Defining elimination as a public health problem for schistosomiasis control programmes: beyond prevalence of heavy-intensity infections

Wiegand, Ryan E.; Fleming, Fiona; Vlas, Sake J. de; Odiere, Maurice R.; Kinung’hi, Safari; King, Charles H.; Evans, Darin; French, Michael; Montgomery, Susan P.; Straily, Anne; Utzinger, Jürg; Vounatsou, Penelope; Secor, W. Evan

doi:10.1016/s2214-109x(22)00287-x

Cited by 27 publications

(24 citation statements)

References 25 publications

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“…Very interestingly, our data show how two main characteristics identi ed as risk factors in the S. mansoni area (no school education and never been treated with praziquantel before) could not be described in the S. haematobium area. This might be due to the different cultural contexts, but in line with Wiegand, et al [50], it can also be suggested that measurements for the two species should differ in order to prevent a neglect of diverting transmission and risk factors of the schistosome spp.…”

Section: Discussionmentioning

confidence: 74%

Prevalence, risk and spatial distribution of schistosomiasis among adults to promote Universal Health Coverage: a cross-sectional study in Madagascar

Gruninger

Rasamoelina

Rakotoarivelo

et al. 2023

Preprint

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Background: The goal to eliminate the parasitic disease of poverty schistosomiasis as a public health problem is aligned with the 2030 United Nations agenda for Sustainable Development Goals, including Universal Health Coverage (UHC). Current control strategies focus on school-aged children, systematically neglecting adults. We aimed at providing evidence for the need of shifting the paradigm of schistosomiasis control programs from targeted to generalized approaches as key element for both the elimination of schistosomiasis as a public health problem and the promotion of UHC. Methods: In a cross-sectional study we determined prevalence and risk factors for schistosomiasis by a semi-quantitative PCR assay from specimens collected from 1,482 adult participants at three primary health-care centers in north-western and central areas of Madagascar. Results: The highest prevalence of S. mansoni, S. haematobium and co-infection of both species was 59.5%, 61.3% and 3.3%, respectively. Higher prevalence was observed among males and main contributors to the family income. Not working as a farmer and higher age were found to be protective factors for infection. Conclusions: Our findings provide evidence that adults are a high-risk group for schistosomiasis. The general focus on children and the exclusion of adults from control strategies for schistosomiasis in high endemic countries may hamper the achievement of both the schistosomiasis elimination goal and UHC. Our data suggests that, for ensuring basic health as a human right, current public health strategies for schistosomiasis prevention and control need to be re-addressed towards more context specific, holistic and integrated approaches.

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Section: Discussionmentioning

confidence: 74%

Prevalence, risk and spatial distribution of schistosomiasis among adults to promote Universal Health Coverage: a cross-sectional study in Madagascar

Gruninger

Rasamoelina

Rakotoarivelo

et al. 2023

Preprint

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“…First, the WBLP validated the feasibility of the WHO guidelines for schistosomiasis elimination in the People’s Republic of China and identified shortcomings in some of the control measures. The WBLP project proved that MDA is feasible for S. japonicum control, both in humans and animals, which is a key lesson for schistosomiasis morbidity control and elimination as a public health problem [ 31 ]. On the other hand, the WBLP also revealed some shortcomings of MDA, such as the risk of developing drug resistance and a reduction in residents’ compliance to MDA in the face of declining prevalence and intensity of infection coupled with reduced levels of morbidity [ 32 ].…”

Section: Resultsmentioning

confidence: 99%

Short-, Mid-, and Long-Term Epidemiological and Economic Effects of the World Bank Loan Project on Schistosomiasis Control in the People’s Republic of China

et al. 2022

Diseases

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It is widely acknowledged that the 10-year World Bank Loan Project (WBLP) on schistosomiasis control in the People’s Republic of China played an important role in raising the public and political profile of schistosomiasis, particularly regarding its prevention, control, and elimination. The WBLP adopted large-scale administration of praziquantel as the main control measure. At the end of the 10-year project in 2001, data from high-, medium-, and low-endemic areas suggested that the infection rates of both humans and domestic animals had fallen to the expected levels. However, major floods in the Yangtze River basin, coupled with reduced funding for schistosomiasis control, resulted in a rebound of the disease in endemic areas. Since 2005, a steady decline in infection rates was observed and it was hypothesized that the experiences and technological advances accumulated during the WBLP played a role. Nonetheless, relatively little is known about the long-term effects of the WBLP on schistosomiasis, particularly management mechanisms, technological innovations, epidemiological changes, and long-term economic impact. To fill these gaps, we systematically searched the literature for articles in English and Chinese on the WBLP on schistosomiasis from 1 January 1992 to 30 July 2022. Relevant studies were analyzed for short-, mid-, and long-term epidemiological and economic effects of the WBLP on schistosomiasis prevention, control, and elimination. Overall, 81 articles met our inclusion criteria, of which 17 were related to management mechanism reform, 20 pertained to technological innovation, and 44 examined epidemiological changes and economic effects. Most papers documented the WBLP as a positive contribution to schistosomiasis prevention and control in the People’s Republic of China. Regarding the long-term effects, there was a significant contribution to the national schistosomiasis control and elimination programme in terms of renewed management mechanisms, talent development, and technological innovation. In conclusion, the WBLP contributed to enhanced control of schistosomiasis and shaped the ultimate response towards schistosomiasis elimination in the People’s Republic of China. Experiences and lessons learned might guide schistosomiasis control and elimination elsewhere.

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“…Our results indicate that the studied sub-districts had an overall prevalence of heavy intensity infections of 23% and 24% for S. mansoni and S. haematobium, respectively. The use of intensity of infection as an indicator for reaching the elimination stage is debatable, and has attracted different views [34].…”

Section: Implications Of the Current Findings For Mda Programmesmentioning

confidence: 99%

Precision and geographical prevalence mapping of schistosomiasis and soil-transmitted helminthiasis among school-aged children in selected districts of north-western Tanzania

et al. 2022

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Background The identification and mapping of at-risk populations at a lower administrative level than the district are prerequisites for the planning, resource allocation and design of impactful control intervention measures. Thus, the objective of the current study was to conduct sub-district precision mapping of soil-transmitted helminthiasis (STH) and schistosomiasis in 29 districts of north-western Tanzania using the current recommended World Health Organization criteria. Methods A cross-sectional survey was conducted in 145 schools between March and May 2021. A urine filtration technique was used for the quantification of Schistosoma haematobium eggs, whereas quantification of Schistosoma mansoni and STH eggs was done using the Kato–Katz technique. Microhaematuria was examined using a urine dipstick. Results The overall prevalences of any STH and schistosome infections were 9.3% [95% confidence interval (95%CI) 8.6–9.9] and 14.6% (95%CI 13.9–15.4), respectively. The overall prevalence of S. mansoni was 8.7% (95%CI 8.1–9.3), and 36.4%, 41.6%, and 21.9% of the children had low, moderate, and heavy infections, respectively. The overall prevalence of S. haematobium was 6.1% (95%CI 5.5–6.5), and 71.7% and 28.3% of the infected children had light and heavy intensity infections, respectively. The prevalence of microhaematuria was 7.3% (95%CI 6.7–7.8), with males having the highest prevalence (8.4%, P < 0.001). The prevalences of Trichuris trichiura, Ascaris lumbricoides and hookworm were, respectively, 1.3% (95%CI 0.1–1.5), 2.9% (95%CI 2.5–3.3) and 6.2% (95%CI 5.7–6.7). Most of the children infected with STH had light to moderate intensities of infection. The overall prevalence of co-infection with STH and schistosomiasis was 19.1%. The prevalence of schistosomiasis (P < 00.1) and STH (P < 0.001) varied significantly between schools and sub-districts. Schistosoma mansoni and S. haematobium were observed in 60 and 71 schools, respectively, whereas any STH was observed in 49 schools. In schools where schistosomiasis was observed, prevalence was < 10% in 90.8% of them, and ranged from ≥ 10% to < 50% in the other 9.2%. In schools where any STH was observed, the prevalence was < 10% in 87.7% of them. Conclusions The data reported here show that schistosomiasis and STH are widely distributed around Lake Victoria. In most of the schools where schistosomiasis and STH occurred the transmission thresholds were low. These data are important and need to be taken into consideration when decisions are made on the implementation of the next round of mass chemotherapies for schistosomiasis and STH in Tanzania. Graphical Abstract

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Defining elimination as a public health problem for schistosomiasis control programmes: beyond prevalence of heavy-intensity infections

Cited by 27 publications

References 25 publications

Prevalence, risk and spatial distribution of schistosomiasis among adults to promote Universal Health Coverage: a cross-sectional study in Madagascar

Prevalence, risk and spatial distribution of schistosomiasis among adults to promote Universal Health Coverage: a cross-sectional study in Madagascar

Short-, Mid-, and Long-Term Epidemiological and Economic Effects of the World Bank Loan Project on Schistosomiasis Control in the People’s Republic of China

Precision and geographical prevalence mapping of schistosomiasis and soil-transmitted helminthiasis among school-aged children in selected districts of north-western Tanzania

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