The WHO ultrasonography protocol for assessing morbidity due to Schistosoma haematobium. Acceptance and evolution over 14 years. Systematic review

Abstract

In 2000, the World Health Organization (WHO) published an ultrasound field protocol for assessing morbidity due to schistosomiasis. The present study aims to review the acceptance of the WHO protocol for Schistosoma haematobium. A PubMed literature research using the keywords "ultrasound OR ultrasonography (US) AND schistosomiasis," "US AND S. haematobium," "US AND urinary schistosomiasis" from 2001 through 2014 was performed. Thirty-eight eligible publications reporting on 17,861 patients from 13 endemic and 2 non-endemic countries were analysed. Of these, 33 referred to field studies on 17,317 patients. The Niamey protocol was applied to 15,367/17,317 (88.74%) patients in 23/33 (69.70%) of field studies (all studies: 15,649/17,861 [87.61%] patients (25/38 [68.42%] studies). The acceptance of the protocol by single country in field studies varied from 0 to 100%. It varied over time between 55.56% (5/9) in the period from 2001 to 2004, to 87.50% (7/8) from 2005 to 2008, to 62.50% (5/8) from 2009 to 2011 and 75.00% (6/8) from 2012 through 2014 (all studies: 50% [5/10], 88.89% [8/9], 62.50% [5/8], 63.64% [7/11], respectively). The Niamey protocol was applied also in 2/5 hospital studies in 282/544 (51.84%) patients.The usefulness of the WHO protocol for S. haematobium infections is confirmed by its worldwide acceptance. Some simplifications might facilitate its use also for focused ultrasound examinations performed by less skilled examiners. Organ abnormalities due to schistosomiasis detectable by ultrasonography not yet covered by the WHO protocol should be added to the additional investigations section.

Advances in the Diagnosis of Human Schistosomiasis

“…US imaging, which is noninvasive and convenient, is commonly applied for the detection and evaluation of pathological lesions in the urinary tract. As defined in WHO protocols and subsequent revisions, ultrasonic assessment allows the bladder damage by S. haematobium to be classified into grades (grades 0 to III) according to severity, based on the changes in bladder wall thickness, bladder wall irregularities, bladder shape, calcifications, the presence of polyps and tumors, and hydronephrosis (293,301).…”

Ultrasonographic evaluation of urinary tract morbidity in school-aged and preschool-aged children infected with Schistosoma haematobium and its evolution after praziquantel treatment: A randomized controlled trial

“…Nonetheless, we observed an improvement at follow up both in bladder filling and discomfort in urination, though this was not properly validated. Akpata stated that the above mentioned symptoms are better indicators of schistosomiasis than residual volume calculation [21]. Stiffness of detrusor muscle, polyps and hydronephrosis are signs of severe stage of the pathology, which fortunately was rare in our study cohort.…”

“…In settings where control of morbidity is the main goal of public health interventions, the most widely used criteria to determine it is the measurement of egg counts and urine analyses for hematuria and proteinuria, as indirect signs of UT impairment [3,12]. However, obviously a more accurate and specific evaluation of the organ pathology should be the way to follow [12,21–22]. Ultrasound examination allows to assess the damage of bladder wall and genito-urinary tract, which in combination with parasitological results and urine analyses are good indicators of consequences of chronic infection [4,12,13].…”

“…Ultrasound examination allows to assess the damage of bladder wall and genito-urinary tract, which in combination with parasitological results and urine analyses are good indicators of consequences of chronic infection [4,12,13]. Ultrasonography has been applied since the ‘70s [21] for schistosomiasis to detect and describe the morphology of lesions. The need to implement diagnostic and monitoring with ultrasound is widely shared [4,10,21], but so far its use is still limited [21].…”

“…Ultrasonography has been applied since the ‘70s [21] for schistosomiasis to detect and describe the morphology of lesions. The need to implement diagnostic and monitoring with ultrasound is widely shared [4,10,21], but so far its use is still limited [21]. …”