An Epidemiological Trend of Urogenital Schistosomiasis in Ethiopia

Prevalence of Schistosoma infection and associated factors among pregnant women attending antenatal care at Shewa Robit Health Center, North-Central Ethiopia: a cross-sectional study

BACKGROUND

Schistosoma spp. and other intestinal parasites are common in Ethiopia. During pregnancy, SCH increases the risk of adverse birth outcomes. However, its epidemiology among pregnant women and awareness level about the disease are not well addressed in Ethiopia. This study was conducted to address this gap.

METHODS

A cross-sectional study was conducted from April to June 2023 among 422 pregnant women who attended Shewa Robit Health Center. Pregnant women who came to the health center for antenatal care services were enrolled in the study following systematic random sampling technique. Questionnaire data was collected on socio-demographic characteristics, KAP towards SCH, and associated factors. Stool samples were processed using the Kato-Katz technique, while urine samples were tested with urine test strips for hematuria, and filtration and centrifugation methods for detection of S. haematobium. Data were entered and analyzed using SPSS software version 25. Descriptive statistics and logistic regression were performed at a 95% confidence level.

RESULTS

Among 422 pregnant women, 38 (9.0%) were positive for hematuria, but none were infected by S. haematobium. Schistosoma mansoni was detected in 40 (9.5%; 95% confidence interval (CI): 6.6-12.6) participants. Habit of swimming or bathing (adjusted odds ratio (AOR) = 4.896; 95% CI: 2.193-10.933, p < 0.001) and habit of crossing freshwater on barefoot (AOR = 5.113; 95% CI: 1.171-22.324, p = 0.030) were significantly associated with S. mansoni infection. Of the participants, only 74 (17.5%) had previously heard of SCH. Out of 74 aware participants, 49 (66.2%) and 14 (18.9%) were unaware of the causative agent and possibility of a cure for SCH, respectively. Sixty-one (82.4%) were aware that SCH is preventable. Fifty-three (71.6%) and 4 (5.4%) participants believed that SCH is preventable and serious disease, respectively. Eight (10.8%) and 9 (12.2%) participants avoided contact with freshwater and used clean water for drinking and washing, respectively.

CONCLUSIONS

There is nearly moderate prevalence of S. mansoni infection in the study area. Pregnant women who often had freshwater contact were more likely to contract S. mansoni. Most pregnant women in the study area had low KAP levels towards SCH. Therefore, women of reproductive age groups should be the focus of SCH control programs.

Schistosoma mansoni and soil-transmitted helminthic infections and associated factors among pregnant women in Jimma Town, Southwest Ethiopia

BACKGROUND

Schistosomiasis and soil-transmitted helminth (STH) infections occurring during pregnancy may pose adverse health consequences to the mother and the developing baby. This study aims to determine the prevalence of Schistosoma mansoni and STHs, and their association with adverse birth outcomes among pregnant women in Jimma Town.

METHODS

A cross-sectional study involving 314 pregnant women was conducted in Jimma Town, Southwest Ethiopia. The pregnant women were recruited from selected public health facilities during their antenatal care (ANC) visits from August to December 2021. Data on demographic characteristics and factors associated with S. mansoni and STH infections were collected using a pretested questionnaire. Moreover, during the third trimester, stool specimen of each pregnant woman was examined using Kato-Katz technique, and hemoglobin was measured using a HemoCue analyzer. Data on adverse birth outcomes were collected during delivery. Data were analyzed using STATA-MP_12 (StataCorp., TX, USA).

RESULTS

The overall prevalence of intestinal helminthic infections was 26.1%. Soil-transmitted helminths and S. mansoni were detected in 20.4% (95%CI: 15.9-24.8) and 5.7% (95%CI: 3.2-8.3) of the pregnant women, respectively. The magnitude of low birth weight was 6.4%, higher in those with late-term delivery and maternal anemia (p < 0.05). Maternal anemia was also associated with post-partum bleeding (p < 0.05). Pregnant women who carry out laundry activities in the river were significantly more infected by S. mansoni (AOR 10.7, 95% CI: 2.2-51.9).

CONCLUSIONS

This study sheds light on the burden of maternal STH and S. mansoni infections in Jimma Town. A quarter of the pregnant women were infected with STHs and S. mansoni. It is recommended that pregnant women in the area avoid washing clothes in the river to reduce the risk of S. mansoni infection. Screening for intestinal parasitic infections should be conducted for pregnant women living in endemic areas during their ANC follow-up.

Urogenital schistosomiasis among school children in northwestern Tanzania: Prevalence, intensity of infection, associated factors, and pattern of urinary tract morbidities

Background

The planning and implementation of intervention measures against schistosomiasis, particularly mass administration, require knowledge of the current status of the infection. This is important for monitoring the impact of the intervention on disease indicators such as a decline in infection prevalence, intensity of infection, and urogenital morbidities. Following repeated rounds of mass treatment in northwestern Tanzania, the epidemiology of urogenital schistosomiasis has changed; thus, for the effective planning and allocation of resources, it is important to understand the current status of the disease in the targeted groups. Therefore, the objective of the current study was to determine the prevalence, intensity, and associated factors of Schistosoma haematobium infection and urinary tract morbidities in school-aged children from northwestern Tanzania.

Materials and methods

An analytical cross-sectional study was conducted among schoolchildren aged 5-17 years between November and December 2022. A single urine sample was collected from each child and examined for the presence of S. haematobium eggs and microhaematuria using a urine filtration technique and a urine reagent dipstick. Each child underwent an ultrasonographic examination of the urinary tract according to the World Health Organization standards (Niamey protocol) to detect S. haematobium-related morbidities.

Results

Of the 3225 participants, 54.2 % were female, and the mean age was 10.9 (±1.89) years. The overall prevalence of S. haematobium was 17.7 % (95 % CI: 16.4-19.1, 572/3225). Of the 572 infected children, 81.8 % (95 % CI: 78.4-84.9, 468/572) had light-intensity infections, and 18.2 % (95 % CI: 14.9-21.4, 104/572) had heavy-intensity infections. The prevalence of macro- and microhaematuria was 2.4 % (95 % CI: 1.9-3) and 18.5 % (95 % CI: 17.2-19.8), respectively. Age (aOR: 1.2, 95 % CI: 1.0-1.5), district of residence (aOR: 2.1, 95 % CI: 1.7-2.7) and history of schistosomiasis (aOR: 2.5, 95 % CI: 1.9-3.2) were significantly associated with urinary schistosomiasis infection. However, swallowing praziquantel during the last mass drug administration was protective (aOR 0.6, 95 % CI: 0.4-0.8). The overall prevalence of ultrasound-detectable urinary tract abnormalities was 9.9 % (95 % CI: 8.9-11.1, 299/2994) and included urinary bladder abnormalities in 9.9 % (95 % CI: 8.8-11, 297/2994), ureter abnormalities in 0.2 % (95 % CI: 0.07-0.4, 6/2994), and kidney abnormalities in 0.2 % (95 % CI: 0.09-0.4, 7/2994). Calcification of the urinary bladder was observed in 0.9 % (95 % CI: 0.6-1.3, 29/2994) of the examined children.

Conclusions

Schistosoma haematobium infection is still prevalent among schoolchildren in the study setting, and it causes substantial morbidity at an early age. Transmission is driven by the age of the child, district of residence, and history of schistosomiasis. However, swallowing praziquantel in rounds of mass drug administration reduces transmission. Urogenital schistosomiasis infection is associated with haematuria and ultrasound-detectable morbidities. In S. haematobium endemic areas, routine ultrasound screening for urinary tract morbidities could be considered in annual mass treatment programmes for early management. Special attention should be given to children with proteinuria, microhaematuria, and heavy infection intensities.

Efficacy of Praziquantel in Treating Schistosoma haematobium Infection Among Ethiopian Children

Background/Objectives: Praziquantel is a cornerstone of schistosomiasis control and elimination efforts. Continued surveillance of praziquantel efficacy is needed to monitor for the development of resistance, as well as to help public health officials gauge the effect of mass praziquantel administration on schistosomiasis control in communities, since it is the only drug used in schistosomiasis control programs. The objective of this study was to assess the praziquantel cure rate and egg reduction rate against urogenital schistosomiasis. Methods: This study enrolled 977 children from 12 villages in Afar and Gambella, Ethiopia, who provided urine samples that were checked for Schistosoma haematobium infection at baseline using urine filtration microscopy. Infected individuals were provided a single dose of praziquantel (40 mg/kg body weight) and retested six weeks post-treatment. Results:S. haematobium was recovered from baseline urine specimens in 177 of 977 (18%) participating children. One hundred six of these children completed therapy and presented for subsequent evaluation at six weeks; 91 children were egg-free. The egg reduction rate was 97%; changes in egg burden among the 15 children who did not achieve cure varied widely. Cure rates were better among children with light-intensity infections. No significant differences in egg reduction rates were found based on the demographic variables examined. Conclusions: Standard praziquantel monotherapy remains an effective treatment against urogenital schistosomiasis in Ethiopia.

Arborized pattern of MRI enhancement in spinal cord schistosomiasis: A report of 2 successful case outcomes

This case report describes 2 patients with spinal cord schistosomiasis diagnosed based on a magnetic resonance imaging finding of a unique arborized type of postcontrast enhancement. Both patients presented with back pain and lower limb weakness, and prompt treatment with an anti-schistomal agent and steroid resulted in significant neurological and radiological improvement. The report emphasizes the role of imaging in the early diagnosis of spinal cord schistosomiasis, as well as the importance of early treatment for the best clinical outcomes.

Burden of schistosomiasis in global, regional, and national 1990-2019: A systematic analysis for the Global Burden of Disease Study 2019

BACKGROUND

Despite the gradual decline of schistosomiasis due to the efforts of the WHO and various countries, with the WHO setting a goal to eliminate schistosomiasis by 2030, a comprehensive global assessment of the current status of schistosomiasis has not been conducted.

OBJECTIVES

To provide a detailed description of the changes in schistosomiasis from 1990 to 2019 by using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 database.

METHODS

We obtained all relevant data on schistosomiasis worldwide from the Global Burden of Diseases (GBD) database from 1990 to 2019. The mortality, prevalence, disability-adjusted life-years (DALYs), Years of Life Lost (YLLs), Years Lived with Disability (YLDs) of schistosomiasis were examined by Socio-demographic Index (SDI), age, sex, and year at the global, region and national level.

RESULTS

From 1990 to 2019, the age-standardized rate(ASR)-prevalence of schistosomiasis has decreased from 2600.9 per 100,000(95% uncertainty interval (UI) 2191.2 to 3059.3) to 1805.0 per 100,000(95% UI 1503.4 to 2146.9). The estimated annual percentage change (EAPC) from 1990 to 2019 was 1.28 (95% UI 1.22 to 1.33) in high SDI regions and -2.45 (95% UI -3.03 to -1.86) in low SDI regions. In North Africa and the Middle East, the most substantial reduction in DALYs occurred, with an observed EAPC of -5.36.

CONCLUSION

The burden of schistosomiasis has decreased over the past three decades worldwide. However, the high SDI regions have shown the increasing burden of schistosomiasis. Besides, Multiple countries in Africa still bear a significant burden of schistosomiasis, necessitating robust prevention and control efforts.

Evaluating the Performance of FlukeCatcher at Detecting Urogenital Schistosomiasis

Urine filtration microscopy (UFM) lacks sensitivity in detecting low-intensity Schistosoma haematobium infections. In pursuit of a superior alternative, this study evaluated the performance of FlukeCatcher microscopy (FCM) at detecting S. haematobium eggs in human urine samples. Urine samples were collected from 572 school-age children in Afar, Ethiopia in July 2023 and examined using UFM and FCM approaches. Using the combined UFM and FCM results as a reference, the sensitivity, negative predictive value, and agreement levels for the two testing methods in detecting S. haematobium eggs in urine samples were calculated. The sensitivity and negative predictive value of detecting S. haematobium eggs in urine samples for FCM was 84% and 97%, respectively, compared to 65% and 93% for UFM. The FCM test results had an agreement of 61% with the UFM results, compared to 90% with the combined results of FCM and UFM. However, the average egg count estimates were lower when using FCM (6.6 eggs per 10 mL) compared to UFM (14.7 eggs per 10 mL) (p < 0.0001). Incorporating FCM into specimen processing could improve the diagnosis of S. haematobium infection but may underperform in characterizing the intensity of infection.

In Silico Comparison of Bioactive Compounds Characterized from Azadirachta indica with an FDA-Approved Drug against Schistosomal Agents: New Insight into Schistosomiasis Treatment

The burden of human schistosomiasis, a known but neglected tropical disease in Sub-Saharan Africa, has been worrisome in recent years. It is becoming increasingly difficult to tackle schistosomiasis with praziquantel, a drug known to be effective against all Schistosoma species, due to reports of reduced efficacy and resistance. Therefore, this study seeks to investigate the antischistosomal potential of phytochemicals from Azadirachta indica against proteins that have been implicated as druggable targets for the treatment of schistosomiasis using computational techniques. In this study, sixty-three (63) previously isolated and characterized phytochemicals from A. indica were identified from the literature and retrieved from the PubChem database. In silico screening was conducted to assess the inhibitory potential of these phytochemicals against three receptors (Schistosoma mansoni Thioredoxin glutathione reductase, dihydroorotate dehydrogenase, and Arginase) that may serve as therapeutic targets for schistosomiasis treatment. Molecular docking, ADMET prediction, ligand interaction, MMGBSA, and molecular dynamics simulation of the hit compounds were conducted using the Schrodinger molecular drug discovery suite. The results show that Andrographolide possesses a satisfactory pharmacokinetic profile, does not violate the Lipinski rule of five, binds with favourable affinity with the receptors, and interacts with key amino acids at the active site. Importantly, its interaction with dihydroorotate dehydrogenase, an enzyme responsible for the catalysis of the de novo pyrimidine nucleotide biosynthetic pathway rate-limiting step, shows a glide score and MMGBSA of -10.19 and -45.75 Kcal/mol, respectively. In addition, the MD simulation shows its stability at the active site of the receptor. Overall, this study revealed that Andrographolide from Azadirachta indica could serve as a potential lead compound for the development of an anti-schistosomal drug.

MaxEnt modeling of the potential risk of schistosomiasis in the Philippines using bioclimatic factors

Schistosomiasis is a parasitic infection caused by Schistosoma japonicum. It remains a principal local health issue in the Philippines, demonstrating endemicity in 28 provinces and afflicting thousands of Filipino individuals annually. Despite this, no clear distribution maps for the disease have been comprehensively reported. Therefore, species distribution modeling (SDM) employing the MaxEnt algorithm and GIS application techniques was utilized to denote the potential risk of schistosomiasis in the country. With a high AUC score of 0.846, the SDM yielded a favorable and reliable correlative map illustrating a predicted schistosomal temporal distribution concentrated primarily on the country's eastern portion with a more pronounced wet than dry season. The precipitation of the driest quarter was determined to be the most significant contributing factor among the bioclimatic variables evaluated. This suggests a possible increase in adaptations concerning the rainfall and thermal tolerances of the parasites' vectors. Moreover, socioeconomic status between Philippine regions revealed an inverse proportion with the number of schistosomiasis cases. This study also discussed the potential role of climate change on the range shifts and the potential risk of parasite infection in the Philippines.

Molecular detection of Schistosoma haematobium in infected Bulinus truncatus snails associated with immune response

Schistosomiasis is one of the most common waterborne parasite illnesses, it is a major public health issue in developing countries. The polymerase chain reaction (PCR) technique is used to find Schistosoma haematobium DNA in Bulinus truncatus, which could speed up the discovery of infections before cercariae are shed. DraI-PCR detected S. haematobium infection at different infection intervals with bands at 300 bp in shedding snails 40 days after exposure and even on the first day after B. turancuts snails exposure to miracidia. Transmission electron microscopy showed the structure of sporocyst from 1 to 40 days post-exposure and activated hemocytes in infected non-shedding snails as well as sporocyst degradation. Flow cytometry was used to measure the percentage of Bax and TGF-β1 positive stained cells that have been linked with infection progression. In conclusion, molecular tools and immune response play an important role in the strategy of controlling schistosomiasis through the early detection of larval stages in intermediate hosts toward certification of schistosomiasis elimination. RESEARCH HIGHLIGHTS: DraI-PCR allowed early detection of S. haematobium at 300 bp in B. truncatus snail. Transmission electron microscopy showed the structure of S. haematobium sporocyst in snail and activated hemocytes in non-shedding snail. Bax protein that induced apoptotic changes and Transforming Growth Factor Beta1 level have been linked with parasite development.

Prevalence of Soil-Transmitted Helminths and Schistosoma mansoni among Schoolchildren across Altitudinal Gradients in Amhara National Regional State, Ethiopia

Soil-transmitted helminths (STHs) and Schistosoma mansoni infections are common parasitic infections in sub-Saharan Africa. Their distributions vary across altitudes in Ethiopia. Hence, ongoing updates of infection risk factors and prevalence data are necessary for successful intervention. A school-based, cross-sectional study was conducted from October to December 2019 involving 530 schoolchildren who were recruited by systematic random sampling from Amhara Regional State. A structured questionnaire was used to collect data on sociodemographic, geographical and environmental factors. Stool samples were collected and processed by Ritchie's and Kato Katz techniques. Data were entered into EpiData and analyzed using SPSS. Descriptive statistics were used to compute prevalence, and logistic regression was used to assess factors associated with STHs and S. mansoni infections. Variables with P < 0.05 were considered statistically significant. Among 530 schoolchildren, 169 (31.9%) and 78 (14.7%) were infected with STHs and S. mansoni, respectively. The prevalence of STHs (40.2%) in the semi-highlands and S. mansoni (30.4%) in the lowlands was high. Infrequent shoes wearing, exposure to soil, not washing vegetables before eating, and living outside in lowland areas were significantly associated with STHs infections (P < 0.05). Schoolchildren who fetched water to irrigate fields, swam in rivers, and lived in lowland areas were significantly associated with S. mansoni infection (P < 0.05). In conclusion, prevalence rates of STHs and S. mansoni infections differed across altitudes in Amhara Regional State. Therefore, current control strategies including deworming and provision of clean water and education on sanitation and hygiene should be intensified and adapted to the local context.

Understanding key vectors and vector-borne diseases associated with freshwater ecosystem across Africa: Implications for public health

The emerging and re-emerging vector-borne diseases transmitted by key freshwater organisms have remained a global concern. As one of the leading biodiversity hotspots, the African ecoregion is suggested to harbour the highest number of freshwater organisms globally. Among the commonly found organisms in the African ecoregion are mosquitoes and snails, with a majority of their life cycle in freshwater, and these freshwater organisms can transmit diseases or serve as carriers of devastating diseases of public health concerns. However, synthetic studies to link the evident abundant presence and wide distribution of these vectors across the freshwater ecosystems in Africa with the increasing emerging and re-emerging vector-borne diseases in Africa are still limited. Here, we reviewed documented evidence on vector-borne diseases and their transmission pathways in Africa to reduce the knowledge gap on the factors influencing the increasing emerging and re-emerging vector-borne diseases across Africa. We found the population distributions or abundance of these freshwater organisms to be increasing, which is directly associated with the increasing emerging and re-emerging vector-borne diseases across Africa. Furthermore, we found that although the current changing environmental conditions in Africa affect the habitats of these freshwater organisms, current changing environmental conditions may not be suppressing the population distributions or abundance of these freshwater organisms. Instead, we found that these freshwater organisms are extending their geographic ranges across Africa, which may have significant public health implications in Africa. Thus, our study demonstrates the need for future studies to integrate the environmental conditions of vectors' habitats to understand if these environmental conditions directly or indirectly influence the vectorial capacities and transmission abilities of vectors of diseases. We propose that such studies will be necessary to guide policymakers in making informed policies to help control vector-borne diseases.

The trend of schistosomiasis related bladder cancer in the lake zone, Tanzania: a retrospective review over 10 years period

INTRODUCTION

Bladder cancer is a possible outcome of chronic urinary schistosomiasis in many endemic countries. In Tanzania, the Lake Victoria area is one of the areas with the highest prevalence of urinary schistosomiasis and higher incidences of squamous cell carcinoma (SCC) of the urinary bladder. A previous study in the area over one decade (2001-2010) showed SCC to be common in patients aged below 50 years. With various prevention and intervention programs there are likely to be notable changes in schistosomiasis-related urinary bladder cancer, which is currently unknown. Updated information on the status of SCC in this area will be useful for giving an insights into efficacy of control interventions implemented and help guide the initiation of new ones. Therefore, this study was done to determine the current trend of schistosomiasis-related bladder cancer in lake zone, Tanzania.

METHODS

This was a descriptive retrospective study of histologically confirmed urinary bladder cancer cases diagnosed at the Pathology Department of Bugando Medical Centre over 10 years period. The patient files and histopathology reports were retrieved and information was extracted. Data were analyzed using Chi-square and student t-test.

RESULTS

A total of 481 patients were diagnosed with urinary bladder cancer during the study period whereby, 52.6% were males and 47.4% were females. The mean age regardless of histological type of cancer was 55 ± 14.2 years. The SCC was the commonest histological type accounting for 57.0%, followed by transitional cell carcinoma 37.6%, and 5.4% were adenocarcinomas. The Schistosoma haematobium eggs were observed in 25.2% and were commonly associated with SCC (p = 0.001). Poorly differentiated cancers were observed mostly in females (58.6%) compared to males (41.4%) (p = 0.003). Muscular invasion of the urinary bladder by cancer was observed in 11.4% of the patients, and this was significantly higher in non-squamous than in squamous cancers (p = 0.034).

CONCLUSION

Schistosomiasis-related cancers of the urinary bladder in the Lake zone of Tanzania is still a problem. Schistosoma haematobium eggs were associated with SCC type indicating the persistence of infection in the area. This calls for more efforts on preventive and intervention programs to reduce the burden of urinary bladder cancer in the lake zone.

Parasitological and malacological surveys to identify transmission sites for Schistosoma mansoni in Gomma District, south-western Ethiopia

Schistosomiasis is a neglected tropical disease that disproportionately affects the poorest people in tropical and subtropical countries. It is a major parasitic disease causing considerable morbidity in Ethiopia. Despite significant control efforts, schistosomiasis transmission is still widespread in many rural areas of the country. The aim of this study was to determine the prevalence and intensity of intestinal schistosomiasis among schoolchildren, as well as to identify schistosomiasis transmission sites in Gomma District, southwestern Ethiopia. Between October 2018 and September 2019, cross-sectional parasitological and malacological surveys were conducted in the study area. The study comprised 492 school-children aged 6 to 15 years old from four primary schools in Gomma District. To identify and quantify eggs of Schistosoma mansoni from the children, stool specimens were collected and processed using double Kato-Katz thick smears. Water bodies adjacent to human settlements in the study area were surveyed for snail intermediate hosts of S. mansoni. Morphological identification of collected snails was conducted, followed by examining their infection status using a dissecting microscope. The overall prevalence of S. mansoni infection was 73.8% (95%CI: 69.9-77.7%) and 41.6% of them had moderate-to-heavy infections. The prevalence of S. mansoni infection differed considerably by age group, with the older age groups (12-15) having a higher prevalence than the younger age groups (6-11) (p < 0.001). The prevalence of infection also varied significantly among schools; Dedo Ureche had the highest prevalence (86.9%) (p = 0.034), while Goga Kilole had relatively the lowest prevalence of S. mansoni infection (59.6%) (p = 0.003). A total of 1463 Biomphalaria pfeifferi snails were collected from 11 survey sites throughout the study area, with 357 (24.4%) of the snails shedding schistosomes cercariae. Despite intensified efforts to scale up mass drug administration in Ethiopia, this study reported high levels of S. mansoni infection among schoolchildren and snail intermediate hosts in rural communities in Gomma. Such a high infection rate warrants pressing needs for targeted and integrated interventions to control the disease in the area.

Schistosoma mansoni Epidemiology Among Snails, Rodents and Children: A One Health Approach

Background

Schistosoma is one of the prevalent parasitic infection in humans and animals. Schistosomiasis in children is particularly serious and results in liver and spleen enlargement, anemia, stunting, reduced ability to learn and death. The aim of this study was to measure the prevalence and distribution of schistosomiasis in children, rodents and snail populations in Aleffa and Takusa districts, north-west Ethiopia.

Methods

Disease status and exposure were simultaneously measured from December 2020 to December 2021. School children's stool specimens were collected for schistosomiasis examination by Kato Katz and formal-ether techniques. Live rodents and snails were trapped and collected in search of adult schistosoma, eggs, and cercariae, respectively. Multiple logistic regression analytic technique by using SPSS version 20 was conducted.

Results

Of 460 stool specimens examined, 116 (25.22) were found positive for S. mansoni infection. In the present finding, the possible determinants for the occurrence of intestinal schistosomiasis in school children were female sex (AOR = 1.09, 95% CI: 1.37–2.96); working with bare foot (AOR = 1.21, 95% CI: 1.08–1.52); skin cut/abrasion history (AOR = 3.6, 95% CI: 1.08–7.43) and swimming habit (AOR = 1.58, 95% CI: 1.33–1.99). The overall (n = 108) rodent prevalence of S. mansoniwas 23 (21.3%). Only 6 snails were shedding the infective stage of schistosoma cercariae.

Conclusion

The study revealed that there is a moderate prevalence of schistosomiasis in different hosts. Thus, multi-host intervention is crucial to achieving the goal of interrupting transmission of schistosomiasis in the study area. Further research to better understand and exploit the broader environmental, ecological context and encompassing dynamic interactions between all hosts over time will be crucial for building predictive models beyond the known fact of having or not having reservoirs/hybridization of schistosoma in our study area.

Comparing the accuracy of two diagnostic methods for detection of light Schistosoma haematobium infection in an elimination setting in Wolaita Zone, South Western Ethiopia

Reagent urinalysis dipstick and filtration have been recommended diagnostic methods for the detection of urogenital schistosomiasis. However, the accurate diagnosis of light infections using these methods presents a major challenge. This study evaluates the diagnosis accuracy of light infection with Schistosoma haematobium in study participants living in Wolaita Zone, an area targeted for sustainable control of Schistosomiasis, and ultimately interrupt transmission. Urine samples were collected from children and adults in surveys carried out during baseline and longitudinal sentinel site surveys conducted from 2018 to 2020. All urine samples were tested using a reagent urinalysis dipstick test (Haemastix) to detect microhaematuria with reference urine filtration technique as a proxy for S. haematobium infection. Sensitivity and specificity were determined in diagnosing urogenital schistosomiasis. Cohen’s Kappa statistics was done for the agreement of these diagnostic methods. A total of 12,102 participants were enrolled in the current baseline study. Among them, 285 (2.35%) samples tested positive for microhaematuria and 21 (0.20%) positive for S. haematobium eggs. A total of 4,357 samples were examined in year 1 and year 2 using urine dipsticks, and urine filtration 172 (3.95%) and 2 (0.05%) were positive for microhaematuria and S. haematobium eggs. The reagent urinalysis dipsticks showed the highest sensitivity and specificity for diagnosing light intensity of infection,100% (95% CI:85.18–100.00) and 97.4% (95% CI: 97.10–97.60), respectively. There is a slight agreement between the two methods (Kappa = 0.09, 95% CI: 0.01–0.18). The present study revealed very low prevalence and light intensity of S. haematobium infections. The study also highlights that the dipstick test is considered a useful adjunct diagnostic tool for population-based control of urogenital schistosomiasis.

Emerging and Re-emerging Vector-Borne Infectious Diseases and the Challenges for Control: A Review

Vector-borne emerging and re-emerging diseases pose considerable public health problem worldwide. Some of these diseases are emerging and/or re-emerging at increasing rates and appeared in new regions in the past two decades. Studies emphasized that the interactions among pathogens, hosts, and the environment play a key role for the emergence or re-emergence of these diseases. Furthermore, social and demographic factors such as human population growth, urbanization, globalization, trade exchange and travel and close interactions with livestock have significantly been linked with the emergence and/or re-emergence of vector-borne diseases. Other studies emphasize the ongoing evolution of pathogens, proliferation of reservoir populations, and antimicrobial drug use to be the principal exacerbating forces for emergence and re-emergence of vector-borne infectious diseases. Still other studies equivocally claim that climate change has been associated with appearance and resurgence of vector-borne infectious diseases. Despite the fact that many important emerging and re-emerging vector-borne infectious diseases are becoming better controlled, our success in stopping the many new appearing and resurging vector-borne infectious diseases that may happen in the future seems to be uncertain. Hence, this paper reviews and synthesizes the existing literature to explore global patterns of emerging and re-emerging vector-borne infections and the challenges for their control. It also attempts to give insights to the epidemiological profile of major vector-borne diseases including Zika fever, dengue, West Nile fever, Crimean-Congo hemorrhagic fever, Chikungunya, Yellow fever, and Rift Valley fever.

Environmental Drivers and Potential Distribution of Schistosoma mansoni Endemic Areas in Ethiopia

In Ethiopia, human schistosomiasis is caused by two species of schistosome, Schistosoma mansoni and S. haematobium, with the former being dominant in the country, causing infections of more than 5 million people and more than 37 million at risk of infection. What is more, new transmission foci for S. mansoni have been reported over the past years in the country, raising concerns over the potential impacts of environmental changes (e.g., climate change) on the disease spread. Knowledge on the distribution of schistosomiasis endemic areas and associated drivers is much needed for surveillance and control programs in the country. Here we report a study that aims to examine environmental determinants underlying the distribution and suitability of S. mansoni endemic areas at the national scale of Ethiopia. The study identified that, among five physical environmental factors examined, soil property, elevation, and climatic factors (e.g., precipitation and temperature) are key factors associated with the distribution of S. mansoni endemic areas. The model predicted that the suitable areas for schistosomiasis transmission are largely distributed in northern, central, and western parts of the country, suggesting a potentially wide distribution of S. mansoni endemic areas. The findings of this study are potentially instrumental to inform public health surveillance, intervention, and future research on schistosomiasis in Ethiopia. The modeling approaches employed in this study may be extended to other schistosomiasis endemic regions and to other vector-borne diseases.

Bulinus senegalensis and Bulinus umbilicatus Snail Infestations by the Schistosoma haematobium Group in Niakhar, Senegal

Thorough knowledge of the dynamics of Bulinus spp. infestation could help to control the spread of schistosomiasis. This study describes the spatio-temporal dynamics of B. senegalensis and B. umbilicatus infestation by the Schistosoma haematobium group of blood flukes in Niakhar, Senegal. Molecular identification of the S. haematobium group was performed by real-time PCR, targeting the Dra 1 gene in 810 samples of Bulinus spp. collected during the schistosomiasis transmission season in 2013. In addition to Dra 1 PCR, a rapid diagnostic-PCR was performed on a sub-group of 43 snails to discriminate S. haematobium, S. bovis, and S. mattheei. Out of 810 snails, 236 (29.1%) were positive for Dra 1 based on the PCR, including 96.2% and 3.8% of B. senegalensis and B. umbilicatus, respectively. Among the sub-group, 16 samples were confirmed to be S. haematobium while one was identified as a mixture of S. haematobium and S. bovis. Snails infestations were detected in all villages sampled and infestation rates ranged from 15.38% to 42.11%. The prevalence of infestation was higher in the north (33.47%) compared to the south (25.74%). Snail populations infestations appear early in the rainy season, with a peak in the middle of the season, and then a decline towards the end of the rainy season. Molecular techniques showed, for the first time, the presence of S. bovis in the Bulinus spp. population of Niakhar. The heterogeneity of snail infestations at the village level must be taken into account in mass treatment strategies. Further studies should help to improve the characterizations of the schistosome population.

Prevalence of Schistosomiasis (S. mansoni and S. haematobium) and its association with gender of school age children in Ethiopia: A systematic review and meta-analysis

BACKGROUND

Schistosomiasis (S. mansoni and S. haematobium) is an important neglected tropical disease in sub-Saharan Africa including Ethiopia. In Ethiopia, Schistosomiasis has been prioritized as neglected tropical disease and remained among major public health burden on school age children of the country. Few studies conducted on the association between prevalence of Schistosomiasis and gender of school age children have inconclusive finding about the association between these two variables. Therefore, this systematic review and meta-analysis was done to determine the pooled prevalence of Schistosomiasis and its association with gender of school age children in Ethiopia.

METHODS

In this systematic review and meta-analysis, databases such as: Medline/PubMed, EMBASE, CINAHL, Cochrane Central library, Google Scholar, and HINARI were systematically searched. STATA version 14 was used to estimate pooled prevalence of Schistosomiasis using random effects model with 95% confidence interval. The results were presented by using forest plot and statistical heterogeneity was checked by using the Cochran Q test (chi-squared statistic), I2 test statistic and by visual examination of the forest plot.

RESULTS

From the total of 427 studies identified for this review, 50 studies were included in the final analysis. The analysis noted that pooled prevalence of Schistosomiasis in Ethiopia was 28.78% (95% CI: 23.81, 33.74). The subgroup analysis indicated that extreme variability was observed in the prevalence of Schistosomiasis across the regions of the country. The highest (39.77%) prevalence of Schistosomiasis was reported from the southern region, whereas the lowest (14.95%) prevalence of Schistosomiasis was reported from Afar region. Male school age children were 58% more likely infected with Schistosomiasis than female school age children in Ethiopia (OR: 1.58, 95% CI: 1.33, 1.83).

CONCLUSIONS

The Prevalence of Schistosomiasis was higher than the 2018 report of the Ethiopian federal ministry of health. The prevalence of Schistosomiasis was predominant among male gender of the school age children. Therefore, sustainable control of Schistosomiasis requires the approaches that must go beyond current deworming program. Complementary prevention strategies including health education, safe water and adequate sanitary facilities provision should be simultaneously implemented. The underlining causes of variation in risk factors of Schistosomiasis among males and females should be further studied.

Diagnostic accuracy of Schistosoma ICT IgG-IgM and comparison to other used techniques screening urinary schistosomiasis in Nigeria

Objectives

Schistosomiasis is a blood fluke parasitic illness affecting human lives in rural endemic areas. This study evaluated the performance of Schistosoma ICT Ig G - IgM for screening urinary schistosomiasis in Nigeria.

Methods

Three hundred and seventy four (374) urine samples were examined. Reagent strips, urine filtration and Schistosoma ICT Ig G - IgM were used for analysis. Schistosoma ICT Ig G - IgM used 2 mL of each serum for serological examination. Then, 3 mL of each preserved serum was sent to LDBIO Diagnostics, France for re-examination with Schistosoma ICT IgG-IgM and confirmation with SCHISTO Western blot (WB) IgG. The performance of the index tests was determined using sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and positive likelihood ratio (PLR). The Youden index (YI) and diagnostic accuracy (DA) were used to determine the accuracy of each test. The statistical significance was at p-value ≤0.05.

Results

The test had a sensitivity of 94.9%, specificity of 63.9%, positive predictive value of 72.4%, negative predictive value of 92.6%, and positive likelihood ratio of 2.62. Schistosoma ICT Ig G - IgM had a good Cohen's kappa index (κ=0.68), good Youden index (YI=0.58) and good diagnostic accuracy (DA=0.78).

Conclusions

Schistosoma ICT Ig G - IgM has proven to be the best technique for the screening of urinary schistosomiasis in Nigeria.

Prevalence of Schistosoma mansoni-Salmonella coinfection among patients in southern Ethiopia

Concurrent infection with Schistosoma mansoni and Salmonella species is not uncommon in the endemic area of sub-Saharan Africa, although its prevalence may have regional variations. We discuss such coinfection and associated factors in an Ethiopian context. We assessed the prevalence of S. mansoni and Salmonella coinfections among patients attending two hospitals in southern Ethiopia. A facility-based cross-sectional study was carried out between 1 October and 30 November 2019. In total 271 participants with gastrointestinal complaints were selected through a systematic sampling technique. S. mansoni was detected using direct microscopy and formalin-ether concentration techniques, whereas Salmonella was identified by conventional culture methods and the Widal test. Antibiotic susceptibility test for Salmonella isolates was performed. The prevalence rates of S. mansoni and Salmonella infections were 17.30% and 7.70% respectively. The prevalence of S. mansoni-Salmonella coinfection was 7.7%. Of the factors analysed in connection with coinfection, male sex, age and frequency of exposure to contaminated water bodies were found to be statistically significant. S. mansoni-Salmonella coinfections pose a grave health problem in the study area, especially among children. Our conclusions can be used by the medical community to frame and implement intervention strategies for the management of S. mansoni-Salmonella coinfections.

Prevalence, Intensity, and Factors Associated with Urogenital Schistosomiasis among Women of Reproductive Age in Mbogwe District Council, Geita Region, Tanzania

BACKGROUND

Urogenital schistosomiasis remains a public health problem in Tanzania. Control programs mostly target school-going children ignoring other vulnerable groups like women of child bearing age. Previous evidence has shown that women of reproductive age suffer greatest morbidities in endemic areas. This study sought to determine the prevalence, intensity, and factors associated with urogenital schistosomiasis among women of reproductive age in the Mbogwe District.

METHODS

A population-based analytical cross-section study was conducted in the Mbogwe District. A semistructured questionnaire was administered. Urine samples of 20-30 mils collected between 10.00 am to 02.00 pm and examined for Schistosoma eggs and infection intensity microscopically. Data analysis was done using SPSS version 20.

RESULTS

A total of 426 women of reproductive age, with median age of 26, and interquartile range of 11years were recruited and assessed. The prevalence of urogenital schistosomiasis was 4.5% and mean egg intensity of 19.5eggs/10mil of urine. After adjusting for confounders, lower level of education was associated with an increased risk of urogenital schistosomiasis infections (AOR 8.355, 95% CI 3.055-23.001).

CONCLUSION

Urogenital schistosomiasis among women of reproductive age in the Mbogwe District is a problem. Education is the factor associated with the disease; the neglected tropical disease control program should develop strategies that should include provision of health education and should involve women of reproductive age as they act as infection reservoir. More studies are recommended to explore the possibility of reproductive complications among infected women in endemic areas.

Knowledge, Attitude, and Practice of Provincial Dwellers on Prevention and Control of Schistosomiasis: Evidence from a Community-Based Cross-Sectional Study in the Gambia

Background

Socioeconomically disadvantaged and neglected communities were found to be the most affected groups for schistosomiasis as a result of inadequate safe water and sanitation facilities. In order to inform policies and practices, the present study examined the influence of sociodemographic factors and attitudes on the knowledge and practice in the prevention and control of schistosomiasis in eighteen endemic rural communities in the Gambia.

Methods

In January 2019, a community-based cross-sectional study was conducted in which 383 household heads in rural communities across Kuntaur and Janjanbureh Local Government Areas (LGAs) in Central River Region were recruited. A structured interview questionnaire was developed to elicit information regarding residents' knowledge, attitude, and practice on schistosomiasis prevention and control measures. Percentages, chi-square test, and binary and multiple logistic regression models were used to identify sociodemographic factors associated with the KAP variables. The significance level was set at p < 0.05.

Results

Among the 383 participants, only 14.9% had good knowledge, while 54.3% had poor knowledge, 96.9% had positive attitude, and 57.7% had good practice towards prevention and control of schistosomiasis. Older age (≥40 years), compared with residents aged 30-39 years (AOR = 0.331; 95% CI: 0.133, 0.825); ever heard of bilharziasis (AOR = 11.911; 95% CI: 3.452, 41.099); and risks of contact with the polluted river (AOR = 0.101; 95% CI: 0.042, 0.242) were more likely to have good knowledge on schistosomiasis prevention and control in the rural Gambia. Conversely, young people (≤30 years), compared with residents aged ≥40 years (AOR = 2.503; 95% CI = 1.539, 4.071); residents aged 30-39 years (AOR = 2.880; 95% CI = 1.559, 5.320); and male residents (AOR = 2.631; 95% CI = 1.703, 4.067) were more likely to have good practice towards schistosomiasis prevention and control in the rural Gambia.

Conclusion

Despite the low knowledge, rural dwellers' attitudes were found to be positive with slightly good practice towards schistosomiasis prevention and control measures. Thus, while maintaining health system improvement strategies, disease control efforts should focus on these factors as they may influence the knowledge and practices of rural dwellers in a given setting. The findings could prompt appropriate policy responses towards improving the knowledge and practices on schistosomiasis prevention and control in the Gambia.

Prevalence of Schistosoma mansoni Infection and Associated Risk Factors among School Children in Jiga Town, Northwest-Ethiopia: A Cross-Sectional Study

BACKGROUND

Schistosomiasis, one of the 20 Neglected Tropical Diseases, is a human disease which is caused by infection with Schistosoma spp. In Ethiopia, the intestinal form of schistosomiasis (caused by Schistosoma mansoni) is widely distributed. This study is aimed at assessing the prevalence of S. mansoni and associated risk factors among schoolchildren in Jiga town and its surrounding rural "Kebeles", Northwest Ethiopia (Kebele = the smallest administrative unit in Ethiopia).

METHODS

A cross-sectional study was carried out among children from three schools in Jiga town and its surrounding rural "Kebeles". The schools were selected mainly according to their proximity to water bodies that were likely to have been used by the children. A total of 362 randomly selected children were screened for S. mansoni infection. Samples of stool were collected from each pupil and examined by the concentration and microscopic techniques. Semistructured interview questionnaires were administered to the study subjects to identify the possible risk factors of infection with S. mansoni. Data analysis was performed using SPSS version 20 software.

RESULTS

The overall prevalence of S. mansoni was 15.2%. A higher proportion of S. mansoni infection (30.3%) was observed at Chifarit primary school children followed by Tikur Wuha primary school children (17.3%) and Jiga 01 primary school children (10.2%). The habit of contact with river water (AOR, 4.86; 95% CI, 0.991-23.8; P = 0.051) and the irregular wearing of shoes (AOR, 6.06; 95% CI, 2.61-14.13; P = 0.001) were risk factors for S. mansoni infection.

CONCLUSION

S. mansoni infection remains a public health problem in the study area. Snail control, mass deworming, and health promotion are recommended.

Identification of transmission foci of Schistosoma mansoni: narrowing the intervention target from district to transmission focus in Ethiopia

BACKGROUND

Schistosoma mansoni (S. mansoni) infection is a significant public health problem in Ethiopia, and has wide distribution in the country. The impact of the disease is particularly high on school-age children. Nationwide 385 endemic districts were identified, whereby control and elimination interventions are underway using school-based annual mass drug administration (MDA) with praziquantel. The national elimination program targets endemic districts as a whole. The aim of this study was to identify the transmission foci of Schistosoma mansoni and determine prevalence of soil-transmitted helminths (STHs) in Abeshge district.

METHODS

The study was conducted from April to May, 2019 among school-age children randomly selected from public elementary schools in Abeshge district, South-central Ethiopia. Demographic information and data on risk factors of S. mansoni infection were gathered using pre-tested questionnaire. Moreover, a stool sample was collected from each child and examined using Kato-Katz thick smear technique. The data were analyzed using STATA_MP version 12.

RESULTS

A total of 389 school-age children from five public elementary schools were included in the study. The overall prevalence of S. mansoni and STHs was 19.3% (75/389) and 35% (136/389), respectively. The prevalence of S. mansoni was 60.6% in Kulit Elementary school, while it was zero in Geraba. The prevalence of S. mansoni was significantly higher among males (AOR = 2.6, 95% CI 1.3-5.1), those with habit of swimming and/or bathing in rivers (AOR = 2.9, 95%CI 1.3-5.1) and involved in irrigation activities (AOR = 2.9, 95% CI 1.0-8.3). Overall, the prevalence of S. mansoni was significantly higher among school children attending Kulit Elementary School compared to those attending the remaining schools (AOR = 12.5, 95%CI 6.2-25.1).

CONCLUSION

A wide variation of S. mansoni prevalence was observed among the school children in the different schools. Control interventions better identify and target foci of S. mansoni transmission, instead of targeting the district homogenously.

Environmental Predictors of Schistosomiasis Persistent Hotspots following Mass Treatment with Praziquantel

Schistosomiasis control programs rely heavily on mass drug administration (MDA) campaigns with praziquantel for preventative chemotherapy. Areas where the prevalence and/or intensity of schistosomiasis infection remains high even after several rounds of treatment, termed "persistent hotspots" (PHSs), have been identified in trials of MDA effectiveness conducted by the Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) in Kenya, Mozambique, Tanzania, and Côte d'Ivoire. In this analysis, we apply a previously developed set of criteria to classify the PHS status of 531 study villages from five SCORE trials. We then fit logistic regression models to data from SCORE and publically available georeferenced datasets to evaluate the influence of local environmental and population features, pre-intervention infection burden, and treatment scheduling on PHS status in each trial. The frequency of PHS in individual trials ranged from 35.3% to 71.6% in study villages. Significant relationships between PHS status and MDA frequency, distance to freshwater, rainfall, baseline schistosomiasis burden, elevation, land cover type, and village remoteness were each observed in at least one trial, although the strength and direction of these relationships was not always consistent among study sites. These findings suggest that PHSs are driven in part by environmental conditions that modify the risk and frequency of reinfection.

Environmental determinants of distribution of freshwater snails and trematode infection in the Omo Gibe River Basin, southwest Ethiopia

BACKGROUND

Determination of infection rates of snail populations is one of the basic tools for epidemiological studies of snail borne diseases. In this study, we opted to determine the trematode infection of freshwater snails in the Omo-Gibe River Basin, southwest Ethiopia.

METHODS

We collected snail samples from 130 observation sites in lakes, wetlands, rivers, reservoirs and irrigation canals surveyed during the dry season (March to May) in 2016. The snail samples were examined for trematode infections by cercarial shedding immediately after collection. Habitat conditions, water quality, human water contact practices and other human activities were assessed at each survey site. A redundancy analysis (RDA) was used to examine the relationship between cercarial infection and environmental variables. The statistical significance of eigenvalues and cercariae-environment correlations generated by the RDA were tested using Monte Carlo permutations at 499 permutations.

RESULTS

A total of 3107 snails belonging to five species were collected. The most abundant species was Biomphalaria pfeifferi, representing 66% of the total collection. Overall, 109 (3.6%) of the snails were found infected with trematodes (cercariae). Biomphalaria pfeifferi was found to be the most highly infected, accounting 85% of all infected snails. A total of eight morphologically different types of cercariae were recorded, which included: Echinostoma cercariae, brevifurcate apharyngeate distome cercariae, amphistome cercariae, brevifurcate apharyngeate monostome cercariae, xiphidiocercariae, longifurcate pharyngeate distome cercariae, strigea cercariae and unidentified cercariae. Brevifurcate apharyngeate distome cercariae, and Echinostoma cercariae were the most abundant cercariae, accounting for 36 and 34% of all infection, respectively. The mean concentration of water conductivity and 5 days biological oxygen demand were higher in irrigation canals and lake sampling points. Human activities such as open field defecation, urination, livestock grazing, farming, and swimming were highly correlated with trematode infection.

CONCLUSIONS

The abundance, occurrence and infection rates of snail species were largely influenced by water physicochemical quality, sanitation and water contact behaviour of the inhabitants. Human activities, such as open field defecation and urination, livestock grazing, farming, and swimming were important predictors of the abundance of cercariae. Therefore, awareness creation should be implemented for proper containment of excreta (urine and faeces) and reducing human and animal contacts with surface waters to reduce snail-borne disease transmission.

Schistosomiasis: Life Cycle, Diagnosis, and Control

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Three main schistosomiasis species can infect humans; S. haematobium, S. japonicum, and S. mansoni.

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The parasites life cycle includes two kind of reproduction; asexual reproduction in snails and sexual reproduction in mammals.

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Multiple diagnostic techniques are used.

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Currently praziquantel is the only drug therapy approved for control of schistosomiasis but other promising candidate drugs (e.g. SpAE, and ruthenium compounds) are being tested.

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A number of vaccine candidates exist including SmCB1, SjAChE, and SmCB.

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Genetic manipulations are being investigated.

Background

Human schistosomiasis is a parasitic disease caused by blood-worms that infect multiple organs, including the liver, intestine, bladder, and urethra. This disease may be eliminated with Praziquantel, vaccines, and gene therapy.

Aims

In this review, the author describes the progress in a study of schistosomiasis that focused on the life cycle, diagnosis, and control.

Methodology

The author searched the PubMed Database at NCBI for articles on schistosomiasis published between 2014 and 2018. All articles were open access and in English.

Results

The life cycle of this parasites involve two hosts: snails and mammals. Manifestations of schistosomiasis can be acute or chronic. Clinical manifestations of acute schistosomiasis can include fever and headache. Symptoms of chronic infections can include dysuria and hyperplasia. Infection can occur in several sites including the bile ducts, intestine, and bladder. The different sites of infection and symptoms seen are related to which of the species involved. Five species can infect humans. The three most commons are S. haematobium, S. japonicum, and S. mansoni. Detection tools for people with schistosomiasis can include the Kato-Katz and PCR. Praziquantel is at present the only effective treatment of this disease. In the future, vaccination or gene therapy may be used.

Conclusion

Kato-Katz and PCR are tools for detecting schistosomiasis on humans. Praziquantel, diagnosis, vaccines, and gene therapy are useful methods for eliminating schistosomiasis.