| Autor: |
Spencer SA; 1Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom.; 2The University of Manchester Faculty of Biology Medicine and Health, Manchester Academic Health Centre, Manchester, United Kingdom., Linder C; 2The University of Manchester Faculty of Biology Medicine and Health, Manchester Academic Health Centre, Manchester, United Kingdom., Penney JMS; 2The University of Manchester Faculty of Biology Medicine and Health, Manchester Academic Health Centre, Manchester, United Kingdom., Russell HJ; 2The University of Manchester Faculty of Biology Medicine and Health, Manchester Academic Health Centre, Manchester, United Kingdom., Hyde K; 2The University of Manchester Faculty of Biology Medicine and Health, Manchester Academic Health Centre, Manchester, United Kingdom., Sheehy C; 2The University of Manchester Faculty of Biology Medicine and Health, Manchester Academic Health Centre, Manchester, United Kingdom., Reid A; 3Unité d'Epidémiologie et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar., Andriamasy EH; 4Faculté de Médecine, Université d'Antananarivo, Antananarivo, Madagascar.; 5Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom., Raderalazasoa GU; 5Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom., Rakotomampianina DAL; 5Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom., Nandimbiniaina AM; 5Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom., Ranaivoson TN; 5Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom., Andrianiaina A; 5Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom., Cruickshank SM; 5Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom., Bustinduy AL; 6Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom., Stothard JR; 3Unité d'Epidémiologie et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar., Edosoa GT; 7World Health Organization, Madagascar Country Office, Antananarivo, Madagascar.; 8Ministère de la Santé Publique de Madagascar, Antananarivo, Madagascar., Rahetilahy AM; 8Ministère de la Santé Publique de Madagascar, Antananarivo, Madagascar. |
| Abstrakt: |
Schistosomiasis is a major public health problem in Madagascar. The WHO recommends preventive chemotherapy by mass drug administration (MDA) with praziquantel as the primary approach to control Schistosoma mansoni-related morbidity in endemic populations, alongside complementary interventions such as health education. The impact of annual MDA and health education programs was assessed in the hard-to-reach Marolambo district of eastern Madagascar, an area endemic for S. mansoni. Repeated cross-sectional studies undertaken 2015-2019 examined between 300 and 381 school-aged children (aged 5-14 years) annually. The prevalence and infection intensity of S. mansoni were assessed by urine-circulating cathodic antigen (CCA) dipsticks and coproscopy using Kato-Katz (KK) methodologies. After four rounds of annual MDA, a reduction in S. mansoni prevalence was seen in CCA (93.9% in year 1-87.7% in year 5; P = 0.007) and KK (73.9% in year 1-59.4% in year 5; P < 0.0001). The prevalence of heavy-intensity infections roughly halved from 23.7% to 10.1% (P < 0.0001), and the mean intensity of infection fell by 55.0% (480.2-216.3 eggs per gram of feces). A malacological survey found Biomphalaria pfeifferi snail intermediate hosts in multiple water contact sites including rice paddies, streams, and Nosivolo River. Despite reductions in infection prevalence and intensity, schistosomiasis still poses a significant public health challenge in Marolambo district. Twice yearly MDA cycles and/or community-wide MDA are suggested to better reduce infections. Expanding health education, improving standards of water, sanitation and hygiene, and attention on snail-related control will also be important, especially in rice paddy irrigated areas. |
