14
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Hematobium schistosomiasis control for health management of labor force generation at Nkhotakota and Lilongwe in the Republic of Malawi-assumed to be related to occupational risk. Trop Med Health 2019; 47:28. [PMID: 31073271 PMCID: PMC6498665 DOI: 10.1186/s41182-019-0155-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 04/09/2019] [Indexed: 11/26/2022] Open
Abstract
Background In Malawi, hematobium schistosomiasis is highly endemic. According to previous studies, countermeasures have been conducted mainly in school-aged children. In this study, we focused on the age groups, which are assumed to be major labor force generation. Hematobium schistosomiasis is supposed to be related to occupational activities in schistosome-endemic countries because of its infectious route. We chronologically followed the transition of schistosome egg-positive prevalence before and after mass drug administration of praziquantel (MDA) by using a urine filtering examination. We also analyzed the effectiveness of urine reagent strips from the cost perspective. Results The egg-positive prevalence was 34.3% (95% CI 28.5–40.5) just before MDA in June 2010 and the highest prevalence was in the age of twenties. The egg-positive prevalence reduced to 12.7% (95% CI 9.2–17.3, p < 0.01) 8 weeks after the first MDA and the prevalence reduced to 6.9% (95% CI 4.6–10.0, p < 0.01) after the second MDA in August 2011. The egg-positive prevalence after MDA in 2013 was reduced from 3.8% (95% CI 2.1–6.9) to 0.9% (95% CI 0.3–3.4) and p value was 0.050. Using urine reagent strips after MDA, the positive predictive value decreased, but the negative predictive value remained high. The cost of one urine reagent strip and one tablet of praziquantel were US$0.06 and US$0.125 in 2013 in Malawi. If the egg-positive prevalence is 40%, screening subjects for MDA using urine reagent strips, the cost reduction can be estimated to be about 24%, showing an overall cost reduction. Conclusions MDA of praziquantel can assuredly reduce schistosome egg-positive prevalence. The combination of MDA and urine reagent strips could be both a practical and cost-effective countermeasure for hematobium schistosomiasis. It is key to recognize that hematobium schistosomiasis could be considered a disease that is assumed to have some concern with occupational risk at Nkhotakota and Lilongwe in Malawi. From this point of view, it is very important to manage workers’ health; the sound labor force generation is vital for economic growth and development in these areas and countries.
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Freer JB, Bourke CD, Durhuus GH, Kjetland EF, Prendergast AJ. Schistosomiasis in the first 1000 days. THE LANCET. INFECTIOUS DISEASES 2018; 18:e193-e203. [PMID: 29170089 DOI: 10.1016/s1473-3099(17)30490-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 07/02/2017] [Accepted: 07/13/2017] [Indexed: 12/29/2022]
Abstract
Infections during the first 1000 days-the period from conception to a child's second birthday-can have lifelong effects on health, because this is a crucial phase of growth and development. There is increasing recognition of the burden and potential effects of schistosomiasis in women of reproductive age and young children. Exposure to schistosomes during pregnancy can modulate infant immune development and schistosomiasis can occur from early infancy, such that the high disease burden found in adolescents is often due to accumulation of infections with long-lived schistosomes from early life. Women of reproductive age and young children are largely neglected in mass drug administration programmes, but early treatment could avert subsequent disease. We evaluate the evidence that early schistosomiasis has adverse effects on birth, growth, and development. We also discuss the case for expanding public health interventions for schistosomiasis in women of reproductive age and preschool-age children, and the need for further research to evaluate the potential of treating women pre-conception to maximise health across the life course.
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Affiliation(s)
- Joseph B Freer
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; Blizard Institute, Queen Mary University of London, London, UK.
| | - Claire D Bourke
- Blizard Institute, Queen Mary University of London, London, UK
| | - Gunn H Durhuus
- Department of Internal Medicine, Sorlandet Hospital, Kristiansand, Norway
| | - Eyrun F Kjetland
- Norwegian Centre 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
| | - Andrew J Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; Blizard Institute, Queen Mary University of London, London, UK
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Abstract
Schistosomiasis affects over 200 million people worldwide, most of whom are children. Research and control strategies directed at preschool-aged children (PSAC), i.e., ≤5 years old, have lagged behind those in older children and adults. With the recent WHO revision of the schistosomiasis treatment guidelines to include PSAC, and the recognition of gaps in our current knowledge on the disease and its treatment in this age group, there is now a concerted effort to address these shortcomings. Global and national schistosome control strategies are yet to include PSAC in treatment schedules. Maximum impact of schistosome treatment programmes will be realised through effective treatment of PSAC. In this review, we (i) discuss the current knowledge on the dynamics and consequences of paediatric schistosomiasis and (ii) identify knowledge and policy gaps relevant to these areas and to the successful control of schistosome infection and disease in this age group. Herein, we highlight risk factors, immune mechanisms, pathology, and optimal timing for screening, diagnosis, and treatment of paediatric schistosomiasis. We also discuss the tools required for treating schistosomiasis in PSAC and strategies for accessing them for treatment.
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Affiliation(s)
- Derick N. M. Osakunor
- Centre for Immunity, Infection and Evolution, Institute of Immunology and Infection Research, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
- * E-mail:
| | - Mark E. J. Woolhouse
- Centre for Immunity, Infection and Evolution, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
| | - Francisca Mutapi
- Centre for Immunity, Infection and Evolution, Institute of Immunology and Infection Research, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
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Bustinduy AL, Stothard JR, Friedman JF. Paediatric and maternal schistosomiasis: shifting the paradigms. Br Med Bull 2017; 123:115-125. [PMID: 28910994 PMCID: PMC6279106 DOI: 10.1093/bmb/ldx028] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 07/16/2017] [Indexed: 11/13/2022]
Abstract
BACKGROUND In endemic areas, schistosomiasis causes both overt and subclinical disease in young children and their mothers, as well as in returned travellers. SOURCES OF DATA Key recently published literature. AREAS OF AGREEMENT An action plan for paediatric schistosomiasis and female genital schistosomiasis (FGS) is needed with expanded access to praziquantel (PZQ) treatment required. AREAS OF CONTROVERSY Schistosomiasis-related morbidity is underappreciated. Present and future demand for PZQ treatment is bottlenecked, imbalanced and inequitable. Current dosing, treatment algorithms and access plans are suboptimal with treatment stalled during pregnancy. GROWING POINTS Raised dosing of PZQ (>40 mg/kg) is being explored in young children. Surveillance of female genital schistosomiasis FGS is increasing. Use of PZQ in pregnancy is safe and preventive chemotherapy guidelines are being revised in morbidity- and transmission-control settings. AREAS TIMELY FOR DEVELOPING RESEARCH Shifting focus of population-level control to individual-case management. Detection and prevention of FGS within general health services and integration of PZQ treatment for women and children in antenatal clinics. Feasibility studies assessing alternative and expanded access to PZQ treatment to at-risk children and mothers and pregnant women.
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Affiliation(s)
- Amaya L Bustinduy
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - J Russell Stothard
- Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Jennifer F Friedman
- Center for International Health Research, Rhode Island Hospital, 55 Claverick Street, Suite 101, Providence, RI 02903, USA
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Reinhard-Rupp J, Klohe K. Developing a comprehensive response for treatment of children under 6 years of age with schistosomiasis: research and development of a pediatric formulation of praziquantel. Infect Dis Poverty 2017; 6:122. [PMID: 28768535 PMCID: PMC5541653 DOI: 10.1186/s40249-017-0336-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 07/14/2017] [Indexed: 11/10/2022] Open
Abstract
Schistosomiasis is a parasitic disease caused by blood flukes. The disease is caused by an inflammatory reaction to parasite eggs retained in the liver, bladder and reproductive organs. According to 2017 World Health Organization (WHO) estimates 220 million people are potentially infected, from which probably 10% are children under 6 years of age. The regular treatment approach of a single, oral dose of 40 mg/kg body weight with praziquantel however, is difficult for children under the age of 6, leaving them without a treatment option. In order to address this important gap in treatment target populations, an international public-private partnership that works on a not-for-profit basis in the field of drug research and development for schistosomiasis was established in 2012. This is called the Pediatric Praziquantel Consortium. Its mission was and continues to be to develop, register and provide access to a suitable pediatric praziquantel formulation for treating schistosomiasis in preschool-age children (3-6 months up to 6 years). The Target Product Profile for the pediatric formulation of praziquantel that would be suitable to treat children as young as 3-6 months was then defined by a group of experts, including members from the Pediatric Praziquantel Consortium partner organizations as well as experts from WHO (as observer) and schistosomiasis endemic countries. The development of the drug is ongoing and the Pediatric Praziquantel Consortium aims to submit the regulatory dossier for marketing approval in endemic countries and WHO prequalification in 2018/19 with approval and product launch for schistosomiasis pediatric case management in key endemic countries in 2019. Ultimately, the goal is for the product to be considered for a large-scale mass distribution program by 2022.
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Affiliation(s)
| | - Katharina Klohe
- Global Schistosomiasis Alliance, Westenriederstrasse 10, 80331, Munich, Germany.
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Stenzel K, Chakrabarti A, Melesina J, Hansen FK, Lancelot J, Herkenhöhner S, Lungerich B, Marek M, Romier C, Pierce RJ, Sippl W, Jung M, Kurz T. Isophthalic Acid-Based HDAC Inhibitors as Potent Inhibitors of HDAC8 fromSchistosoma mansoni. Arch Pharm (Weinheim) 2017. [DOI: 10.1002/ardp.201700096] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Katharina Stenzel
- Institute of Pharmaceutical and Medicinal Chemistry; Heinrich-Heine-University; Düsseldorf Germany
| | - Alokta Chakrabarti
- Institute of Pharmaceutical Sciences; Albert-Ludwigs-University Freiburg; Freiburg Germany
| | - Jelena Melesina
- Institute of Pharmacy; Martin-Luther-University Halle-Wittenberg; Halle (Saale) Germany
| | - Finn K. Hansen
- Institute of Pharmaceutical and Medicinal Chemistry; Heinrich-Heine-University; Düsseldorf Germany
- Pharmaceutical/Medicinal Chemistry; Institute of Pharmacy; Leipzig University; Leipzig Germany
| | - Julien Lancelot
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille; U1019 UMR 8204CIIL - Centre d'Infection et d'Immunité de Lille; Lille France
| | - Simon Herkenhöhner
- Institute of Pharmaceutical and Medicinal Chemistry; Heinrich-Heine-University; Düsseldorf Germany
| | - Beate Lungerich
- Institute of Pharmaceutical and Medicinal Chemistry; Heinrich-Heine-University; Düsseldorf Germany
| | - Martin Marek
- IGBMC; Université de Strasbourg; Illkirch France
| | | | - Raymond. J. Pierce
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille; U1019 UMR 8204CIIL - Centre d'Infection et d'Immunité de Lille; Lille France
| | - Wolfgang Sippl
- Institute of Pharmacy; Martin-Luther-University Halle-Wittenberg; Halle (Saale) Germany
| | - Manfred Jung
- Institute of Pharmaceutical Sciences; Albert-Ludwigs-University Freiburg; Freiburg Germany
| | - Thomas Kurz
- Institute of Pharmaceutical and Medicinal Chemistry; Heinrich-Heine-University; Düsseldorf Germany
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Xiao H, Peng M, Yan H, Gao M, Li J, Yu B, Wu H, Li S. An instrument based on protection motivation theory to predict Chinese adolescents' intention to engage in protective behaviors against schistosomiasis. Glob Health Res Policy 2016; 1:15. [PMID: 29202064 PMCID: PMC5693510 DOI: 10.1186/s41256-016-0015-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 09/23/2016] [Indexed: 11/10/2022] Open
Abstract
Background Further advancement in schistosomiasis prevention requires new tools to assess protective motivation, and promote innovative intervention program. This study aimed to develop and evaluate an instrument developed based on the Protection Motivation Theory (PMT) to predict protective behavior intention against schistosomiasis among adolescents in China. Methods We developed the Schistosomiasis PMT Scale based on two appraisal pathways of protective motivation- threat appraisal pathway and coping appraisal pathway. Data from a large sample of middle school students (n = 2238, 51 % male, mean age 13.13 ± 1.10) recruited in Hubei, China was used to evaluated the validity and reliability of the scale. Results The final scale contains 18 items with seven sub-constructs. Cronbach's Alpha coefficients for the entire instrument was 0.76, and for the seven sub-constructs of severity, vulnerability, intrinsic reward, extrinsic reward, response efficacy, self-efficacy and response cost was 0.56, 0.82, 0.75, 0.80, 0.90, 0.72 and 0.70, respectively. The construct validity analysis revealed that the one level 7 sub-constructs model fitted data well (GFI = 0.98, CFI = 0.98, RMSEA = 0.03, Chi-sq/df = 3.90, p < 0.001). Predictive validity showed that both the PMT instrument score and the 7 sub-construct scores were significantly correlated with the intention engaged in protective behavior against schistosomiasis (p < 0.05). Conclusions This study provides a reliable and valid tool to measure protective motivation in schistosomiasis prevention control. Further studies are needed to develop more effective intervention programs for schistosomiasis prevention.
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Affiliation(s)
- Han Xiao
- School of Health Science, Wuhan University, Wuhan, Hubei China.,Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Minjin Peng
- School of Health Science, Wuhan University, Wuhan, Hubei China.,Department of Infection Control, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei China
| | - Hong Yan
- School of Health Science, Wuhan University, Wuhan, Hubei China.,Global Health Institute, Wuhan University, Wuhan, Hubei China
| | - Mengting Gao
- School of Health Science, Wuhan University, Wuhan, Hubei China.,Global Health Institute, Wuhan University, Wuhan, Hubei China
| | - Jingjing Li
- School of Health Science, Wuhan University, Wuhan, Hubei China.,Global Health Institute, Wuhan University, Wuhan, Hubei China.,Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Bin Yu
- Department of Epidemiology, University of Florida, Gainesville, FL USA
| | - Hanbo Wu
- School of Demography, College of Arts and Social Science, The Australian National University, Canberra, ACT Australia
| | - Shiyue Li
- School of Health Science, Wuhan University, Wuhan, Hubei China.,Global Health Institute, Wuhan University, Wuhan, Hubei China
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Bustinduy AL, Friedman JF, Kjetland EF, Ezeamama AE, Kabatereine NB, Stothard JR, King CH. Expanding Praziquantel (PZQ) Access beyond Mass Drug Administration Programs: Paving a Way Forward for a Pediatric PZQ Formulation for Schistosomiasis. PLoS Negl Trop Dis 2016; 10:e0004946. [PMID: 27658198 PMCID: PMC5033572 DOI: 10.1371/journal.pntd.0004946] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Amaya L. Bustinduy
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Jennifer F. Friedman
- Center for International Health Research, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Eyrun Floerecke Kjetland
- Norwegian Centre 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
| | - Amara E. Ezeamama
- Department of Epidemiology and Biostatistics University of Georgia, Athens, Georgia, United States of America
| | | | - J. Russell Stothard
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Charles H. King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio, United States of America
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Comparative Assessment of Health Benefits of Praziquantel Treatment of Urogenital Schistosomiasis in Preschool and Primary School-Aged Children. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9162631. [PMID: 27631011 PMCID: PMC5007301 DOI: 10.1155/2016/9162631] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/21/2016] [Accepted: 07/05/2016] [Indexed: 12/15/2022]
Abstract
Schistosomiasis is a major public health problem in Africa. However, it is only recently that its burden has become recognised as a significant component impacting on the health and development of preschool-aged children. A longitudinal study was conducted in Zimbabwean children to determine the effect of single praziquantel treatment on Schistosoma haematobium-related morbidity markers: microhaematuria, proteinuria, and albuminuria. Changes in these indicators were compared in 1-5 years versus 6-10 years age groups to determine if treatment outcomes differed by age. Praziquantel was efficacious at reducing infection 12 weeks after treatment: cure rate = 94.6% (95% CI: 87.9-97.7%). Infection rates remained lower at 12 months after treatment compared to baseline in both age groups. Among treated children, the odds of morbidity at 12 weeks were significantly lower compared to baseline for proteinuria: odds ratio (OR) = 0.54 (95% CI: 0.31-0.95) and albuminuria: OR = 0.05 (95% CI: 0.02-0.14). Microhaematuria significantly reduced 12 months after treatment, and the effect of treatment did not differ by age group: OR = 0.97 (95% CI: 0.50-1.87). In conclusion, praziquantel treatment has health benefits in preschool-aged children exposed to S. haematobium and its efficacy on infection and morbidity is not age-dependent.
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N'Diaye M, Dioukhane EM, Ndao B, Diedhiou K, Diawara L, Talla I, Vernet C, Bessin F, Barbier D, Dewavrin P, Klotz F, Georges P. Schistosomiasis Sustained Control Program in Ethnic Groups Around Ninefescha (Eastern Senegal). Am J Trop Med Hyg 2016; 95:614-22. [PMID: 27430549 DOI: 10.4269/ajtmh.15-0125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 03/25/2016] [Indexed: 11/07/2022] Open
Abstract
Schistosomiasis is the second most significant parasitic disease in children in several African countries. For this purpose, the "Programme National de Lutte contre les Bilharzioses" (PNLB) was developed in partnership with the World Health Organization (WHO) to control this disease in Senegal. However, geographic isolation of Bedik ethnic groups challenged implementation of the key elements of the schistosomiasis program in eastern Senegal, and therefore, a hospital was established in Ninefescha to improve access to health care as well as laboratory support for this population. The program we have implemented from 2008 in partnership with the PNLB/WHO involved campaigns to 1) evaluate schistosomiasis prevalence in children of 53 villages around Ninefescha hospital, 2) perform a mass drug administration following the protocol established by the PNLB in school-aged children, 3) monitor annual prevalence, 4) implement health education campaigns, and 5) oversee the building of latrines. This campaign led to a drop in schistosomiasis prevalence but highlighted that sustainable schistosomiasis control by praziquantel treatment, awareness of the use of latrines, and inhabitants' voluntary commitment to the program are crucial to improve Schistosoma elimination. Moreover, this study revealed that preschool-aged children, for whom praziquantel was not recommended until 2014 in Senegal, constituted a significant reservoir for the parasite.
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Affiliation(s)
- Monique N'Diaye
- Université de Caen Normandie, UNICAEN, UFR des Sciences Pharmaceutiques, Laboratoire de Parasitologie et Mycologie Médicale, Caen, France.
| | | | | | - Kemo Diedhiou
- Programme National de Lutte contre les Bilharzioses/World Health Organization Neglected Tropical Diseases, Dakar, Senegal
| | - Lamine Diawara
- Inter-country Support Team for West Africa, World Health Organization Neglected Tropical Diseases, Ouagadougou, Burkina Faso
| | - Idrissa Talla
- Programme National de Lutte contre les Bilharzioses/World Health Organization Neglected Tropical Diseases, Dakar, Senegal
| | - Charlotte Vernet
- Université de Caen Normandie, UNICAEN, UFR des Sciences Pharmaceutiques, Laboratoire de Parasitologie et Mycologie Médicale, Caen, France
| | - François Bessin
- Université de Caen Normandie, UNICAEN, UFR des Sciences Pharmaceutiques, Laboratoire de Parasitologie et Mycologie Médicale, Caen, France
| | - Dominique Barbier
- Université de Caen Normandie, UNICAEN, UFR des Sciences Pharmaceutiques, Laboratoire de Parasitologie et Mycologie Médicale, Caen, France
| | | | | | - Pierre Georges
- Université de Caen Normandie, UNICAEN, UFR des Sciences Pharmaceutiques, Laboratoire de Parasitologie et Mycologie Médicale, Caen, France
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Abstract
"Infectious diseases of poverty" (IDoP) describes infectious diseases that are more prevalent among poor and vulnerable populations, namely human immunodeficiency virus (HIV) infection, tuberculosis (TB), malaria, and neglected tropical diseases (NTDs). In 2013, 190,000 children died of HIV-related causes and there were 550,000 cases and 80,000 TB deaths in children. Children under age 5 account for 78% of malaria deaths annually. NTDs remain a public health challenge in low- and middle-income countries. This article provides an overview of the major IDoP that affect children. Clinicians must be familiar with the epidemiology and clinical manifestations to ensure prompt diagnosis and treatment.
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Affiliation(s)
- Caitlin Hansen
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Elijah Paintsil
- Department of Pediatrics, Yale University School of Medicine, 464 Congress Ave, New Haven, CT 06520, USA; Department of Pharmacology, Yale University School of Medicine, 464 Congress Avenue, New Haven, CT 06520, USA; Department of Public Health, Yale University School of Medicine, 464 Congress Avenue, New Haven, CT 06520, USA.
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Abstract
Schistosomiasis is a major neglected tropical disease that afflicts more than 240 million people, including many children and young adults, in the tropics and subtropics. The disease is characterized by chronic infections with significant residual morbidity and is of considerable public health importance, with substantial socioeconomic impacts on impoverished communities. Morbidity reduction and eventual elimination through integrated intervention measures are the focuses of current schistosomiasis control programs. Precise diagnosis of schistosome infections, in both mammalian and snail intermediate hosts, will play a pivotal role in achieving these goals. Nevertheless, despite extensive efforts over several decades, the search for sensitive and specific diagnostics for schistosomiasis is ongoing. Here we review the area, paying attention to earlier approaches but emphasizing recent developments in the search for new diagnostics for schistosomiasis with practical applications in the research laboratory, the clinic, and the field. Careful and rigorous validation of these assays and their cost-effectiveness will be needed, however, prior to their adoption in support of policy decisions for national public health programs aimed at the control and elimination of schistosomiasis.
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Trainor-Moss S, Mutapi F. Schistosomiasis therapeutics: whats in the pipeline? Expert Rev Clin Pharmacol 2015; 9:157-60. [DOI: 10.1586/17512433.2015.1102051] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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