Evaluation of the Health-related Quality of Life of Children in Schistosoma haematobium-endemic Communities in Kenya: A Cross-sectional Study

Abstract

BackgroundSchistosomiasis remains a global public health challenge, with 93% of the ∼237 million infections occurring in sub-Saharan Africa. Though rarely fatal, its recurring nature makes it a lifetime disorder with significant chronic health burdens. Much of its negative health impact is due to non-specific conditions such as anemia, undernutrition, pain, exercise intolerance, poor school performance, and decreased work capacity. This makes it difficult to estimate the disease burden specific to schistosomiasis using the standard DALY metric.Methodology/Principal FindingsIn our study, we used Pediatric Quality of Life Inventory (PedsQL), a modular instrument available for ages 2–18 years, to assess health-related quality of life (HrQoL) among children living in a Schistosoma haematobium-endemic area in coastal Kenya. The PedsQL questionnaires were administered by interview to children aged 5–18 years (and their parents) in five villages spread across three districts. HrQoL (total score) was significantly lower in villages with high prevalence of S. haematobium (−4.0%, p<0.001) and among the lower socioeconomic quartiles (−2.0%, p<0.05). A greater effect was seen in the psychosocial scales as compared to the physical function scale. In moderate prevalence villages, detection of any parasite eggs in the urine was associated with a significant 2.1% (p<0.05) reduction in total score. The PedsQL reliabilities were generally high (Cronbach alphas ≥0.70), floor effects were acceptable, and identification of children from low socioeconomic standing was valid.Conclusions/SignificanceWe conclude that exposure to urogenital schistosomiasis is associated with a 2–4% reduction in HrQoL. Further research is warranted to determine the reproducibility and responsiveness properties of QoL testing in relation to schistosomiasis. We anticipate that a case definition based on more sensitive parasitological diagnosis among younger children will better define the immediate and long-term HrQoL impact of Schistosoma infection.

Human schistosomiasis

“…These morbidities are systemic, associated with continuous inflammation during the first decades of life as a child has multiple, recurrent schistosome infections. 56,117–120 These disabling complications are particularly relevant in low-income countries, where they contribute to impaired physical performance and limited educational attainment—disabilities that become irreversible if infection cannot be prevented or suppressed throughout childhood. Schistosomiasis does not occur in isolation.…”

Infection with Schistosoma mansoni has an Effect on Quality of Life, but not on Physical Fitness in Schoolchildren in Mwanza Region, North-Western Tanzania: A Cross-Sectional Study

“…japonicum infections, and in Côte d’Ivoire another questionnaire (SF-36v2) was used to assess the physical burden of polyparasitism [17]. Currently, only two studies have quantified the effect of schistosome infection on overall wellbeing or quality of life using the Pediatric Quality of Life Inventory (PedsQL) [18,19]. Both studies used the same short form of the tool as the present study (PedsQL 4.0 SF15) and both found a lack of association between quality of life and infections at the individual level.…”

Health metrics for helminth infections

“…In response to the DALY’s brief ‘scenario’ approach to quantifying disability due to parasitic infection, researchers have begun the time-consuming task of formally quantifying health performance status of people with these chronic helminth-associated conditions (Furst et al, 2012b; Jia et al, 2007; Jia et al, 2011; Terer et al, 2013). Their studies have utilized standardized HRQoL instruments, such as the Euro-QoL 5, WHOQoL-Bref, and the Peds-QL to more fully assess patient physical performance and psychosocial status, and linked those to QALY-based estimates of disease impact for schistosomiasis and soil-transmitted helminths.…”