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Investigating a strategy for quantifying schistosome infection levels in preschool-aged children using prevalence
Rivka M Lim1, Mark E J Woolhouse2,3, Takafira Mduluza4
1Institute of Immunology & Infection Research, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom.
Insights
Schistosomiasis prevalence in school-aged children (SAC) can predict infection levels in preschool-aged children (PSAC). This finding aids in targeting schistosomiasis treatment programs for young children, supporting global elimination goals.
Area of Science:
- Public Health
- Infectious Diseases
- Epidemiology
Background:
- The World Health Organization aims to eliminate schistosomiasis by 2025, requiring treatment of preschool-aged children (PSAC).
- Quantifying schistosomiasis infection in PSAC is crucial for effective treatment strategies but remains a challenge.
- Existing methods for assessing infection in PSAC need validation and simplification for public health programs.
Purpose of the Study:
- To investigate the relationship between schistosomiasis infection levels in PSAC and school-aged children (SAC).
- To determine if SAC infection prevalence can serve as a proxy for estimating PSAC infection prevalence.
- To inform schistosomiasis treatment program strategies for PSAC in Africa.
Main Methods:
- Systematic literature review of schistosomiasis prevalence studies in African PSAC and SAC.
- PRISMA guidelines and SPIDER search strategy tool were employed for data collection.
- Regression analysis was used to assess the correlation between PSAC and SAC infection levels, controlling for covariates.
Main Results:
- A significant positive correlation was found between PSAC and SAC infection prevalence for both Schistosoma mansoni (r=0.812) and S. haematobium (r=0.786).
- This relationship remained significant after accounting for diagnostic methods, treatment history, and geographical sub-region.
- Regression models accurately classified over 90% of PSAC prevalence studies based on SAC data, irrespective of treatment history.
Conclusions:
- Schistosomiasis prevalence in SAC is a reliable proxy for estimating infection levels in PSAC.
- This finding supports the use of SAC prevalence data to guide and accelerate schistosomiasis treatment efforts in PSAC.
- The study provides a practical approach to identify areas needing intensified PSAC treatment for schistosomiasis elimination.
Abstract:
In 2012, the World Health Organisation (WHO) set out a roadmap for eliminating schistosomiasis as a public health problem by 2025. To achieve this target, preschool-aged children (PSAC; aged 6 years and below) will need to be included in schistosomiasis treatment programmes. As the global community discusses the tools and approaches for treating this group, one of the main questions that remains unanswered is how to quantify infection in this age group to inform treatment strategies. The aim of this study was thus to determine whether a relationship exists between levels of schistosome infection in PSAC and school-aged children (SAC), that can be used to determine unknown schistosome infection prevalence levels in PSAC. A systematic search of publications reporting schistosomiasis prevalence in African PSAC and SAC was conducted. The search strategy was formulated using the PRISMA guidelines and SPIDER search strategy tool. The published data was subjected to regression analysis to determine if a relationship exists between infection levels in PSAC and SAC. The interaction between SAC and community treatment history was also entered in the regression model to determine if treatment history significantly affected the relationship between PSAC and SAC prevalence. The results showed that a significant positive relationship exists between infection prevalence levels in PSAC and SAC for Schistosoma mansoni (r = 0.812, df (88, 1), p = <0.0001) and S. haematobium (r = 0.786, df (53, 1), p = <0.0001). The relationship was still significant after allowing for diagnostic method, treatment history, and the African sub-region where the study was conducted (S. mansoni: F = 25.63, df (88, 9), p = <0.0001; S. haematobium: F = 10.20, df (53, 10), p = <0.0001). Using the regression equation for PSAC and SAC prevalence, over 90% of the PSAC prevalence studies were placed in the correct WHO classifications category based on the SAC levels, regardless of treatment history. The study indicated that schistosome prevalence in SAC can be extended as a proxy for infection levels in PSAC, extending on its current use in the adult population. SAC prevalence data could identify where there is a need to accelerate and facilitate the treatment of PSAC for schistosomiasis in Africa.
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