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Tadesse G, Wuletaw Y, Mekete K, Sime H, Yard E, Appleby L, Grimes J, Dejene N, Gardiner I, Kazienga A, Abbeddou S, French M, Levecke B, Drake L. Investigating the effect of a school-based WASH intervention on soil-transmitted helminth and schistosome infections and nutritional status of school children in Ethiopia: a quasi-experimental study. Parasit Vectors 2024; 17:130. [PMID: 38486228 PMCID: PMC10938701 DOI: 10.1186/s13071-024-06155-2] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 01/22/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND The impact of access to improved water, sanitation and hygiene (WASH) and health education on large-scale deworming programs aimed at controlling soil-transmitted helminth (STH) and schistosome (SCH) infections has not been well studied. We assessed the additional impact of improved WASH infrastructure and health education at schools on STH and SCH infections in Ethiopia. METHODS The study used a quasi-experimental design under which 30 schools were assigned to either an intervention (15 schools) or control (15 schools) arm. Both arms received a standard deworming treatment and lunch. In the intervention arm, improved WASH and health education were provided. At three consecutive time points (baseline in 2013, 2014 and 2015), the prevalence and intensity of STH and SCH infections and the nutritional status [hemoglobin concentrations and physical growth (height and weight)] were determined. To verify whether interventions were successfully implemented, the WASH status at school and the student knowledge, attitudes and practices related to WASH (WASH-KAP) were recorded. Differences in metrics between arms at baseline (2013) and follow-up (2015) were assessed both within and between the arms. RESULTS A significant increase in scores for both the school WASH and student KAP was found in the intervention arm, indicating successful implementation of the intervention. The prevalence of any STH infection was significantly reduced in the intervention arm but not in the control arm (F = 4.486, p = 0.034). There was a significantly greater reduction in the intensity of infection of hookworm and Ascaris lumbricoides compared to baseline in both arms. The intervention did not affect school children's height-for-age z-score (intervention arm * time coef = 0.12, p = 0.400) and body mass index-for-age z-scores (intervention * time coef = - 0.06, p = 0.526). Hemoglobin concentrations increased significantly more in the control than the intervention arm (coef = - 0.16, p = 0.006). CONCLUSIONS Although the intervention did increase school WASH and student WASH-KAP, our study found poor evidence of the additional benefit of improved WASH and health education to deworming and school food programs on parasite re-infection and the health outcomes of children.
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Affiliation(s)
- Gemechu Tadesse
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
- Department of Translational Physiology, Infectiology and Public Health, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
| | - Yonas Wuletaw
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Heven Sime
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Elodie Yard
- Partnership for Child Development, London, UK
| | | | - Jack Grimes
- Department of Civil and Environmental Engineering, South Kensington Campus, Imperial College London, London, UK
| | | | | | - Adama Kazienga
- Department of Translational Physiology, Infectiology and Public Health, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Souheila Abbeddou
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Bruno Levecke
- Department of Translational Physiology, Infectiology and Public Health, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Gebreyesus TD, Makonnen E, Tadele T, Mekete K, Gashaw H, Gerba H, Aklillu E. Reduced efficacy of single-dose albendazole against Ascaris lumbricoides, and Trichuris trichiura, and high reinfection rate after cure among school children in southern Ethiopia: a prospective cohort study. Infect Dis Poverty 2024; 13:8. [PMID: 38246985 PMCID: PMC10802031 DOI: 10.1186/s40249-024-01176-6] [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: 10/19/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Mass drug administration (MDA) program of albendazole to at-risk populations as preventive chemotherapy is the core public health intervention to control soil-transmitted helminths (STHs). Achieving this goal relies on drug effectiveness in reducing the parasite reservoirs in the community and preventing reinfection. We assessed the efficacy of albendazole against STH parasite infection and reinfection status after cure. METHODS A total of 984 schoolchildren infected with at least one type of STH parasite (hookworm, Ascaris lumbricoides, Trichuris trichiura) in southern Ethiopia were enrolled and received albendazole and praziquantel in MDA campaign conducted from January to March 2019. Stool exams at week-4 and at week-8 of post-MDA were done using Kato Katz technique. The primary outcome was efficacy assessed by cure rate (CR) and fecal egg reduction rates (ERRs) at four weeks of post-MDA. The secondary outcome was reinfection status defined as parasite egg positivity at eight weeks among those who were cured at 4 weeks of post-MDA. Group comparisons in CR and related factors were assessed with chi-square or Fisher's exact tests. Predictors of CR were examined through univariate and multivariate regression analyses. RESULTS The overall CR and ERR for hookworm infection were 97.2% (95% CI 94.6-99.4) and 97.02%, respectively. The overall CR and ERR for A. lumbricoides were 71.5% (95% CI 68.3-74.6) and 84.5% respectively. The overall CR and ERR and for T. trichiura were 49.5% (95% CI 44.8-54.2) and 68.3%, respectively. The CR among moderate T. trichiura infection intensity was 28.6%. Among children cured of hookworm, A. lumbricoides and T. trichiura at week 4 post-MDA, 4.6%, 18.3% and 52.4% became reinfected at week-8 post-MDA, respectively. Significantly lower CR (36.6%) and higher reinfection after cure (60.6%) among A. lumbricoides and T. trichiura coinfected children than A. lumbricoides only (CR = 69.6%, reinfection rate = 15.1%) or T. trichiura only infected children (CR = 55.6%, reinfection rate = 47.1%) was observed. Pre-treatment coinfection with ≥ two types of STH parasites was significantly associated with re-infection after cure. CONCLUSION Albendazole MDA is efficacious against hookworm but has reduced efficacy against A. lumbricoides and is not effective against T. trichiura. The low drug efficacy and high reinfection rate after cure underscore the need for alternative treatment and integration of other preventive measures to achieve the target of eliminating STHs as a public health problem by 2030.
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Affiliation(s)
- Tigist Dires Gebreyesus
- Department of Global Public Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Ethiopian Food and Drug Authority, Addis Ababa, Ethiopia
| | - Eyasu Makonnen
- Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Departments of Pharmacology and Clinical Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tafesse Tadele
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | | | - Habtamu Gashaw
- Ethiopian Food and Drug Authority, Addis Ababa, Ethiopia
| | - Heran Gerba
- Ethiopian Food and Drug Authority, Addis Ababa, Ethiopia
| | - Eleni Aklillu
- Department of Global Public Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
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Phillips AE, Ower AK, Mekete K, Liyew EF, Maddren R, Mengistu B, Anjulo U, Chernet M, Dunn JC, Mohammed H, Belay H, Gidey B, Tasew G, Tadesse G, Salasibew M, Tollera G, Anderson R. Baseline soil-transmitted helminth and schistosome infection in the Geshiyaro project, Ethiopia: A unique transmission interruption project using biometric fingerprinting for longitudinal individual analysis. PLoS Negl Trop Dis 2023; 17:e0011589. [PMID: 37851666 PMCID: PMC10615263 DOI: 10.1371/journal.pntd.0011589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/30/2023] [Accepted: 09/07/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND The Geshiyaro project aims to assess the feasibility of interrupting transmission of soil-transmitted helminths (STH) and schistosome (SCH) infection in the Wolaita zone of southern Ethiopia through high coverage community-wide mass drug administration (MDA), in combination with improved water, sanitation, and hygiene services and behaviour change communication delivered through the existing health care infrastructure. To accurately measure treatment coverage a population census was conducted enrolling individuals with biometric fingerprinting and barcoded ID cards. This paper details the baseline census and parasitology surveys conducted before the start of any interventions. METHODS The census was conducted in five of the 15 Wolaita districts between October 2018 and December 2019, enrolling all consenting participants from every household. Simultaneously, a cross-sectional parasitology survey was conducted in 130 out of 361 randomly selected communities from all 15 districts, with 100 individuals across all age groups (infant to adult) per community providing stool and urine for analysis by duplicate Kato-Katz and a point-of-care circulating cathodic antigen (POC-CCA) to test for Schistosoma mansoni and STH, and microhaematuria and urine filtration for Schistosoma haematobium. Of the 130 communities, 30 were randomly selected for annual, longitudinal parasitological monitoring, with 150 randomly selected individuals from infant to adult providing two days of stool and urine samples for analysis by the same diagnostic tests per community. RESULTS In total 97,919 households participated in the baseline census enrolling 466,071 individuals, with parasitological data obtained from 10,785 people. At baseline, 15.5% were infected with at least one STH species, with Ascaris lumbricoides (9.5%), followed by hookworm (7.2%) and Trichuris trichiura (1.8%). Substantial heterogeneity in STH prevalence was observed between communities ranging from 0% to 61% where most infections were low intensity. Schistosoma mansoni infection was the dominant schistosome infection (0.85% by Kato-Katz and 13.3% by POC-CCA trace negative and 21.5% trace positive), with few Schistosoma haematobium infections identified (2.77% haematuria positive and 0.13% positive by urine filtration). CONCLUSIONS While the national control program in Ethiopia has made good progress in reducing prevalence of STH and SCH in Wolaita since it was launched in 2015, there remain areas of persistent infection suggesting the existence of environmental or behavioural risk factors that contribute to ongoing transmission. This project aims to identify the most efficient intervention strategies to reduce community burden and reach interruption of transmission.
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Affiliation(s)
- Anna E. Phillips
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, St Mary’s Campus, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | - Alison K. Ower
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, St Mary’s Campus, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | | | | | - Rosie Maddren
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, St Mary’s Campus, London, United Kingdom
| | - Birhan Mengistu
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, St Mary’s Campus, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | - Ufaysa Anjulo
- Children’s Investment Fund Foundation, London, United Kingdom
| | - Melkie Chernet
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Julia C. Dunn
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, St Mary’s Campus, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | | | - Habtamu Belay
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Geremew Tasew
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | | | - Roy Anderson
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, St Mary’s Campus, London, United Kingdom
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
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Gebreyesus TD, Makonnen E, Tadele T, Mekete K, Gashaw H, Gerba H, Aklillu E. Efficacy and safety of praziquantel preventive chemotherapy in Schistosoma mansoni infected school children in Southern Ethiopia: A prospective cohort study. Front Pharmacol 2023; 14:968106. [PMID: 36937860 PMCID: PMC10014719 DOI: 10.3389/fphar.2023.968106] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 02/13/2023] [Indexed: 03/05/2023] Open
Abstract
Background: The World Health Organization recommends efficacy and safety surveillance of anti-helminths used in mass drug administration campaigns. We evaluated the effectiveness of single-dose praziquantel against Schistosoma mansoni infection, and the safety of praziquantel plus albendazole preventive chemotherapy (PC) in Schistosoma mansoni infected school children (n = 512) in Southern Ethiopia. Method: Stool examinations were done using thick smear Kato-Katz at baseline, week-4, and week-8 of post-Mass drug administration (MDA) to assess praziquantel efficacy. Participants were followed for MDA-associated adverse events up to day 7 of post-MDA. The primary and secondary study outcomes were praziquantel efficacy (parasitological cure and egg reduction rates) and MDA-associated adverse events (AEs), respectively. Result: The overall cure rates at week-4 and week-8 were 89.1% (95%CI = 86.1-91.7) and 87.5% (95%CI = 83.6-90.8), respectively. Cure rates among moderate-to-heavily infected children were significantly lower (p = 0.001) compared to those with light infection at week-4 (84.4% vs. 91.1%, p = 0.03) and week-8 (78.6% vs. 91.9%, respectively). Older children had a higher cure rate than younger ones at week-8 (90.1% vs. 79.5%, p = 0.01). Among those who were Schistosoma egg-free (cured) at week 4, 7.8% became egg-positive at week 8. The overall egg reduction rate (ERR) at week-4 and week-8 were 93.5% and 91.3%, respectively, being lower among the 5-9 years old age groups (p = 0.01) at week-8. The proportion of children who remained schistosoma egg-positive throughout the study follow-up period was 4.6%, and their ERR at week-4 and week-8 was 50% and 51%, respectively, which is below the 90% World Health Organization threshold for efficacy. The incidence of experiencing at least one type of MDA-associated AEs were 17.0% (95%CI = 13.8%-20.5%); abdominal pain, headache, and vomiting were the most common. The proportion of mild, moderate, and severe AEs was 63.2%, 26.3%, and 10.5%, respectively. Females experienced more AEs than males (p = 0.03). Conclusion: Single-dose praziquantel is still effective for the treatment of intestinal schistosomiasis. Praziquantel and albendazole preventive chemotherapy is safe and tolerable, and associated AEs are mostly mild-to-moderate and transient. However, the reduced PZQ effectiveness in moderate-to-heavy infection and observed AEs in about one-fifth of infected children underscores the need for better treatment strategies and surveillance for early detection of parasite resistance and management of AEs.
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Affiliation(s)
- Tigist Dires Gebreyesus
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Ethiopian Food and Drug Authority, Addis Ababa, Ethiopia
| | - Eyasu Makonnen
- Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Departments of Pharmacology and Clinical Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tafesse Tadele
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | | | - Habtamu Gashaw
- Ethiopian Food and Drug Authority, Addis Ababa, Ethiopia
| | - Heran Gerba
- Ethiopian Food and Drug Authority, Addis Ababa, Ethiopia
| | - Eleni Aklillu
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- *Correspondence: Eleni Aklillu,
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Phillips AE, Ower AK, Mekete K, Liyew EF, Maddren R, Belay H, Chernet M, Anjulo U, Mengistu B, Salasibew M, Tasew G, Anderson R. Association between water, sanitation, and hygiene access and the prevalence of soil-transmitted helminth and schistosome infections in Wolayita, Ethiopia. Parasit Vectors 2022; 15:410. [DOI: 10.1186/s13071-022-05465-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 09/03/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
The Geshiyaro project is a 5-year intervention to assess the impact of community- and school-based water, sanitation, and hygiene (WaSH) interventions on reducing infection with soil-transmitted helminths (STH) and schistosome parasites in combination with deworming in Wolayita zone, Ethiopia.
Methods
A population-based, cross-sectional census and parasitological mapping activity was conducted between 2018 and 2019. Individuals in the census were identified using either a registered study ID card or biometric fingerprint to enable linkage of their household WaSH data with baseline STH and schistosome prevalence for risk analysis.
Results
Prevalence of STH was 15.5% for any STH species, 9.47% for Ascaris lumbricoides, 1.78% for Trichuris trichiura, and 7.24% for hookworm. Intestinal schistosomiasis (Schistosoma mansoni) infection prevalence was 0.85% by Kato Katz, 21.6% by POC-CCA trace positive (Tr +), and 13.3% trace negative (Tr-). Microhaematuria was 2.77%, with 0.13% of people examined with S. haematobium eggs detected by urine filtration. At the household level, increased (> 30 min) time taken to collect drinking water, sharing a latrine, and lack of handwashing facilities were all associated with a greater risk of A. lumbricoides, hookworm, and S. mansoni infection. Not disposing of infant stool at the household and clothes washing/recreational freshwater contact were significantly associated with higher risk of schistosomiasis infection. Aggregating WaSH data at the community level showed odds of A. lumbricoides, hookworm, and T. trichiura infection were significantly lower as both community sanitation coverage and access to improved drinking water improved.
Conclusions
The principal finding of this study is that lack of access to WaSH, such as improved drinking water and shared toilet and hand-washing facilities, were linked to an increased risk of infection with STH and schistosome parasites. These associations are difficult to establish at an individual household level because of wide variability in access between houses but are detectable when coverage is aggregated at the community level. Maintenance of WaSH facilities as well as increased access within the whole community is important in influencing the community-wide prevalence of infection with STH and schistosome parasites.
Graphical Abstract
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Roose S, Leta GT, Vlaminck J, Getachew B, Mekete K, Peelaers I, Geldhof P, Levecke B. Comparison of coproprevalence and seroprevalence to guide decision-making in national soil-transmitted helminthiasis control programs: Ethiopia as a case study. PLoS Negl Trop Dis 2022; 16:e0010824. [PMID: 36197895 PMCID: PMC9534397 DOI: 10.1371/journal.pntd.0010824] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 05/25/2022] [Accepted: 09/16/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND WHO recommends periodical assessment of the prevalence of any soil-transmitted helminth (STH) infections to adapt the frequency of mass drug administration targeting STHs. Today, detection of eggs in stool smears (Kato-Katz thick smear) remains the diagnostic standard. However, stool examination (coprology) has important operational drawbacks and impedes integrated surveys of multiple neglected tropical diseases. Therefore, the aim of the present study was to assess the potential of applying serology instead of coprology in STH control program decision-making. METHODOLOGY An antibody-ELISA based on extract of Ascaris lung stage larvae (AsLungL3-ELISA) was applied in ongoing monitoring activities of the Ethiopian national control program against schistosomiasis and soil-transmitted helminthiasis. Blood and stool samples were collected from over 6,700 students (median age: 11) from 63 schools in 33 woredas (districts) across the country. Stool samples of two consecutive days were analyzed applying duplicate Kato-Katz thick smear. PRINCIPAL FINDINGS On woreda level, qualitative (seroprevalence) and quantitative (mean optical density ratio) serology results were highly correlated, and hence seroprevalence was chosen as parameter. For 85% of the woredas, prevalence based on serology was higher than those based on coprology. The results suggested cross-reactivity of the AsLungL3-ELISA with Trichuris. When extrapolating the WHO coproprevalence thresholds, there was a moderate agreement (weighted κ = 0.43) in program decision-making. Using the same threshold values would predominantly lead to a higher frequency of drug administration. SIGNIFICANCE This is the first time that serology for soil-transmitted helminthiasis is applied on such large scale, thereby embedded in a control program context. The results underscore that serology holds promise as a tool to monitor STH control programs. Further research should focus on the optimization of the diagnostic assay and the refinement of serology-specific program decision-making thresholds.
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Affiliation(s)
- Sara Roose
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
- * E-mail: (SR); (BL)
| | - Gemechu Tadesse Leta
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Johnny Vlaminck
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - Birhanu Getachew
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Kalkidan Mekete
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Iris Peelaers
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - Peter Geldhof
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - Bruno Levecke
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
- * E-mail: (SR); (BL)
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Mohammed H, Landeryou T, Chernet M, Liyew EF, Wulataw Y, Getachew B, Difabachew H, Phillips A, Maddren R, Ower A, Mekete K, Belay H, Endrias T, Anjulo U, Tasew G, Anderson R, Tollera G, Abate E. Comparing the accuracy of two diagnostic methods for detection of light Schistosoma haematobium infection in an elimination setting in Wolaita Zone, South Western Ethiopia. PLoS One 2022; 17:e0267378. [PMID: 35486627 PMCID: PMC9053789 DOI: 10.1371/journal.pone.0267378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/12/2021] [Accepted: 04/07/2022] [Indexed: 11/18/2022] Open
Abstract
Reagent urinalysis dipstick and filtration have been recommended diagnostic methods for the detection of urogenital schistosomiasis. However, the accurate diagnosis of light infections using these methods presents a major challenge. This study evaluates the diagnosis accuracy of light infection with Schistosoma haematobium in study participants living in Wolaita Zone, an area targeted for sustainable control of Schistosomiasis, and ultimately interrupt transmission. Urine samples were collected from children and adults in surveys carried out during baseline and longitudinal sentinel site surveys conducted from 2018 to 2020. All urine samples were tested using a reagent urinalysis dipstick test (Haemastix) to detect microhaematuria with reference urine filtration technique as a proxy for S. haematobium infection. Sensitivity and specificity were determined in diagnosing urogenital schistosomiasis. Cohen’s Kappa statistics was done for the agreement of these diagnostic methods. A total of 12,102 participants were enrolled in the current baseline study. Among them, 285 (2.35%) samples tested positive for microhaematuria and 21 (0.20%) positive for S. haematobium eggs. A total of 4,357 samples were examined in year 1 and year 2 using urine dipsticks, and urine filtration 172 (3.95%) and 2 (0.05%) were positive for microhaematuria and S. haematobium eggs. The reagent urinalysis dipsticks showed the highest sensitivity and specificity for diagnosing light intensity of infection,100% (95% CI:85.18–100.00) and 97.4% (95% CI: 97.10–97.60), respectively. There is a slight agreement between the two methods (Kappa = 0.09, 95% CI: 0.01–0.18). The present study revealed very low prevalence and light intensity of S. haematobium infections. The study also highlights that the dipstick test is considered a useful adjunct diagnostic tool for population-based control of urogenital schistosomiasis.
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Affiliation(s)
- Hussein Mohammed
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- * E-mail:
| | - Toby Landeryou
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | - Melkie Chernet
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ewnetu Firdawek Liyew
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Yonas Wulataw
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Birhanu Getachew
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Hailemariam Difabachew
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Anna Phillips
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | - Rosie Maddren
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | - Alison Ower
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | - Kalkidan Mekete
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Habtamu Belay
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Tujuba Endrias
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ufaysa Anjulo
- Disease Prevention and Health Promotion Core Process, Ministry of Health, Wolaita, Ethiopia
| | - Geremew Tasew
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Roy Anderson
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | - Getachew Tollera
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ebba Abate
- Bacterial, Parasitic and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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Adane A, Adege TM, Ahmed MM, Anteneh HA, Ayalew ES, Berhanu D, Berhanu N, Getnet M, Bishaw T, Busza J, Cherinet E, Dereje M, Desta TH, Dibabe A, Firew HS, Gebrehiwot F, Gebreyohannes E, Gella Z, Girma A, Halefom Z, Jama SF, Janson A, Kemal B, Kiflom A, Mazengiya YD, Mekete K, Mengesha M, Nega MW, Otoro IA, Schellenberg J, Taddele T, Tefera G, Teketel A, Tesfaye M, Tsegaye T, Woldesenbet K, Wondarad Y, Yusuf ZM, Zealiyas K, Zeweli MH, Persson LÅ, Lemma S. Exploring data quality and use of the routine health information system in Ethiopia: a mixed-methods study. BMJ Open 2021; 11:e050356. [PMID: 34949613 PMCID: PMC8710857 DOI: 10.1136/bmjopen-2021-050356] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE A routine health information system (RHIS) enables decision making in the healthcare system. We aimed to analyse data quality at the district and regional level and explore factors and perceptions affecting the quality and use of routine data. DESIGN This was a mixed-methods study. We used the WHO toolkit for analysing data quality and interviewed staff at the point of data generation and along with the flow of data. Data were analysed using the Performance of Routine Information System Management framework. SETTING This study was performed in eight districts in four regions of Ethiopia. The study was nested within a 2-year programme of the Operational Research and Coaching for government Analysts. PARTICIPANTS We visited 45 health posts, 1 district hospital, 16 health centres and 8 district offices for analysis of routine RHIS data and interviewed 117 staff members for the qualitative assessment. OUTCOME MEASURES We assessed availability of source documents, completeness, timeliness and accuracy of reporting of routine data, and explored data quality and use perceptions. RESULTS There was variable quality of both indicator and data element. Data on maternal health and immunisation were of higher quality than data on child nutrition. Issues ranged from simple organisational factors, such as availability of register books, to intricate technical issues, like complexity of indicators and choice of denominators based on population estimates. Respondents showed knowledge of the reporting procedures, but also demonstrated limited skills, lack of supportive supervision and reporting to please the next level. We saw limited examples of the use of data by the staff who were responsible for data reporting. CONCLUSION We identified important organisational, technical, behavioural and process factors that need further attention to improve the quality and use of RHIS data in Ethiopia.
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Affiliation(s)
- Abyot Adane
- Ethiopian Pharmaceutical Supply Agency, Addis Ababa, Ethiopia
| | | | | | | | | | - Della Berhanu
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Misrak Getnet
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Joanna Busza
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Mamo Dereje
- Ethiopia Ministry of Health, Addis Ababa, Ethiopia
| | | | - Abera Dibabe
- Ethiopia Ministry of Health, Addis Ababa, Ethiopia
| | - Heven S Firew
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | | | - Addis Girma
- Ethiopia Ministry of Health, Addis Ababa, Ethiopia
| | | | - Sorsa F Jama
- Ethiopia Ministry of Health, Addis Ababa, Ethiopia
| | - Annika Janson
- London School of Hygiene & Tropical Medicine, London, UK
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Binyam Kemal
- Ethiopia Ministry of Health, Addis Ababa, Ethiopia
| | - Abiy Kiflom
- Ethiopian Pharmaceutical Supply Agency, Addis Ababa, Ethiopia
| | | | | | | | | | | | | | - Tefera Taddele
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Gulilat Tefera
- Ethiopian Pharmaceutical Supply Agency, Addis Ababa, Ethiopia
| | - Admasu Teketel
- Ethiopian Pharmaceutical Supply Agency, Addis Ababa, Ethiopia
| | | | - Tsion Tsegaye
- Ethiopian Pharmaceutical Supply Agency, Addis Ababa, Ethiopia
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Adane A, Adege TM, Ahmed MM, Anteneh HA, Ayalew ES, Berhanu D, Berhanu N, Beyene MG, Bhattacharya A, Bishaw T, Cherinet E, Dereje M, Desta TH, Dibabe A, Firew HS, Gebrehiwot F, Gebreyohannes E, Gella Z, Girma A, Halefom Z, Jama SF, Kemal B, Kiflom A, Källestål C, Lemma S, Mazengiya YD, Mekete K, Mengesha M, Nega MW, Otoro IA, Schellenberg J, Taddele T, Tefera G, Teketel A, Tesfaye M, Tsegaye T, Woldesenbet K, Wondarad Y, Yosuf ZM, Zealiyas K, Zeweli MH, Persson LÅ, Janson A. Routine health management information system data in Ethiopia: consistency, trends, and challenges. Glob Health Action 2021; 14:1868961. [PMID: 33446081 PMCID: PMC7833046 DOI: 10.1080/16549716.2020.1868961] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/22/2020] [Indexed: 11/02/2022] Open
Abstract
Background: Ethiopia is investing in the routine Health Management Information System. Improved routine data are needed for decision-making in the health sector. Objective: To analyse the quality of the routine Health Management Information System data and triangulate with other sources, such as the Demographic and Health Surveys. Methods: We analysed national Health Management Information System data on 19 indicators of maternal health, neonatal survival, immunization, child nutrition, malaria, and tuberculosis over the 2012-2018 time period. The analyses were conducted by 38 analysts from the Ministry of Health, Ethiopia, and two government agencies who participated in the Operational Research and Coaching for Analysts (ORCA) project between June 2018 and June 2020. Using a World Health Organization Data Quality Review toolkit, we assessed indicator definitions, completeness, internal consistency over time and between related indicators, and external consistency compared with other data sources. Results: Several services reported coverage of above 100%. For many indicators, denominators were based on poor-quality population data estimates. Data on individual vaccinations had relatively good internal consistency. In contrast, there was low external consistency for data on fully vaccinated children, with the routine Health Management Information System showing 89% coverage but the Demographic and Health Survey estimate at 39%. Maternal health indicators displayed increasing coverage over time. Indicators on child nutrition, malaria, and tuberculosis were less consistent. Data on neonatal mortality were incomplete and operationalised as mortality on day 0-6. Our comparisons with survey and population projections indicated that one in eight early neonatal deaths were reported in the routine Health Management Information System. Data quality varied between regions. Conclusions: The quality of routine data gathered in the health system needs further attention. We suggest regular triangulation with data from other sources. We recommend addressing the denominator issues, reducing the complexity of indicators, and aligning indicators to international definitions.
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Affiliation(s)
- Abyot Adane
- Ethiopian Pharmaceutical Supply Agency, Addis Ababa, Ethiopia
| | | | | | | | | | - Della Berhanu
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | | | | | | | | | - Heven S. Firew
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | | | | | | | | | | | - Abyi Kiflom
- Ethiopian Pharmaceutical Supply Agency, Addis Ababa, Ethiopia
| | - Carina Källestål
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Seblewengel Lemma
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | | | - Joanna Schellenberg
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Tefera Taddele
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Gulilat Tefera
- Ethiopian Pharmaceutical Supply Agency, Addis Ababa, Ethiopia
| | - Admasu Teketel
- Ethiopian Pharmaceutical Supply Agency, Addis Ababa, Ethiopia
| | | | - Tsion Tsegaye
- Ethiopian Pharmaceutical Supply Agency, Addis Ababa, Ethiopia
| | | | | | | | | | | | - Lars Åke Persson
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Annika Janson
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
- Department of Women´s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
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Abera A, Belay H, Zewude A, Gidey B, Nega D, Dufera B, Abebe A, Endriyas T, Getachew B, Birhanu H, Difabachew H, Mekonnen B, Legesse H, Bekele F, Mekete K, Seifu S, Sime H, Yemanebrhan N, Tefera M, Amare H, Beyene B, Tsige E, Kebede A, Tasew G, Tollera G, Abate E, Woyessa A, Assefa A. Establishment of COVID-19 testing laboratory in resource-limited settings: challenges and prospects reported from Ethiopia. Glob Health Action 2020; 13:1841963. [PMID: 33200686 PMCID: PMC7671712 DOI: 10.1080/16549716.2020.1841963] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Indexed: 10/31/2022] Open
Abstract
The Coronavirus pandemic is recording unprecedented deaths worldwide. The temporal distribution and burden of the disease varies from setting to setting based on economic status, demography and geographic location. A rapid increase in the number of COVID-19 cases is being reported in Africa as of June 2020. Ethiopia reported the first COVID-19 case on 13 March 2020. Limited molecular laboratory capacity in resource constrained settings is a challenge in the diagnosis of the ever-increasing cases and the overall management of the disease. In this article, the Ethiopian Public Health Institute (EPHI) shares the experience, challenges and prospects in the rapid establishment of one of its COVID-19 testing laboratories from available resources. The first steps in establishing the COVID-19 molecular testing laboratory were i) identifying a suitable space ii) renovating it and iii) mobilizing materials including consumables, mainly from the Malaria and Neglected Tropical Diseases (NTDs) research team at the EPHI. A chain of experimental design was set up with distinct laboratories to standardize the extraction of samples, preparation of the master mix and detection. At the commencement of sample reception and testing, laboratory contamination was among the primary challenges faced. The source of the contamination was identified in the master mix room and resolved. In summary, the established COVID-19 testing lab has tested more than 40,000 samples (August 2020) and is the preferred setting for research and training. The lessons learned may benefit the further establishment of emergency testing laboratories for COVID-19 and/or other epidemic/pandemic diseases in resource-limited settings.
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Affiliation(s)
- Adugna Abera
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Habtamu Belay
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Aboma Zewude
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Bokretsion Gidey
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Desalegn Nega
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Boja Dufera
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Abnet Abebe
- National Laboratories Capacity Building Directorate, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Tujuba Endriyas
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Birhanu Getachew
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Henok Birhanu
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Hailemariam Difabachew
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Bacha Mekonnen
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Helina Legesse
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Firdawek Bekele
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Kalkidan Mekete
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Seble Seifu
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Heven Sime
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Nebiyou Yemanebrhan
- National Laboratories Capacity Building Directorate, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Mesfin Tefera
- National Polio and Measles Laboratory, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Hiwot Amare
- Influenza and Arbovirus Research Laboratory, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Berhane Beyene
- Laboratory Coordinator, WHO Ethiopia Country Office , Addis Ababa, Ethiopia
| | - Estifanos Tsige
- Clinical Bacteriology and Mycology Case Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Adisu Kebede
- National Laboratories Capacity Building Directorate, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Geremew Tasew
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | | | - Ebba Abate
- Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Adugna Woyessa
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
| | - Ashenafi Assefa
- Malaria and Neglected Tropical Diseases Research Team, Ethiopian Public Health Institute , Addis Ababa, Ethiopia
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11
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Gebreyesus TD, Tadele T, Mekete K, Barry A, Gashaw H, Degefe W, Tadesse BT, Gerba H, Gurumurthy P, Makonnen E, Aklillu E. Prevalence, Intensity, and Correlates of Schistosomiasis and Soil-Transmitted Helminth Infections after Five Rounds of Preventive Chemotherapy among School Children in Southern Ethiopia. Pathogens 2020; 9:E920. [PMID: 33172114 PMCID: PMC7694749 DOI: 10.3390/pathogens9110920] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 01/04/2023] Open
Abstract
Preventive chemotherapy (PC) is a WHO-recommended strategy to control and eliminate schistosomiasis and soil-transmitted helminths (STHs). We assessed the prevalence, intensity, and correlates of schistosomiasis and STH infection after five rounds of PC in southern Ethiopia. A total of 3162 school children from four schools in Wondo Gennet and Hawella Tula districts were screened for Schistosoma mansoni and STHs infection. The overall prevalence of S. mansoni infection was 25.8% (range between schools 11.6% to 54.1%), with light (19.1%), moderate (5.3%), and heavy (1.4%) infection intensities. A total of 61.6% S. mansoni-infected children were STH co-infected. The overall prevalence of STHs infection was 54.7% (range between schools 30.6-71.0%), with moderate-to-heavy intensity infections being 16.3%. Ascaris lumbricoides was the most prevalent 45% (95% CI, 43.5-47) followed by Trichuris trichiura 25.3% (95% CI, 23.8-26.9) and hookworm 6.1% (95% CI, 5.3-7). A total of 33.7% of STHs-infected children had A. lumbricoides and T. trichiura co-infections. S. mansoni infection was significantly associated with school and STHs co-infection (p < 0.001). STH infection was correlated with school and younger age (p < 0.001). Despite repeated PC, S. mansoni and STH infection remain significant health problems, and the WHO target to control schistosomiasis and eliminate STH by 2020 may not be achieved. Intensified control and prevention measures, including drug efficacy surveillance, is recommended.
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Affiliation(s)
- Tigist Dires Gebreyesus
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge,14186 Stockholm, Sweden; (T.D.G.); (A.B.); (B.T.T.)
- Ethiopian Food and Drug Authority, Addis Ababa P.O. Box 5681, Ethiopia; (H.G.); (W.D.); (H.G.)
| | - Tafesse Tadele
- College of Medicine and Health Sciences, Hawassa University, Hawassa P.O. Box 1560, Ethiopia;
| | - Kalkidan Mekete
- Ethiopian Public Health Institute, Addis Ababa P.O. Box 1242, Ethiopia;
| | - Abbie Barry
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge,14186 Stockholm, Sweden; (T.D.G.); (A.B.); (B.T.T.)
| | - Habtamu Gashaw
- Ethiopian Food and Drug Authority, Addis Ababa P.O. Box 5681, Ethiopia; (H.G.); (W.D.); (H.G.)
| | - Workagegnehu Degefe
- Ethiopian Food and Drug Authority, Addis Ababa P.O. Box 5681, Ethiopia; (H.G.); (W.D.); (H.G.)
| | - Birkneh Tilahun Tadesse
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge,14186 Stockholm, Sweden; (T.D.G.); (A.B.); (B.T.T.)
- College of Medicine and Health Sciences, Hawassa University, Hawassa P.O. Box 1560, Ethiopia;
| | - Heran Gerba
- Ethiopian Food and Drug Authority, Addis Ababa P.O. Box 5681, Ethiopia; (H.G.); (W.D.); (H.G.)
| | - Parthasarathi Gurumurthy
- Pharmacovigilance and Clinical Trials, Botswana Medicines Regulatory Authority, Gaborone P.O. Box 505155, Botswana;
| | - Eyasu Makonnen
- Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 9086, Ethiopia;
- Departments of Pharmacology and Clinical Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 9086, Ethiopia
| | - Eleni Aklillu
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge,14186 Stockholm, Sweden; (T.D.G.); (A.B.); (B.T.T.)
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12
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Leta GT, Mekete K, Wuletaw Y, Gebretsadik A, Sime H, Mekasha S, Woyessa A, Shafi O, Vercruysse J, Grimes JET, Gardiner I, French M, Levecke B, Drake L, Harrison W, Fenwick A. National mapping of soil-transmitted helminth and schistosome infections in Ethiopia. Parasit Vectors 2020; 13:437. [PMID: 32873333 PMCID: PMC7466696 DOI: 10.1186/s13071-020-04317-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 01/10/2020] [Accepted: 08/25/2020] [Indexed: 11/10/2022] Open
Abstract
Background An accurate understanding of the geographical distributions of both soil-transmitted helminths (STHs; Ascaris lumbricoides, Trichuris trichiura, and the hookworms Necator americanus and Ancylostoma duodenale) and schistosomes (SCH; Schistosoma mansoni and S. haematobium) is pivotal to be able to effectively design and implement mass drug administration (MDA) programmes. The objective of this study was to provide up-to-date data on the distribution of both STH and SCH in Ethiopia to inform the design of the national control program and to be able to efficiently achieve the 75% MDA coverage target set by the WHO. Methods Between 2013 and 2015, we assessed the distributions of STH and SCH infections in a nationwide survey covering 153,238 school-aged children (aged 5–15 years), from 625 woredas (districts), representing all nine Regional States and two City Administrations of Ethiopia. Nationwide disease maps were developed at the woreda level to enable recommendations on the design of the national MDA programme. Results The prevalence of any STH infection across the study population was 21.7%, with A. lumbricoides (12.8%) being the most prevalent STH, followed by hookworms (7.6%) and T. trichiura (5.9%). The prevalence for any SCH was 4.0% in areas where both SCH species were evaluated. Schistosoma mansoni was the most prevalent SCH (3.5 vs 0.3%). STHs were more prevalent in southwest Ethiopia, whereas SCH was found mostly in the west and northeast of the country. The prevalence of moderate-to-heavy intensity infections was 2.0% for STHs and 1.6% for SCH. For STH, a total of 251 woredas were classified as moderately (n = 178) or highly endemic (n = 73), and therefore qualify for an annual and biannual MDA program, respectively. For SCH, 67 woredas were classified as endemic and 8 as highly endemic, and hence they require every two years and annual MDA programme, respectively. Conclusions The results confirm that Ethiopia is endemic for both STHs and SCH, posing a significant public health problem. Following the WHO recommendations on mass drug administration, 18 and 14 million school-aged children are in need of MDA for STHs and SCH, respectively, based on the number of SACs that live on the eligible geographical areas.![]()
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Affiliation(s)
- Gemechu Tadesse Leta
- Ethiopian Public Health Institute, PO Box 1242/5654, Addis Ababa, Ethiopia. .,Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
| | - Kalkidan Mekete
- Ethiopian Public Health Institute, PO Box 1242/5654, Addis Ababa, Ethiopia
| | - Yonas Wuletaw
- Ethiopian Public Health Institute, PO Box 1242/5654, Addis Ababa, Ethiopia
| | - Abeba Gebretsadik
- Ethiopian Public Health Institute, PO Box 1242/5654, Addis Ababa, Ethiopia
| | - Heven Sime
- Ethiopian Public Health Institute, PO Box 1242/5654, Addis Ababa, Ethiopia
| | - Sindew Mekasha
- Ethiopian Public Health Institute, PO Box 1242/5654, Addis Ababa, Ethiopia
| | - Adugna Woyessa
- Ethiopian Public Health Institute, PO Box 1242/5654, Addis Ababa, Ethiopia
| | - Oumer Shafi
- Federal Ministry of Health, PO Box 1234, Addis Ababa, Ethiopia
| | - Jozef Vercruysse
- Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Jack E T Grimes
- Department of Civil and Environmental Engineering, South Kensington Campus, Imperial College London, London, SW7 2AZ, UK
| | - Iain Gardiner
- Partnership for Child Development, Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College London, London, W2 1PG, UK
| | - Michael French
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College London, London, W2 1PG, UK.,RTI International, Washington D.C, USA
| | - Bruno Levecke
- Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Lesley Drake
- Partnership for Child Development, Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College London, London, W2 1PG, UK
| | - Wendy Harrison
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College London, London, W2 1PG, UK
| | - Alan Fenwick
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College London, London, W2 1PG, UK
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13
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Mohammed H, Hassen K, Assefa A, Mekete K, Tadesse G, Taye G, Commons RJ. Genetic diversity of Plasmodium falciparum isolates from patients with uncomplicated and severe malaria based on msp-1 and msp-2 genes in Gublak, North West Ethiopia. Malar J 2019; 18:413. [PMID: 31823778 PMCID: PMC6905089 DOI: 10.1186/s12936-019-3039-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 09/29/2019] [Accepted: 11/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria infection can present with a wide variety of symptoms, ranging from mild to severe. Plasmodium falciparum isolates in uncomplicated and severe malaria infections may have different parasite genetic profiles. This study was conducted to assess differences in genetic diversity and allelic frequencies in P. falciparum isolates according to malaria severity and age of patients in the Gublack area, northwest Ethiopia. METHODS Cross-sectional health facility-based study conducted in Gublak, Ethiopia between July, 2017 and October, 2017. Symptomatic P. falciparum malaria patients with microscopically-confirmed infection were enrolled. Parasite DNA was extracted from filter paper blood spots and the polymorphic regions of the msp-1 and msp-2 genes were genotyped using allele-specific nested-PCR with fragment analysis by gel electrophoresis. RESULTS A total of 118 patients were enrolled including 95 (80.5%) with uncomplicated infection and 23 (19.5%) with severe disease. In msp-1, the K1 allelic family was similarly prevalent in uncomplicated 42 (44.2%) and severe disease 12 (52.2%). In msp-2, FC27 was detected in 55 (57.9%) of uncomplicated infections and IC/3D7 in 14 (60.9%) of severe infections. 76 (64.4%) of the 118 isolates contained multiple genotypes; 56 (58.9%) in uncomplicated infections and 19 (82.6%) in severe infections. The overall of multiplicity of infection was 2.2 (95% CI 1.98-2.42) with 1.4 (95% CI 1.23-1.55) and 1.7 (95% CI 1.49-1.86) for msp-1 and msp-2, respectively. Multiplicity of infection was significantly higher in severe than uncomplicated infections (3.0 (95% CI 2.61-3.47) versus 2.0 (95% CI 1.83-2.23), respectively, p = 0.001). There was no difference in multiplicity of infection across age groups (p = 0.104). CONCLUSION Patients with severe malaria were more likely to have multiclonal infections. Further studies are needed to describe the association between P. falciparum genotypes and malaria severity in different malaria transmission areas.
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Affiliation(s)
| | - Kedir Hassen
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | | | - Girum Taye
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Robert J Commons
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia.,Internal Medical Services, Ballarat Health Services, Ballarat, Australia
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14
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Mekete K, Ower A, Dunn J, Sime H, Tadesse G, Abate E, Nigussu N, Seife F, McNaughton E, Anderson RM, Phillips AE. The Geshiyaro Project: a study protocol for developing a scalable model of interventions for moving towards the interruption of the transmission of soil-transmitted helminths and schistosome infections in the Wolaita zone of Ethiopia. Parasit Vectors 2019; 12:503. [PMID: 31665080 PMCID: PMC6820996 DOI: 10.1186/s13071-019-3757-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 05/07/2019] [Accepted: 10/22/2019] [Indexed: 12/21/2022] Open
Abstract
Background National deworming programmes rely almost exclusively on mass drug administration (MDA) to children to control morbidity caused by these parasitic infections. The provision of other interventions, consisting of preventive chemotherapy at high population level coverage together with water, sanitation and hygiene (WaSH) and changes in risk behaviour, should enable sustainable control of soil-transmitted helminths (STH) and schistosomiasis and ultimately interrupt transmission. Methods/Design Two interventions will be implemented by the project: (i) community-wide biannual albendazole and annual praziquantel treatment with a target of 80–90% treatment coverage (“expanded MDA”); and (ii) provision of WaSH with behaviour change communication (BCC), within the Wolaita zone, Ethiopia. The project has three study arms: (i) expanded community-wide MDA, WaSH and BCC; (ii) expanded community-wide MDA only; and (iii) annual school-based MDA (the current National STH/schistosomiasis Control Programme). The impact of these interventions will be evaluated through prevalence mapping at baseline and endline (after four rounds of MDA), combined with annual longitudinal parasitological surveillance in defined cohorts of people to monitor trends in prevalence and reinfection throughout the project. Treatment coverage and individual compliance to treatment will be monitored by employing fingerprint biometric technology and barcoded identification cards at treatment. WaSH utilisation will be evaluated through school and household level observations and annual WaSH assessment survey. Complementary qualitative surveys will explore practices, cultural and social drivers of risk behaviours, uptake of WaSH and treatment, and assessing the impact of the BCC. Discussion The study has the potential to define an ‘End Game’ for STH and schistosomiasis programmes through provision of multiple interventions. Interrupting transmission of these infections would eliminate the need for long-term repeated MDA, lead to sustained health improvements in children and adults, thereby allowing health systems to focus on other disease control priorities.
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Affiliation(s)
| | - Alison Ower
- London Centre for Neglected Tropical Disease Research, Department of Infectious Diseases Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, W2 1PG, UK
| | - Julia Dunn
- London Centre for Neglected Tropical Disease Research, Department of Infectious Diseases Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, W2 1PG, UK
| | - Heven Sime
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Ebba Abate
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | - Emily McNaughton
- London Centre for Neglected Tropical Disease Research, Department of Infectious Diseases Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, W2 1PG, UK
| | - Roy Malcolm Anderson
- London Centre for Neglected Tropical Disease Research, Department of Infectious Diseases Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, W2 1PG, UK
| | - Anna Elizabeth Phillips
- London Centre for Neglected Tropical Disease Research, Department of Infectious Diseases Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, W2 1PG, UK.
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Mohammed H, Kassa M, Mekete K, Assefa A, Taye G, Commons RJ. Genetic diversity of the msp-1, msp-2, and glurp genes of Plasmodium falciparum isolates in Northwest Ethiopia. Malar J 2018; 17:386. [PMID: 30359280 PMCID: PMC6203214 DOI: 10.1186/s12936-018-2540-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 07/04/2018] [Accepted: 10/20/2018] [Indexed: 11/30/2022] Open
Abstract
Background Determination of the genetic diversity of malaria parasites can inform the intensity of transmission and identify potential deficiencies in malaria control programmes. This study was conducted to characterize the genetic diversity and allele frequencies of Plasmodium falciparum in Northwest Ethiopia along the Eritrea and Sudan border. Methods A total of 90 isolates from patients presenting to the local health centre with uncomplicated P. falciparum were collected from October 2014 to January 2015. DNA was extracted and the polymorphic regions of the msp-1, msp-2 and glurp loci were genotyped by nested polymerase chain reactions followed by gel electrophoresis for fragment analysis. Results Allelic variation in msp-1, msp-2 and glurp were identified in 90 blood samples. A total of 34 msp alleles (12 for msp-1 and 22 for msp-2) were detected. For msp-1 97.8% (88/90), msp-2 82.2% (74/90) and glurp 46.7% (42/90) were detected. In msp-1, MAD20 was the predominant allelic family detected in 47.7% (42/88) of the isolates followed by RO33 and K1. For msp-2, the frequency of FC27 and IC/3D7 were 77% (57/74) and 76% (56/74), respectively. Nine glurp RII region genotypes were identified. Seventy percent of isolates had multiple genotypes and the overall mean multiplicity of infection was 2.6 (95% CI 2.25–2.97). The heterozygosity index was 0.82, 0.62 and 0.20 for msp-1, msp-2 and glurp, respectively. There was no significant association between multiplicity of infection and age or parasite density. Conclusions There was a high degree of genetic diversity with multiple clones in P. falciparum isolates from Northwest Ethiopia suggesting that there is a need for improved malaria control efforts in this region. Electronic supplementary material The online version of this article (10.1186/s12936-018-2540-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hussein Mohammed
- Malaria, Neglected Tropical Diseases Research Team Bacterial, Parasitic, Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
| | - Moges Kassa
- Malaria, Neglected Tropical Diseases Research Team Bacterial, Parasitic, Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Kalkidan Mekete
- Malaria, Neglected Tropical Diseases Research Team Bacterial, Parasitic, Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ashenafi Assefa
- Malaria, Neglected Tropical Diseases Research Team Bacterial, Parasitic, Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Girum Taye
- Malaria, Neglected Tropical Diseases Research Team Bacterial, Parasitic, Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Robert J Commons
- Menzies School of Health Research and Charles Darwin University, Darwin, Australia
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Negussu N, Mengistu B, Kebede B, Deribe K, Ejigu E, Tadesse G, Mekete K, Sileshi M. Ethiopia Schistosomiasis and Soil-Transmitted Helminthes Control Programme: Progress and Prospects. Ethiop Med J 2017; 55:75-80. [PMID: 28878432 PMCID: PMC5582635] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Schistosomiasis and soil-transmitted helminthes are among seventeen WHO prioritized neglected tropical diseases that infect humans. These parasitic infections can be treated using single-dose and safe drugs. Ethiopia successfully mapped the distribution of these infections nationwide. According to the mapping there are an estimated 37.3 million people living in schistosomiasis endemic areas, and 79 million in schistosomiasis and soil-transmitted helminthes endemic areas. The Federal Ministry of Health successfully scaled up Schistosomiasis and schistosomiasis and soil-transmitted helminthes intervention in endemic areas and treated over 19 million individuals in 2015. The Ministry of Health has made a huge effort to establish neglected tropical diseases, including schistosomiasis and soil-transmitted helminthes program in the health system which helped to map majority of the woredas and initiate nationwide intervention. The National control programme is designed to achieve elimination for those diseases as a major public health problem by 2020 and aim to attain transmission break by 2025. The programme focuses on reaching those school-aged children who are not attending school, integration between neglected tropical diseases programme, and further collaboration with the WASH actors.
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Affiliation(s)
| | | | | | - Kebede Deribe
- Federal Ministry of Health, Addis Ababa Ethiopia
- Wellcome Trust Brighton & Sussex Centre for Global Health Research, Brighton & Sussex Medical School, Falmer, Brighton, UK
- Addis Ababa University, School of Public Health, Addis Ababa, Ethiopia
- RTI International, Addis Ababa, Ethiopia
| | | | | | | | - Mesfin Sileshi
- Federal Ministry of Health, Addis Ababa Ethiopia
- RTI International, Addis Ababa, Ethiopia
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Grimes JET, Tadesse G, Mekete K, Wuletaw Y, Gebretsadik A, French MD, Harrison WE, Drake LJ, Gardiner IA, Yard E, Templeton MR. School Water, Sanitation, and Hygiene, Soil-Transmitted Helminths, and Schistosomes: National Mapping in Ethiopia. PLoS Negl Trop Dis 2016; 10:e0004515. [PMID: 26954688 PMCID: PMC4783033 DOI: 10.1371/journal.pntd.0004515] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 02/14/2016] [Indexed: 12/21/2022] Open
Abstract
Background It is thought that improving water, sanitation, and hygiene (WASH) might reduce the transmission of schistosomes and soil-transmitted helminths, owing to their life cycles. However, few large-scale studies have yet assessed the real extent of associations between WASH and these parasites. Methodology/Principal Findings In the 2013–2014 Ethiopian national mapping of infections with these parasites, school WASH was assessed alongside infection intensity in children, mostly between 10 and 15 years of age. Scores were constructed reflecting exposure to schistosomes arising from water collection for schools, from freshwater sources, and the adequacy of school sanitation and hygiene facilities. Kendall’s τb was used to test the WASH scores against the school-level arithmetic mean intensity of infection with each parasite, in schools with at least one child positive for the parasite in question. WASH and parasitology data were available for 1,645 schools. More frequent collection of water for schools, from open freshwater sources was associated with statistically significantly higher Schistosoma mansoni infection intensity (Kendall’s τb = 0.097, 95% confidence interval, CI: 0.011 to 0.18), better sanitation was associated with significantly lower Ascaris lumbricoides intensity (Kendall’s τb = -0.067, 95% CI: -0.11 to -0.023) and borderline significant lower hookworm intensity (Kendall’s τb = -0.039, 95% CI: -0.090 to 0.012, P = 0.067), and better hygiene was associated with significantly lower hookworm intensity (Kendall’s τb = -0.076, 95% CI: -0.13 to -0.020). However, no significant differences were observed when comparing sanitation and infection with S. mansoni or Trichuris trichiura, or hygiene and infection with A. lumbricoides or T. trichiura. Conclusions/Significance Improving school WASH may reduce transmission of these parasites. However, different forms of WASH appear to have different effects on infection with the various parasites, with our analysis finding the strongest associations between water and S. mansoni, sanitation and A. lumbricoides, and hygiene and hookworm. Water, sanitation, and hygiene (WASH) are potentially important control measures for parasitic worms, but few large-scale and well-designed research studies have aimed to quantify the relationships between WASH and infections with these parasites, or demonstrated the practicality of integrating WASH assessments into large-scale worm mapping. Here we use data from 80,475 children in 1,645 schools visited during the 2013–2014 Ethiopian national mapping of schistosomiasis and soil-transmitted helminthiases, to compare school WASH conditions with the mean intensity of infection with these parasites, using Kendall’s τb, a statistic that assesses for correlation between two variables by comparing their rankings. More frequent collection of water for schools was associated with statistically significantly (P < 0.05) higher-intensity intestinal schistosomiasis infections, better sanitation significantly with lower roundworm burdens, and better hygiene with significantly lower hookworm burdens. No statistically significant associations (P > 0.05) were found for sanitation and intestinal schistosomiasis or whipworm infections, or hygiene and roundworm or whipworm infections, but better sanitation was associated with a borderline statistically significantly less hookworm infections (P = 0.067). The results suggest that WASH improvements might have different impacts on infection with the various parasites. These differences should be borne in mind when designing WASH interventions to reduce transmission of, and prevent infection with, these parasites.
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Affiliation(s)
- Jack E. T. Grimes
- Department of Civil and Environmental Engineering, South Kensington Campus, Imperial College London, London, United Kingdom
- * E-mail:
| | | | | | - Yonas Wuletaw
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Michael D. French
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, St Mary’s Campus, Imperial College London, London, United Kingdom
| | - Wendy E. Harrison
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, St Mary’s Campus, Imperial College London, London, United Kingdom
| | - Lesley J. Drake
- Partnership for Child Development, Department of Infectious Disease Epidemiology, St Mary’s Campus, Imperial College London, London, United Kingdom
| | - Iain A. Gardiner
- Partnership for Child Development, Department of Infectious Disease Epidemiology, St Mary’s Campus, Imperial College London, London, United Kingdom
| | - Elodie Yard
- Partnership for Child Development, Department of Infectious Disease Epidemiology, St Mary’s Campus, Imperial College London, London, United Kingdom
| | - Michael R. Templeton
- Department of Civil and Environmental Engineering, South Kensington Campus, Imperial College London, London, United Kingdom
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