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Colt S, Miller CD, Edielu A, Webb EL, Mawa PA, Wu HW, Nakyesige R, Muheki E, Kabatereine N, Bustinduy AL, Friedman JF. Relationships Between Schistosoma mansoni Infection Intensity and Nutritional Status and Anemia Among Preschool-aged Children in Uganda. Clin Infect Dis 2024; 78:90-93. [PMID: 37585653 PMCID: PMC10810701 DOI: 10.1093/cid/ciad470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/03/2023] [Accepted: 08/09/2023] [Indexed: 08/18/2023] Open
Abstract
In a cross-sectional analysis of 354 Ugandan children (age 12-48 months) infected with Schistosoma mansoni, we assessed relationships between infection intensity and nutritional morbidities. Higher intensity was associated with an increased risk for anemia (RR = 1.05, 95% confidence interval [CI] 1.01-1.10) yet not associated with risk for underweight, stunting, or wasting.
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Affiliation(s)
- Susannah Colt
- Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Cole D Miller
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Andrew Edielu
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Emily L Webb
- Medical Research Council International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Patrice A Mawa
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Immunology, Uganda Virus Research Institute, Entebbe, Uganda
| | - Hannah W Wu
- Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Racheal Nakyesige
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Edridah Muheki
- Vector Control Division, Ministry of Health, Kampala, Uganda
| | | | - Amaya L Bustinduy
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jennifer F Friedman
- Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Burgert-Brucker CR, Zoerhoff KL, Headland M, Shoemaker EA, Stelmach R, Karim MJ, Batcho W, Bougouma C, Bougma R, Benjamin Didier B, Georges N, Marfo B, Lemoine JF, Pangaribuan HU, Wijayanti E, Coulibaly YI, Doumbia SS, Rimal P, Salissou AB, Bah Y, Mwingira U, Nshala A, Muheki E, Shott J, Yevstigneyeva V, Ndayishimye E, Baker M, Kraemer J, Brady M. Risk factors associated with failing pre-transmission assessment surveys (pre-TAS) in lymphatic filariasis elimination programs: Results of a multi-country analysis. PLoS Negl Trop Dis 2020; 14:e0008301. [PMID: 32479495 PMCID: PMC7289444 DOI: 10.1371/journal.pntd.0008301] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 06/11/2020] [Accepted: 04/16/2020] [Indexed: 11/20/2022] Open
Abstract
Achieving elimination of lymphatic filariasis (LF) as a public health problem requires a minimum of five effective rounds of mass drug administration (MDA) and demonstrating low prevalence in subsequent assessments. The first assessments recommended by the World Health Organization (WHO) are sentinel and spot-check sites—referred to as pre-transmission assessment surveys (pre-TAS)—in each implementation unit after MDA. If pre-TAS shows that prevalence in each site has been lowered to less than 1% microfilaremia or less than 2% antigenemia, the implementation unit conducts a TAS to determine whether MDA can be stopped. Failure to pass pre-TAS means that further rounds of MDA are required. This study aims to understand factors influencing pre-TAS results using existing programmatic data from 554 implementation units, of which 74 (13%) failed, in 13 countries. Secondary data analysis was completed using existing data from Bangladesh, Benin, Burkina Faso, Cameroon, Ghana, Haiti, Indonesia, Mali, Nepal, Niger, Sierra Leone, Tanzania, and Uganda. Additional covariate data were obtained from spatial raster data sets. Bivariate analysis and multilinear regression were performed to establish potential relationships between variables and the pre-TAS result. Higher baseline prevalence and lower elevation were significant in the regression model. Variables statistically significantly associated with failure (p-value ≤0.05) in the bivariate analyses included baseline prevalence at or above 5% or 10%, use of Filariasis Test Strips (FTS), primary vector of Culex, treatment with diethylcarbamazine-albendazole, higher elevation, higher population density, higher enhanced vegetation index (EVI), higher annual rainfall, and 6 or more rounds of MDA. This paper reports for the first time factors associated with pre-TAS results from a multi-country analysis. This information can help countries more effectively forecast program activities, such as the potential need for more rounds of MDA, and prioritize resources to ensure adequate coverage of all persons in areas at highest risk of failing pre-TAS. Achieving elimination of lymphatic filariasis (LF) as a public health problem requires a minimum of five rounds of mass drug administration (MDA) and being able to demonstrate low prevalence in several subsequent assessments. LF elimination programs implement sentinel and spot-check site assessments, called pre-TAS, to determine whether districts are eligible to implement more rigorous population-based surveys to determine whether MDA can be stopped or if further rounds are required. Reasons for failing pre-TAS are not well understood and have not previously been examined with data compiled from multiple countries. For this analysis, we analyzed data from routine USAID and WHO reports from Bangladesh, Benin, Burkina Faso, Cameroon, Ghana, Haiti, Indonesia, Mali, Nepal, Niger, Sierra Leone, Tanzania, and Uganda. In a model that included multiple variables, high baseline prevalence and lower elevation were significant. In models comparing only one variable to the outcome, the following were statistically significantly associated with failure: higher baseline prevalence at or above 5% or 10%, use of the FTS, primary vector of Culex, treatment with diethylcarbamazine-albendazole, lower elevation, higher population density, higher Enhanced Vegetation Index, higher annual rainfall, and six or more rounds of mass drug administration. These results can help national programs plan MDA more effectively, e.g., by focusing resources on areas with higher baseline prevalence and/or lower elevation.
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Affiliation(s)
| | - Kathryn L. Zoerhoff
- Global Health Division, RTI International, Washington, DC, United States of America
| | - Maureen Headland
- Global Health Division, RTI International, Washington, DC, United States of America
- Global Health, Population, and Nutrition, FHI 360, Washington, DC, United States of America
| | - Erica A. Shoemaker
- Global Health Division, RTI International, Washington, DC, United States of America
| | - Rachel Stelmach
- Global Health Division, RTI International, Washington, DC, United States of America
| | | | - Wilfrid Batcho
- National Control Program of Communicable Diseases, Ministry of Health, Cotonou, Benin
| | - Clarisse Bougouma
- Lymphatic Filariasis Elimination Program, Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Roland Bougma
- Lymphatic Filariasis Elimination Program, Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Biholong Benjamin Didier
- National Onchocerciasis and Lymphatic Filariasis Control Program, Ministry of Health, Yaounde, Cameroon
| | - Nko'Ayissi Georges
- National Onchocerciasis and Lymphatic Filariasis Control Program, Ministry of Health, Yaounde, Cameroon
| | - Benjamin Marfo
- Neglected Tropical Diseases Programme, Ghana Health Service, Accra, Ghana
| | | | | | - Eksi Wijayanti
- National Institute Health Research & Development, Ministry of Health, Jakarta, Indonesia
| | - Yaya Ibrahim Coulibaly
- Filariasis Unit, International Center of Excellence in Research, Faculty of Medicine and Odontostomatology, Bamako, Mali
| | - Salif Seriba Doumbia
- Filariasis Unit, International Center of Excellence in Research, Faculty of Medicine and Odontostomatology, Bamako, Mali
| | - Pradip Rimal
- Epidemiology and Disease Control Division, Department of Health Service, Kathmandu, Nepal
| | | | - Yukaba Bah
- National Neglected Tropical Disease Program, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Upendo Mwingira
- Neglected Tropical Disease Control Programme, National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Andreas Nshala
- IMA World Health/Tanzania NTD Control Programme, Uppsala University, & TIBA Fellow, Dar es Salaam, Tanzania
| | - Edridah Muheki
- Programme to Eliminate Lymphatic Filariasis, Ministry of Health, Kampala, Uganda
| | - Joseph Shott
- Division of Neglected Tropical Diseases, Office of Infectious Diseases, Bureau for Global Health, USAID, Washington, DC, United States of America
| | - Violetta Yevstigneyeva
- Division of Neglected Tropical Diseases, Office of Infectious Diseases, Bureau for Global Health, USAID, Washington, DC, United States of America
| | - Egide Ndayishimye
- Global Health, Population, and Nutrition, FHI 360, Washington, DC, United States of America
| | - Margaret Baker
- Global Health Division, RTI International, Washington, DC, United States of America
| | - John Kraemer
- Global Health Division, RTI International, Washington, DC, United States of America
- Georgetown University, Washington, DC, United States of America
| | - Molly Brady
- Global Health Division, RTI International, Washington, DC, United States of America
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Stanton MC, Adriko M, Arinaitwe M, Howell A, Davies J, Allison G, LaCourse EJ, Muheki E, Kabatereine NB, Stothard JR. Intestinal schistosomiasis in Uganda at high altitude (>1400 m): malacological and epidemiological surveys on Mount Elgon and in Fort Portal crater lakes reveal extra preventive chemotherapy needs. Infect Dis Poverty 2017; 6:34. [PMID: 28162096 PMCID: PMC5292801 DOI: 10.1186/s40249-017-0248-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 01/19/2017] [Indexed: 01/24/2023] Open
Abstract
Background Intestinal schistosomiasis is of public health importance in Uganda but communities living above 1400 m are not targeted for control as natural transmission is thought unlikely. To assess altitudinal boundaries and at-risk populations, conjoint malacological and epidemiological surveys were undertaken on Mount Elgon (1139 m–3937 m), in Fort Portal crater lakes and in the Rwenzori Mountains (1123 m–4050 m). Methods Seventy freshwater habitats [Mount Elgon (37), Fort Portal crater lakes (23), Rwenzori Mountains (8) and Lake Albert (2)] were inspected for Biomphalaria species. Water temperature, pH and conductivity were recorded. A parasitological examination of 756 schoolchildren [Mount Elgon (300), Fort Portal crater lakes (456)] by faecal microscopy of duplicate Kato-Katz smears from two consecutive stool samples was bolstered by antigen (urine-CCA dipstick) and antibody (SEA-ELISA) diagnostic assays. Results Biomphalaria spp. was found up to 1951 m on Mount Elgon and 1567 m in the Fort Portal crater lakes. Although no snail from Mount Elgon shed cercariae, molecular analysis judged 7.1% of snails sampled at altitudes above 1400 m as having DNA of Schistosoma mansoni; in Fort Portal crater lakes three snails shed schistosome cercariae. Prevalence of intestinal schistosomiasis as measured in schoolchildren by Kato-Katz (Mount Elgon = 5.3% v. Fort Portal crater lakes = 10.7%), CCA urine-dipsticks (18.3% v. 34.4%) and SEA-ELISA (42.3% v. 63.7%) showed negative associations with increasing altitude with some evidence of infection up to 2000 m. Conclusions Contrary to expectations, these surveys clearly show that natural transmission of intestinal schistosomiasis occurs above 1400 m, possibly extending up to 2000 m. Using spatial epidemiological predictions, this now places some extra six million people at-risk, denoting an expansion of preventive chemotherapy needs in Uganda. Electronic supplementary material The online version of this article (doi:10.1186/s40249-017-0248-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michelle C Stanton
- Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Moses Adriko
- Vector Control Division, Ministry of Health, Kampala, P.O. Box 1661, Uganda
| | - Moses Arinaitwe
- Vector Control Division, Ministry of Health, Kampala, P.O. Box 1661, Uganda
| | - Alison Howell
- Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Juliet Davies
- Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Gillian Allison
- Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - E James LaCourse
- Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Edridah Muheki
- Vector Control Division, Ministry of Health, Kampala, P.O. Box 1661, Uganda
| | - Narcis B Kabatereine
- Vector Control Division, Ministry of Health, Kampala, P.O. Box 1661, Uganda.,Schistosomiasis Control Initiative, Imperial College London, London, W2 1PG, UK
| | - J Russell Stothard
- Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
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