Changes in Morbidity, Physical Fitness, and Perceived Quality of Life among Schoolchildren following Four Years of Different Mass Drug Administration Strategies against Schistosoma mansoni Infection in Mwanza Region, Northwestern Tanzania

Abstract

Schistosoma mansoni infection negatively impacts children's physical health and may influence general well-being. Schistosomiasis control programs aim at reducing morbidity through mass drug administration (MDA). This study aimed to compare morbidity markers between two cohorts of Tanzanian schoolchildren with initial high prevalence of S. mansoni infection. One cohort (N = 254 at baseline) received annual MDA for 4 years using community-wide treatment (CWT). The second cohort (N = 318 at baseline) received school-based treatment (SBT) every other year for 4 years. At year 5, the CWT cohort and the SBT cohort were reduced to 153 and 221 children, respectively. The characteristics of the 198 children lost to follow-up did not differ at baseline from those who were examined in year 5. Schistosoma mansoni infection, hemoglobin (Hb) and anemia, physical fitness, and perceived quality of life were investigated at baseline, year 3, and year 5, whereas liver and spleen pathology (ultrasound) were investigated only at baseline and year 5. Cohorts were compared using two-way mixed-model analysis of variance (ANOVA). Both treatment regimens significantly decreased individual-level mean intensity of S. mansoni infection, anemia, and hepatomegaly, and increased Hb levels after 5 years. Hepatomegaly was the only parameter affected by the treatment regimen as the CWT approach reduced the percentage of individuals with hepatomegaly significantly more than the SBT approach. Both treatment regimens led to reduced physical fitness at year 5 compared with baseline. The modest impact of the two control strategies are probably due to initial low intensity of infection, ensuring low level of schistosomiasis-related morbidity.

Quality of Life Assessment Among Patients Living With Hepatosplenic Schistosomiasis and Schistosomal Myeloradiculopathy

“…Assessment of HRQOL in schistosomiasis patients is commonly used to evaluate therapeutic interventions and mass drug administration strategies in endemic areas (16,19,21,(23)(24)(25). However, studies that determine the burden of severe forms of schistosomiasis on patients' quality of life are scarce and rarely include an appropriate control group with similar sociodemographic background for comparison (15,17,18,22,26).…”

“…Assessment of HRQOL, together with morbidity and mortality measurements, is crucial to determine the disease's burden in the community, evaluate interventions and standard health care policies, and identify areas that require further improvement (12-16). Generic HRQOL, such as WHOQOL-BREF or EQ-5D-3L, has been validated in different languages, cultural settings, and different diseases, including schistosomiasis (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25).…”

SCORE Studies on the Impact of Drug Treatment on Morbidity due to Schistosoma mansoni and Schistosoma haematobium Infection

“…The Kenya and Tanzania gaining control studies were able to successfully complete their Year 3 and Year 5 cohort reexaminations. 41 – 43 In a secondary analysis of their pooled S. mansoni longitudinal data, overall infection intensity and odds of infection were significantly reduced in both treatment arms of the study. 44 Furthermore, both annual CWT and every-other-year SBT were associated with reduced odds of undernutrition in Year 5 (at the time, the children were aged 12–13 years).…”

The short-term impact of Schistosoma mansoni infection on health-related quality of life: implications for current elimination policies

“…The effect of severe and chronic S. mansoni infection has been associated with increased morbidity and reduced HRQoL [16,17]. However, short-term effects of mild infections on HRQoL have yielded contradictory results: some studies showed negative associations among adults and children, with higher impact on emotional rather than physical dimensions [18][19][20], but others reported no associations [21][22][23]. Importantly, the effect of MDA on morbidity outcomes and HRQoL remains unclear [20,21,24].…”