Abstract
Ever since the first known written report of schistosomiasis in the mid-19th century, researchers have aimed to increase knowledge of the parasites, their hosts, and the mechanisms contributing to infection and disease. This knowledge generation has been paramount for the development of improved intervention strategies. Yet, despite a broad knowledge base of direct risk factors for schistosomiasis, there remains a paucity of information related to more complex, interconnected, and often hidden drivers of transmission that hamper intervention successes and sustainability. Such complex, multidirectional, non-linear, and synergistic interdependencies are best understood by looking at the integrated system as a whole. A research approach able to address this complexity and find previously neglected causal mechanisms for transmission, which include a wide variety of influencing factors, is needed. Systems epidemiology, as a holistic research approach, can integrate knowledge from classical epidemiology, with that of biology, ecology, social sciences, and other disciplines, and link this with informal, tacit knowledge from experts and affected populations. It can help to uncover wider-reaching but difficult-to-identify processes that directly or indirectly influence exposure, infection, transmission, and disease development, as well as how these interrelate and impact one another. Drawing on systems epidemiology to address persisting disease hotspots, failed intervention programmes, and systematically neglected population groups in mass drug administration programmes and research studies, can help overcome barriers in the progress towards schistosomiasis elimination. Generating a comprehensive view of the schistosomiasis system as a whole should thus be a priority research agenda towards the strategic goal of morbidity control and transmission elimination.
Highlights
The parasites classified as Schistosoma spp. were first described in 1851 in Egypt by Theodor Bilharz [1]
With estimated local prevalence ranging from 50–90% [3,4], and deaths from infections not uncommon, the disease initially named Bilharzia was recognised as a serious public health concern [3,4]
The parasite Bilharz first described as Distomum haematobium [1] was later renamed Bilharzia haematobium [3] and re-classified as Schistosoma haematobium [5]
Summary
To overcome current shortcomings of control efforts and move towards schistosomiasis elimination, there is a need to improve intervention strategies. Adam (2014) emphasised the importance of including evidence beyond traditional epidemiology and economic analysis into the design and evaluation of public health interventions and discussed the usefulness of visual representations for the analysis and interpretation of a system [30] We build on these ideas by proposing the integration of systems science tools and systems modelling into the field of epidemiology for schistosomiasis and other NTDs. We build on these ideas by proposing the integration of systems science tools and systems modelling into the field of epidemiology for schistosomiasis and other NTDs This approach, described as “systems epidemiology”, will more effectively integrate knowledge to better understand and control schistosomiasis, as well as focus on contextually relevant factors. Working together in a trans-disciplinary manner, researchers, policymakers, health providers, and the affected population could generate much-needed insights into the drivers of persisting Schistosoma transmission
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