Prevalence, Intensity, and Factors Associated with Urogenital Schistosomiasis among Women of Reproductive Age in Mbogwe District Council, Geita Region, Tanzania.

BACKGROUND: Urogenital schistosomiasis remains a public health problem in Tanzania. Control programs mostly target school-going children ignoring other vulnerable groups like women of child bearing age. Previous evidence has shown that women of reproductive age suffer greatest morbidities in endemic areas. This study sought to determine the prevalence, intensity, and factors associated with urogenital schistosomiasis among women of reproductive age in the Mbogwe District. METHODS: A population-based analytical cross-section study was conducted in the Mbogwe District. A semistructured questionnaire was administered. Urine samples of 20-30 mils collected between 10.00 am to 02.00 pm and examined for Schistosoma eggs and infection intensity microscopically. Data analysis was done using SPSS version 20. RESULTS: A total of 426 women of reproductive age, with median age of 26, and interquartile range of 11years were recruited and assessed. The prevalence of urogenital schistosomiasis was 4.5% and mean egg intensity of 19.5eggs/10mil of urine. After adjusting for confounders, lower level of education was associated with an increased risk of urogenital schistosomiasis infections (AOR 8.355, 95% CI 3.055-23.001). CONCLUSION: Urogenital schistosomiasis among women of reproductive age in the Mbogwe District is a problem. Education is the factor associated with the disease; the neglected tropical disease control program should develop strategies that should include provision of health education and should involve women of reproductive age as they act as infection reservoir. More studies are recommended to explore the possibility of reproductive complications among infected women in endemic areas.

Financial Costs of the Zanzibar Elimination of Schistosomiasis Transmission Project.

We estimated the financial costs of different interventions against urogenital schistosomiasis, implemented by the Zanzibar Elimination of Schistosomiasis Transmission (ZEST) project, on Pemba and Unguja islands, Tanzania. We used available data on project activities, resources used, and costs reported in the accounting information systems of ZEST partners. The costs were estimated for all the activities related to snail control, behavior change interventions, the impact assessment surveys, and management of the whole program. Costs are presented in US$ for the full duration of the ZEST project from 2011/2012 to 2017. The total financial costs of implementing snail control activities over 5 years, excluding the costs for donated Bayluscide, were US$55,796 on Pemba and US$73,581 on Unguja, mainly driven by personnel costs. The total financial costs of implementing behavior change activities were US$109,165 on Pemba and US$155,828 on Unguja, with costs for personnel accounting for 47% on Pemba and 69% on Unguja. Costs of implementing biannual mass drug administration refer to the estimated 2.4 million treatments provided on Pemba over 4 years (2013-2016), and do not include the costs of donated praziquantel. The total cost per provided treatment was, on average, US$0.21. This study showed the value of exploiting administrative data to estimate costs of major global health interventions. It also provides an evidence base for financial costs and main cost drivers of implementing multiple combinations of intervention sets that inform decisions regarding the feasibility and affordability of implementing schistosomiasis control and elimination strategies.

Epidemiological, clinical, diagnostic and economic features of an immigrant population of chronic schistosomiasis sufferers with long-term residence in a non-endemic country (North Metropolitan area of Barcelona, 2002-2016).

BACKGROUND: Schistosomiasis, one of the neglected tropical diseases (NTD) listed by the WHO, is an acute and chronic parasitic disease caused by blood flukes (trematode worms) of the genus Schistosoma. Complications of long-term infestation include liver cirrhosis, bladder tumors and kidney failure. The objective of this study was to carry out a clinical and epidemiological characterization of a schistosomiasis-diagnosed immigrant population with long-term residencein the EU as well as to evaluate the diagnostic methods available to date. METHODS AND RESULTS: A total of 61 individuals with Schistosoma infection who received medical attention between June 2002 and June 2016 at the North Metropolitan International Health Unit in Barcelona (Catalonia, Spain), were included in the study. All patients were sub-Saharan African immigrants. The majority were male (91.8%) with a median age of 34 years. Symptoms attributable to infection such as haematuria, abdominal pain and dysuria were recorded in up to 90% of patients. The percentage of eosinophils decreased amongst older patients (p = 0.002) and those with symptoms associated with urinary tract infections (p = 0.017). Serology was used for diagnosis in 80.3% of the cases, with microscopic examination showing the remaining 9.8% positive for parasite eggs. Direct microbiological diagnosis was more useful in patients with less than 5 years of residence in the EU (p = 0.05). Chronic complications were present in 22 (36%) of the patients, with renal failure affecting 20 (33%). Of these 20, 6(10%) developed terminal renal failure and required hemodialysis, while 3 (5%) received a renal transplantation. CONCLUSION: Morbidity associated with chronic long-term schistosomiasis is frequent among African immigrants in non-endemic countries. Better diagnostic tools and appropriate early treatment would prevent the development of visceral damage. Thorough screening in selected patients would also be useful to avoid chronic complications.

Schistosomiasis in school-age children in Burkina Faso after a decade of preventive chemotherapy.

OBJECTIVE: To assess the impact of a decade of biennial mass administration of praziquantel on schistosomiasis in school-age children in Burkina Faso. METHODS: In 2013, in a national assessment based on 22 sentinel sites, 3514 school children aged 7-11 years were checked for Schistosoma haematobium and Schistosoma mansoni infection by the examination of urine and stool samples, respectively. We analysed the observed prevalence and intensity of infections and compared these with the relevant results of earlier surveys in Burkina Faso. FINDINGS: S. haematobium was detected in 287/3514 school children (adjusted prevalence: 8.76%, range across sentinel sites: 0.0-56.3%; median: 2.5%). The prevalence of S. haematobium infection was higher in the children from the Centre-Est, Est and Sahel regions than in those from Burkina Faso's other eight regions with sentinel sites (P < 0.001). The adjusted arithmetic mean intensity of S. haematobium infection, among all children, was 6.0 eggs per 10 ml urine. Less than 1% of the children in six regions had heavy S. haematobium infections - i.e. at least 50 eggs per 10 ml urine - but such infections were detected in 8.75% (28/320) and 11.56% (37/320) of the children from the Centre-Est and Sahel regions, respectively. Schistosoma mansoni was only detected in two regions and 43 children - i.e. 1 (0.31%) of the 320 from Centre-Sud and 42 (8.75%) of the 480 from Hauts Bassins. CONCLUSION: By mass use of preventive chemotherapy, Burkina Faso may have eliminated schistosomiasis as a public health problem in eight regions and controlled schistosome-related morbidity in another three regions.

A combined school- and community-based campaign targeting all school-age children of Burkina Faso against schistosomiasis and soil-transmitted helminthiasis: performance, financial costs and implications for sustainability.

A combined school- and community-based campaign targeting the entire school-age population of Burkina Faso with drugs against schistosomiasis (praziquantel) and soil-transmitted helminthiasis (albendazole) was implemented in 2004-2005. In total, 3,322,564 children from 5 to 15 years of age were treated, equivalent to a 90.8% coverage of the total school-age population of the country. The total costs of the campaign were estimated to be US 1,067,284 dollars, of which 69.4% was spent on the drugs. Delivery costs per child treated were US 0.098 dollar, in the same range as school-based only interventions implemented in other countries; total costs per child treated (including drugs) were US 0.32 dollar. We conclude that a combined school- and community-based strategy is effective in attaining a high coverage among school-age children in countries where school enrolment is low and where primary schools cannot serve as the exclusive drug distribution points. The challenge for Burkina Faso will now be to ensure the sustainability of these disease control activities.

The socio-economic effects of tropical diseases in Nigeria.

Urinary schistosomiasis is the most prevalent of the endemic tropical diseases: 48% of the population is afflicted in the study area. The socio-economic, environmental and health-seeking behavioural characteristics of the population are conducive to the spread of urinary schistosomiasis. The attitudes considered include knowledge of what causes the disease and how to control it, attitude toward the disease, care of oneself, hygiene and sanitation. The effect of such social variables as stigmatisation, and environmental variables such as water source is also considered. We find that a unit increase in the hygiene/sanitation index for adult males and adult females lead to a reduction of about 7.3 and 4.0 eggs S. haematobium in 10 ml urine sample, respectively. Thus, simple hygienic activities such as keeping the immediate environment of the household free from human wastes contribute substantially to disease control. Furthermore, prevalence of the disease is higher among males. Losses from work attributed to urinary schistosomiasis are high. Average values of key socio-economic variables-labour flow for land clearing, farm size and cash income-computed for farm families with high urinary schistosomiasis intensity in the sample are 1085 h, 1.4 ha and N 1,432 (US dollars 65) respectively. The corresponding figures for farm families free from the disease are significantly higher: 1325 h, 1.9 ha and N 3,759 (US dollars 171), respectively.

Comparative cost-effectiveness of diagnostic tests for urinary schistosomiasis and the implications for school health programmes.

The use of self-reported schistosomiasis or blood in urine has received a great deal of interest as a cheap and simple technique for diagnosing individuals infected with Schistosoma haematobium and identifying schools with a high prevalence of infection. Although the answers to questions about the signs and symptoms of urinary schistosomiasis have been shown to be good markers of parasitological infection, a formal cost-effectiveness analysis of their performance in relation to urine filtration and parasitological examination (assumed to be the gold standard) is lacking. Using empirical data on the costs and effectiveness of these techniques in 15 schools in Tanzania, the cost for every correct diagnosis or for every infected child identified was assessed. Although self-reported schistosomiasis was shown to be three times more cost-effective than urine filtration in identifying infected individuals, it would have resulted in a third of the infected children being missed. Use of self-reported schistosomiasis first to identify high-risk schools for mass treatment and then to identify infected children in low-risk schools (for individual treatment) also appeared more cost-effective than urine filtration and would have resulted in only 8% of the infected children not being treated. The use of self-reported schistosomiasis or self-reported blood in urine should be continually supported as a simple, cheap and cost-effective tool for identifying schools at high-risk of schistosomiasis.

Evaluation of staff performance and material resources for integrated schistosomiasis control in northern Senegal.

BACKGROUND: A project to improve integrated control of schistosomiasis in the primary health care system of northern Senegal was implemented from February 1995 until September 1999, shortly after a Schistosoma mansoni outbreak. The activities included additional training of doctors and nurses in symptom-based treatment and making praziquantel (PZQ) available for an affordable price. OBJECTIVE: To investigate staff performance and the availability and costs of diagnostic materials and PZQ at the end of this intervention project. METHODS: We performed structured interviews with staff from 55 health care facilities in five districts. RESULTS: Respondents from 23 health care facilities reported both S. haematobium and S. mansoni in the coverage area, 32 reported only S. haematobium and three only S. mansoni. The average cost to patients for consultation, diagnosis, treatment and transportation to a referral health care facility was approximately 1.60 Euro. Fifty-seven per cent of the health care facilities with reported S. haematobium in the coverage area treated patients presenting with haematuria on symptoms; 56% of the health care facilities with reported S. mansoni in the coverage area treated patients presenting with blood in stool on symptoms. Thirteen per cent performed a diagnostic test for patients presenting with haematuria and 12% for patients presenting with blood in stool. The remainder, approximately one-third of the health care facilities, referred their patients to another facility for a diagnostic test. Implementation of symptom-based treatment in all health care facilities will reduce the total costs by 0.43 Euro (29%) for patients infected with S. haematobium and 0.78 Euro (46%) for patients infected with S. mansoni. Of the 53 health care facilities with schistosomiasis in their area, 37 had PZQ in stock of which 33 (88%) sold PZQ for the recommended retail price of 0.15 Euro per tablet (or 0.60 Euro per course of four tablets) or lower. CONCLUSION: Four years after the start of the intervention project, patients presenting with schistosomiasis related symptoms can generally expect proper diagnosis and treatment at all levels of the health care system in Northern Senegal, either at the initial visited health care facility or after referral. However, a further reduction of the total costs of treatment is still possible by a better implementation of symptom-based treatment and further reduction of the costs of PZQ.

The impact of a school health programme on the prevalence and morbidity of urinary schistosomiasis in Mwera Division, Pangani District, Tanzania.

The prevalence of urinary schistosomiasis among schoolchildren in Pangani District (Tanzania) was assessed rapidly by a questionnaire approach. Based on the results, a strategy of selective treatment with praziquantel was adopted. Eleven primary schools in Mwera Division, Pangani District, with about 2500 schoolchildren were included in a control programme for urinary schistosomiasis. Macro- and microscopic haematuria diagnosed visually and with urine reagent strips was used as an indirect indicator of Schistosoma haematobium infection. Intensity of infection among children was monitored in class 5 (median age 14 years, range 11-17) by urine filtration techniques. Treatment was administered as 40 mg/kg praziquantel in a single dose at the beginning of the school year. The programme was implemented by schoolteachers and coordinated by the District Health Management Team in collaboration with the District Education Office. Teachers were responsible for carrying out all programme activities. Community participation was through collaboration with Teachers-Parents Associations and Village Health Committees. Coverage at yearly (1995-99) examination varied from 67.7% to 80.3%. Prevalence of haematuria decreased from 51.2% (range 22.2-89.5%) at baseline to 23.4% (range 5.8-56.7%) in 1999, a reduction of 54.3%. Macrohaematuria was 21.2% at baseline and 7.2% in 1999, a reduction of 66.0%. Prevalence of infection in class 5 was reduced by 71.4% and geometric mean intensity of positives reduced from 71 eggs/10 mL (95% confidence interval [CI] 52.5-97.7) to 28 eggs/10 mL (95% CI 25.7-55.0), a reduction of 60.6%. Teachers were highly committed, and secured community participation and a smooth implementation of the programme. The community accepted the introduction of a cost-recovery system, whereby parents pay for the treatment of children with episodes of visible haematuria during the school year. Communities also participated in the improvement of sanitary installations at the schools.

The costs and coverage of a strategy to control schistosomiasis morbidity in non-enrolled school-age children in Egypt.

Schistosomiasis still constitutes a major public health problem in some endemic parts of rural Egypt, particularly in school-aged children. The school-based health programme for schistosomiasis control adopted by the Egyptian Ministry of Health and Population (MOHP) focuses on treating enrolled schoolchildren. Children who are not enrolled or who do not attend regularly (out-of-school) do not have access to this service, in spite of evidence that the prevalence and intensity of infection are higher in these children than among children who attend school regularly. The aim of the present study was to test an intervention to extend the existing routinely applied school-based treatment to the out-of-school children. This paper reports on the costs and the coverage obtained by the intervention under 2 alternative delivery strategies: selective versus mass chemotherapy for out-of-school children. The intervention reached 88.5% of the out-of-school children at a relatively low cost per infected child of 2.29 L.E. (US$0.67) and 2.02 L.E. (US$0.59) for selective and mass chemotherapy, respectively. The calculations also suggest that, if the government were to implement such a programme, it would be more efficient to offer mass than selective chemotherapy at observed levels of prevalence. Sensitivity analysis showed that selective chemotherapy would be more cost-effective in areas where the prevalence of infection in out-of-school children was < 43%.

Community-based approach to schistosomiasis control.

With few exceptions, efforts to control schistosomiasis have relied upon ongoing community cooperation with "outsiders' rather than creating within the community the capacity and means for carrying out ongoing disease control measures with minimal external support. Offered as a useful model is a program in Kaele subdivision, Extreme North Province, Cameroon designed to establish and integrate within the primary health care (PHC) system the control of urinary schistosomiasis, hyperendemic in the region. At the community level, and with minimal dependence upon external resources, culturally appropriate and effective health education was instituted, the capacity to diagnose and treat schistosomiasis was created, diagnosis and drug therapy (praziquantel) was made available conveniently and at low cost, and, on a very limited basis, snails were controlled. Efforts were made to build upon and strengthen existing community structures and institutions rather than create new ones. The impact of the interventions was measured in terms of changes in knowledge and behavior, prevalence and intensity of infection, utilization of health services, and the ability to finance the control activities within the context of a generalized cost recovery system. Program successes and failures are discussed, as well as lessons learned and their implications.

Costs, benefits and operational implications of using quantitative techniques to screen for schistosomiasis haematobium in Egypt.

The official strategy for schistosomiasis control in Egypt relies on individual case detection and treatment. Screening for Schistosoma haematobium has traditionally involved urine sedimentation which shows whether or not eggs are present in the urine, thereby providing only a qualitative assessment of infection status. Recently the Ministry of Health introduced the nucleopore filtration technique into a few villages to assess its applicability for broader use in areas where S. haematobium is endemic. This method gives an indirect quantitative measure of morbidity in terms of egg counts/10 ml urine. The overall purpose of this study was to provide rapid feedback to the Ministry on the likely implications of expanding the use of the filtration technique by examining the benefits, costs and operational problems that may be involved. From 2 villages in Giza Governorate, systematic random samples were taken from the general populations and from schools. Each selected person provided a urine specimen on which the two diagnostic techniques were performed. Filtration offered no additional benefits over sedimentation in terms of defining if a person was infected or not, with sensitivities ranging from 59.6%-75% for filtration and from 60%-73.1% for sedimentation. The additional non-labor costs of using the filtration technique in the two villages were calculated and showed that, if extended to all rural health units in Egypt, the Ministry would need to find an additional 31.6 million pounds (US$9.5 million) each year. A number of operational problems would also be involved in the wider application of the technique.

The costs of schistosomiasis control in a Sahelian country.

The cost of schistosomiasis control in Mali was calculated on the assumption that the programme is fully nationalized and organized using the experience gained during the past seven years. In order to expand the model and to extrapolate from actual cost that arose, activities have been standardized into preparatory, baseline and follow-up sample surveys for monitoring purposes and into blanket and case mass chemotherapy for interventions. Health education is contained in them as a component, sanitation is seen as a standard item linked at a fixed cost to the duration of the intervention phase. These activities were divided into months of action and their unit cost was calculated on the basis of requirements of field allowances, transport, drugs, expendable materials, and equipment. Fixed operational costs were calculated on a yearly basis for salaries, data processing and administrative overheads. Using these unit costs, and on the basis of present knowledge of the prevalence, epidemiology and efficiency of control, the need and quantity of activities and the probable duration of a programme to achieve the goals set in the national health plan were estimated. If a population of 180,000 persons in about 300 villages is to be included in a programme that has as target to diminish the prevalence of both, Schistosoma haematobium and S. mansoni to less than 20% and that plans to diminish the prevalence of intensive infections of both parasites to less than 5%, a total amount of DM 6.9 to 7.5 million over a period of seven to nine years are required.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparative trials of regimes for the treatment of urinary schistosomiasis in The Gambia.

Alternative regimes for the treatment of Schistosoma haematobium infection were compared in two trials. Praziquantel at a dose of 40 mg kg-1 appeared to cure 63% of a random sample of heavily infected subjects; significantly more than the 18% cured by three fortnightly doses of metrifonate at 10 mg kg-1. However, praziquantel led to a greater incidence of mild, transient side-effects. A single dose of metrifonate was found to be an inadequate treatment in the same group of subjects as it left 53% with an egg count of at least 100 ova/10 ml. A combination of 10 mg kg-1 of metrifonate and 25 mg kg-1 of niridazole had a similar effect to that of a single dose of metrifonate alone and it had more side-effects. Reduced doses of praziquantel had less effect on egg counts than the standard regime, but the difference was not significant in the case of 20 mg kg-1. Although a combination of metrifonate and praziquantel, each at 10 mg kg-1, had a greater effect than either constituent alone, the difference was not significant. Factors affecting the choice of drug for use in mass treatment of urinary schistosomiasis in The Gambia are discussed. The present findings suggest that the standard regime of praziquantel should be used or, if this is not possible, a three-dose metrifonate regime.

Cost and effectiveness of different approaches to schistosomiasis control in Africa.

In order to analyze the cost-effectiveness of selected mass-chemotherapy, a model is used to compare the treatment of urinary schistosomiasis with metrifonate (3 dose regimen, fortnightly intervals) and praziquantel (one dose regimen). The model was applied to two situations. Setting I, based on experiences in the Peoples Republic of the Congo, assumes that the average distance between the project base and the area of intervention is 80 km, the other, setting II, based on the situation in Mali, assumes an average distance of 250 km. The aim of the project is defined as the reduction of a prevalence of 50% to less than 5% in the absence of reinfection. Using metrifonate, the cost per person rendered negative is calculated at DM 12.57 for the Congo and at DM 32.52 for Mali. Prevalence will be 4.2% after intervention. Using praziquantel, the costs are DM 8.36 and 11.47, respectively, and the prevalence reached at the end of the intervention will be 1.1%. The cost difference is mainly due to the high operational cost incurred by the 3 dose regimen. Once low prevalence levels are reached, operational cost further outweigh drug expenses.