The prevalence of schistosomiasis in Uganda: A nationally representative population estimate to inform control programs and water and sanitation interventions
| Autor: | Julien Nobili, Scott Radloff, John C. Ssempebwa, Kellogg J. Schwab, Fredrick Makumbi, Edridah M. Tukahebwa, Simon P. S. Kibira, Alexandra K. Shannon, Natalie G. Exum, Ronald Ssenyonga |
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| Rok vydání: | 2019 |
| Předmět: |
0301 basic medicine
Schistosoma Mansoni Sanitation Cross-sectional study RC955-962 Prevalence Psychological intervention Geographical Locations 0302 clinical medicine Risk Factors Arctic medicine. Tropical medicine Surveys and Questionnaires Medicine and Health Sciences Schistosomiasis Uganda Public and Occupational Health Child Family Characteristics Pharmaceutics Behavior change Eukaryota Infectious Diseases Helminth Infections Child Preschool Schistosoma Public aspects of medicine RA1-1270 Environmental Health Research Article Neglected Tropical Diseases medicine.medical_specialty Drug Administration Adolescent 030231 tropical medicine Environment 03 medical and health sciences Drug Therapy Surface Water Helminths Environmental health Parasitic Diseases medicine Animals Humans Open defecation business.industry Public health Organisms Public Health Environmental and Occupational Health Biology and Life Sciences Water Tropical Diseases medicine.disease Invertebrates Schistosomiasis mansoni Health Care Cross-Sectional Studies 030104 developmental biology Age Groups People and Places Africa Earth Sciences Population Groupings Hydrology business |
| Zdroj: | PLoS Neglected Tropical Diseases PLoS Neglected Tropical Diseases, Vol 13, Iss 8, p e0007617 (2019) |
| ISSN: | 1935-2735 |
| DOI: | 10.1371/journal.pntd.0007617 |
| Popis: | Background To improve schistosomiasis control programs in Uganda, where intestinal schistosomiasis is a widespread public health problem, a country-wide assessment of the disease prevalence among all age ranges is needed. Few studies have aimed to quantify the relationships between disease prevalence and water and sanitation characteristics across Uganda to understand the potential to interrupt disease transmission with an integrated package of interventions. Methodology/Principal findings A nationally representative survey was undertaken that included a household and individual questionnaire followed by disease testing based on detection of worm antigens (circulating cathodic antigen–CCA), diagnosis and treatment. A comprehensive set of questions was asked of randomly sampled individuals, two years of age and above, to understand their water and sanitation infrastructure, open defecation behaviors, exposure to surface water bodies, and knowledge of schistosomiasis. From a set of 170 randomly sampled, geographically diverse enumeration areas, a total of 9,183 study participants were included. After adjustment with sample weights, the national prevalence of schistosomiasis was 25.6% (95% confidence interval (CI): 22.3, 29.0) with children ages two to four most at risk for the disease with 36.1% infected (95% CI: 30.1, 42.2). The defecation behaviors of an individual were more strongly associated with infection status than the household water and sanitation infrastructure, indicating the importance of incorporating behavior change into community-led total sanitation coverage. Conclusions/Significance Our results highlight the importance of incorporating monitoring and evaluation data into control programs in Uganda to understand the geographic distribution of schistosomiasis prevalence outside of communities where endemicity is known to be high. The high prevalence of schistosomiasis among the youngest age group, ineligible to receive drug treatment, shows the imperative to develop a child-appropriate drug protocol that can be safely administered to preschool-aged children. Water and sanitation interventions should be considered an essential investment for elimination alongside drug treatment. Author summary Schistosomiasis is a neglected tropical disease in sub-Saharan Africa that has remained intractable despite efforts to eliminate it through mass drug administration. The transmission cycle is perpetuated when sanitation infrastructure does not adequately capture infected urine or feces and local water bodies, with snail vectors, are contaminated. Schistosomiasis has been linked with stunting and cognitive deficits and there is particular concern for the most vulnerable age group under five years old who are undergoing critical intestinal development but are ineligible to receive drug treatment. Efforts to reduce the disease have focused on children and young adolescents in endemic areas, near water bodies where transmission is known to be high. In Uganda, where fresh water bodies are abundant and intestinal schistosomiasis is endemic, very little is understood about the disease prevalence at a national level. We conducted a large, nationally representative survey and found a national prevalence of 25.6% where the 2–4 year old children had the highest prevalence for schistosomiasis with 36.1% infected. The most significant risk-factor for the disease was an individual’s open defecation behaviors in surface waters. This emphasizes the need to include water and sanitation investments alongside drug treatment and behavior change to control schistosomiasis in Uganda. |
| Databáze: | OpenAIRE |
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