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Singer BJ, Coulibaly JT, Park HJ, Andrews JR, Bogoch II, Lo NC. Development of prediction models to identify hotspots of schistosomiasis in endemic regions to guide mass drug administration. Proc Natl Acad Sci U S A 2024; 121:e2315463120. [PMID: 38181058 PMCID: PMC10786280 DOI: 10.1073/pnas.2315463120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/13/2023] [Indexed: 01/07/2024] Open
Abstract
Schistosomiasis is a neglected tropical disease affecting over 150 million people. Hotspots of Schistosoma transmission-communities where infection prevalence does not decline adequately with mass drug administration-present a key challenge in eliminating schistosomiasis. Current approaches to identify hotspots require evaluation 2-5 y after a baseline survey and subsequent mass drug administration. Here, we develop statistical models to predict hotspots at baseline prior to treatment comparing three common hotspot definitions, using epidemiologic, survey-based, and remote sensing data. In a reanalysis of randomized trials in 589 communities in five endemic countries, a regression model predicts whether Schistosoma mansoni infection prevalence will exceed the WHO threshold of 10% in year 5 ("prevalence hotspot") with 86% sensitivity, 74% specificity, and 93% negative predictive value (NPV; assuming 30% hotspot prevalence), and a regression model for Schistosoma haematobium achieves 90% sensitivity, 90% specificity, and 96% NPV. A random forest model predicts whether S. mansoni moderate and heavy infection prevalence will exceed a public health goal of 1% in year 5 ("intensity hotspot") with 92% sensitivity, 79% specificity, and 96% NPV, and a boosted trees model for S. haematobium achieves 77% sensitivity, 95% specificity, and 91% NPV. Baseline prevalence is a top predictor in all models. Prediction is less accurate in countries not represented in training data and for a third hotspot definition based on relative prevalence reduction over time ("persistent hotspot"). These models may be a tool to prioritize high-risk communities for more frequent surveillance or intervention against schistosomiasis, but prediction of hotspots remains a challenge.
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Affiliation(s)
- Benjamin J. Singer
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, CA94304
| | - Jean T. Coulibaly
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
- Swiss Tropical and Public Health Institute, Basel, Allschwil4123Switzerland
- University of Basel, Basel4001, Switzerland
| | - Hailey J. Park
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, CA94304
| | - Jason R. Andrews
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, CA94304
| | - Isaac I. Bogoch
- Department of Medicine, University of Toronto, Toronto, ONM5S 1A8, Canada
| | - Nathan C. Lo
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, CA94304
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Lim RM, Arme TM, Pedersen AB, Webster JP, Lamberton PHL. Defining schistosomiasis hotspots based on literature and shareholder interviews. Trends Parasitol 2023; 39:1032-1049. [PMID: 37806786 DOI: 10.1016/j.pt.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 10/10/2023]
Abstract
The World Health Organization (WHO) recently proposed a new operational definition which designates communities with ≥10% prevalence of Schistosoma spp. infection as a persistent hotspot, when, after at least two rounds of high-coverage annual preventive chemotherapy, there is a lack of appropriate reduction. However, inconsistencies and challenges from both biological and operational perspectives remain, making the prescriptive use of this definition difficult. Here, we present a comprehensive analysis of the use of the term 'hotspot' across schistosomiasis research over time, including both literature searches and opinions from a range of stakeholders, to assess the utility and generalisability of the new WHO definition of a persistent hotspot. Importantly, we propose an updated definition based on our analyses.
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Affiliation(s)
- Rivka M Lim
- Institute of Evolution and Ecology, School of Biological Sciences, Ashworth Laboratories, University of Edinburgh, Edinburgh, UK.
| | - Thomas M Arme
- School of Biodiversity, One Health and Veterinary Medicine, Wellcome Centre for Integrative Parasitology, University of Glasgow, Glasgow, UK
| | - Amy B Pedersen
- Institute of Evolution and Ecology, School of Biological Sciences, Ashworth Laboratories, University of Edinburgh, Edinburgh, UK
| | - Joanne P Webster
- Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, Hatfield, Herts, UK
| | - Poppy H L Lamberton
- School of Biodiversity, One Health and Veterinary Medicine, Wellcome Centre for Integrative Parasitology, University of Glasgow, Glasgow, UK
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3
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Lo NC, Bezerra FSM, Colley DG, Fleming FM, Homeida M, Kabatereine N, Kabole FM, King CH, Mafe MA, Midzi N, Mutapi F, Mwanga JR, Ramzy RMR, Satrija F, Stothard JR, Traoré MS, Webster JP, Utzinger J, Zhou XN, Danso-Appiah A, Eusebi P, Loker ES, Obonyo CO, Quansah R, Liang S, Vaillant M, Murad MH, Hagan P, Garba A. Review of 2022 WHO guidelines on the control and elimination of schistosomiasis. THE LANCET. INFECTIOUS DISEASES 2022; 22:e327-e335. [PMID: 35594896 DOI: 10.1016/s1473-3099(22)00221-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/13/2022] [Accepted: 03/21/2022] [Indexed: 01/13/2023]
Abstract
Schistosomiasis is a helminthiasis infecting approximately 250 million people worldwide. In 2001, the World Health Assembly (WHA) 54.19 resolution defined a new global strategy for control of schistosomiasis through preventive chemotherapy programmes. This resolution culminated in the 2006 WHO guidelines that recommended empirical treatment by mass drug administration with praziquantel, predominately to school-aged children in endemic settings at regular intervals. Since then, school-based and community-based preventive chemotherapy programmes have been scaled-up, reducing schistosomiasis-associated morbidity. Over the past 15 years, new scientific evidence-combined with a more ambitious goal of eliminating schistosomiasis and an increase in the global donated supply of praziquantel-has highlighted the need to update public health guidance worldwide. In February, 2022, WHO published new guidelines with six recommendations to update the global public health strategy against schistosomiasis, including expansion of preventive chemotherapy eligibility from the predominant group of school-aged children to all age groups (2 years and older), lowering the prevalence threshold for annual preventive chemotherapy, and increasing the frequency of treatment. This Review, written by the 2018-2022 Schistosomiasis Guidelines Development Group and its international partners, presents a summary of the new WHO guideline recommendations for schistosomiasis along with their historical context, supporting evidence, implications for public health implementation, and future research needs.
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Affiliation(s)
- Nathan C Lo
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, CA, USA.
| | | | - Daniel G Colley
- Department of Microbiology, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA, USA
| | | | - Mamoun Homeida
- Academy of Medical Sciences and Technology, Khartoum, Sudan
| | - Narcis Kabatereine
- Accelerating Resilient, Innovative, and Sustainable Elimination of NTDs, Vector Control Division, Kampala, Uganda
| | | | - Charles H King
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Nicholas Midzi
- National Institute of Health Research, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Francisca Mutapi
- Institute of Immunology and Infection Research, Tackling Infections to Benefit Africa Partnership, University of Edinburgh, Edinburgh, UK
| | - Joseph R Mwanga
- Department of Epidemiology, Biostatistics and Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Reda M R Ramzy
- National Nutrition Institute, General Organization for Teaching Hospitals and Institutes, Cairo, Egypt
| | - Fadjar Satrija
- School of Veterinary Medicine and Biomedicine, IPB University, Bogor, Indonesia
| | - J Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Joanne P Webster
- Department of Pathobiology and Population Science, Royal Veterinary College, University of London, London, UK
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China; School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Paolo Eusebi
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Eric S Loker
- Department of Biology, University of New Mexico, Albuquerque, NM, USA
| | - Charles O Obonyo
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Song Liang
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA; Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Michel Vaillant
- Competence Centre for Methodology and Statistics, Luxembourg Institute of Health, Strassen, Luxembourg
| | - M Hassan Murad
- Evidence-based Practice Center, Mayo Clinic, Rochester, NY, USA
| | - Paul Hagan
- Faculty of Health Sciences, University of Hull, Hull, UK
| | - Amadou Garba
- Department of Control of Neglected Tropical Diseases, WHO, Geneva, Switzerland
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Gal LB, Bruck M, Tal R, Baum S, Ali JM, Weldegabriel LL, Sabar G, Golan R, Bentwich Z. Sustainable Elimination of Schistosomiasis in Ethiopia-A Five-Year Follow-Up Study. Trop Med Infect Dis 2022; 7:tropicalmed7090218. [PMID: 36136629 PMCID: PMC9501490 DOI: 10.3390/tropicalmed7090218] [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: 07/07/2022] [Revised: 08/21/2022] [Accepted: 08/27/2022] [Indexed: 11/16/2022] Open
Abstract
In 2009, Mekele, the capital of the Tigray Region in Ethiopia, presented a mean prevalence of 44.7% of schistosomiasis (S. mansoni) in school children. Termed a public health problem, NALA, an international public health non-governmental organization, and their partners implemented a novel model of intervention, which aimed to compliment mass drug administration (MDA) campaigns with behavioral change (BC) and improved sanitation to achieve sustained elimination of schistosomiasis. The four-year intervention (2009−2012) covered 38 primary schools. The objective of this study was to examine factors associated with control or resurgence of the disease, and the association between the behavioral change program and disease prevalence, ten years after initiation. Eleven primary schools were selected for this follow-up study. All students provided a stool sample and filled in a knowledge, attitude and practice (KAP) questionnaire. In seven out of eleven schools (63.6%) the prevalence of schistosomiasis was maintained below 2% ten years after the initiation of the intervention. In four schools, prevalence returned to pre-intervention levels, defining them as persistent hot spots (PHS). Students from PHS schools scored lower on KAP questionnaires compared to students from responder schools; 3.9 ± 0.9 vs. 4.2 ± 0.9 (p-value < 0.001) for practice questions and 4.4 ± 1.4 vs. 4.6 ± 1.5 (p-value = 0.03) for attitude questions. The prevalence of schistosomiasis correlated positively with age, (p-value = 0.049), sex (relative risk = 1.7, p-value < 0.001), and location. Semi-urban locations (n = 382) had higher disease prevalence than urban locations (n = 242), (22.7% vs. 5.5%, p-value < 0.001). Students residing in semi-urban areas and close to a river (<500 m) were at higher risk of contracting schistosomiasis than those living in urban areas far from the river (RR = 5.95, p-value < 0.001). Finally, a correlation between prevalence and proximity of schools to rivers was found (semi-urban areas; RR = −0.91, p-value = 0.001 vs. urban areas; RR = −0.51, p-value = 0.001). Soil-transmitted-helminths prevalence in 2009 was 8.1% and declined during the intervention years to 0.5%. Prevalence in 2018 was found to be stable at 0.8%. These results demonstrate the long-term success of NALAs’ comprehensive model of intervention for elimination of schistosomiasis in school children, combining behavioral change and improved sanitation with MDA.
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Affiliation(s)
| | - Michal Bruck
- NALA, Carlebach 29, Tel Aviv-Yafo 6713224, Israel
| | - Robyn Tal
- NALA, Carlebach 29, Tel Aviv-Yafo 6713224, Israel
| | - Sarit Baum
- NALA, Carlebach 29, Tel Aviv-Yafo 6713224, Israel
| | - Jemal Mahdi Ali
- Department of Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | | | - Galia Sabar
- The Department of Middle Eastern and African History, Tel Aviv University, Tel Aviv-Yafo P.O. Box 39040, Israel
| | - Rachel Golan
- NALA, Carlebach 29, Tel Aviv-Yafo 6713224, Israel
- Department of Epidemiology, Biostatistics and Community Health Sciences, Ben-Gurion University of the Negev, Beer Sheva P.O. Box 653, Israel
| | - Zvi Bentwich
- NALA, Carlebach 29, Tel Aviv-Yafo 6713224, Israel
- Shraga Segal Department of Microbiology, Immunology and Genetics, Ben-Gurion University of the Negev, Beer Sheva P.O. Box 653, Israel
- Correspondence: ; Tel.: +972-522440060
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5
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Ochola EA, Karanja DMS, Elliott SJ. Local tips, global impact: community-driven measures as avenues of promoting inclusion in the control of neglected tropical diseases: a case study in Kenya. Infect Dis Poverty 2022; 11:88. [PMID: 35932055 PMCID: PMC9356398 DOI: 10.1186/s40249-022-01011-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neglected tropical diseases (NTDs) affect poor populations with little or no 'political voice' to influence control activities. While most NTDs have interventions that work, the biggest challenge remains in delivering targeted interventions to affected populations residing in areas experiencing weak health systems. Despite the upward development trends in most countries of sub-Saharan Africa (SSA), the healthcare worker to population ratio remains exceptionally low, with some areas not served at all; thus, there is a need to involve other personnel for school and community-based healthcare approaches. Nonetheless, the current community-based programs suffer from inconsistent community participation due to a lack of coordinated response, and an expanded intervention agenda that lacks context-specific solutions applicable to rural, urban, and marginalized areas. METHODS This research investigated the capacity of local communities to address the burden of NTDs. Informed by the social theory of human capability, the research collected primary qualitative data by conducting key informant interviews and focus group discussions of people infected or affected by NTDs. The interview data were collected and transcribed verbatim for thematic analysis using Nvivo version 12. RESULTS Our findings reveal, first, a need for intersectoral collaboration between governments and affected populations for inclusive and sustainable NTD solutions. Second, a 'bottom-up' approach that enhances capacity building, sensitization, and behaviour change for improved uptake of NTD interventions. Third, the enforcement of Public Health Legislative Acts that mandates the reporting and treatment of NTDs such as leprosy. Fourth, the establishment of support groups and counseling services to assist persons suffering from debilitating and permanent effects of NTDs. CONCLUSIONS Our research demonstrates the importance of human agency in encouraging new forms of participation leading to the co-production of inclusive and sustainable solutions against NTDs.
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Affiliation(s)
- Elizabeth A Ochola
- Department of Geography and Environmental Management, University of Waterloo, Waterloo, ON, Canada
| | | | - Susan J Elliott
- Department of Geography and Environmental Management, University of Waterloo, Waterloo, ON, Canada.
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Pennance T, Ame SM, Amour AK, Suleiman KR, Muhsin MA, Kabole F, Ali SM, Archer J, Allan F, Emery A, Rabone M, Knopp S, Rollinson D, Cable J, Webster BL. Transmission and diversity of Schistosoma haematobium and S. bovis and their freshwater intermediate snail hosts Bulinus globosus and B. nasutus in the Zanzibar Archipelago, United Republic of Tanzania. PLoS Negl Trop Dis 2022; 16:e0010585. [PMID: 35788199 PMCID: PMC9286283 DOI: 10.1371/journal.pntd.0010585] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 07/15/2022] [Accepted: 06/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background The Zanzibar Archipelago (Pemba and Unguja islands) is targeted for the elimination of human urogenital schistosomiasis caused by infection with Schistosoma haematobium where the intermediate snail host is Bulinus globosus. Following multiple studies, it has remained unclear if B. nasutus (a snail species that occupies geographically distinct regions on the Archipelago) is involved in S. haematobium transmission on Zanzibar. Additionally, S. haematobium was thought to be the only Schistosoma species present on the Zanzibar Archipelago until the sympatric transmission of S. bovis, a parasite of ruminants, was recently identified. Here we re-assess the epidemiology of schistosomiasis on Pemba and Unguja together with the role and genetic diversity of the Bulinus spp. involved in transmission. Methodology/Principal findings Malacological and parasitological surveys were conducted between 2016 and 2019. In total, 11,116 Bulinus spp. snails were collected from 65 of 112 freshwater bodies surveyed. Bulinus species identification were determined using mitochondrial cox1 sequences for a representative subset of collected Bulinus (n = 504) and together with archived museum specimens (n = 6), 433 B. globosus and 77 B. nasutus were identified. Phylogenetic analysis of cox1 haplotypes revealed three distinct populations of B. globosus, two with an overlapping distribution on Pemba and one on Unguja. For B. nasutus, only a single clade with matching haplotypes was observed across the islands and included reference sequences from Kenya. Schistosoma haematobium cercariae (n = 158) were identified from 12 infected B. globosus and one B. nasutus collected between 2016 and 2019 in Pemba, and cercariae originating from 69 Bulinus spp. archived in museum collections. Schistosoma bovis cercariae (n = 21) were identified from seven additional B. globosus collected between 2016 and 2019 in Pemba. By analysing a partial mitochondrial cox1 region and the nuclear ITS (1–5.8S-2) rDNA region of Schistosoma cercariae, we identified 18 S. haematobium and three S. bovis haplotypes representing populations associated with mainland Africa and the Indian Ocean Islands (Zanzibar, Madagascar, Mauritius and Mafia). Conclusions/Significance The individual B. nasutus on Pemba infected with S. haematobium demonstrates that B. nasutus could also play a role in the local transmission of S. haematobium. We provide preliminary evidence that intraspecific variability of S. haematobium on Pemba may increase the transmission potential of S. haematobium locally due to the expanded intermediate host range, and that the presence of S. bovis complicates the environmental surveillance of schistosome infections. Schistosomiasis is a snail-borne neglected tropical disease caused by parasitic blood flukes of the genus Schistosoma. Human urogenital schistosomiasis is targeted for elimination on the Zanzibar Archipelago, United Republic of Tanzania, with multiple interventions being implemented to curtail transmission of the parasite to humans on the islands since 2012. Environmental surveillance for schistosomiasis transmission by collecting intermediate host snails, checking snails for Schistosoma infection, and preserving collected snails and Schistosoma parasites offers the possibility for molecular analyses to investigate the evolutionary/genetic relationships of both snails and parasites. Schistosome transmission on Zanzibar was believed to involve a single schistosome species (Schistosoma haematobium) transmitted via a single intermediate host species (Bulinus globosus). However, our findings demonstrate the locally established presence of S. bovis, responsible for bovine intestinal schistosomiasis, and an extended intermediate host compatibility of S. haematobium with the snail B. nasutus on Pemba. Increased parasite diversity and intermediate host species compatibility may increase the transmission of Schistosoma species on Zanzibar and stretch resources for public health interventions with the need for Schistosoma species specific surveillance.
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Affiliation(s)
- Tom Pennance
- Department of Science, Natural History Museum, London, United Kingdom
- School of Biosciences, Cardiff University, Cardiff, United Kingdom
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
- Department of Basic Medical Sciences, College of Osteopathic Medicine of the Pacific–Northwest, Western University of Health Sciences, Lebanon, Oregon, United States of America
- * E-mail:
| | - Shaali Makame Ame
- Public Health Laboratory-Ivo de Carneri, Pemba, United Republic of Tanzania
| | - Amour Khamis Amour
- Public Health Laboratory-Ivo de Carneri, Pemba, United Republic of Tanzania
| | | | - Mtumweni Ali Muhsin
- Neglected Diseases Program, Ministry of Health Zanzibar, United Republic of Tanzania
| | - Fatma Kabole
- Neglected Diseases Program, Ministry of Health Zanzibar, United Republic of Tanzania
| | - Said Mohammed Ali
- Public Health Laboratory-Ivo de Carneri, Pemba, United Republic of Tanzania
| | - John Archer
- Department of Science, Natural History Museum, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | - Fiona Allan
- Department of Science, Natural History Museum, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
- The Scottish Oceans Institute, Gatty Marine Laboratory, University of St Andrews, East Sands, St Andrews, United Kingdom
| | - Aidan Emery
- Department of Science, Natural History Museum, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | - Muriel Rabone
- Department of Science, Natural History Museum, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | - Stefanie Knopp
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - David Rollinson
- Department of Science, Natural History Museum, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | - Joanne Cable
- School of Biosciences, Cardiff University, Cardiff, United Kingdom
| | - Bonnie L. Webster
- Department of Science, Natural History Museum, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
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Le Clec'h W, Chevalier FD, Mattos ACA, Strickland A, Diaz R, McDew-White M, Rohr CM, Kinung'hi S, Allan F, Webster BL, Webster JP, Emery AM, Rollinson D, Djirmay AG, Al Mashikhi KM, Al Yafae S, Idris MA, Moné H, Mouahid G, LoVerde P, Marchant JS, Anderson TJC. Genetic analysis of praziquantel response in schistosome parasites implicates a transient receptor potential channel. Sci Transl Med 2021; 13:eabj9114. [PMID: 34936381 DOI: 10.1126/scitranslmed.abj9114] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Winka Le Clec'h
- Texas Biomedical Research Institute, San Antonio, TX 78227, USA
| | | | - Ana Carolina A Mattos
- University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | | | - Robbie Diaz
- Texas Biomedical Research Institute, San Antonio, TX 78227, USA
| | | | - Claudia M Rohr
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Safari Kinung'hi
- National Institute for Medical Research, Mwanza, United Republic of Tanzania
| | - Fiona Allan
- London Centre for Neglected Tropical Disease Research (LCNDTR), Imperial College, London, UK.,Wolfson Wellcome Biomedical Laboratories, Natural History Museum, London, UK
| | - Bonnie L Webster
- London Centre for Neglected Tropical Disease Research (LCNDTR), Imperial College, London, UK.,Wolfson Wellcome Biomedical Laboratories, Natural History Museum, London, UK
| | - Joanne P Webster
- London Centre for Neglected Tropical Disease Research (LCNDTR), Imperial College, London, UK.,Centre for Emerging, Endemic and Exotic Diseases (CEEED), Royal Veterinary College, University of London, London, UK
| | - Aidan M Emery
- London Centre for Neglected Tropical Disease Research (LCNDTR), Imperial College, London, UK.,Wolfson Wellcome Biomedical Laboratories, Natural History Museum, London, UK
| | - David Rollinson
- London Centre for Neglected Tropical Disease Research (LCNDTR), Imperial College, London, UK.,Wolfson Wellcome Biomedical Laboratories, Natural History Museum, London, UK
| | - Amadou Garba Djirmay
- Réseau International Schistosomiases Environnemental Aménagement et Lutte (RISEAL), Niamey, Niger.,World Health Organization, Geneva, Switzerland
| | - Khalid M Al Mashikhi
- Directorate General of Health Services, Dhofar Governorate, Salalah, Sultanate of Oman
| | - Salem Al Yafae
- Directorate General of Health Services, Dhofar Governorate, Salalah, Sultanate of Oman
| | | | - Hélène Moné
- Host-Pathogen-Environment Interactions Laboratory, University of Perpignan, Perpignan, France
| | - Gabriel Mouahid
- Host-Pathogen-Environment Interactions Laboratory, University of Perpignan, Perpignan, France
| | - Philip LoVerde
- University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Jonathan S Marchant
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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8
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Francoeur R, Atuhaire A, Arinaitwe M, Adriko M, Ajambo D, Nankasi A, Babayan SA, Lamberton PHL. ABO Blood Groups Do Not Predict Schistosoma mansoni Infection Profiles in Highly Endemic Villages of Uganda. Microorganisms 2021; 9:microorganisms9122448. [PMID: 34946048 PMCID: PMC8705964 DOI: 10.3390/microorganisms9122448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/16/2021] [Accepted: 11/23/2021] [Indexed: 01/21/2023] Open
Abstract
Schistosoma mansoni is a parasite which causes significant public-health issues, with over 240 million people infected globally. In Uganda alone, approximately 11.6 million people are affected. Despite over a decade of mass drug administration in this country, hyper-endemic hotspots persist, and individuals who are repeatedly heavily and rapidly reinfected are observed. Human blood-type antigens are known to play a role in the risk of infection for a variety of diseases, due to cross-reactivity between host antibodies and pathogenic antigens. There have been conflicting results on the effect of blood type on schistosomiasis infection and pathology. Moreover, the effect of blood type as a potential intrinsic host factor on S. mansoni prevalence, intensity, clearance, and reinfection dynamics and on co-infection risk remains unknown. Therefore, the epidemiological link between host blood type and S. mansoni infection dynamics was assessed in three hyper-endemic communities in Uganda. Longitudinal data incorporating repeated pretreatment S. mansoni infection intensities and clearance rates were used to analyse associations between blood groups in school-aged children. Soil-transmitted helminth coinfection status and biometric parameters were incorporated in a generalised linear mixed regression model including age, gender, and body mass index (BMI), which have previously been established as significant factors influencing the prevalence and intensity of schistosomiasis. The analysis revealed no associations between blood type and S. mansoni prevalence, infection intensity, clearance, reinfection, or coinfection. Variations in infection profiles were significantly different between the villages, and egg burden significantly decreased with age. While blood type has proven to be a predictor of several diseases, the data collected in this study indicate that it does not play a significant role in S. mansoni infection burdens in these high-endemicity communities.
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Affiliation(s)
- Rachel Francoeur
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, UK;
- Welcome Centre for Integrative Parasitology, University of Glasgow, Glasgow G12 8QQ, UK
- Faculty of Science and Engineering, Department of Biological Sciences, University of Chester, Chester CH1 4BJ, UK
- Correspondence: (R.F.); (P.H.L.L.)
| | - Alon Atuhaire
- Vector Control Division, Ministry of Health, Kampala P.O. Box 1661, Uganda; (A.A.); (M.A.); (M.A.); (A.N.)
| | - Moses Arinaitwe
- Vector Control Division, Ministry of Health, Kampala P.O. Box 1661, Uganda; (A.A.); (M.A.); (M.A.); (A.N.)
| | - Moses Adriko
- Vector Control Division, Ministry of Health, Kampala P.O. Box 1661, Uganda; (A.A.); (M.A.); (M.A.); (A.N.)
| | - Diana Ajambo
- Vector Control Division, Ministry of Health, Kampala P.O. Box 1661, Uganda; (A.A.); (M.A.); (M.A.); (A.N.)
| | - Andrina Nankasi
- Vector Control Division, Ministry of Health, Kampala P.O. Box 1661, Uganda; (A.A.); (M.A.); (M.A.); (A.N.)
| | - Simon A. Babayan
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, UK;
| | - Poppy H. L. Lamberton
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, UK;
- Welcome Centre for Integrative Parasitology, University of Glasgow, Glasgow G12 8QQ, UK
- Correspondence: (R.F.); (P.H.L.L.)
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9
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Omondi I, Odiere MR, Rawago F, Mwinzi PN, Campbell C, Musuva R. Socioeconomic determinants of Schistosoma mansoni infection using multiple correspondence analysis among rural western Kenyan communities: Evidence from a household-based study. PLoS One 2021; 16:e0253041. [PMID: 34161354 PMCID: PMC8221481 DOI: 10.1371/journal.pone.0253041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/28/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Socioeconomic inequality including wealth distribution is a barrier to implementation of health policies. Wealth distribution can be measured effectively using household data on durable assets. Compared to other methods of analysing Socio-economic Status (SES) using durable assets, Multiple Correspondence Analysis (MCA) can create more reliable wealth quintiles. We therefore evaluated socioeconomic determinants of Schistosoma mansoni using MCA on household data among adult population in western Kenya. The hypothesis of this study was that MCA would be a useful predictor of S. mansoni prevalence and/or intensity. METHODOLOGY Twelve villages, 6 villages that had showed the greatest decrease in S. mansoni prevalence (Responder villages) and 6 villages that showed relatively lower decrease (Hotspot villages) between the year 2011 and 2015 were randomly selected for this study. This was according to a previous Schistosomiasis Consortium for Operational Research and Elimination (SCORE) report from western Kenya. From each village, convenience sampling was used to identify 50 adults from 50 households for inclusion in this study. An interview with a questionnaire based upon MCA indicators was conducted. One stool sample from each of the 600 adults was examined based on four slides for S. mansoni eggs using Kato Katz technique. Mean Eggs per gram(EPG) was calculated by taking the average of the readings from the four slides. A log binomial regression model was used to identify the influence of the various age-groups(<30 years, 30-60 years and >60 years), household size, wealth class, occupation, education status, main water supply, sex and sub-county of residence on S. mansoni infection. EPG was then compared across variables that were significant based on multivariate log binomial model analysis using a mixed model. PRINCIPAL FINDINGS Overall prevalence of S. mansoni was 41.3%. Significantly higher prevalence of S. mansoni were associated with males, those aged below 30 years, those who use unsafe water sources (unprotected wells, lakes and rivers), residents of Rachuonyo North, Hotspot villages and those earning livelihood from fishing. Only sex and household size were significant predictors in the multivariate model. Males were associated with significantly higher prevalence compared to the females (aPR = 1.37; 95% CI = 1.14-1.66). In addition, households with at least four persons had higher prevalence compared to those with less than four (aPR = 1.29; 95% CI = 1.03-1.61). However, there was no difference in prevalence between the wealth classes(broadly divided into poor and less poor categories). Intensity of infection (Mean EPG)was also significantly higher among males, younger age group, Rachuonyo North residents and Hotspot Villages. CONCLUSION Socioeconomic status based on an MCA model was not a contributing factor to S. mansoni prevalence and/or intensity possibly because the study populations were not sufficiently dissimilar. The use of convenience sampling to identify participants could also have contributed to the lack of significant findings.
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Affiliation(s)
- Isaiah Omondi
- Neglected Tropical Diseases Branch, Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Maurice R. Odiere
- Neglected Tropical Diseases Branch, Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Fredrick Rawago
- Neglected Tropical Diseases Branch, Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Pauline N. Mwinzi
- Neglected Tropical Diseases Branch, Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Carl Campbell
- Center for Tropical and Emerging Global Diseases and Department of Microbiology, University of Georgia, Athens, Georgia, United States of America
| | - Rosemary Musuva
- Neglected Tropical Diseases Branch, Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
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10
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Spencer SA, Linder C, Penney JMS, Russell HJ, Hyde K, Sheehy C, Reid A, Andriamasy EH, Raderalazasoa GU, Rakotomampianina DAL, Nandimbiniaina AM, Ranaivoson TN, Andrianiaina A, Cruickshank SM, Bustinduy AL, Stothard JR, Edosoa GT, Rahetilahy AM. Five-Year Follow-Up on the Prevalence and Intensity of Infections of Schistosoma mansoni in a Hard-to-Reach District of Madagascar. Am J Trop Med Hyg 2021; 104:1841-1850. [PMID: 33684064 PMCID: PMC8103437 DOI: 10.4269/ajtmh.20-1433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/10/2021] [Indexed: 01/15/2023] Open
Abstract
Schistosomiasis is a major public health problem in Madagascar. The WHO recommends preventive chemotherapy by mass drug administration (MDA) with praziquantel as the primary approach to control Schistosoma mansoni-related morbidity in endemic populations, alongside complementary interventions such as health education. The impact of annual MDA and health education programs was assessed in the hard-to-reach Marolambo district of eastern Madagascar, an area endemic for S. mansoni. Repeated cross-sectional studies undertaken 2015-2019 examined between 300 and 381 school-aged children (aged 5-14 years) annually. The prevalence and infection intensity of S. mansoni were assessed by urine-circulating cathodic antigen (CCA) dipsticks and coproscopy using Kato-Katz (KK) methodologies. After four rounds of annual MDA, a reduction in S. mansoni prevalence was seen in CCA (93.9% in year 1-87.7% in year 5; P = 0.007) and KK (73.9% in year 1-59.4% in year 5; P < 0.0001). The prevalence of heavy-intensity infections roughly halved from 23.7% to 10.1% (P < 0.0001), and the mean intensity of infection fell by 55.0% (480.2-216.3 eggs per gram of feces). A malacological survey found Biomphalaria pfeifferi snail intermediate hosts in multiple water contact sites including rice paddies, streams, and Nosivolo River. Despite reductions in infection prevalence and intensity, schistosomiasis still poses a significant public health challenge in Marolambo district. Twice yearly MDA cycles and/or community-wide MDA are suggested to better reduce infections. Expanding health education, improving standards of water, sanitation and hygiene, and attention on snail-related control will also be important, especially in rice paddy irrigated areas.
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Affiliation(s)
- Stephen A. Spencer
- Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom;,The University of Manchester Faculty of Biology Medicine and Health, Manchester Academic Health Centre, Manchester, United Kingdom;,Address correspondence to Stephen A. Spencer, Post-Graduate Medical Centre, Royal United Hospital, Combe Park, Bath BA1 3NG, United Kingdom. E-mail:
| | - Cortland Linder
- The University of Manchester Faculty of Biology Medicine and Health, Manchester Academic Health Centre, Manchester, United Kingdom
| | - James M. StJ. Penney
- The University of Manchester Faculty of Biology Medicine and Health, Manchester Academic Health Centre, Manchester, United Kingdom
| | - Hannah J. Russell
- The University of Manchester Faculty of Biology Medicine and Health, Manchester Academic Health Centre, Manchester, United Kingdom
| | - Kate Hyde
- The University of Manchester Faculty of Biology Medicine and Health, Manchester Academic Health Centre, Manchester, United Kingdom
| | - Caitlin Sheehy
- The University of Manchester Faculty of Biology Medicine and Health, Manchester Academic Health Centre, Manchester, United Kingdom
| | - Alice Reid
- Unité d’Epidémiologie et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Emmanuel H. Andriamasy
- Faculté de Médecine, Université d’Antananarivo, Antananarivo, Madagascar;,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Gina U. Raderalazasoa
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Anjara M. Nandimbiniaina
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tahiry N. Ranaivoson
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Antsa Andrianiaina
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sheena M. Cruickshank
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Amaya L. Bustinduy
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - J. Russell Stothard
- Unité d’Epidémiologie et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Glenn T. Edosoa
- World Health Organization, Madagascar Country Office, Antananarivo, Madagascar;,Ministère de la Santé Publique de Madagascar, Antananarivo, Madagascar
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11
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Mwanga JR, Kinung'hi SM, Mosha J, Angelo T, Maganga J, Campbell CH. Village Response to Mass Drug Administration for Schistosomiasis in Mwanza Region, Northwestern Tanzania: Are We Missing Socioeconomic, Cultural, and Political Dimensions? Am J Trop Med Hyg 2021; 103:1969-1977. [PMID: 32901610 PMCID: PMC7646777 DOI: 10.4269/ajtmh.19-0843] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Praziquantel (PZQ)-based mass drug administration (MDA) is the main approach for controlling schistosomiasis in endemic areas. Interventions such as provision and use of clean and safe water, minimizing contacts with infested water, disposal of human waste in latrines, and snail control provide additional key interventions to break the transmission cycle and could complement and perhaps sustain the benefits of MDA. However, all interventions deployed need to be accepted by the targeted communities. A qualitative study was conducted to examine factors that might differentiate villages which did not show a substantial decrease in Schistosoma mansoni prevalence despite repeated, high treatment coverage referred to as “persistent hotspot (PHS) villages” from villages which showed a substantial decrease in prevalence referred to as “responding (RES) villages.” A convenient sample of adults was drawn from eight villages. Thirty-nine key informants were interviewed and 16 focus groups were held with a total of 123 participants. Data were analyzed manually using a thematic content approach. In both PHS and RES villages, schistosomiasis was not considered to be a priority health problem because of its chronic nature, lack of knowledge and awareness, and poverty among study communities. Persistent hotspot villages exhibited poor leadership style, lack of or insufficient social engagement, little or lack of genuine community participation, little motivation, and commitment to schistosomiasis control compared with RES villages where there were commitment and motivation to fight schistosomiasis. We support the view of scholars who advocate for the adoption of a biosocial approach for effective and sustainable PZQ-based MDA for schistosomiasis control.
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Affiliation(s)
- Joseph R Mwanga
- Department of Epidemiology, Biostatistics and Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Safari M Kinung'hi
- National Institute of Medical Research (NIMR), Mwanza Center, Mwanza, Tanzania
| | - Justina Mosha
- National Institute of Medical Research (NIMR), Mwanza Center, Mwanza, Tanzania
| | - Teckla Angelo
- National Institute of Medical Research (NIMR), Mwanza Center, Mwanza, Tanzania
| | - Jane Maganga
- National Institute of Medical Research (NIMR), Mwanza Center, Mwanza, Tanzania
| | - Carl H Campbell
- Schistosomiasis Consortium for Operational Research and Evaluation (SCORE), Center for Tropical and Emerging Global Diseases (CTEGD), University of Georgia, Athens, Georgia
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12
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King CH, Kittur N, Binder S, Campbell CH, N'Goran EK, Meite A, Utzinger J, Olsen A, Magnussen P, Kinung'hi S, Fenwick A, Phillips AE, Gazzinelli-Guimaraes PH, Dhanani N, Ferro J, Karanja DMS, Mwinzi PNM, Montgomery SP, Wiegand RE, Secor WE, Hamidou AA, Garba A, Colley DG. Impact of Different Mass Drug Administration Strategies for Gaining and Sustaining Control of Schistosoma mansoni and Schistosoma haematobium Infection in Africa. Am J Trop Med Hyg 2020; 103:14-23. [PMID: 32400356 PMCID: PMC7351298 DOI: 10.4269/ajtmh.19-0829] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
This report summarizes the design and outcomes of randomized controlled operational research trials performed by the Bill & Melinda Gates Foundation–funded Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) from 2009 to 2019. Their goal was to define the effectiveness and test the limitations of current WHO-recommended schistosomiasis control protocols by performing large-scale pragmatic trials to compare the impact of different schedules and coverage regimens of praziquantel mass drug administration (MDA). Although there were limitations to study designs and performance, analysis of their primary outcomes confirmed that all tested regimens of praziquantel MDA significantly reduced local Schistosoma infection prevalence and intensity among school-age children. Secondary analysis suggested that outcomes in locations receiving four annual rounds of MDA were better than those in communities that had treatment holiday years, in which no praziquantel MDA was given. Statistical significance of differences was obscured by a wider-than-expected variation in community-level responses to MDA, defining a persistent hot spot obstacle to MDA success. No MDA schedule led to elimination of infection, even in those communities that started at low prevalence of infection, and it is likely that programs aiming for elimination of transmission will need to add supplemental interventions (e.g., snail control, improvement in water, sanitation and hygiene, and behavior change interventions) to achieve that next stage of control. Recommendations for future implementation research, including exploration of the value of earlier program impact assessment combined with intensification of intervention in hot spot locations, are discussed.
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Affiliation(s)
- Charles H King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio.,Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Nupur Kittur
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Sue Binder
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Carl H Campbell
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Eliézer K N'Goran
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire.,Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | - Aboulaye Meite
- Programme National de Lutte Contre les Maladies Tropicales Négligées à Chimiothérapie Préventive (PNLMTN-CP), Abidjan, Côte d'Ivoire
| | - Jürg Utzinger
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Annette Olsen
- Section for Parasitology and Aquatic Pathobiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pascal Magnussen
- Centre for Medical Parasitology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Alan Fenwick
- Schistosomiasis Control Initiative, Imperial College, London, United Kingdom
| | - Anna E Phillips
- Schistosomiasis Control Initiative, Imperial College, London, United Kingdom
| | | | - Neerav Dhanani
- Schistosomiasis Control Initiative, Imperial College, London, United Kingdom
| | - Josefo Ferro
- Catholic University of Mozambique, Beira, Mozambique
| | - Diana M S Karanja
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Pauline N M Mwinzi
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Ryan E Wiegand
- Centers for Disease Control and Prevention, Atlanta, Georgia.,University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | - Amina A Hamidou
- Réseau International Schistosomoses, Environnement, Aménagement et Lutte (RISEAL-Niger), Niamey, Niger
| | - Amadou Garba
- Department of Control of Neglected Tropical Diseases, Preventive Chemotherapy and Transmission Control Unit, World Health Organization, Geneva, Switzerland
| | - Daniel G Colley
- Department of Microbiology, University of Georgia, Athens, Georgia.,Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
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13
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King CH, Yoon N, Wang X, Lo NC, Alsallaq R, Ndeffo-Mbah M, Li E, Gurarie D. Application of Schistosomiasis Consortium for Operational Research and Evaluation Study Findings to Refine Predictive Modeling of Schistosoma mansoni and Schistosoma haematobium Control in Sub-Saharan Africa. Am J Trop Med Hyg 2020; 103:97-104. [PMID: 32400357 PMCID: PMC7351296 DOI: 10.4269/ajtmh.19-0852] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
An essential mission of the Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) was to help inform global health practices related to the control and elimination of schistosomiasis. To provide more accurate, evidence-based projections of the most likely impact of different control interventions, whether implemented alone or in combination, SCORE supported mathematical modeling teams to provide simulations of community-level Schistosoma infection outcomes in the setting of real or hypothetical programs implementing multiyear mass drug administration (MDA) for parasite control. These models were calibrated using SCORE experience with Schistosoma mansoni and Schistosoma haematobium gaining and sustaining control studies, and with data from comparable programs that used community-based or school-based praziquantel MDA in other parts of sub-Saharan Africa. From 2010 to 2019, models were developed and refined, first to project the likely SCORE control outcomes, and later to more accurately reflect impact of MDA across different transmission settings, including the role of snail ecology and the impact of seasonal rainfall on snail abundance. Starting in 2014, SCORE modeling projections were also compared with the models of colleagues in the Neglected Tropical Diseases Modelling Consortium. To explore further possible improvement to program-based control, later simulations examined the cost-effectiveness of combining MDA with environmental snail control, and the utility of early impact assessment to more quickly identify persistent hot spots of transmission. This article provides a nontechnical summary of the 11 SCORE-related modeling projects and provides links to the original open-access articles describing model development and projections relevant to schistosomiasis control policy.
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Affiliation(s)
- Charles H King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio.,Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Nara Yoon
- Department of Mathematics, Applied Mathematics and Statistics, Case Western Reserve University, Cleveland, Ohio
| | - Xiaoxia Wang
- Department of Mathematics, Applied Mathematics and Statistics, Case Western Reserve University, Cleveland, Ohio
| | - Nathan C Lo
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Ramzi Alsallaq
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio
| | | | - Emily Li
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - David Gurarie
- Department of Mathematics, Applied Mathematics and Statistics, Case Western Reserve University, Cleveland, Ohio.,Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio
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14
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Colley DG, Jacobson JA, Binder S. Schistosomiasis Consortium for Operational Research and Evaluation (SCORE): Its Foundations, Development, and Evolution. Am J Trop Med Hyg 2020; 103:5-13. [PMID: 32400343 PMCID: PMC7351300 DOI: 10.4269/ajtmh.19-0785] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) was established in late 2008 to conduct operational research that would inform practices related to the control and elimination of schistosomiasis. This article traces SCORE’s beginnings and underpinnings. These include an emphasis on openness and contributing to the development of a cohesive schistosomiasis control community, building linkages between researchers and national programs, and focusing on answering questions that will help Neglected Tropical Disease program managers to better control and eliminate schistosomiasis. It describes the development and implementation of SCORE’s multiple projects. SCORE began by drawing on advice from a broad range of experts by holding wide-ranging meetings that informed the priorities and protocols for SCORE research. SCORE’s major efforts included large, multicountry field studies comparing multiple strategies for mass drug administration with praziquantel, assessment of approaches to elimination, evaluation of a point-of-care assay for field mapping Schistosoma mansoni, and increasing the sensitivity of a laboratory-based diagnostic. SCORE also supported studies on morbidity due to schistosomiasis, quantification of vector snails and the detection of schistosome infections in snails, and changes in schistosome population genetics under praziquantel drug pressure. SCORE data and specimens are archived and will remain available for future research. Although much remains to be carried out, our hope is that through the already published articles and SCORE results described in this supplement, we will have provided a body of evidence to assist policy makers in the development of judicious guidelines for the control and elimination of schistosomiasis.
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Affiliation(s)
- Daniel G Colley
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia.,Department of Microbiology, University of Georgia, Athens, Georgia
| | | | - Sue Binder
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
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15
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Webster JP, Neves MI, Webster BL, Pennance T, Rabone M, Gouvras AN, Allan F, Walker M, Rollinson D. Parasite Population Genetic Contributions to the Schistosomiasis Consortium for Operational Research and Evaluation within Sub-Saharan Africa. Am J Trop Med Hyg 2020; 103:80-91. [PMID: 32400355 PMCID: PMC7351308 DOI: 10.4269/ajtmh.19-0827] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Analyses of the population genetic structure of schistosomes under the "Schistosomiasis Consortium for Operational Research and Evaluation" (SCORE) contrasting treatment pressure scenarios in Tanzania, Niger, and Zanzibar were performed to provide supplementary critical information with which to evaluate the impact of these large-scale control activities and guide how activities could be adjusted. We predicted that population genetic analyses would reveal information on a range of important parameters including, but not exclusive to, recruitment and transmission of genotypes, occurrence of hybridization events, differences in reproductive mode, and degrees of inbreeding, and hence, the evolutionary potential, and responses of parasite populations under contrasting treatment pressures. Key findings revealed that naturally high levels of gene flow and mixing of the parasite populations between neighboring sites were likely to dilute any effects imposed by the SCORE treatment arms. Furthermore, significant inherent differences in parasite fecundity were observed, independent of current treatment arm, but potentially of major impact in terms of maintaining high levels of ongoing transmission in persistent "biological hotspot" sites. Within Niger, naturally occurring Schistosoma haematobium/Schistosoma bovis viable hybrids were found to be abundant, often occurring in significantly higher proportions than that of single-species S. haematobium infections. By examining parasite population genetic structures across hosts, treatment regimens, and the spatial landscape, our results to date illustrate key transmission processes over and above that which could be achieved through standard parasitological monitoring of prevalence and intensity alone, as well as adding to our understanding of Schistosoma spp. life history strategies in general.
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Affiliation(s)
- Joanne P Webster
- London Centre for Neglected Tropical Disease Research (LCNTDR), Imperial College Faculty of Medicine, London, United Kingdom.,Department of Pathobiology and Population Sciences, Centre for Emerging, Endemic and Exotic Diseases (CEEED), Royal Veterinary College, University of London, Hawkshead Campus, Herts, United Kingdom
| | - Maria Inês Neves
- London Centre for Neglected Tropical Disease Research (LCNTDR), Imperial College Faculty of Medicine, London, United Kingdom.,Department of Pathobiology and Population Sciences, Centre for Emerging, Endemic and Exotic Diseases (CEEED), Royal Veterinary College, University of London, Hawkshead Campus, Herts, United Kingdom
| | - Bonnie L Webster
- Department of Life Sciences, Wolfson Wellcome Biomedical Laboratories, The Natural History Museum, London, United Kingdom.,London Centre for Neglected Tropical Disease Research (LCNTDR), Imperial College Faculty of Medicine, London, United Kingdom
| | - Tom Pennance
- School of Biosciences, Cardiff University, Cardiff, United Kingdom.,Department of Life Sciences, Wolfson Wellcome Biomedical Laboratories, The Natural History Museum, London, United Kingdom.,London Centre for Neglected Tropical Disease Research (LCNTDR), Imperial College Faculty of Medicine, London, United Kingdom
| | - Muriel Rabone
- Department of Life Sciences, Wolfson Wellcome Biomedical Laboratories, The Natural History Museum, London, United Kingdom.,London Centre for Neglected Tropical Disease Research (LCNTDR), Imperial College Faculty of Medicine, London, United Kingdom
| | - Anouk N Gouvras
- Department of Life Sciences, Wolfson Wellcome Biomedical Laboratories, The Natural History Museum, London, United Kingdom.,London Centre for Neglected Tropical Disease Research (LCNTDR), Imperial College Faculty of Medicine, London, United Kingdom
| | - Fiona Allan
- Department of Life Sciences, Wolfson Wellcome Biomedical Laboratories, The Natural History Museum, London, United Kingdom.,London Centre for Neglected Tropical Disease Research (LCNTDR), Imperial College Faculty of Medicine, London, United Kingdom
| | - Martin Walker
- London Centre for Neglected Tropical Disease Research (LCNTDR), Imperial College Faculty of Medicine, London, United Kingdom.,Department of Pathobiology and Population Sciences, Centre for Emerging, Endemic and Exotic Diseases (CEEED), Royal Veterinary College, University of London, Hawkshead Campus, Herts, United Kingdom
| | - David Rollinson
- Department of Life Sciences, Wolfson Wellcome Biomedical Laboratories, The Natural History Museum, London, United Kingdom.,London Centre for Neglected Tropical Disease Research (LCNTDR), Imperial College Faculty of Medicine, London, United Kingdom
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16
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Colley DG, Fleming FM, Matendechero SH, Knopp S, Rollinson D, Utzinger J, Castleman JD, Kittur N, King CH, Campbell CH, Kabole FM, Kinung'hi S, Ramzy RMR, Binder S. Contributions of the Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) to Schistosomiasis Control and Elimination: Key Findings and Messages for Future Goals, Thresholds, and Operational Research. Am J Trop Med Hyg 2020; 103:125-134. [PMID: 32400345 PMCID: PMC7351304 DOI: 10.4269/ajtmh.19-0787] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Herein, we summarize what we consider are major contributions resulting from the Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) program, including its key findings and key messages from those findings. Briefly, SCORE's key findings are as follows: i) biennial mass drug administration (MDA) with praziquantel can control schistosomiasis to moderate levels of prevalence; ii) MDA alone will not achieve elimination; iii) to attain and sustain control throughout endemic areas, persistent hotspots need to be identified following a minimal number of years of annual MDA and controlled through adaptive strategies; iv) annual MDA is more effective than biennial MDA in high-prevalence areas; v) the current World Health Organization thresholds for decision-making based on the prevalence of heavy infections should be redefined; and vi) point-of-care circulating cathodic antigen urine assays are useful for Schistosoma mansoni mapping in low-to-moderate prevalence areas. The data and specimens collected and curated through SCORE efforts will continue to be critical resource for future research. Besides providing useful information for program managers and revision of guidelines for schistosomiasis control and elimination, SCORE research and outcomes have identified additional questions that need to be answered as the schistosomiasis community continues to implement effective, evidence-based programs. An overarching contribution of SCORE has been increased cohesiveness within the schistosomiasis field-oriented community, thereby fostering new and productive collaborations. Based on SCORE's findings and experiences, we propose new approaches, thresholds, targets, and goals for control and elimination of schistosomiasis, and recommend research and evaluation activities to achieve these targets and goals.
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Affiliation(s)
- Daniel G Colley
- Department of Microbiology, University of Georgia, Athens, Georgia.,Schistosomiasis Consortium for Operational Research and Evaluation (SCORE), Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Fiona M Fleming
- Department of Infectious Disease Epidemiology, Schistosomiasis Control Initiative, London, United Kingdom
| | - Sultani H Matendechero
- Division of Communicable Disease Prevention and Control, Neglected Tropical Diseases Unit, Ministry of Health, Nairobi, Kenya
| | - Stefanie Knopp
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Life Sciences, Wolfson Wellcome Biomedical Laboratories, Natural History Museum, London, United Kingdom
| | - David Rollinson
- Department of Life Sciences, Wolfson Wellcome Biomedical Laboratories, Natural History Museum, London, United Kingdom
| | - Jürg Utzinger
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Jennifer D Castleman
- Schistosomiasis Consortium for Operational Research and Evaluation (SCORE), Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Nupur Kittur
- Schistosomiasis Consortium for Operational Research and Evaluation (SCORE), Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Charles H King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio.,Schistosomiasis Consortium for Operational Research and Evaluation (SCORE), Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Carl H Campbell
- Schistosomiasis Consortium for Operational Research and Evaluation (SCORE), Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Fatma M Kabole
- Neglected Diseases Programme, Ministry of Health of Zanzibar, Zanzibar, United Republic of Tanzania
| | - Safari Kinung'hi
- National Institute for Medical Research (NIMR), Mwanza Centre, Mwanza, United Republic of Tanzania
| | - Reda M R Ramzy
- National Nutrition Institute, General Organization for Teaching Hospitals and Institutes, Cairo, Egypt
| | - Sue Binder
- Schistosomiasis Consortium for Operational Research and Evaluation (SCORE), Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
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17
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Bergquist NR. Schistosomiasis Consortium for Operational Research and Evaluation: Mission Accomplished. Am J Trop Med Hyg 2020; 103:1-4. [PMID: 32400351 PMCID: PMC7351299 DOI: 10.4269/ajtmh.19-0838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 11/10/2019] [Indexed: 11/30/2022] Open
Abstract
The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE), a program focusing on schistosomiasis control in sub-Saharan Africa between 2008 and 2019, investigated ways to improve coverage and efficacy of ongoing chemotherapy programs and concluded that because of continued transmission, mass distribution of praziquantel cannot eliminate the disease without complementary control activities. Schistosomiasis Consortium for Operational Research and Evaluation's activities comprised large-scale, multicountry field studies comparing various mass drug administration strategies and some specific research avenues, such as assessment of high-sensitivity diagnostics, identification of hotspots, quantification of the role of the snail host, predictive modeling, and changes in schistosome population genetics under drug pressure. The discoveries made and the insights gained regarding cost-effective strategies for delivering preventive chemotherapy should assist policy makers to develop guidelines for the control and ultimate elimination of schistosomiasis.
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18
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Binder S, Campbell CH, Andros TS, Castleman JD, Kittur N, King CH, Colley DG. The Schistosomiasis Consortium for Operational Research and Evaluation 2008-2020: Approaches, Experiences, Lessons, and Recommendations. Am J Trop Med Hyg 2020; 103:114-124. [PMID: 32400350 PMCID: PMC7351309 DOI: 10.4269/ajtmh.19-0786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
For the past 10 years, the Schistosomiasis Consortium for Operational Research and Evaluation (SCORE), funded by the Bill & Melinda Gates Foundation, has been supporting operational research to provide a stronger evidence base for controlling and moving toward elimination of schistosomiasis. The SCORE portfolio was developed and implemented with engagement from many stakeholders and sectors. Particular efforts were made to include endemic country neglected tropical disease program managers. Examples of the challenges we encountered include the need to balance rigor (e.g., conducting large cluster-randomized trials) with ensuring relevance to real-world settings, allowing for local contexts while standardizing key study aspects, adjusting to evolving technologies, and incorporating changing technologies into multiyear studies. The Schistosomiasis Consortium for Operational Research and Evaluation's findings and data and the collected specimens will continue to be useful in the years to come. Our experiences and lessons learned can benefit both program managers and researchers conducting similar work in the future.
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Affiliation(s)
- Sue Binder
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Carl H Campbell
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Tamara S Andros
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Jennifer D Castleman
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Nupur Kittur
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Charles H King
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Daniel G Colley
- Department of Microbiology, University of Georgia, Athens, Georgia.,Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
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19
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King CH, Kittur N, Wiegand RE, Shen Y, Ge Y, Whalen CC, Campbell CH, Hattendorf J, Binder S. Challenges in Protocol Development and Interpretation of the Schistosomiasis Consortium for Operational Research and Evaluation Intervention Studies. Am J Trop Med Hyg 2020; 103:36-41. [PMID: 32400342 PMCID: PMC7351306 DOI: 10.4269/ajtmh.19-0805] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
In 2010, the Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) began the design of randomized controlled trials to compare different strategies for praziquantel mass drug administration, whether for gaining or sustaining control of schistosomiasis or for approaching local elimination of Schistosoma transmission. The goal of this operational research was to expand the evidence base for policy-making for regional and national control of schistosomiasis in sub-Saharan Africa. Over the 10-year period of its research programs, as SCORE operational research projects were implemented, their scope and scale posed important challenges in terms of research performance and the final interpretation of their results. The SCORE projects yielded valuable data on program-level effectiveness and strengths and weaknesses in performance, but in most of the trials, a greater-than-expected variation in community-level responses to assigned schedules of mass drug administration meant that identification of a dominant control strategy was not possible. This article critically reviews the impact of SCORE’s cluster randomized study design on performance and interpretation of large-scale operational research such as ours.
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Affiliation(s)
- Charles H King
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia.,Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio
| | - Nupur Kittur
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Ryan E Wiegand
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ye Shen
- Department of Epidemiology & Biostatistics, University of Georgia, Athens, Georgia
| | - Yang Ge
- Department of Epidemiology & Biostatistics, University of Georgia, Athens, Georgia
| | - Christopher C Whalen
- Department of Epidemiology & Biostatistics, University of Georgia, Athens, Georgia
| | - Carl H Campbell
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
| | - Jan Hattendorf
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Sue Binder
- Schistosomiasis Consortium for Operational Research and Evaluation, Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, Georgia
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