One hundred years of neglect in paediatric schistosomiasis

Abstract

Early in the history of schistosomiasis research, children under 5 years of age were known to be infected. Although this problem was recognized over 100 years ago, insufficient action has been taken to address this issue. Under current policy, such infected children only receive their first antiparasitic treatment (praziquantel - PZQ) upon entry into primary school as current mass drug administration programmes typically target school-aged children. For many infected children, they will wait up to 6 years before receiving their first medication and significant schistosomiasis-related morbidity may have already established. This inequity would not be accepted for other diseases. To unveil some of the reasons behind this neglect, it is paramount to understand the intricate historical relationship between schistosomiasis and British Imperial medicine, to underline its lasting influence on today's public health priorities. This review presents a perspective on the historical neglect of paediatric schistosomiasis, focusing on important gaps that persist from the early days after discovery of this parasite. Looking to end this inequity, we address several issues that need to be overcome to move forward towards the lasting success of schistosomiasis control and elimination efforts.

The Schistosomiasis Consortium for Operational Research and Evaluation Rapid Answers Project: Systematic Reviews and Meta-Analysis to Provide Policy Recommendations Based on Available Evidence

“…Results from this most recent RAP study are expected to provoke a policy-level reconsideration of the importance of early childhood treatment for all forms of schistosomiasis. 25 …”

Evaluation of the pharmacokinetic-pharmacodynamic relationship of praziquantel in the Schistosoma mansoni mouse model

“…Schistosomiasis [ 1 – 3 ] causes significant morbidity and mortality in subtropical and tropical regions of the world and estimates show that at least 258 million people required preventive treatment for schistosomiasis in 2014 [ 4 ]. Today treatment and control relies essentially on Praziquantel and gaps in the access plan to pre-school aged children remain an important issue along with an adequate pediatric formulation [ 5 ].…”

Change in children’s school behavior after mass administration of praziquantel for Schistosoma mansoni infection in endemic areas of western Kenya: A pilot study using the Behavioral Assessment System for Children (BASC-2)

“…Low intensity infections often get missed by standard coproscopic testing [8], so that mass treatment is currently the best means to reach all infected residents. When implemented correctly, this strategy has been shown to markedly reduce prevalence of organ-specific Schistosoma- related disease [9–12], but its impact on concurrent systemic morbidities has not been well studied [13]. Specifically, it has been recognized that the presence of schistosomiasis can cause a number of non-specific but potentially very significant functional pathologies, including impairment of children’s memory, learning, and school performance [14], with resultant losses of local human capital due to deficiencies in education [1].…”